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Home exercise program compliance of service members in the deployed environment: An observational cohort study. Eckard, T., J. Lopez, A. Kaus and J. Aden (2015) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 Type of study : Therapeutic Topic : Exercise compliance - Less is more This is a prospective observational study assessing the association between the number of exercises prescribed and compliance with treatment. United States soldiers were recruited (N = 155) to participate in the study if they presented with a musculoskeletal condition. Compliance was assessed through the Henry-Eckert Performance Assessment Tool . Other demographic variables and pain intensity scores were recorded. The results showed that participants who were given 2 or fewer exercises had higher compliance compared to those participants who were given 3 or more. In particular, participants who were given 2 or fewer exercises had 40% more compliance compared to those that were given 4 or more exercises (see figure). 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, prescribing 2 or fewer exercises is advisable to boost treatment compliance. Three exercises are acceptable, however, when 4 or more exercises are provided, the likelihood of clients completing them is reduced by a large extent. This information does not only apply to soldiers but also to older people. Thus, a study in 1998 has shown similar findings in a population of adults over 65 years old . Open access URL : https://doi.org/10.7205/milmed-d-14-00306 Abstract BACKGROUND Home exercise programs (HEP) are an integral part of any physical therapy treatment plan, but are especially important in theater. The primary aim of this study was to determine if the number of exercises prescribed in a HEP was associated with compliance rate of Service Members (SM) in theater with a secondary aim of determining variables associated with compliance and noncompliance. MATERIALS/METHODS Subjects were 155 deployed SM undergoing physical therapy in Iraq and Afghanistan. Clinical evaluation and prescription of a HEP were performed. Pathologic, demographic, and treatment data were obtained. Subjects returned to the clinic 1 week later to demonstrate their HEP. Subjects' performance of each prescribed exercise was rated on a 12-point scale to quantify compliance. RESULTS 2 variables were found to be significantly associated with rate of compliance. These were the number of exercises prescribed (p = 0.02) and if a subject left the base at least once per week (p = 0.01). CONCLUSIONS SM prescribed 4 or more exercises had a lower rate of compliance than those prescribed 2 or fewer. SM who left the base at least once per week also had a lower rate of compliance. 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

Attempting to separate placebo effects from exercise in chronic pain: A systematic review and meta-analysis. Miller, C. T., et al. (2022) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 (4/4 thumbs up) Type of study : Therapeutic Topic : Persistent pain - exercise This is a systematic review on the effect of exercise on pain in people with persistent pain. Of note, studies included both fibromyalgia and persistent pain due to OA, lower back pain, and patellofemoral pain. This is important as fibromyalgia may present with different pain mechanicsms compared to other conditions. A total of 4 randomised placebo controlled studies were included. Different types of exercise were implemented and they included aerobic, motor control, and resistance training. Placebo interventions included sham electrotherapeutic interventions (e.g. inactive TENS). The intervention duration ranged from 4 to 8 weeks. Pain intensity was assessed through the visual analogue or numerical rating scale (0-10). All the studies were included in the meta-analysis and they were assessed through the Risk of Bias criteria recommended by the Cochrane Review Group. The overall strength of evidence was assessed through the GRADE approach ("low", "very low", "moderate", "high"), which has also been suggested by the Cochrane group for systematic reviews. The results showed that there is very low-quality evidence showing no difference between exercise and placebo interventions (e.g. inactive TENS). I calculated for you the absolute difference between the exercise group and the placebo group. This equated to 1 point out of 10 in favour of the exercise group compared to placebo, which would not be defined as clinically relevant (To calculate it yourself, do the following: Standardise mean differece x the smallest SD; 0.94 x 0.91 = 0.86 points out of 10). 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, aerobic/resistance/motor control training exercise are as effective as non-exercise placebos for people with persistent pain. The improvement in pain intensity, beyond placebo, appears to be modest and clinically irrelevant (1 pint out of 10). This is consistent with previous research . Overall, we still may want to advice our clients to take part in general exercise as this has been shown to positively modulate pain mechanisms (e.g. aerobic exercise), improve tissue recovery (if we are still suspecting tissue damage), reduce our clients' risk of developing depression , or reduce their depression symptoms if they already have the condition . URL : https://doi.org/10.1007/s40279-021-01526-6 Abstract Background: Pain is the most disabling characteristic of musculoskeletal disorders, and while exercise is promoted as an important treatment modality for chronic musculoskeletal conditions, the relative contribution of the specific effects of exercise training, placebo effects and non-specific effects such as natural history are not clear. The aim of this systematic review and meta-analysis was to determine the relative contribution of these factors to better understand the true effect of exercise training for reducing pain in chronic primary musculoskeletal pain conditions. Design: Systematic review with meta-analysis. Data Sources: MEDLINE, CINAHL, SPORTDiscus, EMBASE and CENTRAL from inception to February 2021. Reference lists of prior systematic reviews. Eligibility Criteria: Randomised controlled trials of interventions that used exercise training compared to placebo, true control or usual care in adults with chronic primary musculoskeletal pain. The review was registered prospectively with PROSPERO (CRD42019141096). Results: We identified 79 eligible trials for quantitative analysis. Pairwise meta-analysis showed very low-quality evidence (GRADE criteria) that exercise training was not more effective than placebo (g [95% CI]: 0.94 [− 0.17, 2.06], P = 0.098, I2 = 92.46%, studies: n = 4). Exercise training was more effective than true, no intervention controls (g [95% CI]: 0.99 [0.66, 1.32], P < 0.001, I2 = 92.43%, studies: n = 42), usual care controls (g [95% CI]: 0.64 [0.44, 0.83], P < 0.001, I2 = 76.52%, studies: n = 33), and when all controls combined (g [95% CI]: 0.84 [0.64, 1.04], P < 0.001, I2 = 90.02%, studies: n = 79). Conclusions: There is very low-quality evidence that exercise training is not more effective than non-exercise placebo treatments in chronic pain. Exercise training and the associated clinical encounter are more effective than true control or standard medical care for reductions in pain for adults with chronic musculoskeletal pain, with very low quality of evidence based on GRADE criteria. 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

Carpometacarpal and metacarpophalangeal joint collapse is associated with increased pain but not functional impairment in persons with thumb carpometacarpal osteoarthritis. Duong, V., et al. (2021) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 thumbs) Type of study : Symptoms prevalence Topic : Thumb osteoarthritis mcpj hyperextension - Symptoms This is a retrospective analysis of a previously published randomised controlled trial . The aim of the study was to determine whether mcpj hyperextension during pinching was associated with greater pain intensity and worse function in people with thumb OA. Mcpj hyperextension during tip-to-tip pinching was determined by observation. Pain intensity was assessed through visual analogue scale (0 to 100) at baseline, not during pinching. Function was assessed through the functional index of hand OA (FIHOA). The results showed participants presenting with mcpj hyperextension during tip-to-tip pinch presented with greater levels of pain but not worse function. Unfortunately, it is not possible to comment on whether the difference in pain between the two groups was clinically relevant as pain was classified as moderate and high. 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, mcpj hyperextension during tip to tip pinch may be associated with overall greater pain at the base of the thumb in people with OA . At the moment is not possible to determine whether these differences are clinically relevant and whether presenting with this pinch strategy predicts future onset of thumb OA. In addition, it is not known whether modifying this pinching strategy will lead to improvements in pain intensity. What we know is that people with greater levels of 1st cmcj dorsal positioning may be less likely to respond to conservative treatment . URL : https://doi.org/10.1016/j.jht.2020.07.003 Abstract Introduction: Due to the complex shape of the carpometacarpal (CMC) joint, a fixed joint collapse deformity of the thumb CMC (CMC1) and metacarpophalangeal (MCP1) joint can present in advanced stages of CMC1 osteoarthritis (OA), resulting in adduction of the first metacarpal (MC1) and hyperextension of the MCP1. Purpose of the Study: To determine whether joint collapse deformity is associated with worse pain and/or functional impairment. Study Design Cross-sectional. Methods: This study used the baseline data from 140 patients enrolled in a longitudinal study of treatment for CMC1 OA. (efficacy of combined conservative therapies on clinical outcomes in patients with CMC1 OA). Joint collapse was determined at baseline using a pinch gauge. Pain was assessed on a visual analog scale (0-100) and function was assessed using the Functional Index for Hand Osteoarthritis questionnaire (0-30). Pain and function and the presence of joint collapse were entered in a univariate logistic regression. The final adjusted model for pain and joint collapse included age and sex. The final adjusted model for function and joint collapse included Kellgren Lawrence grade and grip strength. Results: About 20% of participants demonstrated joint collapse on the tip-pinch test. The presence of joint collapse was associated with increased pain in the unadjusted [P = .047, OR = 2.45, 95% CI (1.01, 5.910)] and adjusted model [P = .049, OR = 2.45, 95% CI (1.00, 5.98)]. Conclusion: CMC1 patients with joint collapse reported increased pain compared with those without joint collapse. Future studies should determine the relationship between thumb hypermobility and joint collapse and how to manage these conditions effectively. 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

Prevalence and risk factors for postoperative complications following open a1 pulley release for a trigger finger or thumb . Koopman, J. E., et al. (2022) Level of Evidence : 4 Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Trigger finger injections - Are they associated with complications This is a retrospective study assessing post-surgical complications in clients who underwent cortisone injections prior to surgery for trigger finger release. A total of 3,428 participants, took part in this study. Of these, 1303 (38%) did not receive a cortisone injection prior to trigger finger release, and 2,125 (62%) received at least one cortisone injection prior to surgery. The outcome assessed was the presence of complications, which ranged from an increase in analgesic/hand therapy treatment to complex regional pain. The analyses controlled for comorbidities (e.g. diabetes) and other confounders. The results showed that the participants who underwent a cortisone injection one month prior to trigger finger release or had more than three injections prior to surgery had two to three times the odds of developing a complication after surgery compared to those who had more time between the injection and surgery or fewer cortisone injections. Despite these results, we need to keep in mind that association is not equivalent to prediction. 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, more than three cortisone injections or a cortisone injection within one month of trigger finger release appear to be associated with a greater probability of post-surgical complications. These findings are consistent with a previous study in trigger finger release and two previous studies showing that both ialuronic acid injections and cortisone injections increase the risks of post-surgical complications in people 1st cmcj OA. It is important to remember that associations are not necessarily predictions. URL : https://doi.org/10.1016/j.jhsa.2022.04.017 Abstract Purpose: Although A1 pulley release is an effective treatment to reduce pain and improve hand function, complications may occur. More insight into risk factors for complications is essential to improve patient counseling and potentially target modifiable risk factors. This study aimed to identify factors associated with complications following A1 pulley release. Methods: Patients completed baseline questionnaires, including patient characteristics, clinical characteristics, and the Michigan Hand outcomes Questionnaire. We retrospectively reviewed medical records to identify complications classified using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions tool. Grade 1 complications comprise treatment with additional hand therapy, splinting, or analgesics, grade 2 treatment with antibiotics or steroid injections, grade 3A minor surgical treatment, grade 3B major surgical treatment, and grade 3C complex regional pain syndrome. Logistic regression analyses were performed to examine the contribution of patient characteristics, clinical characteristics, and patient-reported outcome measurement scores to complications. Results: Of the included 3,428 patients, 16% incurred a complication. The majority comprised milder grades 1 (6%) and 2 (7%) complications, followed by more severe grades 3B (2%), 3C (0.1%), and 3A (0.1%) complications. A longer symptom duration (standardized odds ratio [SOR], 1.09), ≥3 preoperative steroid injections (SOR, 3.22), a steroid injection within 3 months before surgery (SOR, 2.02), and treatment of the dominant hand (SOR, 1.34), index finger (SOR, 1.65), and middle finger (SOR, 2.01) were associated with a higher complication rate. Conclusion: This study demonstrates that ≥3 preoperative steroid injections and a steroid injection within 3 months before surgery were the most influential factors contributing to complications. These findings can assist clinicians during patient counseling and may guide preoperative treatment. We recommend that clinicians should consider avoiding steroid injections within 3 months before surgery and to be reluctant to perform >2 steroid injections. 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

Efficacy of waterproof cast protectors and their ability to keep casts dry. Kwan, S., et al. (2022) Level of Evidence : 2c Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : Keeping an arm cast dry - Available devices This was an experimental study assessing the water tightness of a plastic bag vs several commercially available cast protectors. A total of 23 participants tested the plastic bag and the different cast protectors by immersing for 30 seconds their covered arm in the water. To assess the effect of motion on water tightness, the same test was repeated with the arm rotating clockwise and counterclockwise for the same amount of time. A piece of paper towel was inserted between the hand and the cast cover to assess the amount of moisture absorbed. The difference in weight of the paper towel between post- and pre-immersion provided a measurement of water tightness. Participants were also asked which device they thought was the most comfortable and reliable. The results showed that the devices labeled as A, B, C, E, and F (see below) were fully waterproof, and most of the participants felt device A as the most comfortable and reliable. 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 plastic bag wrapped around an arm cast is insufficient to keep the cast or a wound dry. Commercially available alternatives such as the DryPro cast cover appear to be waterproof and may be offered to our clients, especially during the summer months, to limit the impact of their injury on their social and physical activity routines. URL : https://doi.org/10.1016/j.jhsa.2022.05.006 Abstract Purpose: The purpose of the study was to compare the efficacy of 6 different commercially available waterproof cast protectors in their ability to maintain a dry environment and evaluate whether cast protectors perform better than a plastic bag secured with tape in keeping casts dry. Methods: We enrolled 23 adult participants to test 6 different commercially available cast protectors and a plastic bag. Participants trialed all cast protectors twice, with and without motion, by fully submerging each cast protector in water with a paper towel held between their index and middle fingers. Moisture accumulation within the cast protectors was estimated by the change in weight of paper towel. An analysis of variance test was performed to compare differences between cast protectors in their ability to maintain a dry internal environment. Results: The plastic bag showed an average moisture accumulation of 5.50 g without motion compared with all other cast protectors, which had 0.0 g of moisture accumulation. One cast protector and the plastic bag had an average moisture accumulation of 0.46 g and 4.51 g with motion compared to all other cast protectors. The plastic bag was ranked the worst by 100% of participants. Conclusion: Cast protectors appear to offer superior protection from moisture compared with a plastic bag. 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

Long-term leisure-time physical activity and risk of all-cause and cardiovascular mortality: dose–response associations in a prospective cohort study of 210,327 Taiwanese adults. Martinez-Gomez, D., et al. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Leisure physical activity - Effect on all-cause and cardiovascular mortality This is a retrospective study assessing the effect of leisure physical activity on all-cause and cardiovascular mortality. A total of 210,327 participants were followed up for 20 years and weekly physical activity was averaged across several time points. The amount of physical activity was compared to World Health Organisation (WHO) guidelines and defines as "none", "insufficient", "recommended", and "additional" through metabolic equivalents (MET). The results showed that "insufficient" or "recommended" levels of physical activity reduce mortality by 20% to 30% respectively compared to people who performed no physical activity (see graph). If you would like to determine whether you or your clients reach the weekly WHO guidelines for physical activity, use to OMNI calculator which is kindly been made available for free (see below). 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, engaging in physical activity can reduce mortality risk even though we do not reach the recommended WHO guidelines for physical activity . Clearly, if we were to reach the threshold suggested, this would provide additional benefits. We can therefore advise our clients that any exercise is better than no exercise. Physical activity not only reduces the risk of mortality in our clients but also the risk of developing depressive symptoms . If this was not enough, aerobic exercise has also been shown to expedite wound healing , which is something that as hand therapists we see often. URL : http://dx.doi.org/10.1136/bjsports-2021-104961 Abstract Objectives: We aimed to investigate the dose–response associations of long-term leisure-time physical activity (LTPA) obtained from repeated measures with all-cause and cardiovascular disease (CVD) mortality outcomes in Taiwanese adults. Methods: We included 210 327 participants with self-reported LTPA at least in two medical examinations (867 968 data points) for up to 20 years (median, IQR: 4.8 years, 2.3–9.0). Dose–response relationships were modelled with restricted cubic spline functions and Cox regressions HRs (95% CIs) adjusted for main covariates. Results: During up to 23 years of follow-up (3 655 734 person-years), 10 539 participants died, of which 1919 of CVD. We observed an inverse, non-linear dose–response association between long-term LTPA and all-cause and CVD mortality. Compared with the referent (0 metabolic equivalent of task (MET) hours/week), insufficient (0.01–7.49 MET hours/week), recommended (7.50–15.00 MET hours/week) and additional (7.50-15.00 MET hours/week) amounts of LTPA had a lower mortality risk of 0.74 (0.69–0.80), 0.64 (0.60–0.70) and 0.59 (0.54–0.64) for all-cause mortality and 0.68 (0.60–0.84), 0.56 (0.47–0.67) and 0.56 (0.47–0.68) for CVD mortality. When using only baseline measures of LTPA, the corresponding mortality risk was 0.88 (0.84–0.93), 0.83 (0.78–0.88) and 0.78 (0.73–0.83) for all-cause and 0.91 (0.81–1.02), 0.78 (0.68–0.89) and 0.80 (0.70–0.92) for CVD mortality. Conclusion: Long-term LTPA was associated with lower risks of all-cause and CVD mortality. The magnitude of risk reductions was larger when modelling repeated measures of LTPA compared with one measure of LTPA at baseline. Data may be obtained from a third party and are not publicly available. The data of this study can be requested from the MJ Health Research Foundation (http://www.mjhrf.org). 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

Agreement between hand therapists and hand surgeons in the management of adults with closed metacarpal fractures. Wong, J., L. Chipchase and A. Gupta (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : Metacarpal fractures management - Hand therapists vs surgeons This is a prospective study assessing whether hand therapists and surgeons make similar therapeutic decisions when assessing closed metacarpal fractures. One hand therapist's decision (12 years of experience) was judged against that of a hand surgeon. In addition, the decision of the more experienced hand therapist was compared to that of less experienced hand therapists (5 and 6 years of experience). A total of 90 participants with closed metacarpal fractures, 50% of which included the 5th metacarpal, were assessed independently by the clinicians. The agreement between the experienced hand therapist and surgeon, as well as between experienced hand therapists and less experienced therapists was moderate to good. The main disagreements were identified when there was no clear indication for conservative or surgical management and a trial of conservative management could have been appropriate (see figure below). 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, hand therapists are able to make independent decisions regarding the need for conservative/surgical management for people with closed metacarpal fractures. If you are interested in metacarpal shaft or 5th metacarpal fractures management, have a look at our previous synopses. If you are interested in hand, wrist, and elbow fractures in general, have a look at the full fractures database . URL : https://doi.org/10.1016/j.msksp.2022.102560 Abstract Background: Hand therapists often work in roles which require an advanced level of experience as Advanced Scope Practitioners (ASP). However, it is not known whether clinical decisions are similar between hand therapists and surgeons when managing simple hand fractures. Objectives: To determine the level of agreement between (i) a hand therapist and five hand surgeons and (ii) three hand therapists, for the management of adults with closed metacarpal fracture(s). Design: A prospective, blinded, crossover inter-rater reliability study. Method: Patient volunteers with closed metacarpal fracture(s) were assessed independently in the first study (n = 90) by a hand therapist and one of five hand surgeons and in the second study (n = 57) by three hand therapists in a randomised order, with each practitioner recording whether the patient participant should be managed conservatively, trialled with conservative or offered surgical treatment. The level of agreement between the hand therapist and hand surgeons was calculated using Cohen's kappa coefficient and between the three hand therapists by calculating Fleiss' Kappa. The observed agreement was also calculated as the proportion of cases for which the assessors had agreement for management. Results: There was good agreement between the hand therapist and surgeons (k = 0.68; 95% CI: 0.537–0.831) and amongst the three hand therapists (k = 0.663; 95% CI: 0.554–0.773) in determining the management of adults with closed metacarpal fracture(s). Conclusions: Hand therapists and surgeons make similar management decision for patients with metacarpal fractures supporting the role of hand therapists as ASP. 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 genetic contribution to carpal tunnel syndrome in women: A twin study. Hakim, A. J., L. Cherkas, S. El Zayat, A. J. MacGregor and T. D. Spector (2002) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Aetiologic Topic : Carpal tunnel syndrome - Genetic determinants This retrospective study assessed the contribution of genetic factors on the presence of carpal tunnel syndrome (CTS) in women twins. The study included a total of 4,488 participants who were either monozygotic (sharing 100% of DNA) or dizygotic (sharing 50% of DNA). The presence of CTS was defined as per table 1 below. The results showed that genetic influences contributed to 46% of the probability to develop CTS (See Table 3). It is unclear whether the increased risk associated with genotype is due to structural impairments (e.g. reduced size of the carpal tunnel), pain mechanism, and/or molecular factors. 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 probability of developing CTS in females is largerly dependent on genetic factors. Additional evidence has shown that biomechanical exposure appears to contribute to the development of CTS , albeit, to a lower extent. If you are interested in CTS, you can have a look at several other synopses on the topic . Open Access URL : https://doi.org/10.1002/art.10395 Abstract Objective: To assess the relative genetic and environmental contribution to carpal tunnel syndrome (CTS) using a classic twin study of monozygotic (MZ) and dizygotic (DZ) twins. Methods: The study group comprised unselected female twin pairs, between 20 and 80 years of age, from the St Thomas' UK Adult Twin Registry. Individuals completed a questionnaire that included details on potential risk factors for CTS. The diagnosis of CTS was made using a standardized hand pain diagram and validated criteria. The genetic contribution to CTS was assessed using variance component and regression methods, the heritability was adjusted for environmental confounders. The role of individual risk factors was assessed by a nested case-control study. Results: An overall prevalence of 14.2% for CTS was found in a population of 4,488 females, comprising 867 MZ and 970 DZ twin pairs, and 814 singletons. The concordance for CTS was significantly higher in MZ compared with DZ twins (case-wise concordance values of 0.35 and 0.24 respectively, with a significantly increased MZ:DZ ratio of 1.48; P = 0.03). Modeling produced a heritability estimate of 0.46 (95% CI 0.34–0.58) that was essentially unchanged after adjustment for environmental risk factors including age, body mass index, physical activities, and hormonal/reproductive factors. No major influence of any individual risk factor was seen in the case-control analysis of 520 cases and 3,154 controls, apart from a modest association with menopausal status with an increased risk of 1.53 and 1.43 in the peri and postmenopausal groups. There was no overall effect of age or body mass index. Conclusion: This is the first study to explore the genetic component of CTS. Our data show that up to half of the liability to CTS in women is genetically determined, and this appears to be the single strongest risk factor, with only minor contributions from known environmental factors. Further studies should focus on genetic mechanisms that may lead to tests for susceptibility and detection of those at risk of developing CTS. 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

Selective denervation of the wrist for chronic pain: A systematic literature review Chin, K., Engelsman, A., van Gulik, T., & Strackee, S. (2020) Level of Evidence : 3a Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic: Wrist denervation for chronic pain – Effect on pain and strength This is a systematic literature review assessing the effectiveness of complete or partial wrist denervation on pain and grip strength in people with chronic wrist pain. Chronic wrist pain was defined as pain lasting for more than 3 months. Wrist pain was associated with a range of conditions including SLAC, SNAC, carpal bone necrosis, OA, CRPS, TFCC injuries, and carpal instabilities. Outcomes were assessed 13 to 146 months post-surgery and included pain (visual analogue scale) and grip strength. Twelve studies were included for a total of 440 participants. The results suggested that there is low-quality evidence showing reductions in pain (36% to 60% reduction) and improvements in grip strength (7% to 64%) following wrist denervation. 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, wrist denervation appears to be useful in reducing symptoms and improving grip strength in a wide variety of conditions associated with persistent pain. If your clients suffer from generalised hand osteoarthritis (OA), they may benefit from a structured resistance training program . Alternatively, in presence of thumb OA, a self-management program may be useful . Also, aerobic exercise appears to have positive effects in people with persistent musculoskeletal pain and you may want to try this before proceeding with more invasive interventions such as surgery. URL : https://journals.sagepub.com/doi/full/10.1177/1753193419886777 Abstract Selective denervation of sensory nerve branches to the wrist is a palliative surgical treatment option for patients with chronic wrist pain when preserving the range of motion and function is preferred. Treatment varies from partial isolated denervation of the posterior interosseous nerve to extensive 'complete' denervations. This study aimed to provide an overview of the literature regarding treatment outcomes in the domains of pain, grip strength, patient satisfaction and return to work. MEDLINE (PubMed), EMBASE and Cochrane databases were systematically searched and identified 993 studies, of which 12 were eligible for analysis. Denervation resulted in high 'return to work' rates (up to 94%), patient satisfaction (up to 92%), increased grip strength (7%-64%) and improved average pain scores (36%-92%). Treatment outcomes of both partial and complete denervations were favourable; however, variations in outcomes suggest the need for improving evidence regarding surgical technique and nerve identification. 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

Adding mobilisation with movement to exercise and advice hastens the improvement in range, pain and function after non-operative cast immobilisation for distal radius fracture: A multicentre, randomised trial Reid, S. A., Andersen, J. M., & Vicenzino, B. (2020) Level of Evidence : 1b- Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : Distal radius fracture - Education, exercises, and MWMs This is a two-group randomised trial assessing the added benefit of Mobilisation With Movement (MWM) on range of movement and function after distal radius fractures treated non-surgically. A total of 67 participants took part in the study. After six weeks of cast immobilisation, participants were randomised to either an education, exercise, and MWM group (n = 33), or an education and exercise-only group (n=34). The education involved information on skin care, pain, and swelling management. The exercises involved making a full fist, wrist and elbow flexion and extension, forearm supination and pronation, and shoulder flexion. Two additional MWM exercises were taught to the participants in the experimental group. The first MWM involved the patient holding the affected distal radio-ulnar joint with the healthy hand and providing an antero-posterior glide to the radius while supinating. The second MWM required participants to perform a passive wrist extension mobilisation while a radially directed carpal glide was provided. To achieve this, participants were advised to relax the affected hand on a table and wrap a strap around the wrist, just distally to the ulnar styloid. Once this was achieved, the radial glide was provided by pulling the strap with the healthy hand whilst the trunk moved forward to achieve passive wrist extension. All the exercises were performed six times, twice daily. The MWM exercises had to be performed pain-free. The treatment lasted four weeks. A total of four face-to-face physiotherapy consultations were provided. During these sessions, 1 to 3 sets of 6-10 MWMs were performed. The outcomes measured included supination range of movement and the QuickDASH. The results showed that immediately after the intervention (4 weeks after randomisation) the experimental group presented a larger supination range of movement (difference between groups: 12°; 95%CI: 5° to 20°) and greater function (QuickDASH difference between groups: -11; 95%CI: -18 to -3). Both the MWM group (mean: 18°; SD:±15) and the control group (mean: 8°; SD:±20) improved to a clinically significant level in supination ( MCID = 8° ). Both the MWM group (mean: 31; SD:±17) and the control group (mean: 23; SD:±14) improved to a clinically significant level on the QuickDASH questionnaire ( MCID = 16 points ). 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, self-directed MWMs for wrist supination and extension can improve range of movement and function following a distal radius fracture. In addition, we should encourage our clients to take part in daily activities as this has been shown to increase wrist joint excursion and psychological well-being following a distal radius fracture. This is important because pain catastrophising and depression are associated with pain intensity and disability independently of upper limb fracture severity . URL : https://doi.org/10.1016/j.jphys.2020.03.010 Abstract Question: Does adding mobilisation with movement (MWM) to usual care (ie, exercises plus advice) improve outcomes after immobilisation for a distal radius fracture? Design: A prospective, multicentre, randomised, clinical trial with concealed allocation, blinding and intention-to-treat analysis. Participants Sixty-seven adults (76% female, mean age 60 years) treated with casting after distal radius fracture. Intervention: The control group received exercises and advice. The experimental group received the same exercises and advice, plus supination and wrist extension MWM. Outcome measures: The primary outcome was forearm supination at 4 weeks (immediately post-intervention). Secondary outcomes included wrist extension, flexion, pronation, grip strength, QuickDASH (Disabilities of Arm, Shoulder and Hand), Patient-Rated Wrist Evaluation (PRWE) and global rating of change. Follow-up time points were 4 and 12 weeks, with patient-rated measures at 26 and 52 weeks. Results: Compared with the control group, supination was greater in the experimental group by 12 deg (95% CI 5 to 20) at 4 weeks and 8 deg (95% CI 1 to 15) at 12 weeks. Various secondary outcomes were better in the experimental group at 4 weeks: extension (14 deg, 95% CI 7 to 20), flexion (9 deg, 95% CI 4 to 15), QuickDASH (−11, 95% CI −18 to −3) and PRWE (−13, 95% CI −23 to −4). Benefits were still evident at 12 weeks for supination, extension, flexion and QuickDASH. The experimental group were more likely to rate their global change as ‘improved’ (risk difference 22%, 95% CI 5 to 39). There were no clear benefits in any of the participant-rated measures at 26 and 52 weeks, and no adverse effects. Conclusion: Adding MWM to exercise and advice gives a faster and greater improvement in motion impairments for non-operative management of distal radius fracture. 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

Personal, biomechanical, psychosocial, and organizational risk factors for carpal tunnel syndrome: A structural equation modeling approach Roquelaure, Y., Garlantezec, R., Evanoff, B., Descatha, A., Fassier, J., & Bodin, J. Level of Evidence : 2b Follow recommendation : 👍 👍 👍 Type of study : Aetiologic Topic : Carpal tunnel syndrome - Demographic, biomechanical, psychological, and work pace factors This prospective study assessed the effect of age, gender, BMI, work-related biomechanical exposure, work-related psychological distress, and machine- vs customer-paced jobs on carpal tunnel syndrome (CTS) development. The study included a large sample ( n = 1367) of participants involved in several different occupations. Work-related biomechanical exposure was defined as repetitive or sustained wrist movements for prolonged periods of time, exposure to vibration hand tools, activities involving pinching, and work requiring physical exertion. Work-related psychological distress factors included the inability to make autonomous decisions. Working pace was either set by machine production (machine-paced) or dependent on customer demands (customer-paced). All of the participants were healthy at baseline. At follow up (average 5 years), 3.7% of sample ( n =51) participants presented with symptomatic CTS (pain/paraesthesia in the 2nd and 3rd digit) and of these, 2.3% of sample ( n = 32) presented with signs of CTS (positive on either wrist flexion and compression, carpal compression, Phalen, or Tinel test). The results showed that older age and female gender were risk factors for CTS in this cohort. Biomechanical exposure was the main risk factor leading to CTS. Work-related psychological distress (inability to make autonomous decisions) indirectly increased the risk of CTS by increasing biomechanical exposure. Both biomechanical exposure and psychological distress (inability to make autonomous decisions) were increased when involved in machine-paced jobs. Customer-paced jobs appeared to reduce biomechanical exposure and reduce psychological distress, which reduced the risk of CTS. No direct link was found between psychological distress and CTS development. BMI was not associated with an increased risk of developing CTS. Clinical Take Home Message : Biomechanical exposure appears to be a key risk factor in the development of CTS. Hand therapists might liaise with the workplace supervisor to find strategies to limit extreme wrist position, repetitive motions, use of vibration hand tools, pinching activities, and physical exertion in patients presenting with CTS, or to prevent the development of this condition. Increasing the number of breaks or reducing the work load may be effective strategies. Hand therapists should be aware that workers in a machine-paced job are at higher risk of developing CTS. URL : https://journals.lww.com/pain/Fulltext/2020/04000/Personal,_biomechanical,_psychosocial,_and.11.aspx

Risk factors and outcomes in carpal tunnel syndrome following distal radius open reduction internal fixation. McEntee, R. M., Tulipan, J., & Beredjiklian, P. K. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Prognostic Topic : Distal radius fractures - Carpal tunnel syndrome This is a retrospective study assessing factors associated with greater carpal tunnel syndrome (CTS) incidence following surgery for distal radius fracture (ORIF). A total of 4,487 participants with a distal radius fracture were included. Of these, 1.5% (n = 68) developed CTS six months post-surgery. Carpal tunnel syndrome was diagnosed clinically by the surgeon. A series of factors including age, sex, kidney disease, and psychological characteristics were included in the analyses. The results showed that older age was associated with a greater risk of developing CTS following a distal radius ORIF. The graph below gives you an idea of what the association looks like if somebody is 60 years old, they have 4 times the odds of getting CTS after distal radius fracture compared to a 20 years old. If somebody is 80 years old, they have 9 time the odds of getting CTS compared to a 20 years old, after a distal radius fracture. 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, older people are more likely to develop carpal tunnel syndrome following a distal radius fracture ORIF. Additional factors impairing functional recovery following a distal radius fracture include diabetes and smoking . Extra care should be taken in people presenting with these comorbidities and habits. URL : https://doi.org/10.1016/j.jhsa.2022.03.016 Abstract Purpose: Carpal tunnel syndrome (CTS) is a common complication following the operative repair of distal radius fractures. It is unclear who is at risk of developing this complication in the postoperative period. This study sought to identify risk factors for developing CTS and to evaluate patient-reported outcomes in patients who develop postoperative CTS. Methods: A retrospective review of all distal radius fractures treated surgically at a single private academic center was performed from January 2007 to October 2019. Of the 4,487 patients, 68 were identified to have an ipsilateral carpal tunnel release within 6 months of the distal radius injury. Collected data comprised patient demographics, medical history, and functional outcome scores. Results: Carpal tunnel syndrome was more likely to develop in older patients (62.9 years vs 57.4 years). Sex, body mass index, smoking history, and the type of insurance were not found to be significantly different between the groups. Medical history of kidney disease, psychiatric conditions, and peripheral vascular disease were found to be associated with developing CTS. Patients who developed CTS had higher average Disabilities of the Arm, Shoulder, and Hand scores than patients without CTS (28.1 vs 20.0) at the final follow-up. In a multivariable analysis, patients who developed CTS were found to be older (Odds ratio, 1.03) and less likely to be smokers (Odds ratio, 0.46). Conclusions: In our cohort, we observed that older patients were more likely to require carpal tunnel release following distal radius fracture. In addition, nonsmokers were more likely to require subsequent carpal tunnel release, probably as a result of confounding effects. Special care should be taken to monitor these patients for CTS in the postoperative period following a distal radius open reduction and internal fixation. 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