Search Results

Stop using eccentric exercises as the gold standard treatment for the management of lateral elbow tendinopathy. Stasinopoulos, D. (2022) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Eccentric training - Tennis elbow This is an expert opinion on tennis elbow treatment. The author suggests that there are other beneficial treatments beyond eccentric training. These include resistance training approaches involving concentric and isometric exercises. In addition, they suggest that full kinetic chain exercises should be utilised (e.g. shoulder resistance training). Considering that proprioceptive impairments have been identified in people with lateral epicondylalgia, they also suggest utilising position sense training. 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, there is a reasonable amount of research suggesting that any form of resistance training is beneficial for tennis elbow. In addition, the use of other interventions such as blood flow restriction training may be useful in the treatment of this condition. Proprioception training may also be useful in the early stages of tennis elbow as it has been found to be impaired compared to healthy controls. Upper limb resistance training including the shoulder has been trialled in people with lateral epicondylalgia but does not appear to provide better outcomes than isolated elbow exercises. If you are interested in more research about tennis elbow, have a look at the full tennis elbow database. URL: https://doi.org/10.3390/jcm11051325 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

Risk factors for reoperation after flexor tendon repair: A registry study. Svingen, J., Wiig, M., Turesson, C., Farnebo, S. and Arner, M. (2022) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Prognostic Topic: Flexor tendon repair - Factors associated with re-rupture This is a retrospective study assessing factors associated with re-rupture of flexor tendon following repair of zone I-III. A total of 1,372 participants were included. The variables recorded included age, sex, type of injury, time between injury and surgery, income, educational level, type and number of fingers involved. Details about post-surgical rehabilitation were missing from 60% of the cohort. Of those who had recorded post-surgical rehabilitation, more than 70% of participants underwent early mobilisation, whilst 20% underwent early passive mobilisation. The remaining 10% had a variable post-surgical rehabilitation. Reoperation for tendon rupture occurred in 6% of cases and greater odds of rupture were associated with being male, being older than 25, and having lesions of both FDS and FDP, or FPL. 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, being male, older than 25, and having injured both FDS and FDP, or FDL increases the likelihood of a re-rupture following flexor tendon repair zone I-II. In addition, existing evidence suggests that greater social deprivation is associated with worse outcomes for our clients. Knowledge of these factors provides us with opportunities to provide better care for our patients. URL: https://doi.org/10.1177/17531934221101563 Abstract The aim of this study was to identify risk factors for reoperations after Zones 1 and 2 flexor tendon repairs. A multiple logistic regression model was used to identify risk factors from data collected via the Swedish national health care registry for hand surgery (HAKIR). The studied potential risk factors were age and gender, socio-economics and surgical techniques. Included were 1372 patients with injuries to 1585 fingers and follow-up of at least 12 months (median 37 IQR 27–56). Tendon ruptures occurred in 80 fingers and tenolysis was required in 76 fingers. Variables that affected the risk of rupture were age >25 years (p < 0.001), flexor pollicis longus tendon injuries (p < 0.001) and being male (p = 0.004). Injury to both finger flexors had an effect on both rupture (p = 0.005) and tenolysis (p < 0.001). Understanding the risk factors may provide important guidance both to surgeons and therapists when treating patients with flexor tendon injuries. 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

Psychological sequelae of hand injuries: An integrative review. Maddison, K., Perry, L. and Debono, D. (2022) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Symptoms prevalence Topic: Psychological results of hand injuries - Depression and anxiety This is a narrative review assessing the prevalence and risk factors for depression and anxiety following hand injuries. A total of nine articles with retrospective and prospective designs were included. Only participants with injuries from the elbow down were included. Of those presenting with depression 15-30% presented with severe symptoms. Depression tended to resolve in 50% of cases in the subacute stage. Anxiety was reported in 15-40% of people after injury. Factors that appeared to be associated with depression and anxiety were pain intensity, persistent pain, reduced social function, and unemployment. One of the limitations of the studies included was the lack of a control group assessing the presence of anxiety and depression in people without hand injuries. 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, depression and anxiety are common post elbow/wrist/hand/finger injury. There is also an association between these psychological factors and pain intensity, persistent pain, and social participation. We also know that given the same type of injury, greater levels of depression significantly increase levels of pain. Acknowledging these issues and providing patients with as much advice as possible (e.g. taking part in regular exercise) may help them cope with their recovery. If you are interested in the effects of mental health on upper limb injury and recovery, have a look at the full database. URL: https://doi.org/10.1177/17531934221117429 Abstract This integrative review investigated reports of psychological impact and sequelae of traumatic hand injuries. A systematic search using Medline, PsychINFO, PubMed, EMBASE, CINAHL and hand-searching methods was conducted from 2008 to 2020. Nine included articles with a total of 503 participants were reported in prospective cross-sectional or longitudinal cohort studies. Depression and anxiety were common, affecting between 7% and 71% and between 23% and 71% of patients, respectively. Post-traumatic stress disorder affected between 3% and 95% of patients. Factors reported predicting psychological sequelae of hand injuries included injury severity, pain, limb dysfunction, negative perceptions of injured limbs, suboptimal coping mechanisms and limited social support. Symptoms persisted for protracted periods of follow-up but broadly attenuated after 3 months. We conclude that the high prevalence and enduring nature of psychological symptoms demonstrate an urgent need for further research to optimize treatment. 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

Rapidly progressive soft tissue infection of the upper extremity with aeromonas veronii biovar sobria. Lujan-Hernandez, J., Schultz, K. S., & Rothkopf, D. M. (2020) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic: Freshwater laceration – Infection This is a case report on Aeromonas infection following a laceration in fresh water. The patient was a 20 years old male who had been experiencing pain in the forearm following a laceration injury while swimming in a freshwater reservoir. They were not immunocompromised and the injury had been treated in ED a few hours (2 hrs) prior to the worsening of symptoms. Objectively, they presented with pain in the distal forearm, erythema around the wound site, pain with passive wrist extension, and purulent discharge from the wounds attended two hours prior. They had no fever. X-ray investigations revealed a small air sack within the volar forearm. Blood tests revealed the presence of a high white blood cells count. The patient was immediately treated with a wide-spectrum series of antibiotics and went through two washouts with the wound left open for primary healing. The symptoms resolved after a few weeks of discharge and there were no hand or upper limb impairments at 6 or 12 months. 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, lacerations or wounds contaminated with fresh or saltwater should be followed closely. This is particularly true for those clients working/spending time in high-risk environments (e.g. fisherman, aquarist). The risk of severe repercussions if an infection is not treated is high. Post-washout we should monitor our smoking/diabetic clients as they are at greater risk (15-20%) of developing an additional infection. X-rays and US are the primary investigations to be utilised if suspecting an infection. URL: https://doi.org/10.1016/j.jhsa.2020.02.003 Abstract Aeromonas veronii, a bacterium found in freshwater, is an unusual pathogen in healthy patients. We present a case report of a rare, aggressive subtype in a young, immunocompetent individual. History of injury in an aquatic environment and culture data are key for identification of the causal agent and should dictate acute clinical management and antibiotic therapy. Coverage should include cephalosporins, quinolones, or sulfas if Aeromonas is suspected, and adjusted depending on culture and sensitivity. Early surgical exploration, incision and drainage, and appropriate antimicrobial therapy are the cornerstones for successful treatment of these aggressive, sometimes life-threatening infections. 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

Carpal tunnel decompression in patients with normal nerve conduction studies. Mackenzie, S. P., et al. (2020) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Prognostic Topic: Carpal tunnel decompression – Outcomes in patients with and without nerve conduction impairments This study assessed the effectiveness of carpal tunnel decompression in patients with and without objective impairments on median nerve conduction studies (NCS). Changes in function were assessed through the QuickDASH before and after surgery. Patients were selected for surgery only if they clinically presented with the following three characteristics: paraesthesia in the median nerve distribution at the hand, positive Tinel’s and/or Phalen’s test, and symptoms reduction after a steroid injection. The results showed that both groups of patients presented with clinically and statistically significant improvements at one year on the QuickDASH questionnaire. There was no clinically significant difference between groups in function. 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, median nerve impairments identified by nerve conduction study may not predict clinical improvements following carpal tunnel decompression. We can therefore reassure our patients that at one-year post carpal tunnel release, they are likely to experience notable improvements independently of their test results. Did you know that the presence of carpal tunnel syndrome is largely influenced by genetics? If you would like to know more about carpal tunnel syndrome assessment and treatment, head over to the database. URL: https://doi.org/10.1177/1753193419866646 Abstract Some patients present with typical clinical features of carpal tunnel syndrome despite normal nerve conduction studies. This study compared the preoperative and 1-year postoperative QuickDASH scores in patients with normal and abnormal nerve conduction studies, who underwent carpal tunnel decompression. Of the 637 patients included in the study, 19 had clinical features of carpal tunnel syndrome but normal nerve conduction studies, and underwent decompression after failure of conservative management. Preoperative QuickDASH scores were comparable in both groups (58 vs 54.8). However, there were significant differences between the normal and abnormal nerve conduction study groups in the QuickDASH at 1 year (34.9 vs 21.5) and change in QuickDASH postoperatively (23.1 vs 33.4). Patients with normal nerve conduction studies had comparable preoperative disability scores compared with those with abnormal studies. Although they had a significant improvement in QuickDASH at 1 year, this was significantly less than those with abnormal nerve conduction studies. 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

Does your bedside neurological examination for suspected peripheral neuropathies measure up? Bender, C., Dove, L. and Schmid, A. B. (2022) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic Topic: Neurological testing - Peripheral neuropathies This is an expert opinion on neurological testing for peripheral neuropathies. Six recommendations are provided based on the available evidence: 1 - Assess light touch sensation in the upper limb in a circular pattern. This will allow you to differentiate between a dermatomal vs a peripheral nerve numbness presentation. 2 - Test small fibre neuropathy through pin-prick in a circular pattern 3 - If there are motor or sensory deficits in both upper limbs, do not consider that "normal". 4 - When performing myotome testing, fatigue may incur more quickly in the affected muscles compared to other myotomes. Instead of a single maximal strength test, repeated testing may be required. 5 - Reflex testing is independent of patients' pain, use them. 6 - Monitor progress/deterioration as accurately as possible. Have a look at: Video 2 for sensory testing Video 5 for motor and reflex testing 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, light touch, pin-prick, myotomes, and reflex testing may be useful in the assessment of people with peripheral neuropathies. Light touch, myotome, and reflex testing assess the gross integrity of nerves and they may be affected when there are moderate/large entrapment neuropathies. If the entrapment is mild, you may only identify impairments on pin-prick (small fibre neuropathy). Pin-prick can be easily tested with a neuropen, which consistently delivers 40g of pin-prick (This is what I use in the clinic). If clients report muscle fatigue and you are testing myotomes, you may want to perform a few repetitions and compare their endurance to unaffected muscles of the same limb. In terms of dermatomes remember that they are inconsistent across people and the best you could do is differentiate between a radicular presentation vs a peripheral nerve entrapment. URL: https://doi.org/10.2519/jospt.2022.11281 Abstract Neurological testing is essential for screening and diagnosing suspected peripheral neuropathies. Detecting changes in somatosensory and motor nerve function can also have direct implications for management decisions. Nevertheless, there is considerable variation in what is included in a bedside neurological examination, and how it is performed. Neurological examinations are often used as screening tools to detect neurological deficits, but not used to their full potential for monitoring progress or deterioration. Here, we advocate for better use of the neurological examination within a clinical reasoning framework. Constrained by the lack of research in this field, our viewpoint is based on neuroscientific principles. We highlight six challenges for clinicians when conducting neurological examinations, and propose ways to overcome these challenges in clinical practice. We challenge widely held ideas about how the results of neurological examinations for peripheral neuropathies are interpreted and how the examinations are performed in practice. 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 ultrasound. Pierce, J. L. and Nacey, N. C. (2016) Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic Topic: Ultrasound imaging – Elbow This is an expert opinion on different ultrasound (US) imaging techniques available to scan the elbow. One of the most interesting appears to be the "cobra" position which is obtained by asking the client to flex the elbow and pronate the forearm while scanning the proximal dorsal forearm in a transverse plane. Pronation and supination of the forearm will reveal the appearance and disappearance of the distal biceps tendon respectively. This approach can be utilised to identify tendinopathies of the distal biceps tendon or partial/full distal biceps tears. Other imaging views can assess the lateral, medial, and posterior aspects of the elbow. Notable pathologies that can be assessed with US include tennis/golfer's elbow, triceps tears, and nerve entrapment lesions due to musculoskeletal or space-invading lesions. 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 "cobra" position may be useful in US imaging assessment of the distal biceps tendon. This position and imaging approach is similar to what has been described in the biceps palpation-rotation test to assess the presence of distal biceps tendinopathies/partial tears. Another test that can be quite useful to identify the integrity of the distal biceps is the hook test. Unfortunately, like many other orthopaedic tests for the elbow, we don't have information regarding their diagnostic accuracy. If you like to read more about pathologies/assessment/treatment of the distal biceps tendon, have a look at the full database. URL: https://doi.org/10.1007/s40134-016-0182-8 Abstract Purpose of the Review: With high-resolution real-time and dynamic imaging capabilities, ultrasound is an excellent imaging modality for the evaluation of the elbow. With the foundational understanding of elbow anatomy and pathology, ultrasound of the elbow can positively impact clinical care with both diagnostic examination and image-guided injections and treatments. Recent Findings: Although there is a learning curve and image quality is operator-dependent, knowledge of proper patient positioning, ultrasound technique, and tips for eliminating common pitfalls will significantly make an impact on performing and interpreting elbow ultrasound. Summary: Elbow ultrasound is an excellent modality for the diagnosis of elbow joint pathology and image-guided injections and treatments. By understanding the anatomy and learning scanning techniques, ultrasound of the elbow can provide integral clinical value. 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 active motion after 3-ligament tenodesis noninferior to late active motion? A prospective, multicenter cohort study. Bakker, D., et al. (2022) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Scapholunate repair - Delayed vs early mobilisation This is a quasi-experimental (no randomisation) study assessing the effect of early vs delayed mobilisation following scapholunate ligament repair. A total of 108 participants were included and outcomes assessed included upper limb function, pain, range of movement, grip strength, and complications. The early mobilisation group was casted for 3-5 days followed by 24/7 wrist splint wearing and gentle wrist range of movement exercises from week 2 post-surgery. The delayed mobilisation group was casted for 10-16 days followed by 24/7 wrist splint wearing and gentle wrist range of movement exercise from week 5-6 post-surgery. The results showed that there were no differences between groups on function, pain, range of movement, grip strength, or complications at three months. 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 of scapholunate repair is feasible and is not associated with worse outcomes. Considering that early mobilisation may provide additional benefits to our clients, it is worth considering as an alternative. If you are interested in outcomes associated with early vs delayed scapholunate repair, have a look at this other synopsis. Open Access URL: https://doi.org/10.1016/j.jhsa.2022.07.002 Abstract Purpose: If early active motion after 3-ligament tenodesis is safe, it may yield more patient comfort and an early return to activities. Therefore, the aim of this study was to investigate whether early active motion is noninferior to late active motion after 3-ligament tenodesis for scapholunate interosseous ligament injuries. Methods: This prospective, multicenter cohort study, using a noninferiority design with propensity score matching, compared a late active motion protocol (immobilization for 10–16 days, wrist therapy in weeks 5–6) with an early active motion protocol (immobilization for 3–5 days, wrist therapy during week 2). Patients who were older than 18 years, had complete baseline information on demographics, and underwent 3-ligament tenodesis were included. The outcome measures were postoperative Patient-Reported Wrist/Hand Evaluation scores, pain, complications, return to work, range of motion, grip strength, and satisfaction with treatment results at 3 months of follow-up. Results: After propensity matching, a total of 108 patients were included. Patient-Reported Wrist/Hand Evaluation and pain scores during physical load following an early active motion protocol were noninferior compared with scores following a late active motion protocol. Furthermore, early active motion did not lead to an increase of complications, differences in range of motion or grip strength, or less satisfaction with the treatment result. An earlier return to work was not observed. Conclusions: Early active motion leads to noninferior results without more complications as compared with late active motion. Based on these findings, early active motion can be considered safe, and might be recommended due to its potential benefits compared with late active motion after 3-ligament tenodesis. 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

Posttraumatic arthrosis and triquetral nonunion associated with pisotriquetral subluxation in adolescent female softball players. Wallace, D. R. and Floyd, W. E. (2022) Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic/Therapeutic This is the answer to last week's Sherlock Handy. The patient was a 19 years old, right-handed, female softball player. They had been gradually developing pain since a fall onto an outstretched hand seven years prior. Despite a course of conservative management that included hand therapy and six weeks of casting, they had been unable to return to batting. Objectively, they presented with pain at the pisotriquetral joint. X-rays are shown below. Surgery was performed and intraoperatively there was evidence of pisotriquetral osteoarthritis associated with a triquetrum fracture non-union. A pisiform excision was performed. Three months post-surgery, the patient was back playing softball without pain and remained asymptomatic at the two years follow-up. 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, pisotriquetral impaction syndrome may be the result of an old fracture of the pisiform/triquetrum. This presentation may be associated with pisotriquetral osteoarthritis even in young clients. If conservative treatment fails, pisiform excision may be a useful treatment. If you are interested in another case of ulnar-sided wrist pain, have a look at this synopsis. URL: https://doi.org/10.1016/j.jhsa.2021.07.032 Abstract Impaction fracture subluxation of the pisotriquetral joint producing arthrosis and ulnar triquetral osteochondral nonunion is a cause for ulnar wrist pain in batting athletes. Two cases of adolescent female softball players managed successfully with pisiform and triquetral fragment excision are reported. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic/Therapeutic Have a think about this case study. Leave a diagnostic comment if you like. The patient was a 19 years old, right-handed, female softball player. They had been gradually developing pain since a fall onto an outstretched hand seven years prior. Despite a recent course of conservative management that included hand therapy and six weeks of casting, they had been unable to return to batting. Objectively, they presented with pain at the pisotriquetral joint. X-rays are shown below. What is it?

Driving performance following a wrist fracture: A pilot study using a driving simulator Stinton, S., Pappas, E., Edgar, D., & Moloney, N. (2019) Level of Evidence: 3b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Preventative Topic: Return to driving - Radius fracture ORIF This is a pilot study assessing patients' fitness to drive after a distal radius fracture. All distal radius fractures were treated through open reduction and internal fixation (ORIF). The ORIF group (n = 6) was compared to a healthy uninjured group (n = 16). All the participants were assessed through a driving simulator. The ORIF group was assessed at two time points (5/52 and 7/52 post surgery) while the control group was assessed at one time point only. The results of this study need to be considered in the context of a few limitations. The sample size was small and it is possible that a larger study would provide different results. In addition, the validity of the driving simulator has not been assessed and we are not sure whether the results obtained from this test are able to identify people at higher risk of a car accident. At the first assessment point (5/52 post surgery), the results showed that the ORIF group spent a greater proportion of time out of their lane (ORIF: 13% vs Control: 0.2%), which represents a risky driving behaviour. Also at the first assessment point (5/52 post surgery), the time spent over the speed limit was lower for the ORIF group (3%) compared to the control group (16%), suggesting that the ORIF group had a safer driving behaviour. At the second assessment point (7/52 post surgery), the ORIF group was no different compared to the control group, suggesting that their driving behaviour had normalised. 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, five weeks after distal radius fracture ORIF, patients are slower and less accurate in keeping to their lane when driving compared to their peers. At seven weeks, such differences no longer existed. We should therefore encourage our patients to practice driving in a safe environment (e.g. empty parking lot) before driving on the road, which may help in improving car control. In addition, patients may check with their insurance company requirements before engaging in driving. Open Access URL: https://doi.org/10.1177/1758998319887526 Abstract Introduction: Driving performance, as assessed using a driving simulator, after distal radius fracture has not been previously studied. Our aims were to undertake a pilot study to assess feasibility via: (i) acceptability of driving simulation for this assessment purpose, (ii) recruitment and retention, (iii) sample size calculation. Preliminary evaluations of differences in driving performance between individuals recovering from distal radius fracture and controls were conducted to confirm if the methodology provided meaningful results to aid in justification for future studies. Methods: Driving performance of 22 current drivers (aged 21–81 years), recruited by convenience sampling, was assessed using a driving simulator. The fracture group included those recovering from distal radius fracture managed with open reduction and internal fixation using a volar plate. The control group were uninjured individuals. Assessment was performed approximately five weeks post-surgery and follow-up assessment two weeks later. Acceptability outcome measures included pain and simulator sickness scores, feasibility measures included retention rates and measures of driving performance included time spent speeding, time spent out of the lane, standard deviation of lateral position and hazard reactions. Results: The assessment was completed by 91% of participants; two participants dropped out secondary to simulator sickness. Retention rates were 83%. Preliminary results suggest those with distal radius fracture spent more time out of the lane and less time speeding. Conclusion: This method was sensitive, acceptable and feasible according to the parameters of this pilot study. The results from this small sample suggest that between-group differences in driving performance are measurable using driving simulation five weeks following distal radius fracture. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Metacarpal fractures in the national football league: Injury characteristics, management, and return to play. Sharareh, B., et al. (2022) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic: Metacarpal fracture - Surgery vs conservative treatment for return to sport This is a retrospective study describing common metacarpal fractures as well as return to sport in the National Football League (NFL) players. The data were obtained from a database of NFL injuries recorded between 2012 and 2018. A total of about 19,000 participants (including repeated measures) were included in the analysis. Across the years, a total of 208 metacarpal fractures were recorded. Only three players sustained two separate injuries within these seven years. There were no refractures. The average return to sport time was three weeks. Return to sport was delayed in those player who had a thumb metacarpal fracture. There was no correlation between age, position, type of fracture, conservative/surgical management of fractures and return to sport time. 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, in professional NFL players with metacarpal fracture II to IV, return to sport can happen at three weeks without evidence of refracture. However, the use of protective splints is required. Given these findings, it is possible that our clients may benefit from an early return to sport without significant risks following a metacarpal fracture. Also, remember that tenderness on palpation is not a reliable way of assessing fracture healing and it is unlikely to be useful in determining when people can return to work/sport. URL: https://doi.org/10.1016/j.jhsa.2022.01.011 Abstract Purpose: This study investigated metacarpal fracture occurrences, characteristics, treatments, and return-to-play times for National Football League (NFL) athletes. Methods: NFL players who sustained metacarpal fractures during the 2012 to 2018 seasons were reviewed. All players on the 32 NFL team active rosters with metacarpal fractures recorded through the NFL Injury Database were included. Player age, time in the league, player position, injury setting, injury mechanism, fractured ray, management, and return-to-play were recorded. Results: There were 208 injury occurrences resulting in 1 or more metacarpal fractures, identified in 205 players. Of these, 81 (39%) injuries were operated. Return-to-play data were available for 173 (83%) injured players. The median return-to-play time for all athletes was 15 days (interquartile range, 1-55 days). Of the injured players, 130 (71%) missed time but returned the same season. Within this 130-player subset, 69 (53%) were treated nonsurgically and 61 (47%) operatively with median return-to-play times of 16 days (interquartile range, 6-30 days) and 20 days (interquartile range, 16-42 days) respectively. Eighteen individuals in this 130-player subgroup sustained a thumb metacarpal fracture. The return-to-play time was slower for patients sustaining thumb metacarpal fractures compared to other metacarpal fractures, and was significantly longer (median, 55 days) following nonsurgical treatment of thumb fractures compared with operative intervention (median, 24 days). A regression analysis revealed no trend or difference in return to football with respect to player age, time in the league, injury setting (practice vs game), injury mechanism, articular involvement, multiple concomitant injuries, or player position. Conclusions: Most NFL players who sustain metacarpal fractures miss less than 3 weeks and return to play the same season. The only variables that lessen the return-to-play time are involvement of lesser digit metacarpals and operative intervention for treatment of thumb metacarpal 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