Search Results

Which patient and surgeon characteristics are associated with surgeon experience of stress during an office visit? Crijns, T., Al Salman, A., Bashour, L., Ring, D. and Teunis, T. (2022) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Clinicians' stress - Clients' psychosocial health This is a survey assessing the surgeons' levels of stress associated with simulated patients' presentations. A total of 111 surgeons took part in the study. Surgeons' were asked to rate their level of stress when consulting different types of patients. Simulated patients were described as presenting with different characteristics. Simulated patients presented with or without disproportionate levels of pain, a high number of prior consultations with other surgeons, as well as "googling" their condition and being convinced that they knew what to do for their condition prior to the appointment. The results showed that surgeons experience greater levels of futility, inadequacy, and frustration when patients presented with the characteristics described above. 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, clinicians experience greater levels of stress when interacting with clients presenting with unhelpful pain beliefs/disproportionate levels of pain or clients with a long list of office visits/second opinions. Being aware of this link may help us provide better care for our clients as well as provide them with a different perspective on pain. URL: https://doi.org/10.1016/j.pecinn.2022.100043 Abstract Objective: To determine clinician and patient factors associated with the surgeon feelings of stress, futility, inadequacy, and frustration during an office visit. Methods: A survey-based experiment presented clinical vignettes with randomized patient factors (such as symptom intensity, the number of prior consultations, and involvement in a legal dispute) and feeling behind schedule in order to determine which are most related to surgeon ratings of stress, futility, inadequacy, and frustration on 11-point Likert scales. Results: Higher surgeon stress levels were independently associated with women patients, multiple prior consultations, a legal dispute, disproportionate symptom intensity, and being an hour behind in the office. The findings were similar for feelings of futility, inadequacy, and frustration. Conclusion: Patient factors potentially indicative of mental and social health opportunities are associated with greater surgeon-rated stress and frustration. Innovation: Training for surgeon self-awareness and effective communication can transform stressful or adversarial interactions into an effective part of helping patients get and stay healthy by diagnosing and addressing psychosocial aspects of the illness. 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

Preseason shoulder range of motion screening and in-season risk of shoulder and elbow injuries in overhead athletes: Systematic review and meta-analysis. Pozzi, F., et al. (2020) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Prognostic Topic: Elbow injury - Risk factors This is a systematic review and meta-analysis assessing the usefulness of shoulder range of movement screening to predict upper limb injury in overhead athletes. The systematic review included prospective studies only. Shoulder flexion, shoulder internal/external rotation at 90° of shoulder abduction, and shoulder horizontal adduction were assessed. Injury was defined as any shoulder- or elbow-related complaint incurred in the season. A total of 7 studies were included in the meta-analysis. Overhead sports included baseball (n = 2471), handball (n = 535), softball (n = 103), swimming (n = 74), volleyball (n = 66), and tennis (n = 65). The results showed that shoulder external rotation on the throwing arm was a useful screening tool for professional baseball pitchers. Those players who did not present with an external rotation of the throwing arm of at least 5° greater than the contralateral, were twice as likely to injure their pitching shoulder or elbow. Limited evidence was available for the other overhead sports. This may be due to the small number of studies investigating athletes involved in other sports. 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 may test shoulder external rotation in professional baseball pitchers to assess their risk of developing an elbow or shoulder injury. Interventions aimed at modifying these impairments may be useful in reducing their risk of elbow and shoulder injury. For example, eccentric resistance training of internal rotators towards the end of shoulder external rotation may be a useful exercise. Thus, resistance training has been shown to not only improve strength but also the flexibility of the exercising muscles. Structural limitations may be suspected if this exercise regime does not lead to flexibility changes. Open Access URL: http://dx.doi.org/10.1136/bjsports-2019-100698 Abstract Objective: To characterise whether preseason screening of shoulder range of motion (ROM) is associated with the risk of shoulder and elbow injuries in overhead athletes. Design: Systematic review and meta-analysis. Data sources: Six electronic databases up to 22 September 2018. Eligibility criteria: Inclusion criteria were (1) overhead athletes from Olympic or college sports, (2) preseason measures of shoulder ROM, (3) tracked in-season injuries at the shoulder and elbow, and (4) prospective cohort design. Exclusion criteria were (1) included contact injuries, (2) lower extremity, spine and hand injuries, and (3) full report not published in English. Results: Fifteen studies were identified, and they included 3314 overhead athletes (baseball (74.6%), softball (3.1%), handball (16.1%), tennis (2.0%), volleyball (2.0%) and swimming (2.2%)). Female athletes are unrepresented (12% of the overall sample). Study quality ranged from 11 to 18 points on a modified Downs and Black checklist (maximum score 21, better quality). In one study, swimmers with low (<93°) or high (>100°) shoulder external rotation were at higher risk of injuries. Using data pooled from three studies of professional baseball pitchers, we showed in the meta-analysis that shoulder external rotation insufficiency (throwing arm <5° greater than the non-throwing arm) was associated with injury (odds ratio=1.90, 95% confidence interval 1.24 to 2.92, p<0.01). Conclusion: Preseason screening of shoulder external rotation ROM may identify professional baseball pitchers and swimmers at risk of injury. Shoulder ROM screening may not be effective to identify handball, softball, volleyball and tennis players at risk of injuries. The results of this systematic review and meta-analysis should be interpreted with caution due to the limited number of studies and their high degree of heterogeneity. 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

Physical examination of the elbow, what is the evidence? A systematic literature review. Zwerus, E. L., et al. (2018) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 thumbs up) Type of study: Diagnostic Topic: Elbow conditions – Physical tests This is a systematic review assessing the diagnostic accuracy of physical tests for elbow conditions. A total of ten studies were included. The variables of interest were the sensitivity and specificity of physical tests. If a test is very sensitive and its result is negative, you can be more certain that the patient does not have the condition. If the test is specific and its result is positive, you can be more certain that the patient has the condition. A large number of studies presented a high risk of bias. The results showed that tests for distal biceps tendon rupture were the most common in the literature. Only a few papers assessed the diagnostic validity of tests for other conditions. One of the largest issues with the published papers was the over-recruitment of people with the studied condition (e.g. PLRI), which makes it hard to generalise the sensitivity/specificity of these tests to clinical practice. Nevertheless, the study provided an extensive table presenting elbow conditions and relative tests (See below). 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 diagnostic accuracy of clinical tests for elbow conditions has not been investigated thoroughly. Sound anatomical knowledge combined with a thorough subjective examination is therefore necessary when trying to differentiate between common elbow conditions. In the future, we will have more details about the ability of common tests such as the hook test, distal biceps tendinopathy, tennis elbow, and ligament testing in identifying the pathologies that they aim to diagnose. URL: http://dx.doi.org/10.1136/bjsports-2016-096712 Abstract OBJECTIVE: Primary to provide an overview of diagnostic accuracy for clinical tests for common elbow (sport) injuries, secondary accompanied by reproducible instructions to perform these tests. DESIGN: A systematic literature review according to the PRISMA statement. DATA SOURCES: A comprehensive literature search was performed in MEDLINE via PubMed and EMBASE. ELIGIBILITY CRITERIA: We included studies reporting diagnostic accuracy and a description on the performance for elbow tests, targeting the following conditions: distal biceps rupture, triceps rupture, posteromedial impingement, medial collateral ligament (MCL) insufficiency, posterolateral rotatory instability (PLRI), lateral epicondylitis and medial epicondylitis. After identifying the articles, the methodological quality was assessed using the QUADAS-2 checklist. RESULTS: Our primary literature search yielded 1144 hits. After assessment 10 articles were included: six for distal biceps rupture, one for MCL insufficiency, two for PLRI and one for lateral epicondylitis. No articles were selected for triceps rupture, posteromedial impingement and medial epicondylitis. Quality assessment showed high or unclear risk of bias in nine studies. We described 24 test procedures of which 14 tests contained data on diagnostic accuracy. CONCLUSIONS: Numerous clinical tests for the elbow were described in literature, seldom accompanied with data on diagnostic accuracy. None of the described tests can provide adequate certainty to rule in or rule out a disease based on sufficient diagnostic accuracy. 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 biomechanics: Soft tissue stabilizers. Kaufmann, R. A. M. D., Wilps, T. B. S., Musahl, V. M. D. and Debski, R. E. P. (2020) Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Anatomical Topic: Elbow ligaments - Biomechanics This is a narrative review on passive elbow structures contributing to valgus and varus joint stability. The authors report that valgus flexibility at the elbow is greatest at 30° of flexion and that the medial ulnar collateral ligament (MUCL) resists these valgus forces. The MUCL is divided into anterior and posterior bundles, with the anterior bundle being the main source of valgus stability. The MUCL (anterior bundle) tightens incrementally with elbow flexion, reaching the highest tension at 80° of elbow flexion. The lateral collateral ligaments of the elbow control varus forces and they include the lateral ulnar collateral ligament (LUCL) and the radial collateral ligament (RCL). The stabilisation role of these ligaments is debated, however, it is believed that both control varus forces and are important in the postero-lateral rotatory stability of the elbow. 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, valgus stress test of the elbow (30° of flexion) is restrained by the anterior bundle of the MUCL. Injury to the lateral collateral ligaments can be assessed through varus stress testing. Simple elbow dislocations may involve injury to a limited number of ligaments whilst complex dislocations are likely to injure multiple ligaments as well as the capsule. Have a look at these synopses for more info on the treatment and classification of elbow dislocations. URL: http://dx.doi.org/10.1016/j.jhsa.2019.10.034 Abstract The elbow positions the hand in a stable manner relative to the trunk while allowing flexion and extension as well as forearm rotation at varying shoulder positions. Its ability to perform this task without joint subluxation is accomplished through a combination of bony congruency, ligamentous restraint, and dynamic stabilization. Elbow stability is challenged repeatedly during everyday activities, particularly when the arm is abducted. Traumatic injuries that lead to an elbow dislocation or the microtrauma associated with pitching are frequent situations that destabilize the elbow. This article reviews the soft tissue stabilizers that contribute to elbow kinematics and stability. 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

Early functional mobilization for non-operative treatment of simple elbow dislocations: A systematic review. Catapano, M., Pupic, N., Multani, I., Wasserstein, D. and Henry, P. (2022) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Simple elbow dislocation - Rehabilitation This is a systematic review assessing the best rehabilitation interventions for simple elbow dislocations. Simple elbow dislocations were characterised by stability through range after reduction associated or not with small fractures. A total of 15 studies were included in the review. Of these, three studies were randomised controlled studies. The two interventions most commonly utilised were either Plaster of Paris (PoP) for 21 days or early mobilisation with the intermittent use of an elbow splint. The studies adopting an early mobilisation approach performed forearm pronation/supination as well as elbow flexion/extension through a comfortable range. Most commonly, exercises were performed supine with the shoulder at 90° of flexion. In the early mobilisation group, a posterior elbow splint was utilised for three weeks and removed to perform exercises. The results showed that early mobilisation was associated with earlier return to work, reduced elbow stiffness, higher pain, and a lower likelihood of heterotopic ossification in the short term compared to 21 days of PoP cast. At one year, there was no difference between the early motion compared to PoP cast 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, simple elbow dislocations treated with early mobilisation appear to have better outcomes compared to PoP immobilisation for three weeks. There may be higher levels of pain in the short term but it appears that the benefit may outweigh this inconvenience. The treatment of complex elbow dislocations should follow surgeons' advice as these often need surgical management. URL: https://doi.org/10.1177/1758573220957631 Abstract Purpose: This systematic review aims to elucidate a non-operative rehabilitation program that optimizes recovery based on published approaches and outcomes. Methods: Searches of four databases from inception to 1 January 2020 were performed to identify clinical studies addressing the non-operative management of simple elbow dislocations. Results: Of 2435 studies that were eligible for title screen, 15 studies satisfied inclusion criteria. Three randomized control studies demonstrated that early mobilization expedited the return of range of motion, function and return to work or activities, however, resulted in increased pain within the six-week rehabilitation period compared to Plaster of Paris casting for 21 days. Patients returned to work sooner after early mobilization (10 vs. 18 days; p = 0.02) compared to Plaster of Paris casting. In all studies, early mobilization resulted in similar re-dislocation rates of 1.3% (3/237) versus 2.2% (12/549) in those with Plaster of Paris casting as well as lower incidence of heterotopic ossification (36% vs. 54%). No significant differences between rehabilitation protocols were determined; however, the large majority of recent papers utilized rehabilitation protocols. Conclusion: Early mobilization of simple elbow dislocations results in early return of Range-of-Motion, function and return to work with no increase in complication rates; however, increased pain during the rehabilitation period. 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 dislocations: A review ranging from soft tissue injuries to complex elbow fracture dislocations. Englert, C., Zellner, J., Koller, M., Nerlich, M. and Lenich, A. (2013) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic Topic: Elbow dislocation - Classification This is an expert opinion on the diagnosis and treatment of elbow dislocations. What the authors suggest is to classify elbow dislocations as simple and complex. Simple elbow dislocations may be associated with small fractures and can be reduced without anaesthesia. These injuries are usually stable and a splint limiting extension/flexion is usually advisable for a short period of time. Complex dislocations often cannot be reduced without anaesthesia and are often associated with larger displaced fractures, which require surgical interventions. The common complications of elbow dislocations include chronic instability/stiffness, and heterotopic ossification. 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, elbow dislocations may be classified as simple or complex according to the size/displacement of the fracture and the stability through range after reduction. Gross neurovascular function assessment and x-ray investigations are often required. If you are uncertain whether an x-ray is required, you can perform the elbow extension test. For the rehabilitation of simple dislocations, have a look at this other synopsis. URL: https://doi.org/10.1155/2013/951397 Abstract This review on elbow dislocations describes ligament and bone injuries as well as the typical injury mechanisms and the main classifications of elbow dislocations. Current treatment concepts of simple, that is, stable, or complex unstable elbow dislocations are outlined by means of case reports. Special emphasis is put on injuries to the medial ulnar collateral ligament (MUCL) and on posttraumatic elbow stiffness. 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

Catastrophic thinking is associated with finger stiffness after distal radius fracture surgery. Teunis, T., Bot, A. G., Thornton, E. R. and Ring, D. (2015) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Prognostic Topic: Finger stiffness post distal radius fracture - The effect of catastrophising This is a retrospective study assessing the association between several variables and finger stiffness following open reduction internal fixation for distal radius fracture. A total of 96 participants were included in the study. Demographic characteristics, fracture severity and psychological variables (e.g. pain catastrophising) were measured at baseline and utilised to predict finger stiffness (distance to palmar crease across four fingers) at six weeks. The results showed that greater pain catastrophising was associated with worse finger stiffness at six weeks. In particular, for every 10 points increase in catastrophising, there is a 1 cm increase (for each finger) in distance to palmar crease (see figure below). 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, pain catastrophising at baseline predicts finger stiffness at six weeks after distal radius fracture open reduction internal fixation. This study contributes to the growing amount of evidence showing that pain catastrophising negatively affects recovery in upper limb conditions and upper limb function. URL: https://doi.org/10.1097/bot.0000000000000342 Abstract Objectives: To identify demographic, injury-related, or psychologic factors associated with finger stiffness at suture removal and 6 weeks after distal radius fracture surgery. We hypothesize that there are no factors associated with distance to palmar crease at suture removal. Design: Prospective cohort study. Setting: Level I Academic Urban Trauma Center. Patients: One hundred sixteen adult patients underwent open reduction and internal fixation of their distal radius fractures; 96 of whom were also available 6 weeks after surgery. Intervention: None. Main outcome measurements: At suture removal, we recorded patients' demographics, AO fracture type, carpal tunnel release at the time of surgery, pain catastrophizing scale, Whiteley Index, Patient Health Questionnaire-9, and disabilities of the arm, shoulder, and hand questionnaire, 11-point ordinal measure of pain intensity, distance to palmar crease, and active flexion of the thumb through the small finger. At 6 weeks after surgery, we measured motion, disabilities of the arm, shoulder, and hand, and pain intensity. Prereduction and postsurgery radiographic fracture characteristics were assessed. Results: Female sex, being married, specific surgeons, carpal tunnel release, AO type C fractures, and greater catastrophic thinking were associated with increased distance to palmar crease at suture removal. At 6 weeks, greater catastrophic thinking was the only factor associated with increased distance to palmar crease. Conclusions: Catastrophic thinking was a consistent and major determinant of finger stiffness at suture removal and 6 weeks after injury. Future research should assess if treatments that ameliorate catastrophic thinking can facilitate recovery of finger motion after operative treatment of a 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

The impact of psychological factors on outcome after salvage surgery for wrist osteoarthritis. Swärd, E. M., Brodda-Jansen, G., Schriever, T. U., Andersson-Franko, M. and Wilcke, M. K. (2022) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Prognostic Topic: Salvage surgery for wrist osteoarthritis - The role of pain catastrophising This is a retrospective study assessing the association between psychological variables and disability in participants undergoing salvage surgery for wrist osteoarthritis (OA). A total of 79 participants with wrist OA were included in the study. Psychological variables included pain catastrophising, anxiety, and depression. Disability was measured through the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire at 6 and 12 months post surgery. The results showed that greater pain catastrophising and anxiety were associated with worse disability after surgery. 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, pain catastrophising and anxiety are associated with recovery following salvage surgery for wrist OA. This study is in line with previous research showing that pain catastrophising explains a large proportion of pain intensity in people with thumb OA, distal radius fracture, and upper limb fractures. Open access URL: https://doi.org/10.1177/17531934221104603 Abstract This prospective longitudinal study of 80 patients analysed the effect of preoperative pain catastrophizing, anxiety, depression and sense of coherence on the Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation, quality of life, grip strength and range of motion during the first year after salvage surgery for wrist osteoarthritis. Generalized estimating equations were used to analyse the effect of the psychological factors on the outcome variables. Pain catastrophizing or a tendency for anxiety preoperatively had a strong negative impact on postoperative Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation. Anxiety also predicted a lower postoperative quality of life, whereas pain catastrophizing had a negative impact on grip strength. Sense of coherence did not influence the 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

The impact of smoking on delayed osseous union after arthrodesis procedures in the hand and wrist. Foster, B. K., et al. (2022) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Hand arthrodesis – Smoking and non-union This is a retrospective study assessing the effect of smoking on non-union following upper limb arthrodesis. A total of 306 participants were included in the study. Of these, 73 (24%) were smokers. Participants were included if they underwent arthrodesis of wrist/carpometacarpal/metacarpalphalangeal/interphalangeal surgery. Non-union was assessed radiographically at 3 months. Symptomatic non-union was defined as the need for further surgery to correct the non-union. The statistical analyses took into account demographic, comorbidity, and affected joints information to reduce the contribution of confounding factors to the overall results. The results showed that smoking and non-smoking participants presented non-union rates of 27% and 14% of cases respectively. Symptomatic non union was present in 15% and 6% of smokers and non-smokers respectively. Overall, smokers had twice the odds of having non-union or symptomatic non-union compared to non-smokers. One limitation of this study was that there is no information regarding the blinding of the assessors determining union/non-union on x-rays. 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, smoking increases the risk of lateral epicondylalgia, post-surgical infections, arthrodesis non-union, and other complications (e.g. re-operation) following distal radius fracture. We should always offer our clients advice to quit smoking. URL: https://doi.org/10.1016/j.jhsa.2022.05.016 Abstract Purpose: The purpose of this study was to evaluate the relationship between smoking and delayed radiographic union after hand and wrist arthrodesis procedures. We hypothesized that smoking would be associated with a higher rate of delayed union. Methods: All cases of hand or wrist arthrodesis procedures in patients aged ≥18 years from 2006 to 2020 were identified. Cases were included if they had >90 days of radiographic follow-up or evidence of union before 90 days. Baseline demographics were recorded for each case including smoking status at the time of surgery. Complications were recorded and all postoperative radiographs were reviewed to assess for evidence of delayed union (defined as lack of osseous union by 90 days after surgery). We compared active smokers and nonsmokers and performed a logistic regression analysis to estimate the odds of experiencing a delayed radiographic union. Results: A total of 309 arthrodesis cases were included and 24% were active smokers. Overall, radiographic evidence of a delayed union was found in 17% of cases. Smokers were significantly more likely to have a delayed union compared with nonsmokers (27% vs 14%). Results of the adjusted logistic regression analysis demonstrated that there was a significantly increased odds of experiencing a delayed union for patients who were active smokers compared with nonsmokers (odds ratio, 2.20; 95% confidence interval, 1.09–4.43). In addition, the rate of symptomatic nonunion requiring reoperation was higher in smokers (15%) compared with nonsmokers (6%). Conclusions: Smoking was associated with increased odds of delayed radiographic union in patients undergoing hand and wrist arthrodesis procedures. Patients should be counseled appropriately on the risks of smoking on bone healing and encouraged to abstain from nicotine use in the perioperative period. 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

Blood flow restriction resistance training in tendon rehabilitation: A scoping review on intervention parameters, physiological effects, and outcomes. Burton, I. and McCormack, A. (2022) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Blood flow restriction training - Tendinopathies This is a scoping review of studies implementing blood flow restriction (BFR) training in participants with tendinopathies and healthy tendons. A total of 13 studies were included, 10 were completed in people with healthy tendons whilst three in people with tendinopathy. Blood flow restriction was compared to high-intensity resistance training. The interventions were targeted at the upper limb or lower limb. The results showed that both BFR and high-intensity training were useful in providing positive changes within healthy tendons. When BFR training was applied to people with tendinopathy, this induced improvements in muscle strength, function, and pain. 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, BFR induces positive changes in healthy tendons to a similar extent to what traditional high-intensity training provides. This form of low-load resistance training can be implemented in those people with irritable tendinopathies who cannot cope with high levels of exercise intensity. In addition to this scoping review, there is some initial evidence that BFR can be utilised in people with tennis elbow and it appears to provide better outcomes in terms of functional recovery compared to the same exercises without BFR. URL: https://doi.org/10.3389/fspor.2022.879860 Abstract Objective: To identify current evidence on blood flow restriction training (BFRT) in tendon injuries and healthy tendons, evaluating physiological tendon effects, intervention parameters, and outcomes. Methods: This scoping review was reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Databases searched included MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, Cochrane library (Controlled trials, Systematic reviews), and five trial registries. Two independent reviewers screened studies at title/abstract and full text. Following screening, data was extracted and charted, and presented as figures and tables alongside a narrative synthesis. Any study design conducted on adults, investigating the effects of BFRT on healthy tendons or tendon pathology were included. Data were extracted on physiological tendon effects, intervention parameters and outcomes with BFRT. Results: Thirteen studies were included, three on tendinopathy, two on tendon ruptures, and eight on healthy Achilles, patellar, and supraspinatus tendons. A variety of outcomes were assessed, including pain, function, strength, and tendon morphological and mechanical properties, particularly changes in tendon thickness. BFRT intervention parameters were heterogeneously prescribed. Conclusion: Despite a dearth of studies to date on the effects of BFRT on healthy tendons and in tendon pathologies, preliminary evidence for beneficial effects of BFRT on tendons and clinical outcomes is encouraging. As BFRT is a relatively novel method, definitive conclusions, and recommendations on BFRT in tendon rehabilitation cannot be made at present, which should be addressed in future research, due to the potential therapeutic benefits highlighted in this review. 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

Upper-extremity blood flow restriction: The proximal, distal, and contralateral effects. A randomized controlled trial. Bowman, E., Elshaar, R., Milligan, H., Jue, G., Mohr, K., Brown, P., Watanabe, D., & Limpisvasti, O. (2020) Level of Evidence: 1b- Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic: Resistance training - Blood flow restriction training This is a randomised single-blind controlled trial assessing the effectiveness of blood flow restriction (BFR) training on grip strength and forearm circumference in healthy participants. Participants (N = 24) were young (26±3.4 years old) recreational athletes. Participants were excluded if they had a history of upper limb pathology, blood clot, cardiovascular disease, or hypertension (systolic/diastolic 140/90 mmHg). Grip strength was measured through a hand held dynamometer and forearm circumference was measured through a standard measuring tape 10 cm distal to medial epicondyle. Treatment allocation was randomised and the assessor was blinded to treatment allocation. Participants were provided with either low intensity BFR training (n = 14) or low intensity training (n = 10). Participants trained twice a week for six weeks in both groups. During each session participants performed shoulder external rotation in side lying, prone shoulder horizontal abduction, triceps extensions in supine, shoulder internal rotation in standing with a pulley, and biceps curls in forearm supination. At each session, 4 sets of 30, 15, 15, 15 repetitions were completed for each exercise. An interset rest of 30 seconds was provided. Participants started to exercise at an intensity of 30% of 1-repetition maximum identified at baseline. The training weight was modified at each session to maintain the rate of perceived exertion (RPE) at 7-8/10. While exercising, the BFR group wore a pressure cuff (10cm wide) inflated at 60% of arterial occlusion around their proximal arm. The pressure cuff was worn on one upper limb only, although the exercises were performed bilaterally. The cuff was inflated for the whole duration of the session. The results showed that the BFR group improved to a significant greater level in grip strength (10%±2) and forearm circumference (4.2%±0.8) compared to the control group (grip strength: -3%±3; forearm circumference: 1.4%±0.9). The authors report no differences in RPE between groups, although the overall exercise volume for both exercise groups was not reported. This would have been useful to explain the differences 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, we may utilise BFR training when the aim of the intervention is to increase muscle strength and high exercise intensities are contraindicated. This regime appears to provide greater strength gains when compared to traditional low-intensity exercises. URL: https://doi.org/10.1016/j.jse.2020.02.003 Abstract Background: Blood flow restriction (BFR) training with low weight is purported to induce similar physiological changes to high-weight regimens with the benefit of less tissue stress. We hypothesized that low-weight training with BFR would produce increased gains in strength and hypertrophy for muscle groups proximal, distal, and contralateral to tourniquet placement compared with low-weight training alone. Methods: In this prospective, randomized controlled trial, healthy subjects were randomized into a 6-week low-weight training program either with or without BFR on 1 extremity. Outcome measures included limb circumference and strength. Comparisons were made between the BFR and non-BFR extremities, BFR and control groups, and non-BFR extremity and control groups. Results: A total of 24 subjects (14 BFR and 10 control subjects) completed the protocol. Significantly greater gains were observed in dynamometric strength both proximal (shoulder scaption [30% greater], flexion [23%], and abduction [22%]) and distal (grip strength [13%]) to the tourniquet in the BFR limb compared with both the non-BFR extremity and the control group (P < .05). Arm and forearm circumferences significantly increased in the BFR limb compared with the non-BFR limb and control group (P = .01). The non-BFR extremity demonstrated greater grip strength than the control group (9%, P < .01). No adverse events were reported. Conclusion: Low-weight BFR training provided a greater increase in strength and hypertrophy in the upper-extremity proximal and distal muscle groups compared with the control group. The non-BFR extremity showed a significant increase in grip strength compared with the control group, indicating a potential systemic effect. 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

Low-load resistance training with blood flow restriction is effective for managing lateral elbow tendinopathy: A randomized, sham-controlled trial. Karanasios, S., et al. (2022) Level of Evidence: 1b- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Blood flow restriction training - Tennis elbow This is a randomised single-blind controlled trial assessing the effectiveness of blood flow restriction (BFR) training in people with tennis elbow. Participants (N = 46) were middle-aged (mean range: 43-47 years old) and had been having pain for 6 weeks (median). Tennis elbow diagnosis was made based on the presence of pain at the lateral epicondyle, positive Mill's and/or Cozen's and/or Maudsley's test. Participants were excluded if they had a history of upper limb pathology, blood clot, cardiovascular disease, cancer, or hypertension (systolic/diastolic 140/90 mmHg). A series of exercises were delivered over the course of six weeks and included, but were not limited to, wrist extension/flexion. Exercises were performed with either BFR (50% of arterial occlusion) or with sham BFR (less than 20% of arterial occlusion). Participants attended two sessions per week. Primary outcomes included pain, function, pain-free grip strength, and the global rate of change (from much worse to completely recovered). The results showed that pain, function, and pain-free grip strength improved to a statistically significant larger extent in the BFR group compared to the sham BFR. Only function and pain-free grip strength improved to a clinically relevant level. In addition, 80% of participants reported being at least "much better" in the BFR compared to 50% in the sham BFR. 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, low-load BFR exercises provide greater improvements compared to low-load exercises without BFR. BFR training leads to clinically relevant improvements in function and pain-free grip strength. BFR may be particularly appropriate in those people with high levels of pain intensity or irritability. If you would like to deliver BFR to your clients, you may be interested in using the BFR pressure calculator that I have created! URL: https://doi.org/10.2519/jospt.2022.11211 Abstract Objective: To evaluate the effect of low-load resistance training with blood flow restriction (LLRT-BFR) when compared to LLRT with sham-BFR in patients with lateral elbow tendinopathy (LET). Design: Randomized controlled trial Methods: Forty-six patients with LET were randomly assigned to a LLRT-BFR or a LLRT with sham-BFR treatment group. All patients received soft tissue massage, supervised exercises with BFR or sham-intervention (twice a week for six weeks), advice and a home exercise programme. The primary outcome measures were pain intensity, patient-rated tennis elbow evaluation (PRTEE) score, pain-free grip strength (PFGS) and global rating of change (GROC), measured at baseline, 6 weeks, and 12 weeks. Between-group differences were evaluated using mixed-effects models with participant-specific random effects for continuous data. GROC was analysed using logistic regression. Results: Statistically significant between-group differences were found in favor of LLRT-BFR compared to LLRT with sham-BFR in pain intensity at 12-weeks (-1.54, 95%CI:-2.89 to -0.18; p=0.026), PFGS ratio at 6-weeks (0.20, 95%CI:0.06 to 0.34; p=0.005) and PRTEE at 6- and 12-weeks (-11.92, 95%CI:-20.26 to -3.59; p=0.006 and -15.23, 95%CI:-23.57 to -6.9; p<0.001, respectively) follow-up. At 6- and 12-weeks, patients in the LLRT-BFR group had greater odds of reporting complete recovery or significant improvement (OR=6.0, OR=4.09, respectively). Conclusion: LLRT-BFR produced significantly better results compared to the LLRT with sham-BFR for all primary outcomes. Considering the clinically significant between-group improvement in function (>11 points in PRTEE) and the better success rates in the LLRT-BFR group, this intervention may improve recovery in LET. 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