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Patient-perceived outcomes of recovery after trigger digit release. Blazar, P. E., et al. (2023) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic: Trigger finger surgery - How long does it take to recover? This was a prospective study assessing recovery time for patients recovering from trigger finger release (TFR) surgery. A total of 50 patients were included in the study, with 27 excluded for lack of follow-up. Patients completed a visual analogue scale (VAS) for pain and the Quick-DASH (Disabilities of the Arm, Shoulder, and Hand) to assess baseline pain and function respectively before surgery. In addition, patients were asked when they felt they had "fully recovered". The results showed that the mean time to full recovery was 6 months. Both the VAS and QuickDASH improved to a clinically relevant level at 6 weeks and 3 months. Eight per cent of patients did not feel fully recovered one year after the procedure, and these patients had higher preoperative QuickDASH and VAS pain scores. 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, patients may take longer to feel fully recovered after trigger finger release (TFR) than expected. We should be aware of the discrepancy between what surgeons suggest and what patients expect during their recovery. On average, it takes 6 months for people to feel fully recovered after TFR. If you are interested in trigger finger pathophysiology, you could read about the adhesions between flexor tendons contributing to this pathology. If you want further information about this pathology, have a look at the full database on trigger finger. URL: https://doi.org/10.1016/j.jhsa.2023.03.016 Abstract Purpose: Trigger finger release (TFR) is one of the most commonly performed hand surgeries; nevertheless, the time until patients subjectively feel recovered has not been well documented. The limited literature on patient perceptions of recovery after any type of surgery has described that patients and surgeons may have differing views on the time until full recovery. Our primary study question was to determine how long it takes for patients to subjectively feel fully recovered after TFR. Methods: In this prospective study, patients who underwent isolated TFR completed questionnaires before surgery and at multiple time points following surgery until they reported full recovery. Patients completed visual analog scale (VAS) pain scores and Quick DASH (Disabilities of the Arm, Shoulder, and Hand) and were asked if they felt fully recovered at 4 weeks, 6 weeks, and 3, 6, 9, and 12 months. Results: The average time to self-reported full recovery was 6.2 months (SD 2.6), and the median time to self-reported full recovery was 6 months (IQR 4 months). At 12 months, four out of 50 patients (8%) did not feel fully recovered. Quick DASH and VAS pain scores improved significantly from preoperative assessment to final follow-up. All patients reported improvement in both VAS pain scores and Quick DASH scores greater than the minimal clinically important difference between 6 weeks and 3 months after surgery. Higher preoperative VAS and Quick DASH scores were associated with failure to fully recover by 12 months after surgery. Conclusions: The length of time after surgery until patients felt fully recovered after isolated TFR is longer than the senior authors’ expectations. This suggests that patients and surgeons may consider distinctly different parameters when discussing recovery. Surgeons should be aware of this discrepancy when discussing recovery after surgery. 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

Factors influencing patient experience after cubital tunnel syndrome surgery. Paramsewaran, P., et al. (2021) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Cubital tunnel syndrome - Pre-surgical education This is a qualitative study investigating the experiences of patients undergoing cubital tunnel surgery. A total of 17 participants took part in the study. All of them underwent a semistructured interview to explore their experiences. The results showed that preoperative education and counseling was important to set expectations and providing detailed information about the surgery and recovery process. Participants suggested providing both written and online resources to patients, including specific details about incision size and recovery process in education materials. They also emphasised the importance of surgeon-to-patient education and noted gaps in preoperative education. Overall, the authors suggested that greater emphasis should be placed on preoperative communication to increase patients' satisfaction. 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, communication and expectation management are key components of patient care prior to cubital tunnel surgery. Useful information would include incision size and recovery timeframes. A blend of written materials, videos, online resources, and in-person discussions would ensure that patients have a clear understanding of what to expect from the procedure. Prior to undergoing surgery, a trial of conservative treatment is required as it appears to provide patients with significant symptom relief. URL: https://doi.org/10.1016/j.jhsa.2023.03.012 Abstract Purpose: The purpose of this study was to use qualitative methodology to better understand patient experiences after cubital tunnel surgery, with the goal of identifying areas of improvement in delivery of care. Methods: Patients who underwent surgery ( in situ decompression or anterior transposition) for cubital tunnel syndrome within the last 12 months, which was performed by one of three fellowship-trained hand surgeons, were identified. Participants were invited to an interview regarding “their experiences with ulnar nerve surgery.” An interview guide with semistructured, open-ended questions regarding the decision for surgery, treatment goals, and the recovery process was used. Interim data analyses were conducted to assess emerging themes, and interviews were continued until thematic saturation was achieved. Results: Seventeen participants completed interviews; the mean age of study participants was 57 years, and 71% were women. The mean time between surgery and the interview was 6 months. Participants identified the following two key areas that could improve their surgical experience: (1) the need for detailed preoperative education about the surgery and recovery process, (2) and the importance of discussing treatment goals and expectations. Participants suggested providing both written and online resources to patients, including specific details about incision size and recovery process in education materials, and setting expectations for symptom resolution. Conclusions: Although the overall patient experience after cubital tunnel surgery was positive, participants noted that there is a need for providing improved educational resources and counseling before surgery. 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 impact of a hand therapy workplace-based educational approach on the management of lateral elbow tendinopathy: A randomized controlled study. Tran, T., Harris, C. and Ciccarelli, M. (2021) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Lateral epicondylalgia – Personalise work-based advice This randomised controlled study, investigated the effectiveness of a hand therapy program for tennis elbow. A total of 49 participants were randomly allocated to either the intervention or control group. The intervention group received the same program as the control group but also received an additional 30-minute session, within the first 4 weeks, which was a tailored workplace-based educational intervention. Both groups received a hand therapy program consisting of 10 sessions of 1 hour each over 12 weeks. The hand therapy programme included the prescription of orthoses, the application of heat packs, soft tissue massage, static wrist flexion/extension stretches, and an eccentric strengthening exercise program. Outcome measures included pain level, pain-free grip strength, and upper limb function. The results showed that there was no difference between the two groups. 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, adding a short and personalised educational session for the patient's workplace does not appear to have a large effect in terms of pain, function, or grip strength in people with lateral epicondylalgia. However, a multimodal approach including the provision of orthoses, stretching, and resistance exercises appears to provide some benefits. In addition to these interventions, mobilisation with movement may allow patients with tennis elbow to exercise with less pain in the initial stages of the presentation. URL: https://doi.org/10.1016/j.jht.2021.09.004 Abstract Background: Lateral elbow tendinopathy (LET) is one of the most prevalent work-related musculoskeletal conditions. Management strategies for LET rarely consider patients’ work environments and have limited focus on education regarding occupational risk factors. Workplace-based rehabilitation has shown benefits in the return to work processes for injured workers with other health conditions, but no studies have investigated the impact of a workplace-based educational approach in the management of LET. Purposes: First, to identify the impact of an additional workplace-based educational intervention to standard hand therapy care on the outcomes of pain, grip strength, and function. Second, to identify the effectiveness of standard hand therapy on the same clinical outcomes. Study Design: A randomized controlled trial. Methods: Forty-nine participants were randomized to the control group (n = 25) or intervention group (n = 24). The control group received standard hand therapy for 12 weeks. The intervention group received standard hand therapy for the first 12 weeks plus an additional workplace-based educational intervention, “Working Hands-ED,” delivered by a hand therapist. Pain levels for provocative tests, grip strength, and function were measured using a Numeric Rating Scale, Jamar Dynamometer, and the Patient-Rated Tennis Elbow Evaluation questionnaire at baseline, weeks 6 and 12. The Patient-Specific Functional Scale was also used for the intervention group. Results: There were no statistical differences between both groups for all clinical outcomes by 12 weeks (P> .05). Pain levels for all provocative tests and Patient-Rated Tennis Elbow Evaluation scores statistically improved within both groups (P < .05), however with small effect sizes observed. The Patient-Specific Functional Scale scores statistically improved for the intervention group by 12 weeks (P < .05). Conclusion: The addition of a hand therapy workplace-based intervention did not result in superior clinical outcomes for pain, grip strength, and function. The study identified that a multimodal self-management approach used by hand therapists improved their patients' pain and function regardless of whether the education was given in the clinic or the workplace. 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

Is early mobilization after volar locking plate fixation in distal radius fractures really beneficial? A meta-analysis of prospective randomized studies. Lee, J.-K., et al. (2023) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic: Radius fracture ORIF – Early mobilisation This is a meta-analysis comparing clinical outcomes and complications of early and late range of motion exercises distal radius fractures (DRF) ORIF. A total of four randomized prospective studies were included in the analysis, including 127 patients in the early group and 131 patients in the late group. Outcomes included pain, range of movement, grip strength, and Disability of the Arm, Shoulder, and Hand. The results showed that the early mobilisation group had a lower DASH score at 6 weeks as well as 3 months postoperatively. In addition, grip strength and range of movement were greater in the early movement group. The difference between groups was clinically relevant for all these outcomes. Pain was not different between groups at any time point. There were no differences in complication rate between the two groups. 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, early mobilisation after distal radius fracture ORIF is associated with improved function, range of motion, and grip power at 6 weeks, 3 months, and 6 months postoperatively. In addition, early mobilisation is not associated with a greater complication rate. As previous evidence shows, early exercise is safe and does not increase complication rates, and may lead to an earlier return to daily life and work. URL: https://doi.org/10.1016/j.jht.2021.10.003 Abstract Study design: This was a systematic review with a meta-analysis. Introduction Despite rising trends toward surgical treatment of distal radius fractures (DRF) with volar locking plate (VLP) fixation, there is a lack of consensus on when to start vigorous wrist range of motion (ROM) exercises after surgery. Purpose We performed a meta-analysis to compare early and late mobilization after VLP fixation in patients with DRF. Methods: Four prospective randomized controlled trials with a minimum of 6 months of follow-up were retrieved through MEDLINE (PubMed), EMBASE, Web of Science, the Cochrane Library, and the KoreaMed databases in March 2021. We divided patients into an early group (patients who started ROM exercises of the wrist within 2 weeks after surgery), and a late group (patients who started ROM exercises 5 or 6 weeks after surgery). The primary outcome was treatment efficacy which was measured through improvement in pain score, function score, ROM, and grip power. The secondary outcome was the incidence of postoperative complications. Results: This meta-analysis included 127 patients in the early group and 131 patients in the late group. The outcomes were compared at 6 weeks, 3 months, and 6 months postoperatively. There was no significant difference in pain score, though the early group had a lower average visual analog scale score. The early group had a lower arm, shoulder, and hand disability score than the late group (95 % CI, -16.25 to -8.35 points; P < .001) at 6 weeks postoperatively, suggesting significantly superior outcomes. A similar trend persisted at 3 (n = 74 in the early group and n = 77 in the late group; 95% CI, -5.45 to -0.30; P = .029) and 6 months (n = 102 in the early group and n = 100 in the late group; 95% CI, -4.81 to 0.21; P = .073), but the differences were smaller. The early group had a higher grip power at all follow-up periods, but the difference was only significant at 6 months postoperatively (n = 88 in the early group and n = 83 in the late group; 95% CI, 0.50 to 6.99; P = 0.024). The early group also had more favorable ROM in all directions at 6 weeks, but only in supination at 6 months. The complication rate was not significantly different between the 2 groups. There were no differences in the rates of secondary operation and reduction loss. Conclusion: Early ROM exercise after VLP in DRF resulted in superior functional scores and grip power until 6 months postoperatively. The dominance of the joint ROM, which was seen at 6 weeks after surgery in the early exercise group, decreased with time and ultimately showed little difference at 6 months. Early exercise is safe and did not increase complication rates. 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

Effect of pre-treatment expectations on post-treatment expectation fulfillment or outcomes in patients with distal radius fracture. Kim, J. K., Al-Dhafer, B., Shin, Y. H. and Joo, H. S. (2021) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Symptoms prevalence study Topic: Client's expectations - Distal radius fracture This prospective cohort study assessed the effect of pre-treatment expectations on post-treatment expectation and outcomes in patients with a distal radius fractures. A total of 114 patients were enrolled, 81 of whom underwent surgical treatment and 33 who were managed conservatively. Expectations were measured in all participants prior to the delivery of the intervention. Outcomes measures were re-assessed at 1-year post injury. Results showed that the surgical group had a significantly higher median pre-treatment expectation score than the conservative group. In addition, higher pre-treatment expectation score was moderately correlated with higher post-treatment expectation fulfillment score and better function in the surgical group. There was no association between the pre-treatment expectation score and the post-treatment expectation fulfillment or function in the conservative group. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, pre-treatment expectations may have a moderate effect on post-treatment expectation fulfilment and patient-rated outcomes in surgically treated patients with distal radius fractures. These findings are similar to what has been shown in previous evidence for the conservative treatment of hand OA and outcomes of neurodynamic tests. URL: https://doi.org/10.1016/j.jht.2021.04.023 Abstract Background: The influence of patient expectations on patient-rated outcomes (PRO) after elective orthopedic procedures has been addressed in previous studies. However, the influence of pre-treatment expectations on post-treatment PRO was rarely examined in patients with extremity fractures. Purpose: The purpose of this study was to determine if pre-treatment expectations have an effect on post-treatment expectation fulfillment or PRO in patients surgically and conservatively managed for distal radius fractures (DRFs). Study design: Prospective cohort study Methods: For this study, 114 consecutive patients treated for DRF between January 2017 and February 2018 were enrolled. Of the 114 patients, 81 underwent surgical treatment (surgical group), and 33 were managed conservatively (conservative group). All patients completed a 7-item pre-treatment expectation questionnaire initially. There were 66 patients in the surgical group and 25 patients in the conservative group available at the 1-year follow-up and completed a 6-item post-treatment expectation fulfillment questionnaire and patient-reported wrist evaluation (PRWE) questionnaire. Results: The surgical group showed a significantly higher median pre-treatment expectation score than the conservative group. However, no significant differences in post-treatment expectation fulfillment scores and PRWE scores were observed between groups. Higher pre-treatment expectation score was moderately correlated with higher post-treatment expectation fulfillment score (r = 0.36, P = 0.003) and lower PRWE score (r = -0.3, P = 0.02) in the surgical group. However, the pre-treatment expectation score was not significantly correlated with the post-treatment expectation fulfillment score (r = -0.09, P = 0.65) or PRWE score (r = -0.02, P = 0.93) in conservative group. In the surgical group, multivariable linear regression analysis showed that post-treatment expectation fulfilment score could be explained by the pre-treatment expectation score (Beta = 0.41, P = 0.001), accounting for 15% of the variance, and PRWE score was also explained by the pre-treatment expectation score (Beta = 0.39, P = 0.001), accounting for 14% of the variance. Conclusions: In conclusion, higher pre-treatment expectation score was moderately correlated with higher the post-treatment expectation fulfillment score and lower PRWE score, and the pre-treatment expectation score could only explain a small amount of variance seen in the post-treatment expectation fulfillment and PRWE scores in the surgical group. However, there was no association between the pre-treatment expectation score and the post-treatment expectation fulfillment score or the PRWE score in the conservative group. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

A comparison of supination/flexion to hyperpronation in the reduction of radial head subluxations. Macias, C. G., Bothner, J. and Wiebe, R. (1998) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Pulled elbow - Treatment This is a randomised controlled study comparing two techniques for reducing radial head subluxations in children. A total of 85 patients were included in the study, with 41 randomly assigned to the hyperpronation technique and 44 to the supination technique. Children presenting with bruising or evidence of fractures on x-ray were excluded from the study. The results showed that the hyperpronation technique (see below) was more successful, with 95% of patients reduced on the first attempt compared to 77% for the supination technique. The hyperpronation technique also required fewer attempts to reduce the subluxations, with 97.5% of patients in the hyperpronation group being reduced successfully compared to 86% in the supination group. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, we should consider using the hyperpronation technique as a primary technique for reducing radial head subluxations in children. This intervention is more successful on the first attempt and requires fewer attempts at reduction compared to the traditional supination technique. This technique should be performed solely if the x-ray is negative for fractures and no other pathologies explain the presentation. URL: https://doi.org/10.1542/peds.102.1.e10 Abstract Objective: To compare supination at the wrist followed by flexion at the elbow (the traditional reduction technique) to hyperpronation at the wrist in the reduction of radial head subluxations (nursemaid's elbow). Materials and Methods: This prospective, randomized study involved a consecutive sampling of children younger than 6 years of age who presented to one of two urban pediatric emergency departments and two suburban pediatric ambulatory care centers with a clinical diagnosis of radial head subluxation. Patients were randomized to undergo reduction by one of the two methods and were followed every 5 minutes for return of elbow function. The initial procedure was repeated if baseline functioning did not return 15 minutes after the initial reduction attempt. Failure of that technique 30 minutes after the initial reduction attempt resulted in a cross-over to the alternate method of reduction. The alternate procedure was repeated if baseline functioning did not return 15 minutes after the alternate procedure was attempted. If the patient failed both techniques, radio-graphy of the elbow was performed. Results: A total of 90 patients were enrolled in the study. Five patients were removed from further analysis secondary to a final diagnosis of fracture, 84 were reduced successfully, and 1 failed both techniques. Demographic characteristics of each group were similar. Thirty-nine of 41 patients (95%) randomized to hyper-pronation were reduced successfully on the first attempt versus 34 of 44 patients (77%) randomized to supination. Two patients in the hyperpronation group required two attempts versus 10 patients in the supination group. Hyperpronation was more successful; 40 of 41 patients (97.5%) in the hyperpronation group were reduced successfully versus 38 of 44 patients (86%) in the supination group. Of the 6 patients who crossed over from supination to hyperpronation, 5 were reduced on the first attempt and 1 was reduced on the second attempt. Conclusions: In the reduction of radial head subluxations, the hyperpronation technique required fewer attempts at reduction compared with supination, was successful more often than supination, and was often successful when supination failed. 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 clinical manifestations of the anconeus epitrochlearis and cubital tunnel syndrome. Maslow, J. I., Johnson, D. J., Block, J. J., Lee, D. H. and Desai, M. J. (2018) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic: Cubital tunnel – Anconeous epithrochlearis This retrospective study assessed the prevalence of anconeus epitrochlearis (AE) muscle in patients with cubital tunnel syndrome. It was found that 14% of patients had an AE muscle present and that those with an AE experienced quicker and more reliable symptom improvement after cubital tunnel release than those without the anomalous muscle. It was also found that no patients with an AE underwent a revision operation compared with 10% of the control group. It is suggested that excision of the AE in a patient with cubital tunnel syndrome may be protective against the development of the syndrome. 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 an anconeus epitrochlearis (AE) muscle is associated with cubital tunnel syndrome and has a prevalence of 14%. Patients with an AE experience quicker and more reliable symptom improvement after surgical release than those without the anomalous muscle. Preoperative MRI or US is not likely to change the decision to intervene surgically, but postoperative we may be able to further reassure patients if AE was found and released. Pre-surgical US imaging may be useful in identifying space-occupying lesions and assessing nerve morphology. URL: https://doi.org/10.1177/1558944718789412 Abstract Background: The true prevalence of the anconeus epitrochlearis (AE) and the natural history of cubital tunnel syndrome associated with this anomalous muscle are unknown. The purpose of this study was to evaluate the prevalence of AE and to characterize the preoperative and postoperative features of cubital tunnel syndrome caused by compression from an AE. Methods: All elbow magnetic resonance imaging (MRI) scans and all patients undergoing cubital tunnel surgery during a 20-year period were identified and retrospectively reviewed for the presence of an AE. All patients with an AE identified intra-operatively were matched to patients with no AE identified at surgery based on age, sex, concomitant procedures, and year of surgery. Preoperative and postoperative physical exam findings, electrodiagnostic study results, time to improvement, and reoperations were compared between the groups. Results: A total of 199 patients had an elbow MRI, and 27 (13.6%) patients were noted to have an AE present. Average time to improvement after surgical release was 23.0 days for patients with an AE and 33.2 days for patients with no AE. Twenty-seven patients with an AE noted improvement at the first postoperative visit (68%) compared to 15 patients without an AE (33%). No patients with an AE underwent reoperation for recurrent symptoms (0%) compared with four patients (10%) without an AE. Conclusions: The prevalence of AE in our study is 13.6%. These patients experience quicker and more reliable symptom improvement after surgical release than those without the anomalous muscle. 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

Anconeus syndrome: A potential cause for lateral elbow pain and its therapeutic management - A case report. Gangatharam, S. (2021) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic: Anconeous syndrome – Tennis elbow differential diagnosis This is a case study describing a case of a 55-year-old right-handed male with lateral elbow pain and swelling due to anconeus muscle pathology. The patient was given an elbow splint for 4 weeks, followed by eccentric and concentric strengthening to the elbow and wrist. The splint allowed for the elbow to rest in 60 degrees of flexion and neutral forearm rotation. Grip strength measurement was used to measure progress as there is no orthopaedic test that specifically targets the anconeus muscle. After 9 weeks, the patient was pain-free and returned to pre-injury work with no symptoms. 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, anconeus muscle involvement should be considered in cases of lateral elbow pain that do not respond to the usual treatment for lateral epicondylalgia. Treatment may include an elbow splint for 4-6 weeks, followed by eccentric and concentric strengthening exercises for elbow extension. Grip strength measurement appears to be limited not only in tennis elbow, but also anconeous syndrome and should therefore be used to monitor progress. If you would like to get a more complete picture about lateral epicondylalgia, have a look at the whole collection. URL: https://doi.org/10.1016/j.jht.2019.04.002 Abstract Study Design: This is a case report. Introduction: Anconeus is a small, triangular muscle in the posterior aspect of the elbow, and it functions as weak elbow extensor and abducts the ulna during pronation. The contribution of anconeus muscle can cause lateral elbow pain, which is difficult to diagnose and treat. It also does not respond to the regular treatment for lateral epicondylitis. Purpose of the Study: The purpose of this study was to report anconeus muscle irritation as a sole cause for lateral elbow pain. Methods: The patient was given an elbow splint for 4-6 weeks followed with eccentric and concentric strengthening to the elbow and wrist. Result: At the end of week 9, the patient was pain-free. Conclusion: The clients who are not responding with the usual treatment of lateral epicondylitis should be considered for any anconeus involvement. 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 pain in pediatrics. Crowther, M. (2009) Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic Topic: Paediatric elbow conditions - Differential diagnosis This is an expert opinion on the diagnosis and treatment of elbow pain in pediatric and adolescents. The author highlights the importance of taking a thorough history and physical examination, as well as utilising x-rays and other imaging modalities to exclude important pathologies. Common causes of elbow pain include supracondylar fractures, Nursemaid's elbow (displacement of the anular ligament with forearm traction injuries), osteochondritis dissecans of the capitellum, Panner's Disease (lack of vascular suppy to growth plateleading to capitellum flattening), olecranon apophysitis, and avulsion fractures. Treatment typically involves rest, ice, NSAIDs, compression wrappings and elbow pads, rehabilitation, splinting, and in some cases, surgical fixation. 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, common causes of elbow pain in pediatric patients include fractures, apophysitis, and other more severe conditions such as Panner's Disease and osteochondritis dissecans. If you are interested in osteochondritis dissecans, we have two synopses on its surgical and conservative management. Unfortunately, it is not always easy to predict recovery from these conditions and we need to keep a close eye on their evolution. URL: https://doi.org/10.1007/s12178-009-9049-4 Abstract The pediatric and adolescent elbow is subject to both acute and chronic overuse injuries. The practitioner should develop a classification system to evaluate all such injuries, with first focusing on whether the injury represents an acute episode or rather it represents a more chronic problem. In addition, localizing the area of pain as being either medial, lateral, or posterior can better help differentiate the diagnosis. Youth baseball pitchers and throwers are particularly at risk for overuse injuries of the elbow, most of which are related to an injury mechanism termed “valgus extension overload”. The most common entity related to this is termed “Little Leaguer’s Elbow.” Treatment is usually conservative, but for some injuries surgery may be required, especially for displaced medial epicondylar avulsion fractures. Other acute injuries also should be easily recognizable by the general clinician including annular ligament displacement (nursemaid’s elbow) which represents one of the most common upper extremity injuries presenting to emergency rooms in youngsters under the age of 6. Most studies seem to indicate a hyperpronation reduction technique may be more successful then the flexion/supination technique. It is also important to have an awareness of some of the common elbow fractures seen in the younger patient, in particularly supracondylar fractures owing to their high propensity for complications. When evaluating the elbow for fractures, it is necessary to have an understanding of the appearance of the ossification centers seen on the pediatric elbow. 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 and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma and the Orthopedic Trauma Association. Patrick, B. M., et al. (2023) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 thumbs up) Type of study: Therapeutic Topic: NSAIDs - Fracture non-union This is a systematic review and meta-analysis assessing the efficacy and safety of NSAIDs for the treatment of acute pain following bone fractures. Nineteen studies (RCTs and retrospective studies) for a total of 51,687 participants were included in the present review. Outcomes included fracture non-union, use of opioids, and pain relief. Studies 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 of evidence suggesting that NSAIDs lead to a greater rate of fracture non-union. However, there was high-quality evidence showing that they reduce opiods intake and that they provide significant analgesia. It was therefore concluded that the benefits of NSAIDs outweigh the potential harms. 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 use of NSAIDs in adult patients with fractures appears to reduce pain, the need for opioids, and have a small effect on non-union. Overall, the benefits of NSAIDs in the treatment of acute traumatic fractures appear to outweigh the risks. This provides some clarity on previous arguments against the use of anti-inflammatories in the acute stages of tissue healing. We should therefore encourage the use of NSAIDs in patients suffering from traumatic fractures if they have been prescribed it by their doctors/orthopaedic surgeons. URL: https://doi.org/10.1136/tsaco-2022-001056 Abstract Objectives: Fracture is a common injury after a traumatic event. The efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) to treat acute pain related to fractures is not well established. Methods: Clinically relevant questions were determined regarding NSAID use in the setting of trauma-induced fractures with clearly defined patient populations, interventions, comparisons and appropriately selected outcomes (PICO). These questions centered around efficacy (pain control, reduction in opioid use) and safety (non-union, kidney injury). A systematic review including literature search and meta-analysis was performed, and the quality of evidence was graded per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The working group reached consensus on the final evidence-based recommendations. Results: A total of 19 studies were identified for analysis. Not all outcomes identified as critically important were reported in all studies, and the outcome of pain control was too heterogenous to perform a meta-analysis. Nine studies reported on non-union (three randomized control trials), six of which reported no association with NSAIDs. The overall incidence of non-union in patients receiving NSAIDs compared with patients not receiving NSAIDs was 2.99% and 2.19% (p=0.04), respectively. Of studies reporting on pain control and reduction of opioids, the use of NSAIDs reduced pain and the need for opioids after traumatic fracture. One study reported on the outcome of acute kidney injury and found no association with NSAID use. Conclusions: In patients with traumatic fractures, NSAIDs appear to reduce post-trauma pain, reduce the need for opioids and have a small effect on non-union. We conditionally recommend the use of NSAIDs in patients suffering from traumatic fractures as the benefit appears to outweigh the small potential risks. 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

Considerations for surgical treatment of neurogenic thoracic outlet syndrome: A meta-analysis of patient-reported outcomes. Blondin, M., et al. (2023) Level of Evidence: 2a- Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Thoracic outlet - Rib resection or simple scalenectomy This systematic review and meta-analysis compared the success rates of three different surgical approaches for the treatment of neurogenic thoracic outlet syndrome (nTOS): rib-sparing scalenectomy (RSS), supraclavicular first rib resection (SCFRR), and transaxillary first rib resection (TAFRR). A total of 22 studies (1 RCT, 5 prospective, 16 retrospective) were included in this review. Results showed that RSS had the highest success rate (97.4%) and lowest complication rate (3.6%), while TAFRR had the highest mean difference between preoperative and postoperative visual analogue scale scores (5.3). When the Disability of the Arm Shoulder and Hand score were analysed, RSS provided the largest improvements compared to the other surgical procedures. Overall it appered that RSS is sufficient for treating nTOS with lower risks compared to TAFRR, which leads to pneumothorax in 4% of cases. 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, rib-sparing scalenectomy (RSS) is an effective option for the treatment of nTOS, with a higher success rate and lower complication rate than first rib resection (FRR). If we see patients following these types of surgery, we should keep an eye on potential post-surgical complications, which include wound complications due to lymphatic system damage, pneumothorax, and temporary phrenic nerve damage. If you would like to know more about thoracic outlet syndrome, have a look at this synopsis. URL: https://doi.org/10.1016/j.jhsa.2023.03.005 Abstract Purpose: It remains unclear whether the first rib resection, performed via a supraclavicular (SCFRR) or transaxillary (TAFRR) approach, is necessary for patients with neurogenic thoracic outlet syndrome (nTOS). In a systematic review and meta-analysis, we performed a direct comparison of patient-reported functional outcomes following different surgical approaches for nTOS. Methods: The authors searched PubMed, Embase, Web of Science, Cochrane Library, PROSPERO, Google Scholar, and the gray literature. Data were extracted based on the procedure type. Well-validated patient-reported outcome measures were analyzed in separate time intervals. Random-effects meta-analysis and descriptive statistics were used where appropriate. Results: Twenty-two articles were included, with 11 discussing SCFRR (812 patients), 6 discussing TAFRR (478 patients), and 5 discussing rib-sparing scalenectomy (RSS; 720 patients). The mean difference between preoperative and postoperative Disabilities of the Arm, Shoulder and Hand score was significantly different comparing RSS (43.0), TAFRR (26.8), and SCFRR (21.8). The mean difference between preoperative and postoperative visual analog scale scores was significantly higher for TAFRR (5.3) compared to SCFRR (3.0). Derkash scores were significantly worse for TAFRR compared to RSS or SCFRR. RSS had a success rate of 97.4% based on Derkash score, followed by SCFRR and TAFRR at 93.2% and 87.9%, respectively. RSS had a lower complication rate compared to SCFRR and TAFRR. There was a difference in complication rates: 8.7%, 14.5%, and 3.6% for SCFRR, TAFRR, and RSS, respectively. Conclusions: Mean differences in Disabilities of the Arm, Shoulder and Hand scores and Derkash scores were significantly better for RSS. Higher complication rates were reported after the first rib resection. Our findings suggest that RSS is an effective option for the treatment of nTOS. 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

On the safe position for hand immobilization. Tang, J. B. (2019) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Position of Safe Immobilisation - Effectiveness This article discusses the use of the intrinsic plus position for hand immobilisation, which was proposed by Professor James in the 1970s. It is argued that this position is not necessary and can cause discomfort to patients. A survey of surgeons from two continents and three senior surgeons found a wide spectrum of use, with two from Asian countries using it infrequently. A randomised controlled study in 2008 compared the use of POSI vs neutral mcpj positioning in 5th metacarpal neck fractures. The results showed that similar joint range of motionwas obtained by the end of treatment. However, patient comfort was greater when the hand was splinted in mild MP flexion rather than in POSI. 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 intrinsic plus position for hand immobilisation is not always necessary and can cause discomfort to patients. A mild flexion of the MP joints is a safe position for hand immobilisation and can provide greater patient comfort. This is particularly important as discomfort/pain whilst in a splint/cast increase the chances of developing CRPS. It is important to consider the individual patient's needs when deciding on the best immobilisation position. URL: https://doi.org/10.1177/1753193419873899 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