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Resistance training induces improvements in range of motion: A systematic review and meta-analysis. Alizadeh, S., et al. (2023) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 thumbs up) Type of study: Therapeutic Topic: Resistance training with or without stretching - Range of movement improvements This systematic review and meta-analysis investigated the effects of resistance training on range of motion compared to a control condition, stretch training, or a combination of resistance training and stretch training. A total of 52 studies were included in the review. All studies were assessed through the PEDro risk of bias criteria. The results showed that resistance training with external loads can improve range of motion to a moderate magnitude, and that there were no significant differences between resistance training and stretch training. Additionally, meta-regression showed no effect of age, training duration, or frequency. It was concluded that additional stretching prior to or after resistance training may not be necessary to enhance flexibility. 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, stretching in combination with resistance training does not provide better range of movement results compared to resistance training alone. In addition, it appears that untrained and sedentary individuals present with greater improvements in ROM compared to trained or active individuals. These results are consistent with previous evidence showing that eccentric exercises improve ROM and that resistance exercise or stretching utilised in isolation are equally effective. This information is extremely useful for the treatment of post-traumatic elbow stiffness, which if untreated has the potential to negatively affect the mental wellbeing of patients. URL: https://doi.org/10.1007/s40279-022-01804-x Abstract Background: Although it is known that resistance training can be as effective as stretch training to increase joint range of motion, to date no comprehensive meta-analysis has investigated the effects of resistance training on range of motion with all its potential affecting variables. Objective: The objective of this systematic review with meta-analysis was to evaluate the effect of chronic resistance training on range of motion compared either to a control condition or stretch training or to a combination of resistance training and stretch training to stretch training, while assessing moderating variables. Design: For the main analysis, a random-effect meta-analysis was used and for the subgroup analysis a mixed-effect model was implemented. Whilst subgroup analyses included sex and participants’ activity levels, meta-regression included age, frequency, and duration of resistance training. Data Sources: Following the systematic search in four databases (PubMed, Scopus, SPORTDiscus, and Web of Science) and reference lists, 55 studies were found to be eligible. Eligibility Criteria: Controlled or randomized controlled trials that separately compared the training effects of resistance training exercises with either a control group, stretching group, or combined stretch and resistance training group on range of motion in healthy participants. Results: Resistance training increased range of motion (effect size [ES] = 0.73; p < 0.001) with the exception of no significant range of motion improvement with resistance training using only body mass. There were no significant differences between resistance training versus stretch training (ES = 0.08; p = 0.79) or between resistance training and stretch training versus stretch training alone (ES = − 0.001; p = 0.99). Although “trained or active people” increased range of motion (ES = 0.43; p < 0.001) “untrained and sedentary” individuals had significantly (p = 0.005) higher magnitude range of motion changes (ES = 1.042; p < 0.001). There were no detected differences between sex and contraction type. Meta-regression showed no effect of age, training duration, or frequency. Conclusions: As resistance training with external loads can improve range of motion, stretching prior to or after resistance training may not be necessary to enhance flexibility. 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

Effects of using rigid tape with bandaging techniques on wrist joint motion during boxing shots in elite male athletes. Gatt, I. T., Allen, T. and Wheat, J. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Strapping and taping – Boxing This study investigated the effects of bandaging and strapping techniques on wrist motion on impact during different shot types in elite male boxers. A total of 18 elite male boxers were assessed through digital wearable goniometers under different conditions. In particular, they were tested with bandaging vs bandaging vs bandaging plus tape during bent arm and straight arm boxing shots. Data was processed using Visual 3D and the peak wrist angle on impact was measured. The results showed that adding tape to bandage reduced wrist motion by 25-30% compared to bandage only. In addition, there was a 1.2-1.4 increase in time to peak wrist angle on impact. These findings suggest that adding tape to bandage may reduce the risk of hand-wrist injuries in boxing. 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 tape to a bandaging technique can provide an additional 25-30% reduction in wrist motion compared to bandage only. This information can help to better protect patients from hand-wrist injuries such as carpometacarpal instability in boxing and other sports. If you are interested in boxing injuries, have a look at these other synopses (boxer's knuckle and boxer's elbow). URL: https://doi.org/10.1016/j.ptsp.2023.03.002 Abstract Objectives: To investigate the effects of bandaging techniques on wrist motion on impact during different shot types in elite male boxers. Design: Repeated-measures study. Setting Field Experiment Participants Two shot types, straight and bent arm, were assessed with 18 elite male boxers wearing either bandage only or bandage plus tape. Main Outcomes Measures: Wrist motions and time to peak wrist angles, on impact, were measured with an electromagnetic tracking system. Results: Wrist motion on impact occurred concurrently in flexion and ulnar deviation for both shot types. For both motions, significant (p < 0.001) effects for bandaging techniques (η2 = 0.580–0.729) and shot types (η2 = 0.165–0.280) were observed. For straight and bent arm shots, wrist motion on impact occurred within 50% and 40% respectively of total active wrist motion for bandage only compared to within 20% and 15% for bandage plus tape. Time to peak wrist angle on impact increased significantly (p < 0.001) for both shot types when adding tape to bandage. Conclusions: Adding tape provided an additional 25–30% reduction in wrist motion compared to bandage only, with a 1.2–1.4 increase in time to peak wrist angle, on impact for both shot types. This information could assist various individuals and organisations towards better hand-wrist protection. 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 medial and lateral forearm fascia contribute to overhead elbow extension in displaced olecranon fractures: A biomechanical study. Gedailovich, S., Deegan, L., Hayes, W., Koehler, S. M. and Aibinder, W. R. (2023) Level of Evidence: 4 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Therapeutic Topic: Olecranon fractures - Overhead triceps extension This is a cadaver stusy assessing the contribution of the medial and lateral cubital retinacula to elbow extension in the setting of a displaced olecranon fracture. A total of eight cadavers were assessed. The results showed that intact retinacula allowed for overhead extension, while transection of either the medial or lateral retinaculum prevented it. Extension was possible in two of four specimens with transection of both medial and lateral cubital retinacula, but the force needed to generate extension was significantly higher. Future studies should identify imaging modalities that allow the assessment of retinacula integrity to determine whether this is associated with the ability of overhead triceps extension in clinical populations. 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, with a displaced olecranon fracture, overhead triceps extension may be maintained if either the lateral or medial cubital retinaculum remains in continuity with the distal ulna. This suggests that nonoperative management of displaced olecranon fractures may be feasible in elderly, low-demand, and medically unwell patients. Determining the integrity of the fascial structures preoperatively may help select candidates for nonoperative treatment of displaced olecranon fractures. URL: https://doi.org/10.1016/j.jse.2023.01.005 Abstract Background: In nonoperative management of displaced olecranon fractures, patients are able to maintain overhead extension despite a persistent nonunion. It has been hypothesized that this is feasible due to an intact lateral cubital retinaculum. The purpose of this biomechanical study was to determine the contribution of the medial and lateral cubital retinacula to overhead extension in the setting of a displaced olecranon fracture. Methods: Eight fresh-frozen cadaveric upper extremity specimens were used in this study. The triceps muscle was loaded through a pulley system operated by an Instron 8874 Biaxial Servohydraulic Fatigue Testing System (Norwood, MA, USA) at a rate of 10 mm/sec to simulate overhead elbow extension. Each specimen was tested in four states: 1. Native with an olecranon intact; 2. A transverse olecranon fracture; 3. Transection of one cubital retinaculum (medial or lateral); 4. Transection of both medial and lateral cubital retinacula. The primary outcome was the ability to perform overhead extension. The secondary outcome was the force needed to generate extension. Results: Elbow extension was noted in each specimen for trials one through three. Only when both the lateral and medial fascia were transected was elbow extension not achieved. There was no significant difference in the force required to generate extension in the first three trials (p = 0.99). There was no significant difference in the change in maximal force required to achieve extension between the specimens with the medial side transected only compared to those with the lateral side transected only (p = 0.07). Discussion: In the setting of an olecranon fracture, this biomechanical study suggests that if either the lateral or medial cubital retinaculum remains in continuity with the distal ulna, active overhead extension can be maintained. This may explain positive clinical outcomes of nonoperative management of displaced olecranon fractures in the elderly patient population. Determining the integrity of the fascial structures preoperatively may help select candidates for nonoperative treatment of displaced olecranon fractures. 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 prospective randomised comparative study of dynamic, static progressive and serial static proximal interphalangeal joint extension orthoses. Glasgow, C. and Ballard, E. (2022) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Therapeutic Topic: PIPJ flexion deformity - Splint selection This is a randomised trial, comparing the effects of different orthosis types on the improvements of proximal interphalangeal joint flexion deformity. A total of 50 participants were randomised to either a static progressive (cast), dynamic, or volar orthosis (see picture below). All participants received exercises and were assessed at both baseline and after 4 weeks. At baseline, the abbreviated Weeks Test was performed. This consisted of a static pipj stretching applied by the healthy hand to the affected pipj whilst providing head treatment to the affected hand. Improvement in PROM following this test was assessed. The results showed that the abbreviated Weeks Test was significantly associated with improvement in active PIP joint extension after 4 weeks, and that females made significantly greater gains in PIP extension than males. The study also found that there were no statistically significant differences in outcome between the three orthoses groups. Factors such as adequate TERT, comfort, biomechanical effectiveness and compliance with treatment are important for a positive outcome. 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, no single orthosis is superior in the treatment of PIP joint flexion deformity. Factors such as adequate total end range time, comfort, biomechanical effectiveness and compliance with treatment are important for a positive outcome. The abbreviated Weeks Test is associated with treatment outcome and may provide a more suitable means of examining the likely response to treatment in a busy clinical environment. After 4 weeks, we should expect an improvement of 10deg in pipj extension and with extended treatment (8-17 weeks) range of movement may even reach 20deg improvement. These findings are in line with previous research which assessed predictors of pipj improvement with conservative treatment and the effect of TERT on pipj ROM outcomes. URL: https://doi.org/10.1177/17589983211070658 Abstract Introduction: Many different types of proximal interphalangeal (PIP) joint extension orthoses exist, yet evidence guiding orthosis choice is largely theoretical. The primary aim of this study was to evaluate the clinical effectiveness of three different PIP joint extension orthoses, over 4 weeks of treatment. Secondly, we aimed to explore the relationship between an abbreviated version of the Weeks test (WT) assessment of joint stiffness, and treatment outcome. Lastly, we wished to better understand participants’ satisfaction with orthotic treatment. Methods: Using a randomised comparative study design, 61 participants were allocated to a serial static, dynamic or static progressive orthosis, 50 had follow-up data. Blinded assessment of function was completed before and after 4 weeks of orthotic intervention and a standardised therapy program. Participants were blinded to alternative groups. Results: Baseline active PIP extension ranged from 14° to 65°. The average improvement in active PIP extension was −9.1° (95% CI −11.0°, −7.1°). There were no statistically significant differences in outcome between the three orthoses groups. However, a trend was observed with greater improvement in active extension for those in the dynamic Capener (−11.5°) compared to the static progressive belly gutter (−7.3°) or serial cast (−8.7°) groups, with less total end range time required. The abbreviated WT was significantly associated with improvement in active extension (p = 0.001). Participants reported a high degree of satisfaction with their orthosis regardless of type. Conclusions: No single orthosis demonstrated statistically greater effectiveness, although the dynamic Capener orthosis appeared more efficient. The abbreviated WT is associated with treatment outcome. 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

Incidence of peripheral nerve decompression surgery during pregnancy and the first year after delivery in finland from 1999 to 2017: A retrospective register-based cohort study. Nyrhi, L., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Prognostic Topic: Maternity - Carpal tunnel syndrome This is a retrospective study assessing the incidence of carpal tunnel release (CTR) during pregnancy and the first year after delivery. The study was completed in Finland from 1999 to 2017 and a total of 24,634 women took part in it. The result showed that the incidence of CTR during pregnancy was 38 per 100,000 person-years, with an incidence rate ratio of 0.5 compared to the general population. The incidence of CTR in the first postpartum year increased during the first 4 months and was similar to that of the general population after 8 months. Active smoking before pregnancy was associated with increased incidences of CTR both during and after pregnancy. The yearly incidence of CTR varied greatly during the study period, with a generally decreasing trend. 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, carpal tunnel release (CTR) is performed less frequently during pregnancy and the postpartum period than in the general age-matched female population. Smoking before pregnancy is associated with increased incidences of CTR both during pregnancy and the first year after delivery. If you are interested in learning more about CTS, have a look at the full database. URL: https://doi.org/10.1016/j.jhsa.2023.01.013 Abstract Purpose: We aimed to report the incidence of peripheral nerve decompression surgery during pregnancy and 12 months after delivery in Finland from 1999 to 2017. Methods: Using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register, all women of potentially childbearing age (15–49 years) who underwent peripheral nerve decompression surgery or had a pregnancy ending in delivery from January 1, 1999, to December 31, 2017, were included. Incidence rates and incidence rate ratios for operations were calculated for both childbearing women and the age-adjusted general female population. Results: In total, 308 women underwent carpal tunnel release (CTR) during pregnancy, and an additional 675 women underwent CTR within 12 months after delivery. The incidence of CTR during pregnancy was 38 per 100,000 person-years, with an incidence rate ratio of 0.5 (95% CI, 0.4–0.6), when compared with that in the general population. Women who were active smokers before becoming pregnant were more likely to undergo CTR during pregnancy (odds ratio, 2.4; 95% CI, 1.8–3.0). The highest rates of CTR were observed during the first trimester. The incidence of CTR in the first postpartum year increased steadily during the first 4 months to 79 per 100,000 person-years. During the latter 8 months, incidences were similar to those in the general population (incidence rate ratio, 1.0; 95% CI, 0.9–1.2). Women who smoked were more likely to undergo CTR during the first postpartum year (odds ratio, 1.6; 95% CI, 1.3–1.9). Conclusions: Carpal tunnel release is performed more rarely during pregnancy than in the age-matched general population. Postpartum incidences increased toward the end of the first year, reaching those observed in the general population after the first 4 months. Smoking before pregnancy is associated with increased incidences of CTR both during pregnancy and the first year after delivery. 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

Conservative treatment of ulnar nerve compression at the elbow: A systematic review and meta-analysis. Natroshvili, T., et al. (2023) Level of Evidence: 2a- Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Cubital tunnel syndrome - Splinting This is a systematic review and meta-analysis assessing the effectiveness of conservative treatments for cubital tunnel syndrome. A total of 19 studies were included in the study. Quality assessment was performed using a score ranging from 0 to 10 points. The most common interventions included steroid/lidocaine injection, splinting, physical therapy, therapeutic ultrasound, and laser therapy. The results of the subgroup meta-analyses showed that 1 in 2 patients improved after receiving a steroid/lidocaine injection and 9 in 10 patients improved after using a splint device. It is unclear whether the improvements were clinically relevant as the outcome measures utilised were different across all the papers. 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, splinting, physical therapy, education, and activity modification can be effective for treating ulnar nerve compression at the elbow. Splinting is preferred over injections, as it shows a higher rate of improvement. If patients have not undergone any investigations first, an US and x-ray may be beneficial to exclude space-invading lesions compressing the ulnar nerve. X-rays may be beneficial in excluding the presence of bone spurs leading to ulnar entrapment. URL: https://doi.org/10.1055/s-0042-1757571 Abstract Background: The clinical results of conservative treatment options for ulnar compression at the elbow have not been clearly determined. The aim of this review was to evaluate available conservative treatment options and their effectiveness for ulnar nerve compression at the elbow. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, a systematic review and meta-analysis of studies was performed. Literature search was performed using Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Results: Of the 1,079 retrieved studies, 20 were eligible for analysis and included 687 cases of ulnar neuropathy at the elbow. Improvement of symptoms was reported in 54% of the cases receiving a steroid/lidocaine injection (95% confidence interval [CI], 41-67) and in 89% of the cases using a splint device (95% CI, 69-99). Conclusions: Conservative management seems to be effective. Both lidocaine/steroid injections and splint devices gave a statistically significant improvement of symptoms and are suitable options for patients who refuse an operative procedure or need a bridge to their surgery. Splinting is preferred over injections, as it shows a higher rate of improvement. 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 use of prescription testosterone is associated with an increased likelihood of experiencing a distal biceps tendon injury and subsequently requiring surgical repair. Rebello, E., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic: Distal biceps rupture - Testosterone This case-control study investigated the risk of distal biceps tendon injury (BTI) and subsequent surgical repair among patients who had filled a prescription for testosterone for a minimum of 3 consecutive months. A total of 583,220 participants were retrospectively analysed in the study. Participants' average age was 54 yrs old. The results showed that patients with prior prescription testosterone exposure had an increased rate of BTI and biceps tendon repair compared to those without prescription testosterone exposure. The risk of BTI was particularly high in males, with 4.68-fold increased odds of BTI within 1 year of using testosterone. Despite high odds of having a BTI in people using anabolic steroids, the chance of having this injury was really low (0.002%). 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 who are prescribed testosterone therapy may be at an increased risk of biceps tendon injury and subsequent surgical repair. Testosterone is prescribed by doctors in some instances to improve muscle mass/improve endocrine function (e.g. atrophy due to cancer, endocrine pathologies). If a patient presents with a distal biceps rupture, surgical repair may be considered if a high level of function is required. Thus, there is a high risk of complications when distal biceps repair surgery is performed. URL: https://doi.org/10.1016/j.jse.2023.02.122 Abstract Background: In the United States, testosterone therapy has increased over recent years. Anabolic steroid use has been associated with tendon rupture, although there is a paucity of evidence evaluating the risk of biceps tendon injury (BTI) with testosterone therapy. The aim of this study was to quantify the risk of BTI after initiating testosterone therapy. Methods: This is a retrospective cohort study utilizing the PearlDiver database. Records were queried between 2011 and 2018 for patients aged 35-75 years old who filled a testosterone prescription for a minimum of 3 months. A control group was created of patients aged 35-75 years old who had never filled a prescription for exogenous testosterone. ICD-9, ICD-10, and CPT codes were utilized to identify patients with distal biceps injuries and those undergoing surgical repair. Three matching processes were completed: one for the overall cohort, one for the male-specific cohort, and one for the female-specific cohort. Each cohort was matched to their control on age, gender, Charlson Comorbidity Index (CCI), diabetes, tobacco use, and osteoporosis. Multivariate logistic regression was used to compare rates of distal biceps tendon injury and subsequent surgical repair among the testosterone groups to their control groups. Results: A total of 776,974 patients had filled a prescription for testosterone for a minimum of 3 consecutive months. In the overall matched analysis between testosterone and control groups (N =291,610 in both), the mean age of patients was 53.9-years old and 23.1% were female. Within 1-year of filling a minimum of 3 consecutive months of exogenous testosterone prescriptions, 650 patients experienced a distal BTI compared to 159 patients in the control group (OR = 4.10, 95% CI, 3.45 – 4.89, p<0.001). At any time after the testosterone therapy, patients with testosterone use were more than twice as likely to experience a distal BTI compared to their matched controls (OR = 2.07, 95% CI, 1.94 – 2.38). Patients who filled prescriptions for testosterone were more likely to undergo surgical repair within a year of the injury compared to the control group. There was a similar trend seen in the male-specific cohort (OR = 1.63, 95% CI, 1.29 – 2.07). Conclusion: Patients with prior prescription testosterone exposure have an increased rate of BTI and biceps tendon repair, as compared to patients without prescription testosterone exposure. This provides insight into the risk profile of testosterone therapy and doctors should consider counseling patients of this risk, particularly those of male sex. 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

Clinical outcomes of osteochondritis dissecans lesions of the capitellum treated with arthroscopy with a mean follow-up of 8.3 years. Rothermich, M. A., et al. (2023) Level of Evidence: 4 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Therapeutic Topic: Osteochondritis dissecans - Arthroscopy This is a retrospective study assessing the long-term outcomes of capitellar osteochondritis dissecans lesions which underwent arthroscopic surgery between January 2000 and December 2016. A total of 107 participants were included in the study. The average follow-up time was 8.3 years, with 11 patients (12%) requiring revision surgery. The results showed that out of the 87 athletes who played sports at the time of their arthroscopy, 93% returned to play. 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, arthroscopy for osteochondritis dissecans has an excellent return-to-play rate and good subjective outcome scores. The reoperation rate is 12%. We should remember that positive outcomes are achieved at a minimum of 2 years. This knowledge can be beneficial to young athletes and their families. For less severe cases of osteochondritis dissecans, elbow immobilisation appears to be the most effective treatment. URL: https://doi.org/10.1016/j.jse.2023.02.121 Abstract Background: While numerous studies exist evaluating the short-term clinical outcomes for patients who have undergone elbow arthroscopy for osteochondritis dissecans (OCD) of the capitellum, the literature on minimum 2-year clinical outcomes for a large cohort of patients is limited. Purpose /Hypothesis: We hypothesized that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved postoperative subjective functional and pain scores, and with acceptable return to play for these patients. Methods: A retrospective analysis from a prospectively collected surgical database was performed to identify all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Inclusion criteria for this study included the diagnosis of OCD of the capitellum treated arthroscopically with minimum 2-year follow-up. Exclusion criteria included any prior surgical treatment on the ipsilateral elbow, missing operative reports, and patients with any portions of the surgical procedure performed open. Follow-up was performed by telephone using multiple patient-reported outcome questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-e), Andrews/Carson, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC), and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, 107 eligible patients were identified. Of these, 90 were successfully contacted for a follow-up rate of 84%. The mean age was 15.2 years and mean follow-up time was 8.3 years. Eleven patients had a subsequent revision procedure for a 12% failure rate in these patients. ASES-e pain was an average of 4.0 out of a max pain scale of 100, ASES-e function was an average of 34.5 out of a maximum of 36, and surgical satisfaction was an average of 9.1 out of 10. The average Andrews/Carson score was 87.1 out of 100 and the average KJOC score for overhead athletes was 83.5 out of 100. Additionally, out of the 87 patients evaluated who played sports at the time of their arthroscopy, 81 (93%) returned to play. Conclusion: This study demonstrated an excellent return-to-play rate and satisfactory subjective questionnaire scores with a 12% failure rate following arthroscopy for OCD of the capitellum with a minimum 2-year follow-up. 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

Prediction of disability in trigger finger: A cross-sectional and longitudinal study. Namaldi, S., Kuru, C. A. and Kuru, I. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Treatment Topic: Trigger finger - Splint wearing This was a prospective study assessing the effects of a 3-month conservative treatment programme on functional status, pain intensity, triggering events, depression, anxiety and kinesiophobia in patients with trigger finger. A total of 55 participants were included in the study. Patients were excluded if they were younger than18 years old, presented with concomitant hand disorder, chronic pain syndrome, neurological disease, rheumatological disease, pregnancy, or psychiatric disorder. Outcome variables were assessed before and after treatment utilising the DASH Questionnaire, visual analogue scale, Beck Depression Scale, Beck Anxiety Scale, and Tampa Scale of Kinesiophobia. Results showed that disability correlated strongly with anxiety, moderately with pain and depression and weakly with triggering and kinesiophobia. Anxiety was found to be predictive of post-treatment DASH scores, suggesting that biopsychosocial treatment approaches that consider the potential contribution of depression and ineffective coping strategies, may increase improvement in functional outcomes after treatment. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, psychological variables, such as anxiety, depression, and kinesiophobia, can be predictive of disability in patients with trigger finger. Therefore, incorporating a biopsychosocial approach into the rehabilitation programme to improve the emotional state of trigger finger patients could lead to better functional outcomes. Similar research findings have been highlighted by another group of researchers assessing the effectiveness of splinting for De Quervain tenosynovitis. URL: https://doi.org/10.1177/17531934221131883 Abstract The aim of this prospective study of 55 patients was to analyse the cross-sectional and longitudinal relationship between disability and physical and psychological variables after conservative treatment of trigger finger and to determine the predictive factors for the post-treatment disability score and change in disability score. The primary outcome measure was the Disabilities of the Arm, Shoulder, and Hand questionnaire. Potential predictive factors included pain, number of triggering events, depression, anxiety and kinesiophobia. Disability correlated strongly with anxiety, moderately with pain and depression and weakly with triggering and kinesiophobia. The change in depression score correlated significantly with the change in disability score. Post-treatment pain and anxiety scores accounted for 47% of the explained variance in disability score. Improvement in depression after treatment accounted for 18% of the explained variance in disability change score. Psychological variables appear to be potential predictors of disability. 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

Reliability and validity of the K-force grip dynamometer in healthy subjects: do we need to assess it three times? Magni, N., Olds, M. and McLaine, S. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic: Digital dynamometers - Grip strength This cross-sectional study examined the reliability and validity of the K-force digital grip meter compared to the Jamar hand dynamometer. A total of 27 healthy participants were included in the present study. Grip strength was measured three times with both the K-force and Jamar hand dynamometer. The testing order was randomised. Results showed that both instruments had excellent intra-rater reliability (measurements were consistent when repeated) with ICCs ranging from 0.96 to 0.97. The association between K-force and Jamar measurements was high (r ≥ 0.89), however, the K-force underestimated the grip strength by 4.5–8.5 kg. There was no change in grip strength with either dynamometer over the course of three trials. 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 K-force digital grip meter is reliable when measuring grip strength in healthy people, however, it underestimates grip strength compared to the Jamar hand dynamometer by 5-9 kg. As a result, K-force measurements should not be compared to normative data. However, it can be used to monitor grip strength change over time. In addition, one measurement is sufficient for assessing grip strength in healthy people. If you are interested in knowing what is the minimal clinically important difference for grip strength, have a look at this other synopsis. URL: https://doi.org/10.1177/17589983231152958 Abstract Introduction: Digital dynamometers to assess grip strength are becoming more common in research and clinical settings. The aim of the study was to assess validity and reliability of the K-force dynamometer compared to the Jamar dynamometer. We also aimed to assess differences over the course of three measurements. Methods: Twenty-seven healthy participants were included. Three trials with the K-force and Jamar dynamometers were completed. Testing order was randomised. Intraclass correlation coefficients (ICCs) with absolute agreement assessed reliability and validity. Standard error of the measurement (SEM) and minimal detectable change (MDC95) were calculated. Concurrent validity was assessed using Pearson?s correlations and ICCs. Differences between the three repetitions were assessed using one-way repeated measures ANOVAs. Results: Both the K-force and the Jamar presented excellent intra-rater reliability with ICCs ranging from 0.96 to 0.97. The SEM ranged from 1.7 to 2 kg and the MDC from 4.7 to 5.7 kg for both dynamometers. The concurrent validity of the K-force was high (r ≥ 0.89). However, the K-force underestimated the grip strength by 4.5?8.5 kg. There was no change in grip strength with either dynamometer over the course of three trials. Conclusions: The K-force is reliable, but it underestimates grip strength by 4.5?8.5 kg compared to the Jamar dynamometer. K-force can be used to monitor progress over time but cannot be used to compare results against normative data. The use of a single measurement when assessing grip strength is sufficient when assessing healthy subjects. 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 influence of partial union on the mechanical strength of scaphoid fractures: A finite element study. Rothenfluh, E., Jain, S., Guggenberger, R., Taylor, W. R. and Hosseini Nasab, S. H. (2023) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Scaphoid healing – Fracture stability This study utilised a computer simulation to analyse the ability of the scaphoid bone to withstand biomechanical stresses based on the type of fracture and extent of healing. A high-resolution CT scan of a cadaveric forearm was used to create a computer-aided design (CAD) model of the scaphoid bone. The loading and boundary conditions were based on previously published experimental data. The results showed that the scaphoid is more prone to re-fracture when healing occurs on the ulnar side. In this instance, before returning to loading through the affected hand, at least 60% union is required. When healing occurs on the radial side, the fracture can withstand loads with as little as 25% union. 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, scaphoid fractures showing healing on the radial side may be able to mobilise earlier compared to fractures healing from the ulnar side. For physiological loading (100 N), at least 2/3 of fracture union is required on the ulnar side, and 1/4 on the radial side. Remember that tenderness on palpation is not a reliable indicator of healing in these fractures. URL: https://doi.org/10.1177/17531934231157565 Abstract Assessment of scaphoid fracture union on computed tomography scans is not currently standardized. We investigated the extent of scaphoid waist fracture union required to withstand physiological loads in a finite element model, based on a high-resolution CT scan of a cadaveric forearm. For simulations, the scaphoid waist was partially fused at the radial and ulnar sides. A physiological load of 100?N was transmitted to the scaphoid and the minimal amount of union to maintain biomechanical stability was recorded. The orientation of the fracture plane was varied to analyse the effect on biomechanical stability. The results indicate that the scaphoid is more prone to re-fracture when healing occurs on the ulnar side, where at least 60% union is required. Union occurring from the radial side can withstand loads with as little as 25% union. In fractures more parallel to the radial axis, the scaphoid seems less resistant on the radial side, as at least 50% union is required. A quantitative CT scan analysis with the proposed cut-off values and a consistently applied clinical examination will guide the clinician as to whether mid-waist scaphoid fractures can be considered as truly united. 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

Hand allodynia, lack of finger flexion, and the need for carpal tunnel release. Piñal, F. d. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Finger stiffness & allodynia - Carpal tunnel syndrome This is a retrospective study assessing the effects of Carpal Tunnel Release (CTR) on participants with hand allodynia and lack of full-finger flexion. A total of 22 patients (35 hands) were included in the study. Symptoms duration ranged from 1-36 months. Nineteen patients were previously denied surgery by other institutions due to their unclear clinical presentation. All participants completed the Disability of the Arm Shoulder and Hand at baseline. A mini-incision approach to the median nerve was performed and this was released. After surgery, nonsteroidal anti-inflammatory drugs were prescribed and self-performed active and assisted exercises were advised. The results showed that post-surgery, finger range of movement, pain, allodynia, and DASH score improved to a clinically relevant level. 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, limited finger flexion may be associated with carpal tunnel syndrome presentation. Prior to surgery, a trial of cortisone injection/night splinting plus exercise/surgery are currently recommended treatments. If you would like to know more about carpal tunnel syndrome, have a look at the entire collection. URL: https://doi.org/10.1016/j.jhsa.2023.01.001 Abstract Purpose: The clinical features of classic carpal tunnel syndrome are well known. However, some patients who may respond equally well to carpal tunnel release (CTR) display atypical signs and symptoms. The chief differential features are allodynia (painful dysesthesias), lack of finger flexion, and, on examination, pain on passive finger flexion. The goal of the study was to present the clinical features, increase awareness, facilitate accurate diagnosis, and report the outcomes after surgery. Methods: Thirty-five hands, from 22 patients with the main features of allodynia and lack of full finger flexion, were gathered in the period 2014-2021. The other common complaints included sleeping disturbances (20 patients), hand swelling (31 hands), and shoulder pain on the same side as the hand problem with limited range of motion (30 sides). The Tinel or Phalen signs were obscured by the pain. However, pain with passive flexion of the fingers was universally present. All the patients were treated with carpal tunnel release through a mini-incision approach: four patients had a trigger finger, which was treated concomitantly in six hands, and one patient underwent contralateral CTR for carpal tunnel syndrome with a more standard presentation. Results: At a minimum of 6 months of follow-up (mean, 22 months; range, 6-60 months), the pain decreased by 7.5 ± 1.9 points on the Numerical Rating Scale, which ranges from 0 to 10. The pulp-to-palm distance improved from 3.7 to 0.3 cm. The mean Disabilities of the Arm, Shoulder, and Hand score decreased from 67 to 20. The mean Single-Assessment Numeric Evaluation score for the whole group was 9.7 ± 0.6. Conclusions: Hand allodynia and lack of finger flexion may be indications of median neuropathy in the carpal canal, which responds to CTR. Awareness of this condition is important because the uncharacteristic clinical presentation may not be considered an indication for surgery that can be beneficial. 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