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Adverse events in meditation practices and meditation-based therapies: a systematic review. Farias, M., Maraldi, E., Wallenkampf, K. C., & Lucchetti, G. (2020) Level of Evidence : 1a Follow recommendation : 👍 👍 👍 👍 Type of study : Therapeutic Topic : Meditation - Adverse events This is a systematic review and meta-analysis assessing adverse events associated with meditation practice. Fifty-four experimental studies, 14 cross sectional studies, and 15 case studies were included for a total of 6,464 participants. Studies were included if mindfulness or trascendental mediation were utilised. No formal critique of the included studies was reported (limitation). The prevalence and type of adverse events were reported. The overall prevalence of adverse events was 8.3% ( 95%CI : 5% to 12%). When only experimental studies were included, the prevalence reduced to 4% ( 95%CI : 2% to 5%). The most common adverse events included a worsening of anxiety (33%) and depression (26%). Clinical Take Home Message : Due to the close relationship between psychological factors and upper limb recovery or post surgical satisfaction following CTS surgery , we may refer our clients for meditation classes. If we decide to do so, we should warn them that there may be side effects such as worsening of their anxiety or depression. This occurs on average in 1 person out of 25. An alternative that does not appear to present with as many adverse event is yoga . Yoga sessions including at least 50% of physical exercise (e.g. asanas) appear to provide benefits with little or no side effects. Open Access URL : https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13225 Abstract Objective: Meditation techniques are widely used as therapy and wellbeing practices, but there are growing concerns about its potential for harm. The aim of the present study is to systematically revie w meditation adverse events (MAEs), investigating its major clinical categories and its prevalence. Method: We searched PubMed, PsycINFO, Scopus, Embase and AMED up to October 2019. Eligible studies included origin al reports of meditation practices (excluding related physical practices such as Yoga postures) with adult samples across experimental, observational and case studies. We identified a total of 6742 citations, 83 of which met the inclusion criteria for MAEs with a total of 6703 participants who undertook meditation practice. Results: Of the 83 studies analysed, 55 (65%) included reports of at least one type of MAE. The total prevalence of adverse events was 8.3% (95% CI 0.05–0.12), though this varied considerably across types of studies – 3.7% (95% CI 0.02–0.05) for experimental and 33.2% (95% CI 0.25–0.41) for observational studies. The most common AEs were anxiety (33%, 18), depression (27%, 15) and cognitive anomalies (25%, 14); gastrointestinal problems and suicidal behaviours (both 11%, 6) were the least frequent. Conclusion: We found that the occurrence of AEs during or after meditation practices is not uncommon, and may occu r in individuals with no previous history of mental health problems. These results are relevant both for practitioners and clinicians, and con tribute to a balanced perspective of meditation as a practice that may lead to both positive and negative outcomes

A prospective randomized trial comparing the functional results of buddy taping versus closed reduction and cast immobilization in patients with fifth metacarpal neck fractures. Martínez-Catalán, N., Pajares, S., Llanos, L., Mahillo, I., & Calvo, E. (2020) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 👍 Type of study : Therapeutic Topic : 5th metacarpal neck fracture - buddy splinting This is a randomised controlled trial assessing the effectiveness of buddy taping vs close reduction and immobilisation in participants with 5th metacarpal neck fracture with less than 70° of volar angulation. Participants (N = 72) were included if they presented with a 5th metacarpal fracture within 72 hours to the emergency department. Participants were excluded if they presented with more than 70° of volar angulation, a comminuted fracture, previous 5th metacarpal fracture, rotational deformity, additional fractures, tendon injuries, or open fractures. Effectiveness of each intervention was assessed through the DASH (primary outcome) and pain (VAS), radiographs for fracture alignment, range of movement (degrees of mcpj movement), time for return to work, and grip strength (all secondary outcomes). The outcomes were measured at baseline, 3 and 9 weeks, and 12 months. Treatment allocation was randomised. The assessor was not blinded to treatment allocation. Participants were provided with either buddy taping of the ring finger and little finger (n = 36) or closed reduction and cast immobilisation (n = 38). The buddy taping group did not undergo a closed reduction and could mobilise wrist and fingers immediately. Buddy strapping was removed at three weeks and from nine weeks they could do heavier exercises. The immobilisation group underwent closed reduction followed by casting from the pipj to the forearm. The cast was removed at three weeks and followed a similar treatment progression to the buddy splinting group (You will not find the treatment details in the full text as they did not include them. I emailed the first author Natalia and they kindly provided with further information). The results showed that participants in the buddy splinting group had much greater function (twice the minimal clinical important difference), lower pain, similar volar angulation, and grip strength at 3 weeks compared to the close reduction and immobilisation group. In addition, the buddy splinting group returned to work 29 days earlier compared to the closed reduction and immobilisation group. Unfortunately, no information was provided in terms of what work they return to (sedentary vs manual). When asked, the first author confirmed that also manual laborers took part in the study without complications (Thanks Aaron for suggesting to get more information in this regard). Clinical Take Home Message : Hand therapists may choose to use buddy splinting for 5th metacarpal neck fracture presenting with no rotational deformity and less than 70° of volar angulation. However, hand therapists may utilise a hand based ulnar gutter splint to limit clients who are really eager to return to heavy manual tasks and reduce pain associated with potential knocking of the fracture site (Thanks Aaron White for the awesome discussion about this article!). URL : https://www.jhandsurg.org/article/S0363-5023(20)30280-X/fulltext Available through the Journal of Hand Surgery (American Volume) for HTNZ members. Available through EBSCO Health Databases for PNZ members. Abstract Purpose: Although fifth metacarpal neck fractures are typically treated nonsurgically, most often with closed reduction and orthosis immobilization, cast immobilization may not improve outcomes compared with buddy taping without reduction. The aim of this study was to compare functional outcomes of buddy taping versus reduction and cast immobilization in patients with fifth metacarpal neck fractures. Methods: Adult patients with acute fifth metacarpal neck fractures with less than 70º volar angulation and without rotational deformity were randomly assigned to be treated either with buddy taping or a cast after closed reduction. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score at 9 weeks. Secondary outcomes included the DASH score at 3 weeks and 1 year, range of motion of the metacarpophalangeal joint, pain, grip strength, return to work, radiographic angulation, and complication rate. Results: We recruited 72 patients between August 2016 and January 2018. After 3 weeks, the DASH score was significantly lower for patients treated with buddy taping (19.7 ± 19.7) compared with cast immobilization (44.6 ± 15.0). At 9 weeks, clinical outcomes in the buddy taping group were better in terms of range of motion and DASH score, with a mean difference of 6.3 points, which did not exceed the minimally clinically important difference. There were more complications in the cast immobilization group. Fracture angulation after reduction was followed by a loss of reduction at 3 weeks’ follow-up and equivalent residual radiographic volar angulation was observed at 3 and 9 weeks after injury in both groups. Duration of time off from work was 28 days shorter with buddy taping compared with cast treatment. Conclusion: There is no benefit to reduction and orthosis immobilization of fifth metacarpal neck fractures with an initial angulation less than 70°. Use of buddy taping and early mobilization had good clinical results as well as significant improvement in time lost from work.

Association of daily step count and step intensity with mortality among us adults. Saint-Maurice, P. F., Troiano, R. P., Bassett, D. R., Jr., Graubard, B. I., Carlson, S. A., Shiroma, E. J., . . . Matthews, C. E. (2020) Level of Evidence : 1a Follow recommendation : 👍 👍 👍 👍 Type of study : Prognostic Topic : Daily steps - Mortality prediction This is a prospective cohort study assessing the effectiveness of step count and intensity on mortality. A total of 6,355 participants were included at baseline. Participants were followed up for 3 years. Participants were on average 57 years old. The step count and intensity was measured for one week only at baseline. The step count and intensity (walking speed) was measured through a device placed at the ankle. The results showed that participants completing 8,000 steps a day (7.5% of them died) were 50% less likely to die at any timepoint during the three year study compared to participants completing 4,000 steps per day (15% of them died). Greater step counts (12,000 steps/day - 5% of them died) reduced the likelihood of dying (at any point during the study) by 75% compared to the participants completing 4,000 steps per day. Stepping intensity (walking speed) did not predict mortality. The correlation reported in this study does not suggest causation and there may be other factors that explain this association. Clinical Take Home Message : Mortality appears to be higher in adults with lower number of daily step count. This synopsis is a nice addition to the one that was previously completed on grip strength and mortality . Due to the nature of the study considered, it is not possible to determine causality between the number of daily steps and mortality. However, hand therapists may prescribe clients with a walking regime with the aim of achieving the well known 10,000 seps per day. This may provide them with a longer lifespan (length of life) and healthspan (years of quality life - free from disease). URL : https://jamanetwork.com/journals/jama/article-abstract/2763292 Available through EBSCO Health Databases for PNZ members.

Inappropriate preoperative gabapentinoid use among patients with carpal tunnel syndrome. Billig, J. I., Sears, E. D., Gunaseelan, V., Santosa, K. B., Iwashyna, T. J., Englesbe, M. J., . . . Waljee, J. F. (2020) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 Type of study : Prognostic Topic : Gabapentin - Carpal tunnel syndrome This is a prospective study assessing the risks associated with the use of gabapentinoids (i.e. gabapentin and pregabalin) before a carpal tunnel syndrome (CTS) decompression surgery. A total of 56,593 participants were included. Participants were followed up at 3 and 6 months after surgery. More than 50% of participants were over 50 years old. The risk was assessed by quantifying the number of patients who continued utilising gabapentinoids or started utilising opioids after CTS surgery. The results showed that participants who utilised gabapentinoids prior to CTS surgery were 19 times ( relative risk ) more likely to continue utilising gabapentinoids after surgery. In addition, patients taking gabapentinoids pre-surgery were 2.3 times more likelly ( relative risk ) to start using opiods after CTS surgery. The findings did not change when people with persistent pain conditions (e.g. arthritis) in addition to CTS were excluded from the analyses. Clinical Take Home Message : Hand therapists should advise against the use of gabapentinoids for the treatment of CTS. Gabapentinoids have not shown to be more effective than placebo for CTS ( Hui et al., 2010 ) and they may double the probability of clients starting to use opioids after CTS surgery. Hand therapists should encourage the implementation of evidence-based non surgical interventions (e.g. e ducation and splinting , manual therapy ) instead of gabapentinoids use. If non surgical interventions fail, referral to a hand specialist for potential surgery is indicated. URL : https://www.jhandsurg.org/article/S0363-5023(20)30213-6/fulltext Available through the Journal of Hand Surgery (American Volume) for HTNZ members. Available through EBSCO Health Databases for PNZ members.

Enigmatic and unusual cases of upper extremity pain: Mislabeling as malingerers. Bradburn, K. N., Beleckas, C. M., Peck, K. M., Kaplan, F. T., & Merrell, G. A. (2020) Level of Evidence : 5 Follow recommendation : 👍 Type of study : Diagnostic Topic : What is the differential diagnosis? – Case study The patient was a 38 years old female who had undergone conservative management of radial styloid fracture two years previously. Subjectively, they reported persistent pain on the radial-volar aspect of the wrist. Aggravating factors included writing and flexing the interphalangeal joint of the thumb while keeping a straight index finger. Previous treatment included 1st dorsal compartment cortisone injection (one year after the original injury), which temporarily relieved pain. During that period, they were also treated with intermittent thumb splinting. Objectively, there was no tenderness on palpation of the first dorsal compartment. Wrist range of movement was 85°, 85°, 50°, and 80° of pronation, supination, extension, and flexion respectively. The interphalangeal joint of the thumb could not flex without the distal interphalangeal joint of the index finger flexing. X-rays, MRI, and CT scans revealed no soft tissue or bony abnormalities. Surgical exploration for diagnostic and potential treatment purposes was undertaken. The procedure revealed the presence of a Linburg-Comstock syndrome. This is a tendinous connection between flexor pollicius longus (FPL) and flexor digitorum profondus (FDP) (of the index finger in this case) which is present in 30% of people. A tenosynovectomy was completed to allow for independent tendon gliding of the FPL and FDP. At three months follow up symptoms had markedly improved and at one year follow up, symptoms had completely resolved. Clinical take home message : Hand therapists may consider Lindburg-Comstock syndrome when the ipj of the thumb is unable to flex without dipj flexion of the index finger. This syndrome may be painful and surgical release can provide symptoms resolution. If you enjoyed this type of synopsis, put a like on it! URL : https://www.jhandsurg.org/article/S0363-5023(20)30189-1/fulltext Available through the Journal of Hand Surgery (American Volume) for HTNZ members. Available through EBSCO Health Databases for PNZ members. Abstract With the intricate anatomy of the hand and upper extremity, there are many possible etiologies of pain. In addition, one must be alert to conditions typically affecting other areas of the body presenting in the hand and upper extremity. To add to the complexity of diagnosis, one must also be aware of potential secondary gains. With this in mind, a thorough history, physical examination, and broad differential can help avoid mislabeling patients with uncommon ailments. In this article, we present 4 cases of unusual causes of hand and upper extremity pain.

Entrapment neuropathies: A contemporary approach to pathophysiology, clinical assessment, and management. Schmid, A. B., Fundaun, J., & Tampin, B. (2020) Level of Evidence : 5 Follow recommendation : 👍 Type of study : Symptoms prevalence, Aetiologic, Diagnostic, Therapeutic Topic : Entrapment neuropaties - Presentation and diagnostics This is an updated narrative review on clinical presentation, aetiology, and diagnostic tests for peripheral neuropathies (e.g. carpal tunnel syndrome - CTS). In terms of aetiology, genetic predisposition appears to be one of the strongest risk factors for entrapment neuropathies. It is unknown whether these genetic changes cause entrapment neuropathies due to anatomical alterations of the tunnels or connective tissue impairments within the nerve. The pathophysiology of compression neuropathy includes oedema, ischemia, and fibrosis of tissues within the nerve and outside of the nerve, which are believed to limit neural gliding. Moderate to severe entrapment neuropathies also present with axonal degeneration and/or demyelination, which causes nerve conduction blocks or slowing down of information transmission. These changes may lead to random electric shock symptoms or symptoms provoked by Tinel's testing. These axonal impairments often involve small fibre (detecting hot/cold and pinprick) during the initial stages of the entrapment neuropathy and large fibre (affecting light touch and muscle contraction) when the neuropathy becomes more severe. Interestingly, neuroinflamation has been suggested to increase the sensitivity of the affected nerve, often causing symptoms beyond the peripheral innervation territory of the compressed nerve. Changes within the central nervous system have also been identified in people with entrapment neuropathies. However, it is still unclear whether changes within the central nervous system can lead to on-going symptoms in absence of peripheral nerve entrapment. From an objective assessment point of view, in addition to motor and monofilament testing (Aβ - large fibre), pin prick testing (Aδ and C - small fibre) should be completed. A loss of function (painless weakness, larger monofilament required, or inability to feel pain on pin prick testing) could be used to confirm a neuropathy. Nerve conduction studies and US imaging may be useful in excluding differential diagnoses. Clinical Take Home Message : Hand therapists should be aware that entrapment neuropathies often present with unconventional peripheral nerve patterns. The distribution of symptoms outside of peripheral nerve patterns or dermatomal patterns does not excluded the presence of an entrapment neuropathy. Pin prick testing should be included in the objective assessment, and US imaging may be useful in assessing nerve edema and exclude other conditions. The same authors have published another article, which has been covered in a previous synopsis . Open Access URL : https://journals.lww.com/painrpts/Fulltext/2020/08000/Entrapment_neuropathies__a_contemporary_approach.4.aspx Abstract Entrapment neuropathies such as carpal tunnel syndrome, radiculopathies, or radicular pain are the most common peripheral neuropathies and also the most common cause for neuropathic pain. Despite their high prevalence, they often remain challenging to diagnose and manage in a clinical setting. Summarising the evidence from both preclinical and clinical studies, this review provides an update on the aetiology and pathophysiology of entrapment neuropathies. Potential mechanisms are put in perspective with clinical findings. The contemporary assessment is discussed and diagnostic pitfalls highlighted. The evidence for the noninvasive and surgical management of common entrapment neuropathies is summarised and future areas of research are identified.

Enigmatic and unusual cases of upper extremity pain: Mislabeling as malingerers. Bradburn, K. N., Beleckas, C. M., Peck, K. M., Kaplan, F. T., & Merrell, G. A. (2020) Level of Evidence : 5 Follow recommendation : 👍 Type of study : Diagnostic Topic : What is the differential diagnosis? – Case study This paper presents with four case studies. I covered one case in a previous synopsis and the following is another interesting case. Have a think about it. If you like, you can leave a comment indicating what the diagnosis may be and how you would treat it. I will publish the diagnosis and treatment reported by the paper next week. The patient was a 38 years old female who had undergone conservative management of radial styloid fracture two years previously. Subjectively, they reported persistent pain on the radial-volar aspect of the wrist. Aggravating factors included writing and flexing the interphalangeal joint of the thumb while keeping a straight index finger. Previous treatment included 1st dorsal compartment cortisone injection (one year after the original injury), which temporarily relieved pain. During that period, they were also treated with intermittent thumb splinting. Objectively, there was no tenderness on palpation of the first dorsal compartment. Wrist range of movement was 85°, 85°, 50°, and 80° of pronation, supination, extension, and flexion respectively. The interphalangeal joint of the thumb could not flex without the distal interphalangeal joint of the index finger flexing. X-rays, MRI, and CT scans revealed no soft tissue or bony abnormalities. What is it and how would you treat it? URL : https://www.jhandsurg.org/article/S0363-5023(20)30189-1/fulltext Available through the Journal of Hand Surgery (American Volume) for HTNZ members. Available through EBSCO Health Databases for PNZ members.

Acute scaphoid fractures: guidelines for diagnosis and treatment. Clementson, M., Björkman, A., & Thomsen, N. O. B. (2020) Level of Evidence : 5 Follow recommendation : 👍 Type of study : Diagnostic, Therapeutic Topic : Scaphoid fractures - when to refer This is a narrative review on diagnosis and treatment of schapoid fractures. Scaphoid fractures represent 60% of the carpal fractures and 10% of all hand fractures. Most often, the scaphoid fracture is located at the waist (70%) with a smaller percentage affecting the distal pole (25%), or the proximal proximal pole (5%). A few clinical diagnostic tests are available and they include tenderness on palpation at the snuff box or scaphoid tubercle, and pain on axial compression of the thumb. Each of these three tests is very sensitive (100%), meaning that if no pain is elicited, it is very unlikely that the client presents with a scaphoid fracture. However, only the combination of three positive tests has a reasonable specificity (74%), meaning that if all three tests reproduce pain there is a higher probability of scaphoid fracture. X-rays are useful but are not very sensitive (70% sensitivity - not always useful in excluding a fracture). If an x-ray is negative and there is clinical suspicious of a scaphoid fracture, the wrist should be immobilised and x-ray repeated at 2 weeks. If a scaphoid fracture is identified on x-ray, the treatment depends on the fracture location and stability of the fracture. Distal pole fractures (25% of scaphoid fractures) are the most likely to heal with conservative treatment and require between 4 (tubercle fracture) and 6 weeks (distal pole, not tubercle) of immobilisation. Surgical treatment of scaphoid distal pole fracture should be considered if the fracture is displaced. Scaphoid waist fractures can be treated conservativaly with immobilisation for 6 to 10 weeks if they are not displaced. Longer immobilisation periods are suggested if the fracture is comminuted, the client is a smoker, or if there is limited compliance. Displaced fractures of the waist of the scaphoid require surgical treatment. Proximal pole scaphoid fractures require surgical treatment more often than conservative treatment. This is irrespective of fracture displacement. A short arm cast should be utilised for conservative treatment as there is no benefit in utilising a cast which includes the whole thumb. Clinical Take Home Message : Hand therapists may treat scaphoid distal pole or waist fractures conservatively if there is no displacement. This can be done with a short arm cast, which allows thumb movement. If fracture displacement is suspected, referral to a hand surgeon is warranted in all cases except for a scaphoid tubercle fracture. Scaphoid proximal pole fractures require surgical treatment without exception. Open Access URL : https://online.boneandjoint.org.uk/doi/epub/10.1302/2058-5241.5.190025

Quantification of hand function by power grip and pinch strength force measurements in ulnar nerve lesion simulated by ulnar nerve block. Wachter, N. J., Mentzel, M., Krischak, G. D., & Gülke, J. (2018) Level of Evidence : 4 Follow recommendation : 👍 👍 👍 Type of study : Diagnostic Topic : Ulnar nerve impairment - Grip strength This is a study assessing hand strength before and after an ulnar nerve block at the Guyon's canal in the same participants (within-subject design). Twenty-five healthy participants were recruited for this study. Hand strength was assessed through a Jamar hand dynamometer (power grip) and pinch dynamometer (tip to tip, tripod, and key pinch). The measurement were taken before and after the injection, without randomisation of condition (this is a limitation). The results showed that the greatest impairments were identified in the pinching tests (58-60% reduction) compared to grip testing (27% reduction in strength). Clinical Take Home Message : Hand therapists may utilise pinch strength as a measure of impairment/recovery for clients with entrapment neuropathies or lacerations of the ulnar nerve. The significant impairments in pinch strength following an ulnar nerve block are not surprising considering the innervation of the flexor pollicis brevis (deep portion), adductor pollicis and first dorsal interosseous by the ulnar nerve. In addition, the presence of a Riche-Cannieu anastomosis (ulnar to median nerve within the hand), which is present in 60% of subjects , may further explain the significant impairment caused by an ulnar nerve block at the Guyon's canal. URL : https://www.jhandtherapy.org/article/S0894-1130(16)30191-0/fulltext Available through the Journal of Hand Therapy for HTNZ members. Available through EBSCO Health Databases for PNZ members.

Enigmatic and unusual cases of upper extremity pain: Mislabeling as malingerers. Bradburn, K. N., Beleckas, C. M., Peck, K. M., Kaplan, F. T., & Merrell, G. A. (2020) Level of Evidence : 5 Follow recommendation : 👍 Type of study : Diagnostic Topic : What is the differential diagnosis? – Case study This paper presents with four case studies. I found one particularly interesting. Have a think about it. If you like, you can leave a comment indicating what the diagnosis may be and how you would treat it. I will publish the diagnosis and treatment reported by the paper next week. The patient was a 33 year old female with an insidious onset of pain at the base of the index finger for the last 3 months. Aggravating factors included playing tennis and increasing tennis frequency. In the last three months, they had been playing tennis more frequently. Objectively, there were no massess or skin changes. There was tenderness on palpation at the second metacarpal. There was no extensor digitorum subluxation at mcpj. Laboratory testing was negative for inflammatory conditions. X-rays revealed no bony abnormalities. MRI showed cortical thickening and bone edema of the second metacarpal shaft. What is it and how would you treat it? URL : https://www.jhandsurg.org/article/S0363-5023(20)30189-1/fulltext Available through the Journal of Hand Surgery (American Volume) for HTNZ members. Available through EBSCO Health Databases for PNZ members.

Evaluation of written and video education tools after mallet finger injury. Novak, C., Mak, L., & Chang, M. (2019) Level of Evidence : 4 Follow recommendation : 👍 👍 Type of study : Therapeutic Topic : Mallet splint resources - Video This is a prospective cohort study assessing the usefulness of written and video resources for clients with an acute mallet finger. Participants (N = 61) were diagnosed within four weeks from the injury and never presented with the condition before. They were all able to read and speak English. Participants were provided with a written pamphlet (not provided in the article) and video links to watch in their own time. The effectiveness of the written and video ( stack or through splint) resources was assessed through a 0 (not helpful) to 10 (extremely helpful) numerical rating scale. Outcomes were assessed after 2 weeks from treatment initiation. The results showed that most participants (n = 57) utilised written instruction compared to video instructions (n = 30). However, participants watching the video and reading the material found the video particularly helpful and more easy to understand compared to the written information. Clinical Take Home Message : Hand therapists may provide video resources on finger hygiene to clients presenting with a mallet finger injury. This may be particularly useful when clients cannot physically visit the clinic. In addition, alternatives to a custom made splint exist and may be available at the pharmacy. For instance, a finger cot splint can be easily bought at most pharmacies. URL : https://www.sciencedirect.com/science/article/abs/pii/S0894113018300413 Available through the Journal of Hand Therapy if you have direct access ( HTNZ ) Available through EBSCO Health Databases if you have access ( PNZ )

Predictive factors associated with proximal interphalangeal joint contracture in trigger finger. Sato, J., Ishii, Y., & Noguchi, H. (2020) Level of Evidence : 4 Follow recommendation : 👍 👍 Type of study : Prognostic Topic : Flexion deformity in trigger finger – How to predict it This is a non-peer reviewed prospective study assessing pipj flexion deformity predicting factors in trigger finger. A total of 126 participants affected by trigger finger were included in the study. Potential participants were excluded if the thumb was involved. The variables of interest were the digit involved, gender, age, body mass index (BMI), hand dominance, history of previous trigger finger in other digits, multiple digits involved, previous history of carpal tunnel syndrome (CTS) or De Quervain's syndrome, heavy manual labour, diabetes mellitus, trigger finger grade (I - intermittent, II - actively correctable, III - passively correctable), and duration of triggering. Participants were followed prospectively for a maximum of six years, however, there was no information on the follow up time range. The results showed that on average 30% of trigger digit presented with pipj contracture. In addition participants with a previous history of CTS or De Quervain's (n = 8/29; 28%) had 4.6 times greater odds of presenting with pipj deformity compared to participants without it (5/84; 6%). In addition, trigger finger grade was also found to be a predictor. Participants with a grade III trigger finger (14/22; 64%) had 5 to 8 times greater odds of presenting with pipj flexion deformity compared to participants with grade I (11/48; 19%) and II (12/33; 27%). Lenght of time with trigger finger was not identified as a predictive factor. Clinical Take Home Message : The risk of developing a pipj flexion deformity with grade I trigger finger is relatively low (1 in 5 people). If clients present with grade II or III they have a greater chance of developing pipj flexion deformity (grade II: 1 in 3 people; grade III: 2 in 3 people). Clients with grade III should therefore be referred for surgical management immediately. Clients with grade II may be monitored monitored over time and referred if the clinical presentation worsen. URL : https://journals.sagepub.com/doi/abs/10.1177/1753193420935768 Available through EBSCO Health Databases if you have access ( PNZ )