Search Results

Clinical outcomes following surgical management of post-traumatic elbow contractures in the pediatric age group: A meta-analysis and systematic review. Onggo, J. R., Chua, N. S. H., Onggo, J. D., Wang, K. K. and Ek, E. T. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Therapeutic Topic: Pediatric post-traumatic elbow stiffness - effect of surgery This systematic review and meta-analysis assessed the effect of surgical management of post-traumatic elbow contractures in pediatric patients under 18 years old. A total of 13 papers were included in the present review. The results showed that overall surgical interventions were effective in improving range of motion. On average there was an improvement of 50deg in elbow e/f and 20def for supination/pronation. The results also highlighted that older children, those with radial head fractures, and individuals undergoing open releases tended to experience greater improvements in motion. 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, surgical management of pediatric elbow contractures has shown to be effective in improving range of motion in both flexion-extension and prono-supination by an average of 50 and 20 deg on average. It appears that older children, those with radial head fractures, and patients undergoing open releases are more likely to experience greater improvements post-operatively. Such improvements in elbow range of movement are very important because we have evidence suggesting that elbow stiffness is associated with greater mental health burden in our patients. If you are interested in determining which other factors contribute to improvement in elbow ROM post surgery for post-traumatic stiffness, have a look at this synopsis. URL: https://doi.org/10.1016/j.jhsa.2024.01.010 Abstract Purpose: Post-traumatic elbow stiffness is a common occurrence resulting in potentially substantial functional limitations in both daily activities and recreational endeavors. In children, this can be particularly difficult given the early stages of childhood and development and the challenges of rehabilitation. Several studies have reported favorable results of elbow contracture releases in children, resulting in improvements in outcomes. This meta-analysis aimed to determine the efficacy and safety of elbow contracture releases in the pediatric population (<18 years), along with subgroup analyses comparing age groups, operative approach, and post-traumatic versus nontraumatic etiologies. Methods: Meta-analysis was performed with a multidatabase search (PubMed, OVID, EMBASE, and Medline) according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines on September 25, 2020. Data from all published literature meeting inclusion criteria were extracted and analyzed. Results: Seven studies were included, comprising 114 post-traumatic elbow contractures. Mean age was 13.7 years. Contracture releases of the elbow led to improvements in flexion-extension arc of motion by 48º, and pronosupination arc of motion by 22º. Subgroup analysis comparing age groups of <10, 10–14 and 15–18 years showed greater improvements in flexion-extension arc in the older age group, whereas subgroup analysis comparing injury patterns revealed a larger improvement in pronosupination motion for radial head fractures. Comparing open and arthroscopic procedures, open releases had greater improvement in both flexion-extension and pronosupination motion by 18º and 21º, respectively, although there were limited patients in the arthroscopy group. Conclusion: Operative management of pediatric elbow contractures is effective. Older children, children with radial head fractures, and those receiving open contracture releases may be more likely to have greater improvements. 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

Four-corner fusion versus proximal row carpectomy for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist: A systematic review and meta-analysis. Hones, K. M., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 👍 (4/4 thumbs up) Type of study: Therapeutic Topic: SLAC and SNAC wrist – 4CF vs proximal row carpectomy This systematic review and meta-analysis compared Proximal Row Carpectomy and Four-Corner Fusion (4CF) in treating scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists. A total of 61 studies were included. Amongst these studies, only three were randomised controlled trials. The resultsh showed that Proximal Row Carpectomy showed significantly better postoperative outcomes in terms of extension, ulnar deviation, pain scores, and lower complication rates compared to 4CF. 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, Proximal Row Carpectormy demonstrated superior outcomes in terms of range of movement, pain, and number of complications compared to 4CF for SNAC and SLAC wrists. These results appear to be similar to what has been shown when trapeziectomy vs other interventions have been compared for the treatment of thumb OA. Other interventions available for SLAC and SNAC wrist include denervation. You can find more about this topic in this snopsis. URL: https://doi.org/10.1016/j.jhsa.2024.01.011 Abstract Purpose: Although proximal row carpectomy (PRC) has increasingly been shown to have superior features to four-corner fusion (4CF), individual surgeons may remain convinced of the superiority of one procedure based on personal experience and individual biases. Hence, we sought to perform an updated meta-analysis with some of the largest studies to date to compare outcomes and complications between these procedures in the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists. Methods: A systematic review and meta-analysis was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane were queried for articles on PRC and 4CF performed for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist. Primary outcomes included wrist range of motion; grip strength; outcome measures, including Disabilities of Arm, Shoulder, and Hand and Quick Disabilities of Arm, Shoulder, and Hand scores, Patient-Rated Wrist and Hand Evaluation, and visual analog scale pain scores; and surgical complications. Results: Sixty-one studies reported on 3,174 wrists, of which 54% were treated with PRC and 46% were treated with 4CF. The weighted mean follow-up was 61 months (range, 12–216 months). Meta-analysis comparing PRC and 4CF demonstrated that PRC had significantly greater postoperative extension; ulnar deviation; postoperative improvement in extension, flexion, ulnar deviation; and visual analog scale score. No comparisons showed significant differences in grip strength. The percentage of wrists requiring arthrodesis was 5.2% for PRC and 11% for 4CF. There was an 8.9% (57/640 wrists) 4CF nonunion rate and 2.2% (17/789) hardware removal rate after 4CF. Conclusions: In the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists, PRC results in better outcomes and a lower complication rate compared to 4CF. 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

In-house 3D-printed custom splints for non-operative treatment of distal radial fractures: A randomized controlled trial. Guebeli, A., Thieringer, F., Honigmann, P. and Keller, M. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Distal radius fracture – 3D-printed splints This randomised controlled trial compared patient satisfaction and effectiveness of 3D-printed custom splints to conventional fiberglass casts in treating distal radial fractures. A total of 39 participants were included. To be suitable for inclusion, participants had to present with a minimally displaced distal radius fracture. Participants were randomised to either 3D-printed splints, created using digital light processing technology, or traditional fiberglass casting. Participants in both groups were immobilisation for 6 weeks. The study showed that 3D-printed splints were well tolerated and effective, although complications (e.g. pressure sores, temporary paraesthesias) were twice as likely compared to fiberglass casting. These new 3D-printed splints may be useful for young and active patients. 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, 3D-printed splints may present a safe alternative to conventional fiber glass casts, especially for non-operative treatment of distal radial fractures in young, active patients. However, it is important to keep in mind that at this point in time, they are more likely to be associated with pressure sores and transient numbness/P&N/Tingling. If you are interested in knowing what other complications may be associated with distal radius fractures, especially when ORIFed, have a look at this synopsis. URL: https://doi.org/10.1177/17531934231187554 Abstract We compared patient satisfaction and clinical effectiveness of 3D-printed splints made of photopolymer resin to conventional fibre glass casts in treating distal radial fractures. A total of 39 patients with minimally displaced distal radius fractures were included and randomized. Of them, 20 were immobilized in a fibre glass cast and 19 in a 3D-printed forearm splint. The 3D-printed splints were custom-designed based on forearm surface scanning with a handheld device and printed in-house using digital light processing printing technology. Patient satisfaction and clinical effectiveness were assessed with questionnaires 1 and 6 weeks after the initiation of immobilization. Fracture healing, pain, range of motion, grip strength and the DASH and PRWE scores were assessed up to 1-year follow-up. 3D-printed splints proved to be equally well tolerated by the patients and equally clinically effective as conventional fibre glass casts although there was a higher rate of minor complications. 3D-printed splints present a safe alternative, especially in young, active patients, for non-operative treatment of distal radial 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

Treatment of trigger finger with metacarpophalangeal joint blocking orthosis vs relative motion extension orthosis: A randomized clinical trial. Yendi, B., Atilgan, E., Namaldi, S. and Kuru, C. A. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Trigger finger conservative treatment - mcpj vs RME splint This randomised trial assessed the effectiveness of two orthoses, mcpj blocking splint and Relative Motion Extension (RME) splint, in the treatment of trigger finger. A total of 30 participants were included in the study. Participants were asked to wear the splint for 6 weeks. The results showed that participants in each group reported clinically relevant improvements in pain and function. There were some statistically significant differences between groups, however, they were not clinically relevant. 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, mcpj block and RME splints are both effective for the treatment of trigger finger. Considering that both interventions had similar outcomes, patient preferences, occupation, and specific characteristics, such as which splint is the most comfortable and appears to reduce triggering the most, can be considered. If you would like to read more about trigger finger, have a look at the database on this topic. URL: https://doi.org/10.1016/j.jht.2023.10.008 Abstract Background: The metacarpophalangeal joint blocking orthosis (MCPJ-BO) is one of the first-line orthotic treatment for patients with trigger finger (TF). Relative motion extension orthosis (RME-O) has recently emerged as a treatment option for various hand disorders involving TF. Purpose: The primary objective of this study was to compare the effectiveness of 6 weeks of orthotic treatment with the MCPJ-BO and the RME-O for pain relief. Function and satisfaction with the orthosis were assessed as secondary objectives. Study design Randomized clinical study. Methods: Thirty patients with an average age of 50 years with Froimson stage 1-3 A1 pulley triggering participated in the study. They were randomly assigned to either the MCPJ-BO (n = 15; 10 females, five males) or the RME-O group (n = 15; 12 females, three males). The orthoses were worn full time for 6 weeks. All patients received patient education, activity modification, and flexor tendon gliding exercises as part of the rehabilitation program. Pre- and post-assessments included Numeric Pain Rating Scale, Disability of the Arm, Shoulder, and Hand questionnaire, and Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire. The Mann-Whitney U test was conducted to analyze the difference between the two groups. Results: There were no significant differences between the two groups in pain and function before treatment (p < 0.05). Within-group comparisons indicated that both orthoses relieved pain, but the MCPJ-BO group achieved greater pain relief (p = 0.001). There was a significant improvement in function in the MCPJ-BO group, with a mean change of 12.7 (p = 0.0001). The overall success rates for the MCPJ-BO group and RME-O group were 60% and 27%, respectively. Patients in both groups had high satisfaction with the orthosis. Conclusions: MCPJ-BO and RME-O could be used for pain relief in the treatment of TF. The MCPJ-BO appears to be more effective than the RME-O in improving function. 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 analysis of the distal radioulnar joint ballottement test. Nagashima, M., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: DRUJ Ballottement test - Validity and reliability This diagnostic study assessed the reliability and validity of the Distal Radioulnar Joint (DRUJ) Ballottement Test, used to assess DRUJ instability caused by TFCC injuries. The research aimed to evaluate the test's accuracy and reliability. A total of 25 healthy participants and 8 participants with TFCC injuries were included. The test was validated against a device that tracked DRUJ volar and dorsal movement. The results showed that the test was reliability, and valid when assessing DRUJ instability. It is important to remember that in this study there was no mention to the blinding of surgeons completing the test. 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 DRUJ Ballottement Test, particularly with the holding technique, has been shown to have good reliability and validity for the assessment of TFCC injuries. This test can effectively quantify DRUJ movement and identify mild to moderate instability. It's great to see that there is more research assessing diagnostic tests for the hand and upper limb as we have had a paucity of them up until this point in time. URL: https://doi.org/10.1016/j.jhsa.2023.10.006 Abstract Purpose: Triangular fibrocartilage complex injuries can cause distal radioulnar joint (DRUJ) instability, which can be evaluated clinically with the DRUJ ballottement test. However, the reliability and validity of the test are unclear. This study aimed to analyze the reliability and validity of the test using a tracking device on healthy participants and patients with triangular fibrocartilage complex injuries. Methods: In this cross-sectional study, three orthopedic hand surgeons performed the DRUJ ballottement test using a technique of holding the carpal bones to the radius on 25 healthy participants (50 hands; 10 men and 15 women; mean age, 33 years; range, 20–51 years) and eight patients with triangular fibrocartilage complex injuries (16 hands; six men and two women; mean age, 43 years; range, 27–59 years). We used a three-dimensional electromagnetic tracking device to quantify the movement of the DRUJ and verify the reliability and validity of the test. Results: The intrarater and interrater intraclass correlation coefficients for DRUJ movement were 0.77 and 0.61, respectively, and the kappa coefficient for grading of DRUJ instability was 0.79. The correlation coefficient between DRUJ movement measured using the tracking device and instability judged clinically was 0.77. A comparison of healthy participants and the patients showed significantly greater DRUJ movement in the patients. Conclusions: The test showed substantial intrarater and interrater reliability for assessing DRUJ movement and instability. The significant positive correlation between DRUJ movement and instability indicates the concurrent validity of the test. Moreover, the test showed discriminative validity in identifying mild or moderate DRUJ instability. Clinical relevance: The DRUJ ballottement test using the holding technique has a relatively high diagnostic accuracy and can be used to assess DRUJ instability. 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

Recommendations for radiographic assessment of hand wounds. Druel, T., Jalaguier, T., Gaillard, C. and Gazarian, A. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic: Hand infections – x-ray This retrospective analysis of 945 hand patients focused on the importance of using radiographic assessment in selected cases of hand wounds. The study found that 34% of the cases reviews presented with radiopaque foreign bodies, which were not visible during objective examination. Different mechanisms of injury were categorized, with higher rates of positive radiographic findings seen in cases of high-energy trauma, crushing, avulsion, and falls. Furthermore, x-ray assessment may be required in those patients who had a puncture/laceration obtained through objects that are likely to fragment (e.g. kina/sea urchins). A combined approach with ultrasound has also been suggested to help with the diagnosis. 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, 34% of hand wound cases may present with radiopaque foreign bodies, especially when high-energy trauma, crushing injuries, avulsions, and falls were the mechanism of injury. This article is in line with previous expert opinions suggesting that X-rays and US are the primary investigations to be utilised if suspecting an infection. If you would like to have a look at a case study on the topic, read this synopsis. URL: https://doi.org/10.1177/17531934231211566 Abstract A retrospective study of 945 hand patients was conducted to determine the relevance of systematic radiographic assessment. An osteoarticular lesion or a radiopaque foreign body was found in 34% of cases. The indications for radiographic assessment should be related to the mechanism of injury. 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

Pre-operative hand therapy management of Dupuytren’s disease: A systematic review. Fernando, J. J., et al. (2024) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Dupuytren – Splinting and other interventions This systematic review focused on the non-surgical treatments for Dupuytren's Disease, including extracorporeal shockwave therapy, corticosteroid injection, splinting, massage, stretching, ultrasound therapy, and temperature controlled high energy adjustable laser. A total of 17 studies were included in the present study. For splinting, three studies were included, one of which was an RCT and the others were case studies. Overall, there was a positive effect of conservative treatments for pain, range of motion, grip strength, and Disabilities of the Arm Shoulder Hand scores in individuals with Dupuytren's Disease. Splinting for three months appeared to improve range of movement of the pipj between 10 and 25 degrees. 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, non-surgical interventions can improve ROM and function in patients with Dupuytren's disease. These interventions include splinting and they may need to be applied for three months to see significant improvements. More invasive interventions include surgery or needle fasciectomy. URL: https://doi.org/10.1177/17589983241227162 Abstract Introduction: Dupuytren’s Disease is a fibroproliferative disorder of the hand, with a heterogenous pathogenesis, ranging from early-stage nodule development to late-stage digital contractures. Hand therapy intervention is not routinely provided pre-operatively. The objective of this systematic review was to explore the efficacy of hand therapy interventions provided for pre-operative Dupuytren’s Disease. Methods: A systematic review was undertaken of the databases CENTRAL, CINAHL, OVID Medline and OVID EMBASE, PubMed, BNI, Web of Science, with grey literature and reference searches conducted from database inception to April 2022, and confirmed in August 2023. Included studies required non-surgical intervention and outcome data on individuals with Dupuytren’s Disease who have not had surgical intervention. Two reviewers conducted the searches, independently assessed eligibility and completed methodological quality assessments. Data were summarised narratively. Results: Seventeen studies were selected for final inclusion. Interventions included Extracorporeal Shockwave Therapy (ESWT), Corticosteroid Injection (CSI), Splinting, Massage and Stretching, Ultrasound Therapy (US), Temperature Controlled High Energy Adjustable Laser (THEAL). ESWT positively maintained or improved pain, active range of motion (AROM), Disabilities of the Arm Shoulder, and Hand (DASH) scores, and grip strength. US positively maintained or improved ROM and grip. Splinting positively maintained or improved ROM, CSI positively improved nodule size. Cross Frictional Massage positively impacted AROM and THEAL improved pain and DASH scores. Conclusions: Outcomes from therapeutic interventions for pre-operative management of Dupuytren’s Disease were largely positive. However, there is a need for further high-quality research into these interventions to understand their full potential for the management of Dupuytren’s Disease. 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

Trapezium tunnel syndrome. Afshar, A., Tabrizi, A. and Shariyate, M. J. (2024) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic: Trapezium Tunnel Syndrome - Diagnosis and treatment This expert opinion discusses trapezium tunnel syndrome, a condition involving flexor carpi radialis tendinopathy and peritendinitis leading to complications like tendon rupture and ganglion cyst formation in the wrist. It emphasizes the anatomical relationship of the trapezium bone and the flexor carpi radialis tendon within a fibro-osseous tunnel. Intrinsic and extrinsic factors contribute to the syndrome, which is often overlooked due to other causes of radial side wrist pain. Detection and diagnosis are vital to prevent complications, and various imaging techniques such as US and MRI can be utilised. Treatment options range from non-surgical interventions like immobilisation and corticosteroid injections to surgical decompression, though the latter poses risks such as damaging the palmar cutaneous branch of the median nerve. 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, trapezium tunnel syndrome may coexist with other wrist pathologies, such as carpal tunnel syndrome and/or 1st cmcj OA, and it should be part of our differential diagnosis. Conservative interventions, such as immobilisation followed by gradual loading could be trialed followed by CSI or surgery if these are ineffective. US imaging and x-rays may be useful in differentiating between trapezium tunnel syndrome, carpal tunnel syndrome, and 1st cmcj OA. URL: https://doi.org/10.1016/j.jhsa.2023.10.014 Abstract The trapezium tunnel is situated on the lateral side of the carpal tunnel, lined with synovial tissue, and accommodates the flexor carpi radialis tendon. Trapezium tunnel syndrome is characterized by flexor carpi radialis tendinitis/peritendinitis and may lead to complicated clinical scenarios, such as flexor carpi radialis tendon rupture and the formation of primary or recurrent ganglion cysts on the volar radial side of the wrist and thenar area. Notably, the simultaneous presence of trapezium tunnel syndrome might contribute to unsuccessful outcomes in carpal tunnel surgeries. Trapezium tunnel syndrome may arise from either intrinsic or extrinsic factors. The entity of trapezium tunnel syndrome has attracted a low index of clinical suspicion because the other causes of radial side wrist pain that are more prevalent and frequent. We present a narrative review of this condition in an endeavor to heighten awareness and clinical suspicion of trapezium tunnel syndrome. 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

Time-dependent change in carpal tunnel cross-sectional area and transverse carpal ligament thickness using serial magnetic resonance imaging studies: An anatomical study. Hinckley, N. B., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Aetiologic Topic: Carpal tunnel - Size and thickness over time This longitudinal study investigated changes in carpal tunnel area and transverse carpal ligament thickness over time in patients with carpal tunnel syndrome (CTS). A total of 56 participants with MRI imaging, which was repeated 5 years apart were included in the study. Results showed a decrease in carpal tunnel are and an increase in ligament thickness over time. No factors like sex, age, and medical history were associated with these changes. It is important to keep in mind that this study did not include a control group. We are therefore not sure whether these changes occur solely in people with CTS or in healthy people as well. 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 area and transverse carpal ligament thickness change over time in people with carpal tunnel syndrome. It is unknown whether similar changes occur in people without carpal tunnel syndrome. It is however possible that these changes may worsen symptoms in people who are already suffering from this condition. Unfortunately, the study did not report associations between symptoms and anatomical changes. Considering the genetic contribution to carpal tunnel syndrome, it is possible that people affected by this condition are more likely to have a greater rate of carpal tunnel and ligament thickness changes over time or that they start with an already narrower tunnel or thicker ligament, which is more likely to cause their symptoms. URL: https://doi.org/10.1016/j.jhsa.2023.10.010 Abstract Purpose: Idiopathic carpal tunnel syndrome (CTS) is a common compressive neuropathy. Aging and female sex are risk factors, but the reasons are unclear. The purpose of this study was to evaluate whether identifiable radiographic changes resulting in a decrease in carpal tunnel area (CTA) over time exist. Methods: A database search of a multicenter, academic, tertiary institution from 1998 to 2021 identified 433 patients with serial wrist magnetic resonance images (MRI) at least 5 years apart. Fifty-six met the inclusion criteria with adequate films to measure CTA and transverse carpal ligament (TCL) thickness at the same slice location—the carpal tunnel inlet, hook of the hamate, and carpal tunnel outlet—independently by two observers who were blinded to each other’s measurements. Rates for the change in CTA and TCL thickness were calculated at all three locations. Results: Thickness of the TCL increased, whereas that of the CTA decreased over time. Inlet CTA decreased by 0.9 mm2 per year (95% CI: 0.34–1.5), outlet CTA decreased by 1.8 mm2 per year (95% CI: 1.2–2.5), and CTA at the hook of the hamate decreased by 1.6 mm2 per year (95% CI: 1.0–2.0 per year). The TCL thickened by 0.02 mm per year at all three sections. Taller patients had a decreased rate of CTA loss. Conclusions: In this select cohort, TCL thickened and CTA decreased with time. TCL thickening accounted for about half of the variation in CTA, suggesting that this is a possible contributor to this change. Hypertrophy of the carpal tunnel floor may account for the remaining variation in CTA. The question of whether these results are reliable and generalizable to the general population, or a major influence in the pathophysiology of CTS, is unknown. Clinical relevance: Small decreases in CTA and thickening of the TCL occur with aging. Whether this is a contributing factor in the development of CTS requires further study. 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

Optimising physiotherapy for people with lateral elbow tendinopathy – Results of a mixed-methods pilot and feasibility randomised controlled trial (OPTimisE). Bateman, M., et al. (2024). Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Lateral epicondylalgia – Personalised treatment This randomised feasibility controlled study focused on optimising physiotherapy for lateral elbow tendinopathy (LE) using the OPTimisE intervention and comparing it to usual care. The OPTimisE treatment included condition specific information, the use of a commercial digital grip dynamometer that patients could use at home, and a counterforce brace. The usual care group received general advice on the condition, exercise did not follow a precise prescription, and no splinting was provided. A total of 50 participants in the UK were recruited. Outcomes included upper limb subjective function and objective measures such as pain free grip strength and time off work. The results showed that both patients and physiotherapists found these intervention acceptable. There were no between groups differences on pain, function, or objective measurements and all participants 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, the OPTimisE intervention or usual care provide similar outcomes for people with lateral elbow pain due to a common extensor tendinopathy. If you would like to have a wider view of what treatments have been assessed in research settings for lateral epicondylalgia, have a look at the whole dataset which now contains more than 45 articles on the topic. URL: https://doi.org/10.1016/j.msksp.2023.102905 Abstract Background: The OPTimisE intervention was developed to address uncertainty regarding the most effective physiotherapy treatment strategy for people with Lateral Elbow Tendinopathy (LET). Objectives To assess the feasibility of conducting a fully-powered randomised controlled trial (RCT) evaluating whether the OPTimisE intervention is superior to usual physiotherapy treatment for adults with LET. Design: A mixed-methods multi-centred, parallel pilot and feasibility RCT, conducted in three outpatient physiotherapy departments in the UK. Method: Patients were independently randomised 1:1 in mixed blocks, stratified by site, to the OPTimisE intervention or usual care. Outcomes were assessed using pre-defined feasibility progression criteria. Results: 50 patients were randomised (22 Female, 28 Male), mean age 48 years (range 27–75). Consent rate was 71% (50/70), fidelity to intervention 89% (16/18), attendance rate in the OPTimisE group 82% (55/67) vs 85% (56/66) in usual care, outcome measure completion 81% (39/48) at six-month follow-up. There were no related adverse events. Patients and physiotherapists reported that the OPTimisE intervention was acceptable but suggested improvements to the trial design. 49 patients were recruited from physiotherapy referrals vs one from primary care records. Outcome measure return rates were higher when completed online (74%) compared to postal questionnaire (50%). Exploratory analysis showed improvements in both groups over time. Conclusions: It is methodologically feasible to conduct a fully powered RCT comparing the clinical and cost-effectiveness of the OPTimisE intervention versus usual physiotherapy treatment. Considering the similar improvements observed in both groups, careful consideration is needed regarding the priority research question to be addressed in future research. 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 scoping review to map evidence regarding key domains and questions in the management of non-traumatic wrist disorders. Mitchell, T., et al. (2023). Level of Evidence: 4 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic/Therapeutic Topic: Non-traumatic wrist conditions - Management and treatment The scoping review focused on mapping evidence regarding the diagnosis, management, pathways of care, and outcome measures for non-traumatic wrist disorders (NTWD) in the United Kingdom. An interdisciplinary team of clinicians and academic researchers conducted the review following specific guidelines and checklists, with input from a mixed stakeholder group of patients and healthcare professionals who identified 16 key research questions. The study found common diagnoses such as wrist pain, De Quervain’s syndrome, and ulna-sided pain, along with available best practice guidelines for some NTWD conditions, but noted substantial gaps in evidence throughout the patient journey. Various conservative management options and patient-reported outcome measures for NTWD were identified. The review emphasized the need for rigorous primary studies to address the identified evidence gaps and highlighted opportunities for further research and improvements in non-traumatic wrist disorder management. The text also discussed the importance of utilizing patient-reported outcomes to measure treatment effectiveness, exploring trends in musculoskeletal management towards patient-centered care and shared decision-making, and the limitations of pathoanatomical diagnosis in explaining pain and disability in non-traumatic conditions. 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, non-traumatic wrist disorders (NTWD) such as wrist pain, De Quervain’s syndrome, and ulna-sided pain are commonly encountered in clinical practice. The existing literature on NTWD highlights the use of subjective questioning, self-reported pain, palpation, and special tests for diagnosing these conditions. Unfortunately, few of these tests have gone through appropriate diagnostic accuracy assessment. As a way of compensating this lack of specific hand research, considering new trends in musculoskeletal management, such as patient-centered care and shared decision-making may be useful stategies may be useful strategies. This article also points out that pathoanatomical diagnosis may have limitations in explaining pain and disability in non-traumatic conditions, and other psychosocial factors should be taken into consideration. URL: https://doi.org/10.1177/17589983231219595 Abstract Introduction: Non-traumatic wrist disorders (NTWD) are commonly encountered yet sparse resources exist to aid management. This study aimed to produce a literature map regarding diagnosis, management, pathways of care and outcome measures for NTWDs in the United Kingdom. Methods: An interdisciplinary team of clinicians and academic researchers used Joanna Briggs Institute guidelines and the PRISMA ScR checklist in this scoping review. A mixed stakeholder group of patients and healthcare professionals identified 16 questions of importance to which the literature was mapped. An a-priori search strategy of both published and non-published material from five electronic databases and grey literature resources identified records. Two reviewers independently screened records for inclusion using explicit eligibility criteria with oversight from a third. Data extraction through narrative synthesis, charting and summary was performed independently by two reviewers. Results: Of 185 studies meeting eligibility criteria, diagnoses of wrist pain, De Quervain?s syndrome and ulna-sided pain were encountered most frequently, with uncontrolled non-randomised trial or cohort study being the most frequently used methodology. Diagnostic methods used included subjective questioning, self-reported pain, palpation and special tests. Best practice guidelines were found from three sources for two NTWD conditions. Seventeen types of conservative management, and 20 different patient-reported outcome measures were suggested for NTWD. Conclusion: Substantial gaps in evidence exist in all parts of the patient journey for NTWD when mapped against an analytic framework (AF). Opportunities exist for future rigorous primary studies to address these gaps and the preliminary concerns about the quality of the literature regarding NTWD. 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 relative motion flexion orthoses for chronic boutonniere deformity. Arslan, Ö. B., et al. (2022) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Relative motion flexion splint for chronic Boutonnière - Outcomes This retrospective study assessed the effectiveness of a relative motion flexion splint in treating chronic boutonniere deformity. The study included 28 patients with chronic boutonniere deformity. Chronic was defined as a duration more than four weeks. To be included, patients had also be able to achieve 0 degrees of pipj extension during the pencil test (see picture below). The orthosis was prescribed for full time wear (except for hand hygiene) for at least six weeks. The results showed that pipj extension improved by an average of 10 degrees and dipj flexion improved by 20 degrees. The average total wearing time for the splint was 12 weeks. 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, a relative motion flexion splint has been shown to be effective in improving active pipj extension and dipj flexion in patients with chronic Boutonnière deformity. The average duration of splint wearing was 12 weeks. If you are interested in the use of relative motion flexion splints for acute Boutonnière deformity, have a look at this synopsis. URL: https://doi.org/10.1016/j.jhsa.2022.08.007 Abstract Purpose: This study investigated the effectiveness of a relative motion flexion orthosis (RMFO) for increasing the range of motion for boutonniere deformity. Methods: We included 28 patients aged 13–62 years with chronic boutonniere deformity who could complete 0° proximal interphalangeal (PIP) joint extension with the pencil test and were stage 1 according to the Burton classification of boutonniere deformity. At the initial hand therapy appointment, the RMFO was made. The duration of the orthosis usage at the initial therapy session, after stopping the use of the orthosis (posttreatment), and at the follow-up period were noted. Results: The mean time for orthosis usage of all patients was 11.7 weeks (6–40 weeks). The mean initial active distal interphalangeal joint flexion was 47° (0° to 90°) and improved to 66.8° (5° to 110°). The mean initial extension lag of the PIP joint was 22.5° (5° to 55°) and improved to 12° (0° to 30°). This did not change between discontinuation of the orthosis and final follow-up. Conclusions: The use of RMFO is effective in increasing active distal interphalangeal joint flexion and improving PIP extension in patients with Burton stage 1 chronic boutonniere deformity. 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