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Conservative management of a suspected triangular fibrocartilage complex injury utilizing strength training exercises: A case report. Sergent, A., Shaw, T. and Richardson, M. (2023) Level of Evidence: 4 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Therapeutic Topic: TFCC - Resistance training This is a case report on the conservative management of a 36-year-old Brazilian Jiu-Jitsu athlete with a non-traumatic Triangular Fibrocartilage Complex (TFCC) presentation. Orthopedic tests such as the fovea sign, push-off test, and piano key test were used to diagnose the injury, and radiographic imaging was also performed to rule out fracture, dislocation, or positive ulnar variance. Their initial pain was 5/10. The patient was treated with a combination of progressive kettlebell swing/press, and Turkish Get Up to improve the strength and endurance of the upper limb muscle. After eight weeks of grip strength and resistance exercises, the patient reported no pain with all activities, including a full return to Brazilian Jiu-Jitsu. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, non-traumatic TFCC presentations may be treated succesfully with progressive resistance training and no splinting. This provides us with potential alternative treatments for the management of TFCC conditions. Movement and exercise interventions could be used in certain cases instead of immobilisation approaches. One useful test to keep track of improvements in these patients is the push-off test, which has been previously described in the literature. URL: https://doi.org/10.1016/j.jbmt.2023.07.001 Abstract Objective: The purpose of this case report is to describe the conservative chiropractic management of a patient with a suspected triangular fibrocartilage complex (TFCC) injury. Clinical presentation: A 36-year-old Brazilian Jiu-Jitsu black belt athlete sought care for left-sided diffuse ulnar pain (numeric pain scale 5/10) with a notable bump over the ulna and weakness when grappling. A working diagnosis of suspected TFCC injury was made. Intervention and outcome: The patient was treated with forearm and grip strength exercises to rehabilitate the pain and strength loss. Following 6 visits and a home exercise program for 8 weeks, his numeric pain scale decreased to 0/10. Conclusion: In this case, it is evident that Triangular fibrocartilage complex injury was successfully treated conservatively without the need for surgical intervention or passive care modalities. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Comparison of intralesional corticosteroid injection with and without thumb Spica cast for de-Quervain tenosynovitis. Shahzad, K., et al. (2021) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: De Quervain tenosynovitis - Injection plus splinting? This non-experimental (no randomisation) controlled trial, assessed the effect of corticosteroid injection followed by splinting vs no splinting for De Quervain tenosynovitis. A total of 82 participants were included. Age ranged between 18 and 70 years. Participants were either provided with a cortisone injection and a forearm-based splint (limiting ulnar deviation) or a cortisone injection alone. The results showed that there were no differences between people who wore or did not wear the wrist splint. A limitation of this study was the lack of randomisation of subjects to the treatment group. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, corticosteroid injection alone is sufficient to treat de Quervain syndrome. Splinting does not appear to provide a significant benefit following this procedure. These results appear to be consistent with previous evidence. If you are interested in knowing how many people improve with a single cortisone injection or subsequent injections, head over to this other synopsis. Alternatively, have a look at the full database on De Quervain syndrome. URL: https://doi.org/10.1016/j.jhsa.2013.10.013 Abstract Purpose: To compare the corticosteroid injection (CSI) with or without thumb spica cast (TSC) for de Quervain tendinitis. Methods: In this prospective trial, 67 eligible patients with de Quervain tenosynovitis were randomly assigned into CSI + TSC (33 cases) and CSI (34 cases) groups. All patients received 40 mg of methylprednisolone acetate with 1 cc lidocaine 2% in the first dorsal compartment at the area of maximal point tenderness. The primary outcome was the treatment success rate, and the secondary outcome was the scale and quality of the treatment method using Quick Disabilities of Arm, Shoulder and Hand and visual analog scale scores. Results: The groups had no differences in mean age, sex, and occupation. The visual analog scale and Quick Disabilities of the Arm, Shoulder and Hand scores were similar in both groups before the treatment. The treatment success rate was 93% in the CSI + TSC group and 69% in the CSI group. Although both methods improved the patients' conditions significantly in terms of relieving pain and functional ability, CSI + TSC had a significantly higher treatment success rate. Conclusions: The combined technique of corticosteroid injection and thumb spica casting was better than injection alone in the treatment of de Quervain tenosynovitis in terms of treatment success and functional outcomes. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

A unique discovery of saddle syndrome after elbow fracture-dislocation. MacDonald, J., Ivy, C. C. and Renfree, K. (2020) Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic This is the answer to last week's Sherlock Handy. The patient was a 38 years old right-handed man who had a fracture (coronoid process) dislocation of their right elbow, which was reduced and managed conservatively with early active range of movement. Concurrently to their elbow pain, they also presented with pain (NRS: 8/10) at the dorsal aspect of the hand in the webspace between the index and middle finger. There was objective swelling around the affected mcp joints. There was tenderness on palpation at the second, third, and fourth webspace. There was no pain in active finger adduction/abduction, however, the test shown in the image below reproduced their pain. Hand x-rays showed no fracture. The patient was diagnosed with saddle syndrome, which is caused by scar tissue between the deep transverse metacarpal ligament and the tendons of intrinsic hand muscles (e.g. interossei and lumbricals). Symptoms resolved over the course of 4 weeks with bi-weekly hand therapy sessions. The exercises prescribed included tendon gliding and intrinsic plus stretches. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical take home message: Based on what we know today, saddle syndrome is caused by scar tissue between the deep transverse metacarpal ligament and tendons of the instrinsic hand muscles. Pain location and pain reproduction on mcpjs abduction whilst in an intrinsic minus position may help making the diagnosis. Targeted stretching and tendon gliding in the early stages post-injury, may be helpful for treatment. It is likely that these interventions are most effective in the early stage post-injury when we are more likely to be able to affect the connective tissue. URL: https://doi.org/10.3928/24761222-20191125-04 Abstract Objective: Saddle syndrome occurs when adhesions form between the dorsal or palmar interosseous and lumbrical tendons on the volar side of the hand. This phenomenon was first described by Dr. Watson in 1974 in 12 cases in which surgical release was performed. Therapists and other providers may not identify the diagnosis and may mistake it for generalized hand stiffness. Therefore, this condition may be more prevalent than previously believed. This case report describes a situation in which the hand therapist identified the root cause of the client's stiff, painful hand within the first 2 weeks after injury and facilitated complete restoration of function to a score of zero on the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure. Methods: Outcome measures in this single case included range of motion, pain scale score, QuickDASH score, visual analog scale of function score, and client report. Therapy included targeted stretching and soft tissue mobilization techniques. Results: Pain decreased from 80% to 0% on a visual analog scale, range of motion increased from 4-cm lag/50% of full fist to full fist, analog scale of disability score decreased from from 80% to 0%, circumference around the metacarpophalangeal joints decreased from 21.5 cm to 20 cm, and functional loss decreased from seven functional deficits to zero functional deficits. Conclusion: The hand therapist plays an important role in identifying saddle syndrome and intervening appropriately to prevent long-term pain, stiffness, and dysfunction. Additional research is needed to identify the frequency of saddle syndrome and the prospective effectiveness of therapy targeted at gliding of the lumbricals and inter-ossei. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Radiologic severe osteoarthritis is related to worse clinical outcomes after arthroscopic osteocapsular arthroplasty in primary elbow osteoarthritis for a medium-term follow-up: A retrospective cohort study. So, S.-P., et al. (2023) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Prognostic Topic: Primary elbow osteoarthritis - What are the outcomes of surgery? This retrospective study looked at the clinical outcomes of 97 patients who underwent arthroscopic arthroplasty for primary elbow osteoarthritis (OA). The patients were divided into three groups according to Kwak's classification (I, II, and III). Patients were assessed at baseline, 3-12 months (mid-term), and at long-term follow-up (at least 3 yrs post-surgery). Results showed that the mean ROM and function improved significantly in all groups at the short- and medium-term follow-ups. The mean VAS pain score improved significantly in all groups at the short-term follow-up, but not at the medium-term follow-up. In addition, stage I had better post-surgical ROM and pain than stages II and III. Complications such as postoperative skin eruptions and ulnar nerve irritation occurred in some patients, however, all recovered after treatment. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, greater elbow osteoarthritis is associated with a higher risk of complications post-surgery. It appears that surgery for early stages may provide better improvements in range of motion and pain compared to later stages. As a result, the benefits vs the risks of surgery may require more careful consideration in those severe cases of elbow OA. Thus, in these patients, the risks of postoperative complications (e.g. infection and ulnar nerve palsy) appears to be higher. These results are in line with previous research. If you are interested in calculating the preoperative likelihood of your patients regaining functional elbow range of movement post-surgery, click on the link below. URL: https://doi.org/10.1016/j.jse.2023.05.041 Abstract Purpose: This study aimed to compare the clinical outcomes after arthroscopic OCA in the medium-term follow-up according to the radiologic severity of primary elbow OA and assess serial changes in clinical outcomes in each group. Methods: Patients treated using arthroscopic OCA for primary elbow OA with a minimum 3 years of follow-up, from January 2010 to April 2019, were retrospectively assessed for range of motion (ROM), visual analog scale (VAS) pain score, and Mayo Elbow Performance Score (MEPS), preoperatively and at short- (postoperative 3 to 12 months) and medium-term (at least 3 years after surgery) follow-ups postoperatively. Preoperative computed tomography was performed to evaluate the radiologic severity of OA using the Kwak’s classification. Clinical outcomes were compared according to the radiologic severity of OA by their absolute values and the number of patients achieving patient acceptable symptomatic state (PASS). Serial changes in the clinical outcomes of each subgroup were also assessed. Results: Of the 43 patients, 14, 18, and 11 were classified as stage I, II, and III groups, respectively; the mean follow-up duration was 71.3 ± 28.9 months and mean age was 56.5 ± 7.2 years. At the medium-term follow-up, stage I group had better ROM arc (I, 114°±14°; II, 100°±23°; and III, 97°±20°; P =.067) and VAS pain score (I, 0.9±1.3; II, 1.8±2.1; and III, 2.4±2.1; P =.168) than stage II and III groups without reaching statistical significance, while stage I group had significantly better MEPS (I, 93.2±7.5; II, 84.7±11.9; III, 78.6±15.2; P = .017) than stage III group. The percentage achieving PASS for ROM arc (P =.684) and VAS pain score (P =.398) were comparable between three groups, however, the percentage achieving PASS for MEPS was significantly higher in the stage I group than stage III group (I vs III, 100.0% vs 54.5%; P =.016). During serial assessment, all clinical outcomes tended to improve at the short-term follow-up. Compared to the short-term period, the ROM arc tended to decrease at the medium-term follow-up while VAS pain score and MEPS overall did not show significant changes. Conclusion: After arthroscopic OCA, stage I showed overall better ROM arc and pain than stage II and III at the medium-term follow-up, while stage I showed significantly better MEPS and higher percentage of patients achieving PASS for MEPS than stage III. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Should we give patients what they want? Patient expectations and financial pressures need to be addressed to increase uptake of evidence-based practice. Lord Ferguson, S. (2023) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic: Evidence-based practice - How can we increase uptake This expert opinion examines the challenges faced by health care providers, including hand therapists, when trying to implement evidence-based practice (EBP) in private practice settings. It highlights the importance of managing patient expectations and financial pressures. The authors suggest that to aid the implementation of EBP, several efforts, which include knowledge translation, skills in behaviour change, interpersonal communication, motivational interviewing, coaching, customer relationship management, consumer segmentation, advertising, and selling, may be useful. We are currently at a very early stage on how to achieve EBP smoothly, but further research will help to clarify what are the key aspects that help both patients and private clinics in being successful. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, implementing evidence-based practice is challenging. Even if clinicians were fully aware of the most effective assessment and treatment approaches, patient expectations, financial pressures, and referrer-provider relationships may hinder the integration of such knowledge. Improving our skills in communicating to patients what is the most useful approach, and learning how to "sell" it, may help reduce the burden on hand therapists who find themselves pressured between an internal drive to provide the best care and external factors that may not align with their intention. We also need to realise that patients' expectations drive a large portion of the treatment effect, hence, we may need to find a compromise between what "best practice" is and what the patients' beliefs require for a successful outcome. URL: https://doi.org/10.1016/j.msksp.2023.102831 Abstract Contextual factors such as patient expectations and financial pressures are overlooked challenges for Physiotherapists (PTs) and other rehabilitation professionals trying to implement evidence-based practice (EBP), particularly in private practice settings. In today's hypercompetitive pain management market, PTs may risk detrimental impacts to their reputation and livelihood if they do not give patients what they want, even if what they want does not align with clinical guidelines and research evidence. The aim of this professional practice paper is to shed light on these real-world challenges and encourage discussion among the PT community about strategies to increase uptake of EBP that involve multiple stakeholders such as PT training programs, professional organizations, researchers and clinic owners, which all have a role to play in supporting the translation of evidence into practice in our profession. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic Have a think about this case study. Leave a diagnostic comment if you like. The patient was a 38-years-old right-handed man who had a fracture (coronoid process) dislocation of their right elbow, which was reduced and managed conservatively with early active range of movement. Concurrently to their elbow pain, they also presented with pain (NRS: 8/10) at the dorsal aspect of the hand in the webspace between the index and middle finger. There was objective swelling around the affected mcp joints. There was tenderness on palpation at the second, third, and fourth webspace. There was no pain in active finger adduction/abduction, however, the test shown in the image below reproduced their pain. Hand x-rays showed no fracture. What is it?

Potential effects of dynamic stretching on injury incidence of athletes: A narrative review of risk factors. Behm, D. G., Alizadeh, S., Daneshjoo, A. and Konrad, A. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Dynamic stretching - Injury reduction This narrative review assessed the effect of dynamic stretching (DS) on variables such as range of motion (ROM), strength, balance, proprioception, muscle morphology, psycho-physiological responses, and injury prevention. It was found that DS alone does not provide additional benefit to static stretching (SS). However, it may be useful for injury prevention in high school boys playing soccer. Additionally, a study in dancers found that DS training significantly improved ankle joint stability. The literature is not consistent on the greater potential of DS versus SS in improving ROM or enhancing performance. Finally, there is evidence that incorporating DS into warm-up routines can be effective for injury prevention. Multi-faceted exercise programs, such as the FIFA 11+, FIFA 11+ Kids, FIFA 11+ S, HarmoKnee, Knäkontroll, SISU Idrottsböcker, Neuromuscular Training (NMT) program and bounding exercise program, have been found to be effective in reducing injury incidence. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, dynamic stretching can be an effective tool for injury prevention when incorporated into warm-up routines. This may be useful information to provide our patients if they ask our opinion on "stretching". Several studies have assessed warm-up programs (e.g. FIFA 11+), which include dynamic stretching, and they seem to reduce injury incidence by up to 68-77%. Most of these studies have been assessing lower limb injury rates, however, it is possible that dynamic warm-up in the upper limb may provide similar injury reduction effects. URL: https://doi.org/10.1007/s40279-023-01847-8 Abstract The use of dynamic stretching as a replacement for static stretching in the warm-up is widespread based on the reports of static stretching-induced performance impairments. While acute and chronic static stretching has been reported to reduce musculotendinous injuries, especially with explosive and change of direction actions, the influence of dynamic stretching on injury incidence lacks a similar volume of literature for acute and chronic responses. It was the objective of this narrative review to examine the acute and training effects of dynamic stretching on injury incidence and possible moderating variables such as dynamic stretching effects on range of motion, strength, balance, proprioception, muscle morphology, and psycho-physiological responses. One study demonstrated no significant difference regarding injury incidence when comparing a dynamic stretching-only group versus a combined dynamic stretching plus static stretching group. The only other study examined functional dynamic stretching training with injured dancers and reported improved ankle joint stability. However, several studies have shown that dynamic activity with some dynamic stretching exercises within a warm-up consistently demonstrates positive effects on injury incidence. Regarding moderating variables, while there is evidence that an acute bout of dynamic stretching can enhance range of motion, the acute and training effects of dynamic stretching on strength, balance, proprioception, and musculotendinous stiffness/compliance are less clear. The acute effects of dynamic stretching on thixotropic effects and psycho-physiological responses could be beneficial for injury reduction. However, the overall conflicting studies and a lack of substantial literature compared with SS effects points to a need for more extensive studies in this area. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The Boyd approach: A valuable alternative to treating simple to complex elbow fractures & dislocations. Ayala, A. E., Kim, K., Romero, B. A. and Kam, G. S. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Elbow dislocations - Surgical management This study summarises a case series of 44 patients who underwent surgery for elbow instability. The most common mechanism of injury was a fall, resulting in a Monteggia fracture-dislocation (32% of cases). Postoperative complications were recorded, and the average final follow-up was 8 months. The average elbow active range of motion was between 20 degrees of extension and 124 degrees of flexion. Heterotopic ossification was noted in nine patients, and this contributed to less than functional elbow ROM in two patients. There were no cases of proximal radioulnar postoperative elbow instability reported. Surgical management was found to be a safe and effective technique for the treatment of simple to complex elbow fractures and dislocations. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, surgical management of simple to complex elbow fractures and dislocations is safe and effective. Although there is a risk of postoperative stiffness, the outcome of conservative management for these injuries is far worse. If you are interested in this topic, we have synopses on the diagnosis of elbow dislocations, imaging, and the conservative treatment of simple elbow dislocations. URL: https://doi.org/10.1016/j.jse.2023.06.005 Abstract Background: The Boyd approach is a single-incision posterior approach to the proximal radius and ulna based on a lateral anconeous muscle reflection and release of the lateral collateral ligamentous complex. This approach remains a lesser-utilized technique following early reports of proximal radioulnar synostosis and postoperative elbow instability. Although limited by small case series, recent literature does not support these early reported complications. This study presents a single surgeon’s outcomes utilizing the Boyd approach for the treatment of simple to complex elbow injuries. Methods: Following Institutional Review Board approval, a retrospective review of all patients with simple to complex elbow injuries treated consecutively using a Boyd approach by a Shoulder and Elbow surgeon was conducted from 2016 to 2020. All patients with at least one postoperative clinic visit were included. Data collected included patient demographics, injury description, postoperative complications, elbow range of motion, and radiographic findings including heterotopic ossification and proximal radioulnar synostosis. Categorical and continuous variables were reported using descriptive statistics. Results: A total of 44 patients were included with an average age of 49 years old (range 13-82 years old). The most commonly treated injuries were Monteggia fracture-dislocations (32%) and terrible triad injuries (18%). Average follow-up was 8 months (range 1-24 months). Final average elbow active arc of motion was from 20 degrees (range 0-70 degrees) of extension to 124 degrees (range 75-150 degrees) of flexion. Final supination and pronation were 53 degrees (range 0-80 degrees) and 66 degrees (range 0-90), respectively. There were no cases of proximal radioulnar synostosis. Heterotopic ossification contributing to less than functional elbow ROM occurred in two (5%) patients who elected conservative management. There was one (2%) case of early postoperative posterolateral instability due to repair failure of injured ligaments which required revision using a ligament augmentation procedure. Five (11%) patients experienced postoperative neuropathy, including four (9%) with ulnar neuropathy. Of these, one underwent ulnar nerve transposition, two were improving, and one had persistent symptoms at final follow-up. Conclusions: This is the largest case series available demonstrating the safe utilization of the Boyd approach for the treatment of simple to complex elbow injuries. Postoperative complications including synostosis and elbow instability may not be as common as previously understood. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Repetitive pitching decreases the elbow valgus stability provided by the flexor-pronator mass: The effects of repetitive pitching on elbow valgus stability. Nara, M., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Anatomical Topic: Elbow ucl - Effect of repetetive pitching on its properties This lab-based experimental study investigated the effects of repetitive baseball pitching on elbow valgus stability. A total of 15 male pitchers were included in the study. The valgus range of their picthing elbow was assessed under no load, 3 kg valgus stress, and 3 kg valgus stress whilst gripping. These tests were completed before and after 100 fastball pitches. The elbow valgus measurements were taken by assessing medial joint gapping with an ultrasound machine. The results showed that in the loaded test without grip contraction, there was no difference in elbow valgus gapping between baseline and after pitching measurements. However, due to grip strength fatigue after training, the ability of flexors muscles to reduce valgus whilst gripping was reduced after the pitching session. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, a single session of 100 fastball pitches does not affect elbow ucl integrity. This is in contrast with lab-based results where UCL was cyclically loaded. The likely reason is that when performing cadaveric studies there is no active component limiting the stress on UCL. Nevertheless, if forearm flexors get fatigued over longer pitching or exercise sessions, it is more likely that a greater load will be placed on passive structures, including the UCL ligament. URL: https://doi.org/10.1016/j.jse.2023.03.026 Abstract Background: Baseball pitching induces a large elbow valgus load, stressing the ulnar collateral ligament. Flexor-pronator mass contraction contributes to valgus stability; however, repetitive baseball pitching may weaken the flexor-pronator mass contractile function. The present study investigated the effects of repetitive baseball pitching on the medial valgus stability measured using ultrasonography. We hypothesized that repetitive pitching would decrease elbow valgus stability. Methods: This was a controlled laboratory study. Fifteen young male baseball players at the collegiate level (age: 23.0 ± 1.4 years) were enrolled. The medial elbow joint space was measured using ultrasonography (B-mode, 12-MHz linear array transducer) in the following three conditions: at rest (unloaded), under 3 kg valgus load (loaded), and under valgus load with maximal grip contraction to activate flexor-pronator mass (loaded-contracted). All measurements were performed before and after the pitching tasks, which comprised five sets of 20 pitches. Two-way repeated-measures analysis of variance was applied to determine changes in the medial elbow joint space. The post-hoc test with Bonferroni adjustment was applied to assess the changes within the time and condition. Results: The medial elbow joint space was significantly greater under the loaded than the unloaded and loaded-contracted conditions both before- and after- pitching (p < 0.001). In the loaded-contracted condition, the medial elbow joint space significantly increased after repetitive baseball pitching (p < 0.001). Conclusions: The results of the present study indicated that repetitive baseball pitching reduced the elbow valgus stability. This reduction could be attributed to the decreased flexor-pronator mass contractile function. Insufficient contraction may increase the tensile load on the ulnar collateral ligament with pitching. Flexor-pronator mass contraction plays a role in narrowing the medial elbow joint space; however, repetitive baseball pitching reduced the elbow valgus stability. It has been suggested that sufficient rest and recovery of the flexor-pronator mass function are required to reduce the ulnar collateral ligament injury risk. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Sensitivity & specificity of the posterolateral rotatory drawer test in the diagnosis of lateral collateral ligament insufficiency of the elbow. Stone, A., Venkatakrishnan, S. and Phadnis, J. (2023) Level of Evidence: 1b- Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Diagnostic Topic: Posterolateral rotatory drawer test – Sensitivity and specificity This study assessed the diagnostic accuracy of the Posterolateral Rotatory Drawer Test (PLRD) compared to elbow arthroscopy. A total of 78 patients with lateral and posterior elbow pain were assessed prior to surgery. Patients with post-traumatic osteoarthritis or inflammatory arthritis were excluded. The results showed that the PLRD test had a sensitivity of 88% and specificity of 98% when compared to arthroscopic findings. In particular, the test identified correctly most of the people who had a lateral collateral ligament lesion (16 out of 78) and those who did not (62/78). The results also showed that the test results were highly consistent both with the patient awake and under anaesthesia. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, the Posterolateral Rotatory Drawer (PLRD) test is a reliable and accurate diagnostic tool for Lateral Collateral Ligament (LCL) insufficiency of the elbow. This test should be incorporated when assessing people with traumatic injuries presenting with pain at the lateral and posterior aspects of the elbow. However, this test may not be useful in people with rheumatic conditions. If you are interested in posterolateral rotatory instability, have a look at this synopsis. If you would like to learn how to perform this test, have a look at the video below. URL: https://doi.org/10.1016/j.jse.2023.05.032 Abstract Background: Numerous clinical tests are described for the diagnosis of chronic Lateral Collateral Ligament (LCL) insufficiency of the elbow, however none of these tests have been adequately assessed for sensitivity with at most, eight patients included in previous studies. Furthermore, no test has had specificity assessed. The Posterolateral Rotatory Drawer (PLRD) test is thought to have improved diagnostic accuracy over other tests in the awake patient. The aim of this study is to formally assess this test using reference standards in a large cohort of patients. Methods: 106 eligible patients were identified for inclusion from a single surgeon database of operative procedures. Examination under anesthetic (EUA) and arthroscopy were chosen as the reference standards to compare the PLRD test against. Only patients with a clearly documented PLRD test finding performed preoperatively in the clinic, and a clearly documented EUA and/or arthroscopic findings from surgery were included. 102 patients underwent EUA, 74 of which also underwent arthroscopy. 28 patients had EUA then an open procedure without arthroscopy. 4 patients had arthroscopy without a clearly documented EUA. Sensitivity, specificity, positive and negative predictive values (PPV/NPV) were calculated with 95% confidence intervals. Results: 37 Patients had a positive PLRD test and, 69 had a negative test. Compared to the reference standard of EUA (n=102), the PLRD test had a sensitivity of 97.3% (85.8% - 99.9%) and a specificity of 98.5% (91.7% - 100%) (PPV = 0.973, NPV = 0.985). Compared to the reference standard of arthroscopy (n=78), the PLRD test had a sensitivity of 87.5% (61.7% - 98.5%) and a specificity of 98.4% (91.3% - 100%) (PPV = 0.933, NPV = 0.968). Compared to either reference standard (n=106), the PLRD test has a sensitivity of 94.7% (82.3% - 99.4%) and a specificity of 98.5% (92.1% - 100%) (PPV = 0.973, NPV = 0.971). Conclusion: The PLRD test demonstrated an overall sensitivity of 94.7% and specificity of 98.5% with high positive and negative predictive value. This test is recommended as the primary diagnostic tool for LCL insufficiency in the awake patient and should be widely incorporated into surgical training. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Stability of the distal radioulnar joint with and without activation of forearm muscles. Weber, A., Reissner, L., Friedl, S. and Schweizer, A. (2023) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic: DRUJ - Forearm stabiliser This lab-based experimental study investigated the contributions of extensor carpi ulnaris (ECU) and flexor carpi ulnaris (FCU) to the stability of the distal radioulnar joint (DRUJ). A total of 40 healthy participants aged between 22 and 58 were assessed using ultrasound and electromyography. A force of 5 kg was applied to the distal aspect of the ulna in all participants. The ultrasound imaging was utilised to assess DRUJ movement. The results showed that co-activation of ECU and FCU resulted in 70% less anteroposterior ulnar head translation and greater distal radioulnar joint stability. The study also found that co-activation of these muscles had a greater stabilizing effect than activation of either muscle alone. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, activation of the flexor carpi ulnaris and extensor carpi ulnaris muscles resulted in 70% less ulnar head translation and greater distal radioulnar joint stability. Strengthening these muscles may be beneficial for patients with chronic distal radioulnar joint instability, and should be considered as part of a comprehensive treatment plan. This approach may be particularly useful following distal radius fractures associated with DRUJ instability. URL: https://doi.org/10.1177/17531934231168299 Abstract The purpose of this study was to quantify the effect of the flexor carpi ulnaris and the extensor carpi ulnaris muscles on distal radioulnar joint stability. The anteroposterior ulnar head translation in relation to the radius was measured sonographically when the forearm was in a neutral resting position and when the hand was actively pressed on to a surface, with and without intentional flexor carpi ulnaris and extensor carpi ulnaris activation, while also being monitored by an electromyogram. Data on 40 healthy participants indicated a mean anteroposterior translation in the distal radioulnar joint of 4.1?mm (SD 1.08) without and 1.2?mm (SD 0.54) with muscle activation. Our results indicate that intentional ulnar forearm muscle activation results in 70% less anteroposterior ulnar head translation and greater distal radioulnar joint stability. Therefore, the flexor carpi ulnaris and extensor carpi ulnaris muscles serve as dynamic stabilizers of the distal radioulnar joint. This finding may be clinically significant since ulnar forearm muscles strengthening may increase distal radioulnar joint stability. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Immediate return to normal after releasing nerve entrapment and rebound phenomenon. Tang, J. B. (2023). Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Therapeutic Topic: Release of nerve compressions - Long term outcomes This is a letter to the editor suggesting that the true effectiveness of surgical release for nerve entrapment should be evaluated both in the short and long term. Their reason for suggesting such follow-ups is that a rebound or recurrence of previous symptoms may be common in people undergoing surgical release of entrapment neuropathies. Surgical reports should include a follow-up of a few months to years, as it is possible that a subclinical compression of a more proximal site, could cause recurrence. This appears to be especially true for middle-aged patients. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, recurrence of symptoms (rebound phenomenon) following nerve entrapment release can occur in patients over 50 years old, who are more likely to have multiple compression sites (e.g. carpal tunnel plus cervical spine). This might be the reason why treatment of peripheral and more proximal areas of compression has shown good potential in people with carpal tunnel syndrome when compared to surgery. In addition, this paper reminds us that it is important to set realistic expectations for our patients to improve their post-surgical satisfaction. URL: https://doi.org/10.1177/17531934231177831 No Abstract available publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings