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Hook of hamate fractures. Tian, A. and C. A. Goldfarb (2021) Level of Evidence : 5 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Diagnostic, Therapeutic Topic : Hook of hamate fractures - Diagnosis and treatment This is a narrative review on the diagnosis and treatment of hook of hamate fractures. The hook of the hamate has a variable vascularisation, with around 30% of people relying on a dorsal and volar-radial branch for its nutrition. This means that a base of the hook of hamate fracture may cause a lack of vascular supply to the fragment. Often symptoms present as a vague ulnar-sided pain that can onset either acutely after trauma or insidiously (stress fracture). Usually clients present with tenderness on palpation of the hook of the hamate in the palm of the hand (see picture). Time to diagnosis for these fractures is between 14 and 40 weeks. The main reasons for diagnostic delays include assessment by non-specialists health care providers and the inability of normal x-ray views to identify this lesion. Carpal tunnel views (x-ray - see figure) are usually more useful to diagnose this condition. Treatment alternatives include splinting or short arm casting for 6-8 weeks. The non-union rate with this approach varies widely. Surgical treatment includes open reduction and internal fixation or fragment excision. 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 hook of hamate fractures can have an acute (trauma) or insidious onset (stress fractures). Exquisite tenderness on palpation of the hook of the hamate and carpal tunnel views on x-ray may be useful in the diagnosis. Immobilisation with a short arm cast or wrist splinting for 6 to 8 weeks could be trialled in non-displaced fractures. Due to poor vascularisation, the non-union rate can be higher than 30% with conservative treatment. A hand surgeon review may be appropriate to identify the best treatment for the client. URL : https://doi.org/10.1016/j.hcl.2021.06.013 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

Arthritis as a risk factor for carpal tunnel syndrome: A meta-analysis. Shiri, R. (2016) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Diagnostic, Therapeutic Topic : Hand osteoartritis - Association with carpal tunnel This is a systematic review and meta-analysis on the association between hand osteoarthritis (OA) and carpal tunnel syndrome (CTS). Five prospective/cohort studies were included in the present review for a total of 20,574 participants. The studies compared the prevalence of CTS in people with and without hand OA. The results showed that people with hand OA were 2 (95% CI: 1.7 to 2.8) times more likely to present with CTS compared with their healthy counterparts. 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, people with hand OA are more likely to present with carpal tunnel syndrome compared to people without hand OA. It may therefore be important to assess the presence of sensory impairments in these clients and perform a few tests if the clinical presentation is suggestive of this condition. It is also important to remember that people with hand OA presenting with neuropathic pain report greater levels of pain intensity, greater number of pain medication and disease burden . URL : https://doi.org/10.3109/03009742.2015.1114141 Abstract Objectives: The effects of inflammatory and degenerative arthritis on carpal tunnel syndrome (CTS) are not well known. This systematic review and meta-analysis aimed to assess whether rheumatoid arthritis (RA) and osteoarthritis (OA) increase the risk of CTS. Method: Literature searches were conducted in PubMed, Embase, Web of Science, Scopus, Google Scholar, and ResearchGate until January 2015. Twenty-three (five cohort, 10 case control, and eight cross sectional) studies qualified for the meta-analyses. A random-effects meta-analysis was used and heterogeneity and publication bias were assessed. Results: Both RA and OA were associated with CTS. Pooled unadjusted odds ratios (ORs) were 1.91 [95% confidence interval (CI) 1.33–2.75, I2 = 55.2%, nine studies, n = 10 688] for arthritis (either inflammatory or degenerative), 2.91 (95% CI 2.33–3.62, I2 = 22.3%, 11 studies, n = 74 730) for RA, and 2.13 (95% CI 1.65–2.76, I2 = 39.2%, five studies, n = 20 574) for OA of any joint. Pooled confounder-adjusted ORs were 1.96 (95% CI 1.21–3.18, I2 = 73.1%, six studies, n = 11 542) for arthritis, 1.96 (95% CI 1.57–2.44, I2 = 32.2%, eight studies, n = 72 212) for RA, and 1.87 (95% CI 1.64–2.13, I2 = 0%, two studies, n = 19 480) for OA. There was no evidence of publication bias, and excluding cross-sectional studies or studies appraised as having a high risk of selection bias did not change the magnitude of the associations. Conclusions: The findings of this systematic review and meta-analysis suggest that both RA and OA increase the risk of CTS. Further prospective studies on the effect of wrist OA on CTS are needed. 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

In vivo evidence of lumbricals incursion into the carpal tunnel in healthy hands: An ultrasonographic cross sectional study. Nadar, M. S., H. A. Amr, F. S. Manee and A. A. Ali (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Aetiology Topic : Lumbricals - Carpal tunnel incursion This cross-sectional cohort study assessed the effect of fingers flexion on lubricals incursion within the carpal tunnel. A total of 20 healthy participants were included in the study. Ultrasound measurements were taken to assess the movement of lumbricals into the carpal tunnel during finger extension, partial finger flexion (50%), and full finger flexion. The results showed that 80% of the lumbricals entered the carpal tunnel during full finger flexion. The lumbricals that most consistently entered the carpal tunnel were the middle finger and ring finger. 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, most lumbricals enter the carpal tunnel during finger flexion. In particular, the middle and ring fingers lumbricals consistently do so. In light of this information, some of our clients with carpal tunnel may benefit from the use of a relative motion splint keeping the middle and ring finger in relative extension compared to the index and little finger. Further research is necessary to assess whether this intervention would indeed have a beneficial effect. We have a coupple of other synopses on lumbricals, more specifically one about the origin of their name and the assessment/treatment of lumbrical tears in climbers. URL : https://doi.org/10.1016/j.jht.2022.03.003 Abstract Introduction: During finger flexion, the tendons of flexor digitorum profundus migrate proximally, along with their attached lumbrical muscles. This incursion was suggested to extend into the Carpal Tunnel. Ultrasonographic imaging can be used to assess in vivo soft tissue behavior and incursion. Purpose: of the study To clinically quantify the lumbrical muscles incursion in different finger positions. Study Design Cross sectional, observational study. Methods: The lumbricals of 20 healthy adults with no history of hand injuries were evaluated with neuromuscular ultrasound imaging (n = 160 lumbricals). The lumbrical muscles migration was measured as the participants actively moved their fingers from full extension to 50% flexion, and 100% flexion. Results: Of the 160 lumbricals measures, the incursion occurred at 18.1% of fingers at 50% finger flexion, and increased to 79.4% during full finger flexion. The lumbricals migrated a total of 2.99 cm after full finger flexion, and ended up 0.76 cm (SD = 0.86 cm) inside the Carpal Tunnel. The metacarpophalangeal joint range of motion of the index finger at the point where the lumbricals entered the distal border of the Transverse Carpal Ligament was 84.4° (SD = 6.8°). The Carpal Tunnel cross-sectional area during finger extension was 1.68 (0.35) cm2, and increased to 1.81 (0.33) cm2 after full finger flexion. Conclusion: This study showed direct evidence of lumbrical incursion into the Carpal Tunnel during finger flexion. The cross-sectional area of the Carpal Tunnel increased during full finger flexion in comparison to full finger extension, supplementing the evidence of increase content within the Carpal Tunnel. The findings of this study have significant clinical implications for the conservative treatment of the Carpal Tunnel Syndrome. 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

Prognostic factors for response to treatment by corticosteroid injection or surgery in carpal tunnel syndrome (palms study): A prospective multicenter cohort study Jerosch-Herold, C., L. Shepstone, J. Houghton, E. C. F. Wilson and J. Blake (2019) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 thumb up) Type of study : Prognostic Topic : Carpal tunnel response to cortisone injection - predictor This is a longitudinal cohort study assessing prognostic factors associated with improvements following corticosteroid injections for people with carpal tunnel syndrome. Participants were included (N = 150) if they presented with nerve conduction impairments suggestive of carpal tunnel syndrome and confirmed by a neurophysiologist or hand surgeon. Several potential prognostic variables were collected and they included overall health, mental health, symptoms duration, and the number of cortisone injections provided. Participants were defined as responders after cortisone injection if symptoms were "slightly better" or "much improved". Data were collected every 6 months, for up to 18 months. The results showed that longer symptom duration and a greater number of cortisone injections were associated with lower chances of success with cortisone injections. 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, cortisone injections for carpal tunnel syndrome may be more successful if clients have been complaining of symptoms for a shorter period of time. In addition, if clients have had previous cortisone injections, the likelihood of improvement is reduced. Prior to cortisone injections, ultrasound imaging may be useful to exclude the presence of a space-invading lesion . Cortisone injections may be a useful conservative treatment intervention and they appear to be effective in our clients (≥ 40 years old) with moderate/severe carpal tunnel syndrome . URL : https://doi.org/10.1002/mus.26459 Abstract INTRODUCTION Studies of prognosis for surgery and corticosteroid injection for carpal tunnel syndrome (CTS) have considered only a limited range of explanatory variables for outcome. METHODS Data were prospectively collected on patient-reported symptoms, physical and psychological functioning, comorbidity, and quality of life at baseline and every 6 months for up to 2 years. Outcomes were patient-rated change over a 6-month period and symptom-severity score at 18 months. RESULTS In total, 754 patients with CTS completed baseline questionnaires, and 626 (83%) completed follow-up to 18 months. Multivariable modeling identified, independent of symptom severity at outset, higher health utility, fewer comorbidities, and lower anxiety as significant predictors of better outcome from surgery. In patients treated by steroid injection, independent of symptom severity at outset, shorter duration of symptoms and having no prior injection were significant predictors of better outcome. DISCUSSION These multivariable models of outcome may inform shared decision making about treatment for 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

Cast selection and non-union rates for acute scaphoid fractures treated conservatively: A systematic review and meta-analysis. Siotos, C., et al. (2022) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Diagnostic, Therapeutic Topic : Scaphoid fractures - When to immobilise This is a systematic review and meta-analysis of the non-union rate of scaphoid fractures treated with different types of casts. In particular, the rate of non-union was compared between people whose thumb was immobilised or not. In addition, above and below elbow cast non-union rate were compared. Seven studies were included in the present review for a total of 762 participants. For the subgroup comparison thumb vs no thumb, 353 participants were included. The definition of non-union varied across studies, however, most of the studies defined it as evidence of fracture line on x-ray beyond normal healing times. The results showed that there were no statistically significant differences between casting type and non-union rate. Overall, the rate of non-union was 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, leaving the thumb free to move does not increase the chance of non-union in people immobilised for a scaphoid fracture. The choice between including or not the thumb is therefore based on the client's comfort. Scaphoid fractures are usually conservatively managed if the lesion involves the tubercle/distal pole/ waist and if there is no displacement. In all other cases, a surgeon's review is required . If you are interested in clinical tests for the diagnosis of a scaphoid fracture, have a look at this previous synopsis . URL : https://doi.org/10.1080/2000656X.2021.2024439 Abstract Cast selection for conservatively treated acute scaphoid fractures remains controversial. Cast options include short arm versus long arm, and those that include the thumb or leave it free. We sought to investigate the role of how cast choice affects nonunion rates after conservative management of scaphoid fractures. We searched PubMed, Embase, and Google Scholar from inception through July 14, 2020, according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We extracted information of interest, including cast type, and non-union rates at the end of the treatment period. We then performed a meta-analysis using the random-effects model. We identified seven relevant studies. Non-union was observed in 15 out of 156 (9.6%) with short-arm cast and 13 out of the 124 (10.5%) with long-arm cast (OR = 0.79, 95% CI [0.19, 3.26], p = 0.74). Non-union was observed in 18 out of 174 (10.3%) with thumb immobilization cast and 18 out of the 179 (10.1%) without thumb immobilization (OR = 0.97, 95% CI [0.49, 1.94], p = 0.69). In our study, short arm casting was proven non-inferior to long arm casting. Similarly, casts without thumb immobilization were equally as effective as casts with thumb immobilization in terms of non-union rates for acute scaphoid fractures treated non-operatively. 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

Get a grip: Individual variations in grip strength are a marker of brain health. Carson, R. G. (2018) Level of Evidence : 5 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Prognostic Topic : Grip strength - Index of general health This is an expert opinion reviewing the association between grip strength, body function, and neurological function in older people. The review starts by indicating how grip strength is a predictor of frailty and survival following several medical conditions (e.g. cancer). In addition, lower level grip strength results in greater difficulties during daily function. These difficulties are not limited to upper limb activities but to whole-body tasks, indicating that grip strength is associated with lower limb strength. In contrast to what I would have expected, grip strength is not significantly affected by the size of forearm muscles in older people, suggesting that grip strength (and strength in general) is more dependent on neuromuscular function rather than muscle morphology. This is confirmed by several studies showing associations between lower levels of grip strength and worse cognitive function (e.g. working memory, language). 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, grip strength is useful in screening for frailty/cognitive decline in middle-aged and older people. With such a simple test, which we regularly perform, we can gather a significant amount of information about our clients' cognitive and functional status. Previous research has also shown that grip strength can predict mortality in middle-aged people and upper limb maximum lifting capacity . Open Access URL : https://doi.org/10.1016/j.neurobiolaging.2018.07.023 Abstract Demonstrations that grip strength has predictive power in relation to a range of health conditions—even when these are assessed decades later—has motivated claims that hand-grip dynamometry has the potential to serve as a “vital sign” for middle-aged and older adults. Central to this belief has been the assumption that grip strength is a simple measure of physical performance that provides a marker of muscle status in general, and sarcopenia in particular. It is now evident that while differences in grip strength between individuals are influenced by musculoskeletal factors, “lifespan” changes in grip strength within individuals are exquisitely sensitive to integrity of neural systems that mediate the control of coordinated movement. The close and pervasive relationships between age-related declines in maximum grip strength and expressions of cognitive dysfunction can therefore be understood in terms of the convergent functional and structural mediation of cognitive and motor processes by the human brain. In the context of aging, maximum grip strength is a discriminating measure of neurological function and brain health. 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

Muscle hernia involving the extensor carpi ulnaris muscle. Indiran, V. (2016) Level of Evidence : 5 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Diagnostic/Therapeutic This is the answer to last week's Sherlock Handy. The patient was a 35 years old man presenting with swelling in the dorsal-ulnar aspect of the proximal forearm (see picture). The patient lifted heavy loads for work, however, they did not report any specific trauma resulting in this swelling. As a matter of fact, the swelling had insidiously developed over the course of 3 months. Bulging was objectively more evident with elbow flexion and wrist extension. The lesion was painless. X-ray investigation revealed soft tissue swelling within the dorsal aspect of the forearm. Further MRI imaging revealed the presence of an extensor carpi ulnaris muscle hernia, which was not treated surgically as it was asymptomatic. 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, upper limb muscle hernias are much rarer compared to lower limb ones. This presentation is more common following penetrating injuries or blunt trauma. Hernias can occur both in the extensor and flexors compartment, and they may be associated with neural entrapment syndromes. If these presentations are symptomatic or cause distress for cosmetic reasons, fascial repair is a common and effective therapeutic approach. Ultrasound investigations are very useful in identifying fascial defects and it is important to differentiate muscle hernias from other benign/malignant space invading lesions . URL : https://doi.org/10.4103/0970-0358.197243 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

Mobilisation or immobilisation-based treatments for first carpometacarpal joint osteoarthritis: A systematic review and meta-analysis with subgroup analyses. Magni, N. E., McNair, P. J., & Rice, D. A. (2022) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : Thumb osteoarthritis - Splinting vs movement This is a systematic review and meta-analysis comparing splinting to movement interventions on pain and pinch strength for people with thumb osteoarthritis (OA) in the short term. A total of eight randomised controlled studies were included. 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 not assessed through the GRADE approach ("low", "very low", "moderate", "high"), which has also been suggested by the Cochrane group for systematic reviews. Splinting or movement interventions (exercise/manual therapy) were delivered to people with thumb OA. Efficacy of intervention was assessed through improvements in pain intensity (i.e. NRS, VAS) and pinch strength. Splinting or movement interventions were compared to no intervention or sham US respectively. The treatment duration varied between 2 to 6 weeks. The results showed that there is very low to low-quality evidence suggesting that neither splinting nor movement interventions improve pain or pinch strength in the short term compared to a control group/placebo. There was no difference in terms of effectiveness between the two interventions. 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, neither splinting nor movement interventions provide clinically relevant improvements in people with thumb OA in the short term compared to a control group. A self-management program without the use of splinting appears to be the most cost-effective intervention that we can offer our clients with this condition . However, in clinical practice, it is possible that our clients could report large improvements with either splinting or movement-based interventions due to their positive treatment expectations and/or natural history . URL : https://doi.org/10.1177/17589983221083994 Abstract Introduction: Both joint mobilisation and immobilisation are thought to be effective in the treatment of first carpometacarpal joint (CMCJ) osteoarthritis (OA). The objective of this review was to establish whether either intervention reduced pain and improved pinch strength in people with first CMCJ OA in the short term and assess whether one intervention is superior to the other. Method: This was a systematic review and meta-analysis. Seven databases were searched until May 2021. Only RCTs were included. The Cochrane Risk of Bias Tool and the Grade of Recommendations Assessment, Development and Evaluation system were utilised to rate the evidence. Random-effects meta-analysis with subgroup analyses were used. Results: Eight studies were included with a total of 417 participants. Mobilisation treatments included manual therapy with or without exercise while immobilisation interventions utilised thumb splinting with several different designs. Very low-quality and low-quality evidence showed that mobilisation led to statistically but not clinically significant improvements in pain (standardised mean difference (SMD) = 0.53; 95% confidence interval (CI) = 0.03 to 1; I2 = 60%; p = 0.06) and pinch strength (SMD = 0.35; 95% CI = 0.03 to 0.7; I2 = 12%; p = 0.3) compared to placebo. Very low-quality and low-quality evidence showed no effect on pain and pinch strength compared to a control or no intervention. Subgroup analyses revealed no difference between interventions. Discussion: Neither mobilisation nor immobilisation alone led to clinically important improvements in pain or pinch strength in the short term in people with symptomatic first CMCJ OA. Neither therapeutic strategy appeared to be superior. 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/Therapeutic Have a think about this case study. Leave a diagnostic comment if you like. The patient was a 35 years old man presenting with swelling in the dorsal-ulnar aspect of the proximal forearm (see picture). The patient lifted heavy loads for work, however, they did not report any specific trauma resulting in this swelling. As a matter of fact, the swelling had insidiously developed over the course of 3 months. Bulging was objectively more evident with elbow flexion and wrist extension. The lesion was painless. X-ray investigation revealed soft tissue swelling within the dorsal aspect of the forearm. What is it?

Systematic review of distal biceps tendon rupture in athletes: Treatment and rehabilitation. Pitsilos, C., I. Gigis, K. Chitas, P. Papadopoulos and K. Ditsios (2022) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 (4/4 thumb up) Type of study : Therapeutic Topic : Distal biceps rupture in athletes - Rehabilitation This systematic review assessed rates of return to sport and time to return to sport in athletes with a distal biceps rupture. Ten articles were included for a total of 157 athletes with distal biceps ruptures. All of them underwent surgical repair. Patients' age ranged from 18 to 61 years old (average age = 41). The results showed that 98% of patients returned to sport and this occurred on average at 6 months post-surgery. Return to sport was slower if the surgical repair occurred later than 3 weeks from injury. Post-surgery, rehabilitation consisted of immobilisation of the elbow between 2 days and 6 weeks, followed by range of movement exercises. Progressive resistance training was initiated between 4 and 10 weeks after surgery (see table). 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 surgical treatment of distal biceps ruptures leads to a high return to sport in athletes. Prompt referral to an orthopaedic surgeon is required as repairs completed beyond 3 weeks from injury delay return to sport. Following surgery, a short period of immobilisation (2 to 3 weeks) is followed by range of movement exercises. Resistance training is initiated at 7-10 weeks pos-surgery. It is important to remember that despite better strength and endurance outcomes, surgery for distal biceps repair has a higher risk of complications . URL : https://doi.org/10.1016/j.jse.2022.02.027 Abstract Background: Distal biceps tendon rupture is a rare injury associated to decreased elbow flexion and forearm supination strength. This impairment is not tolerated by high demand patients like athletes. Purpose: To review treatment and rehabilitation applied to injured athletes and study their impact in return to sports. Methods: MEDLINE, Cochrane, Web of Science and Scopus online databases were searched. A systematic review was conducted using the PRISMA guidelines; studies published on distal biceps tendon rupture treatment and rehabilitation of athletes until 30 June of 2021, were identified. A quantitative synthesis of factor related to return to preinjury sport activity was made. Results: Ten articles were identified, including 157 athletes. Mean age was 40.5 years and dominant arm was injured in 66%. Rupture was acute in 77% and mean follow-up was 25.7 months. A 97.5% of return to sport was found within a mean time of 6.2 months. Surgical treatment was followed in all cases. One-incision technique was chosen in 73% and suture anchor fixation in 33%. No postsurgical immobilization was reported in 24% and immobilization for 2 weeks in 79%. Decreased supination-pronation and flexion-extension arc was found in 40% and 17%, respectively. Earlier return to sport was associated with non-dominant side (p=0,007) and acute (p<0,001) injuries, participation in weightlifting (p=0,001), double-incision approach (p=0,005), cortical button fixation (p<0,001) and absence of supination-pronation restriction (p=0,032). Time of return to sport activity was independent of rehabilitation, including immobilization (p=0,539) and strengthening (p=0,155), and decreased flexion-extension arc (p=0,059). Conclusion: Athletes sustaining distal biceps tendon rupture have a high postoperative return to sport rate, independently of selected surgical technique or rehabilitation program. However, a relation between the surgical technique and time of return to sport was found. Rehabilitation did not influence time of return to sport. 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

Two-year changes in magnetic resonance imaging features and pain in thumb base osteoarthritis. van Beest, S., et al. (2021) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 👍 (4/4 thumbs up) Type of study : Symptoms prevalence study Topic : Thumb osteoarthritis - Pain progression This is a longitudinal study, assessing change in thumb osteoarthritis (OA) pain across two years. Participants (N = 165) were included if they presented with the Americal College of Rheumatology (ACR) criteria for hand osteoarthritis. Of these participants, 145 (indirectly calculated from Figure 2 and legend in the article) presented with signs or symptoms of thumb OA. Out of these participants, 93 (56%) frequently reported pain in the thumb. Self-reported hand pain was assessed through the 0-100 VAS. Participants were followed up at 2 years. The results showed that at two years follow-up, 26 participants (16%) reported an improvement in pain, 18 participants (11%) reported higher levels of pain, and 121 reported pain being unchanged (70%). 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, symptomatic thumb OA is symptomatic in over half of people who present signs or symptoms (e.g. pain on palpation) of thumb OA. This suggests that a large proportion of people with objective evidence of thumb OA is asymptomatic. In a large proportion of people, symptoms remain unchanged after two years. In those people who present with pain, there is a 20-30% probability that pain will either get better or worse. If you would like to know what is the current most valuable conservative treatment approach for thumb OA, have a look at this synopsis . Open Acces URL : https://doi.org/10.1002/acr.24355 Abstract Objective: To investigate the two-year course of pain and osteoarthritic features on magnetic resonance imaging (MRI) in the thumb base. Methods: Patients in the Hand Osteoarthritis in Secondary Care (HOSTAS) cohort who had received radiographic examination, MRI, and clinical examination of the right thumb base at baseline and who had a 2-year follow-up period were studied. Pain on palpation of the thumb base was assessed on a 0-3 scale. MRIs were analyzed with the Outcome Measures in Rheumatology (OMERACT) thumb base osteoarthritis MRI scoring system for synovitis, bone marrow lesions (BMLs), subchondral bone defects, cartilage space loss, osteophytes, and subluxation. Radiographs were assessed for osteophytes and joint space narrowing. We studied the associations of changes in synovitis and BMLs with changes in pain using a logistic regression model adjusted for radiographic damage, with values expressed as odds ratios (ORs) and 95% confidence intervals (95% CIs). Results: Of 165 patients, 83% were women and the mean age was 60.7 years. At baseline, 65 patients had thumb base pain. At 2-year follow-up, pain had decreased in 32 patients and increased in 33 patients. MRI features remained stable in most patients. Structural MRI features generally deteriorated, while synovitis and BMLs improved in some individuals and deteriorated in others. Change in radiographic osteophytes rarely occurred (n = 10). Increased synovitis (odds ratio [OR] 3.4 [95% CI 1.3-9.3]) and increased BMLs (OR 5.1 [95% CI 2.1-12.6]) were associated with increased pain. Decreased BMLs appeared to be associated with decreased pain (OR 2.7 [95% CI 0.8-8.9]), and reductions in synovitis occurred too infrequently to calculate associations. Conclusion: Over 2 years, thumb base pain fluctuated, while MRI features changed in a minority of patients with hand osteoarthritis. Changes in synovitis and BMLs were associated with changes in pain on palpation, even after adjustment for radiographic damage. 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

Elbow extension test to rule out elbow fracture: Multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. Appelboam, A., et al. (2008) Level of Evidence : 1c Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Diagnostic Topic : Elbow fractures - Elbow extension test This is a retrospective study on the specificity and sensitivity of the elbow extension test for elbow fractures. If a test is very sensitive and its result is negative, you can be more certain that the patient does not have the condition. If the test is specific and its result is positive, you can be more certain that the patient has the condition. Only participants (n = 1,736) presenting with an acute elbow injury (less than 3 days) and without previous elbow extension limitation were included (see box below). The elbow extension test required participants to flex their shoulders to 90 degrees and fully extend both their elbow. The affected and unaffected sides were visually compared and if there were no obvious limitations of range of movement, the test was defined as negative. The results showed that if the elbow extension test was negative (participants were able to fully extend their elbow) the probability of an elbow fracture was moderately (children) to largely (adults) reduced (Making the test highly sensitive). Nevertheless, the ability of a positive test to detect an elbow fracture if positive (inability to fully extend the elbow) was quite low (Making the test not very specific). 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 presence of full elbow extension reduces the probability of an elbow fracture in clients with an acute elbow injury. In such instances, an x-ray may not be required. It is however important to remember that intermittent limitations in elbow extension (locking) in adolescents requires an x-ray to exclude osteochondritis dissecans . Open Access URL : https://doi.org/10.1136/bmj.a2428 Abstract Objective: To determine whether full elbow extension as assessed by the elbow extension test can be used in routine clinical practice to rule out bony injury in patients presenting with elbow injury. Design: Adults: multicentre prospective interventional validation study in secondary care. Children: multicentre prospective observational study in secondary care. Setting: Five emergency departments in southwest England. Participants: 2127 adults and children presenting to the emergency department with acute elbow injury. Intervention: Elbow extension test during routine care by clinical staff to determine the need for radiography in adults and to guide follow-up in children. Main outcome measures: Presence of elbow fracture on radiograph, or recovery with no indication for further review at 7-10 days. Results: Of 1740 eligible participants, 602 patients were able to fully extend their elbow; 17 of these patients had a fracture. Two adult patients with olecranon fractures needed a change in treatment. In the 1138 patients without full elbow extension, 521 fractures were identified. Overall, the test had sensitivity and specificity (95% confidence interval) for detecting elbow fracture of 96.8% (95.0 to 98.2) and 48.5% (45.6 to 51.4). Full elbow extension had a negative predictive value for fracture of 98.4% (96.3 to 99.5) in adults and 95.8% (92.6 to 97.8) in children. Negative likelihood ratios were 0.03 (0.01 to 0.08) in adults and 0.11 (0.06 to 0.19) in children. Conclusion: The elbow extension test can be used in routine practice to inform clinical decision making. Patients who cannot fully extend their elbow after injury should be referred for radiography, as they have a nearly 50% chance of fracture. For those able to fully extend their elbow, radiography can be deferred if the practitioner is confident that an olecranon fracture is not present. Patients who do not undergo radiography should return if symptoms have not resolved within 7-10 days. 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