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A prospective randomized clinical trial of prescription of full-time versus as-desired splint wear for de Quervain tendinopathy. Menendez, M. E., E. Thornton, S. Kent, T. Kalajian and D. Ring (2015) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 Type of study: Treatment Topic: De Quervain - Splint wearing This is a randomised controlled trial assessing the effectiveness of full time vs part-time splint wearing in people with De Quervain tenosynovitis. Participants were included if they were diagnosed with de Quervain tendinopathy by a hand surgeon. Potential participants were excluded if they were pregnant. A total of 58 participants were allocated to either full-time splint wearing (n=26) or part-time (n=32) splint wearing. All participants were provided with a forearm-based thumb spica splint, which they were either advised to wear full time (except for showering) or as desired. Pain anxiety, the QuickDASH, pain catastrophising, numerical pain scale (NRS), and depression were assessed at baseline and follow up (7.5 weeks). The results showed that there were no statistically or clinically significant differences between groups. Both groups showed some improvement despite it not reaching clinical relevance. The results also showed that greater disability at 7.5 weeks is associated with greater depressive symptoms at baseline. 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 may contribute to higher levels of disability after conservative treatment in de Quervain tendinopathy. It is possible that a tailored approach to modify psychological factors in those with higher levels of mental health issues could help reduce disability in clients with de Quervain. These findings are not surprising considering that most upper limb conditions disability is mediated by mental health (e.g. kinesiophobia, depression). URL: https://doi.org/10.1007/s00264-015-2779-6 Abstract PURPOSE: There is no consensus on the best protocol for splint wear in the non-operative management of de Quervain tendinopathy. This study aimed to determine if there is a difference between prescription of strict splint wear compared to selective splint wear in patients with de Quervain tendinopathy. We tested the primary null hypothesis that there is no difference in upper-extremity disability eight weeks after initiating splinting between patients prescribed full-time or as-desired splint wear. Secondary study questions addressed differences in grip strength, pain intensity, and treatment satisfaction. Additionally, we evaluated the influence of psychological factors on disability. METHODS: Eighty-three patients diagnosed with de Quervain tendinopathy were randomly allocated into two different splint-wearing instructions: full-time wear (N = 43) or as-desired wear (N = 40). At enrollment, patients had grip strength measured and completed measures of upper-extremity disability, pain intensity, and psychological distress. An average of 7.5 weeks later, patients returned for a second visit. Analysis was by intention-to-treat and with use of mean imputation for missing data. RESULTS: Fifty-eight patients (70 %; 26 in the full-time cohort and 32 in the as-desired cohort) completed the study. There were no statistically significant differences in disability (p = 0.77), grip strength (p = 0.82), pain intensity (p = 0.36), and treatment satisfaction (p = 0.91) between patients instructed to wear the splint full-time and those instructed to use it as desired. Disability at final evaluation correlated significantly with baseline levels of pain anxiety (p = 0.008), catastrophic thinking (p = 0.001), and symptoms of depression (p < 0.001). The best multivariable linear regression model included symptoms of depression alone and accounted for 32 % of the variability in disability (p < 0.001). CONCLUSION: There is no difference in patient-reported outcomes and grip strength with prescription of full-time or as-desired splinting, and patients can wear the splint as they prefer. These results suggest that splinting for de Quervain tendinopathy is palliative at best and strict rest is not disease modifying. 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 rare and severe case of pronator teres syndrome. Moura, F. S. E. and A. Agarwal (2020) Level of Evidence: 5 Follow recommendation: 👍 Type of study: Diagnostic/Therapeutic Topic: Median nerve entrapment - Pronator teres This is the answer to last week Sherlock Handy. The patient was a 57 years old presenting with left volar forearm pain and grip/pinch strength weakness, which developed over the course of 5 years. They had a history of cancer, which was in remission. They had no symptoms at night. There was atrophy of the thenar eminence (see picture) and reduced sensation in the thumb, index, middle finger and thenar eminence. Carpal tunnel tests were negative. Neurological examination identified no central nervous system pathology. Nerve conduction studies identified no sensory impairments but a severe left median nerve neuropathy below the elbow. During surgical exploration, entrapment of the median nerve was identified at the level of the pronator teres, and this was released. In addition, the flexor digitorum superficialis' arch, which is another potential area of median nerve entrapment, was also released. Follow up at 8 weeks showed some sensory and motor improvements, with some ability to perform thumb ipj flexion. 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, severe entrapment of the median nerve at the pronator teres entry is a rare presentation. The differential diagnosis for this presentation included cervical entrapment radiculopathy, a median nerve entrapment at the lacertus fibrosus, brachial neuritis, thoracic outlet syndrome, and carpal tunnel syndrome (CTS), or a central nervous system pathology. If you enjoyed this synopsis I am sure that you will enjoy this one too. Open Access URL: https://doi.org/10.1093/jscr/rjaa397 Abstract We present the case of a patient with severe symptoms of proximal forearm median nerve neuropathy. Over the course of 5 years his condition progressed to encompass rare features of combined pronator teres syndrome (PTS) and anterior interosseous nerve syndrome (AINS). The aetiology was found to be pronator teres compression and was managed successfully by surgical decompression. Proximal forearm median nerve compression should be considered as a continuum with two classic endpoints. At one end of the spectrum pure PTS presents with solely or mainly sensory symptoms, whereas at the other end AINS presents with pure motor symptoms. Hence, all possible anatomical sites of compression must be surgically explored in all cases of PTS or AINS, regardless of symptomatology. Timely referral to an experienced specialist is encouraged to ensure good outcomes, whenever a primary care practitioner encounters an atypical carpal tunnel syndrome-like presentation. 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

Feedback-guided exercises performed on a tablet touchscreen improve return to work, function, strength and healthcare usage more than an exercise program prescribed on paper for people with wrist, hand or finger injuries: a randomised trial. Blanquero, J., et al. (2020) Level of Evidence: 1b- Follow recommendation: 👍 👍 👍 Type of study: Therapeutic Topic: ReHand - Benefits for rehabilitation This is a randomised controlled trial assessing the effectiveness of an interactive iPad home exercise programme (HEP) compared to traditional HEP in people with bone and soft tissue hand conditions. A total of 74 participants took part in this study. Participants were included if they presented fractures of the distal radius/metacarpal/phalanges or other soft tissues injuries including sprains of the wrist/fingers. In the experimental group (n=40), the HEP was completed on the iPad through the ReHand app, which allowed participants to use their fingers/wrist to interact and complete the exercise sessions. In addition, the ReHand app digitally recorded compliance and sent reports to the clinicians. The control group (n=34) received the same exercises but prescribed on paper. Compliance in the control group was assessed verbally. The effectiveness of each intervention was assessed by the return to work time (number of days) and the number of appointments required. The results showed that the experimental group returned to work earlier by the very least 3 days. In addition, the number of appointments required was reduced by at least one session in the experimental group. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, utilising interactive solutions for the completion of HEP and clients monitoring may speed up recovery in people with hand conditions. In particular, the implementation of ReHand appears to be useful in hastening return to work and reducing the number of appointments required. In addition to utilising this technology, keeping the number of exercises prescribed small may also double compliance with your treatment! URL: https://www.sciencedirect.com/science/article/pii/S1836955320301077 Available through EBSCO Health Databases for PNZ members. Abstract Question In people with bone and soft tissue injuries of the wrist, hand and/or fingers, do feedback-guided exercises performed on a tablet touchscreen hasten return to work, reduce healthcare usage and improve clinical recovery more than a home exercise program prescribed on paper? Design Randomised, parallel-group trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants Seventy-four workers with limited functional ability due to bone and soft tissue injuries of the wrist, hand and/or fingers. Intervention Participants in the experimental and control groups received the same in-patient physiotherapy and occupational therapy. Participants in the experimental group received a home exercise program using the ReHand tablet application, which guides exercises performed on a tablet touchscreen with feedback, monitoring and progression. Participants in the control group were prescribed an evidence-based home exercise program on paper. Outcome measures The primary outcome was the time taken to return to work. Secondary outcomes included: healthcare usage (number of clinical appointments); and functional ability, pain intensity, and grip and pinch strength 2 and 4 weeks after randomisation. Results Compared with the control group, the experimental group: returned to work sooner (MD –18 days, 95% CI –33 to –3); required fewer physiotherapy sessions (MD –7.4, 95% CI –13.1 to –1.6), rehabilitation consultations (MD –1.9, 95% CI –3.6 to 0.3) and plastic surgery consultations (MD –3.6, 95% CI –6.3 to –0.9); and had better short-term recovery of functional ability and pinch strength. Conclusion In people with bone and soft-tissue injuries of the wrist, hand and/or fingers, prescribing a feedback-guided home exercise program using a tablet-based application instead of a conventional program on paper hastened return to work and improved the short-term recovery of functional ability and pinch strength, while reducing the number of required healthcare appointments. Trial registration ACTRN12619000344190 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: 👍 Type of study: Diagnostic/Therapeutic Have a think about this case study. Leave a diagnostic comment if you like. I will publish the diagnosis reported by the paper next week. The patient was a 57 years old presenting with left volar forearm pain and grip/pinch strength weakness, which developed over the course of 5 years. They had a history of cancer, which was in remission. They had no symptoms at night. There was atrophy of the thenar eminence (see picture) and reduced sensation in the thumb, index, middle finger and thenar eminence. Carpal tunnel tests were negative. Neurological examination identified no central nervous system pathology. What was it?

Practical exercises for thumb proprioception. Cantero-Téllez, R. and I. Medina Porqueres (2021) Level of Evidence: 5 Follow recommendation: 👍 Type of study: Therapeutic Topic: Thumb proprioception - Exercises This is an expert opinion on what exercises can be utilised to improve thumb proprioception. These exercises can be implemented in a series of thumb conditions including post-traumatic rehabilitation and persistent pain. My favourites are the tennis ball one and the force matching one (see pictures below). Clinical Take Home Message: Based on what we know today, several proprioception exercises can be utilised for the rehabilitation of the thumb. I think this may be useful in those conditions where such impairments have been identified. For example, people with symptomatic hand OA have been shown to present with force control impairments (gripping and pinching) and joint position sense is impaired in clients with symptomatic thumb OA. It is, therefore, possible that exercises aiming at proprioception could be beneficial. Further experimental studies are however required to assess whether these proprioceptive impairments improve after training. URL: https://doi.org/10.1016/j.jht.2020.03.005 Available through The Journal of Hand Surgery (American Volume) for HTNZ members. Available through EBSCO Health Databases for PNZ members. 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

Evaluation of short-term and residual effects of Kinesio taping in chronic lateral epicondylitis: A randomized, double-blinded, controlled trial. Balevi, I. S. Y., B. Karaoglan, E. B. Batur and N. Acet (2021) Level of Evidence: 1b- Follow recommendation: 👍 👍 👍 👍 Type of study: Therapeutic Topic: Lateral epicondylalgia – Kinesio taping This is a randomised placebo-controlled trial assessing the effectiveness of inhibitory vs a placebo Kinesio tape for lateral epicondylalgia. Fifty participants were included in the present study. To be included, participants had to present with pain at the lateral epicondyle, and present with pain on at least one of the following tests: resisted wrist extension, resisted supination, and third finger extension. Participants were randomised to either the "inhibitory" Kinesio tape or placebo Kinesio tape (see pictures). Both groups received stretching and resistance exercises for the wrist extensors. The treatment lasted six weeks for both groups. Pain was assessed through the numerical rating scale at baseline and follow-up. The results showed that both groups improved to a clinically and statistically significant level at 6 weeks. However, there were no differences between 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, "inhibitory" Kinesio taping is no more effective than a placebo for lateral epicondylalgia (LE). Currently, the best option for lateral epicondylalgia appears to involve an initial rest followed by graded resistance training. Based on the current evidence, PRP and surgery for LE do not appear to be more effective than placebo and are much more costly than conservative treatment. If you were thinking about cortisone injections, they appear to increase the recurrence rate at one year and may not be the best option either. If you would like to get a more complete picture of lateral epicondylalgia, have a look at the whole collection. URL: https://doi.org/10.1016/j.jht.2021.09.001 Available through The Journal of Hand Therapy for HTNZ members. Available through EBSCO Health Databases for PNZ members. Abstract BACKGROUND Lateral epicondylitis is degenerative tendinosis of the extensor carpi radialis brevis muscle and is the most common work/sports-related chronic musculoskeletal problem affecting the elbow. PURPOSE This study aimed to evaluate the short term and residual effectiveness of the Kinesio taping method on pain, grip force, quality of life, and functionality. STUDY DESIGN Randomized, double-blinded, controlled study. METHODS Subjects were 50 patients diagnosed with chronic unilateral lateral epicondylitis with a symptom duration of at least 12 weeks. During the first four weeks, the study group received a true inhibitor Kinesio taping while the control group received sham taping. In both groups, progressive stretching and strengthening exercises were given as a home program for six weeks. The primary outcome measure was the Numerical Rating Scale (NRS) for self-report of pain intensity; secondary outcome measures were Cyriax resistive muscle test evaluation, maximal grip strength, Patient- Rated Tennis Elbow Evaluation (PRTEE), and Short Form-36 (SF-36). After the treatment, patients were evaluated by the first assessor who was blinded to taping types. RESULTS There was a significant decrease in NRS scores overtime during the first four weeks in both groups (P < .001,) and effect sizes were large. There was no significant difference in Cyriax muscle resistance test maximal grip strength between groups (P > .05). However, there was a significant improvement in muscle strength of elbow extension and pronation in the study group detected in the intragroup analysis. Intragroup comparisons also showed a significant improvement in all subunits of the PRTEE and SF-36 except energy/vitality, social functioning, and pain in both groups (P < .05) with moderate to high effect sizes. PRTEE pain scores were significantly decreased in the study group compared to the placebo group (P < .05, d = 0.48). CONCLUSION The effects of Kinesio taping on muscle strength, quality of life, and function in chronic lateral epicondylitis are not superior to placebo. However, NRS scores showed that in the two weeks after Kinesio taping treatment, pain reduction persisted as a residual effect which may improve the exercise adherence and functionality. 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

Gamer's health guide: Optimizing performance, recognizing hazards, and promoting wellness in esports. Emara, A. K., et al. (2020) Level of Evidence: 5 Follow recommendation: 👍 Type of study: Therapeutic Topic: Gaming – Guidelines for prevention and treatment This is an expert opinion on prevention and treatment of musculoskeletal conditions for gamers. As you can see from the picture below, several upper limb regions can present with musculoskeletal impairments and several body systems can be affected. Wrist pain is often reported in these clients (30% to 36%) and biomechanical factors are likely playing a role. Thus, during intensive gaming activities, players can reach up to 600 moves per minute, which would equate to 10 finger/wrist actions per second, which may be performed over several hours. Additional factors such as sedentary behaviors, mental health issues (e.g. depression, addictive tendencies), poor sleep, and nutrition are likely to contribute to the onset of persistent pain or contribute to a slower recovery following an upper limb injury. The interventions adopted must therefore include not only biomechanical and ergonomic modifications, but also psychosocial interventions aimed at modifying the other contributing factors to pain and musculoskeletal impairments. In addition, the use of virtual or augmented reality games may be helpful in reducing sedentary behaviours. Platform such as Zwift are new gaming consoles that make stationary cycling much more entertaining. Going forward in the future, there will be lots of options for our gaming clients which will help reducing sedentary time and possibly utilise other body parts to take part in gaming. The table below presents with an exhaustive list of interventions that these clients are likely to require. 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, our professional and amateurs game players are at higher risks of upper limb musculoskeletal conditions due to a series of biomechanical and psychosocial factors. An holistic approaching to their assessment and treatment a may be useful for their rehabilitation. Remember that not all musculoskeletal pain presentations are due to overuse syndromes and that other factors may play a significant role in the pain experience. If you want to assess your pain neurophysiology understanding, test yourself through this questionnaire! Open access URL: https://doi.org/10.1249/jsr.0000000000000787 Abstract Electronic sports (esports), or competitive video gaming, is a rapidly growing industry and phenomenon. While around 90% of American children play video games recreationally, the average professional esports athlete spends 5.5 to 10 h gaming daily. These times and efforts parallel those of traditional sports activities where individuals can participate at the casual to the professional level with the respective time commitments. Given the rapid growth in esports, greater emphasis has been placed on identification, management, and prevention of common health hazards that are associated with esports participation while also focusing on the importance of health promotion for this group of athletes. This review outlines a three-point framework for sports medicine providers, trainers, and coaches to provide a holistic approach for the care of the esports athlete. This esports framework includes awareness and management of common musculoskeletal and health hazards, opportunities for health promotion, and recommendations for performance optimization. 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

No time to lift? Designing time-efficient training programs for strength and hypertrophy: A narrative review. Iversen, V. M., M. Norum, B. J. Schoenfeld and M. S. Fimland (2021) Level of Evidence: 5 Follow recommendation: 👍 Type of study: Therapeutic Topic: Resistance training - For people with limited time This is a narrative review on efficient ways to keep us and our clients healthy through resistance training programs. This article cuts right through the fluff. It tells you exactly what are the most useful and effective strategies if you want to perform a resistance training regime and you have limited time and equipment resources. The following sentence summarises it all: Exercise specific warm up with lower intensity, do at least 4 sets of fast, push-pull, hard, multi-joint, body-weight exercises every week with 2 minutes rest in between each set; chuck stretching in the bin. You could do push up, pull up, chair stands, or other lower body multi-joint exercises. Get creative and use some weights that you may have at home (e.g. partner/flatmates/babies/logs/briks) to increase your intensity, especially for lower limb exercises. Stretching should only be included if your goal is to increase flexibility. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, short burst of high intensity exercises involving large muscle groups can still provide reasonable results in people who cannot spend hours at the gym. Stretching can be eliminated from your regime as it is not needed. Thus, there is moderate quality evidence showing that resistance training improves joint active range of movement as much as stretching alone. Hence, you or your clients do not need to perform stretching if you already have a resistance training program on the go. For populations where high intensity, high impact resistance training may be contraindicated, alternative resistance training interventions such as blood flow restriction training may be used. If you would like additional information on the use of resistance training throughout your clients' lifespan, have a look at the international guidelines for physical activity. Open access URL: https://doi.org/10.1007/s40279-021-01490-1 Abstract Lack of time is among the more commonly reported barriers for abstention from exercise programs. The aim of this review was to determine how strength training can be most effectively carried out in a time-efficient manner by critically evaluating research on acute training variables, advanced training techniques, and the need for warm-up and stretching. When programming strength training for optimum time-efficiency we recommend prioritizing bilateral, multi-joint exercises that include full dynamic movements (i.e. both eccentric and concentric muscle actions), and to perform a minimum of one leg pressing exercise (e.g. squats), one upper-body pulling exercise (e.g. pull-up) and one upper-body pushing exercise (e.g. bench press). Exercises can be performed with machines and/or free weights based on training goals, availability, and personal preferences. Weekly training volume is more important than training frequency and we recommend performing a minimum of 4 weekly sets per muscle group using a 6–15 RM loading range (15–40 repetitions can be used if training is performed to volitional failure). Advanced training techniques, such as supersets, drop sets and rest-pause training roughly halves training time compared to traditional training, while maintaining training volume. However, these methods are probably better at inducing hypertrophy than muscular strength, and more research is needed on longitudinal training effects. Finally, we advise restricting the warm-up to exercise-specific warm-ups, and only prioritize stretching if the goal of training is to increase flexibility. This review shows how acute training variables can be manipulated, and how specific training techniques can be used to optimize the training response: time ratio in regard to improvements in strength and hypertrophy. 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

Platelet-rich plasma injection versus operative treatment for lateral elbow tendinosis: A systematic review and meta-analysis. Kim, C.-H., Y.-B. Park, J.-S. Lee and H.-S. Jung (2021) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 Type of study: Therapeutic Topic: Lateral epicondylalgia – surgery vs platelet-rich plasma injections This is a systematic review and meta-analysis assessing the effectiveness of platelet-rich plasma (PRP) vs surgery for lateral epicondylalgia. Two randomised controlled trials (RCT) and two retrospective studies were included for a total of 340 participants. All the studies were assessed through a critiquing tool suitable for experimental and non-experimental studies. Intervention efficacy was assessed through improvements in pain (visual analogue scale - VAS) and function (patient-related tennis elbow evaluation - PRTEE). To be included in the review, studies had to compare PRP injections to surgery. Surgery involved in all cases debridement with decortication. Follow-up periods ranged between 3 and 12 months. The results showed that there was no statistical or clinically significant difference between PRP and surgery in terms of pain or function at any time point. 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, surgery for tennis elbow does not appear to be more effective than PRP injections. In addition, PRP injections do not appear to be more effective than placebo saline injections for tennis elbow. Surgery for tennis elbow is therefore unlikely to be more effective than placebo. Considering the high cost of surgery and PRP injections, we may be better of telling our clients to adopt other less expensive alternatives such as initial rest followed by graded resistance training. If you would like to get a more complete picture about lateral epicondylalgia, have a look at the whole collection. URL: https://www.sciencedirect.com/science/article/pii/S1058274621007242 Available through EBSCO Health Databases for PNZ members. Abstract Background Although surgical treatment is considered reliable for lateral elbow tendinosis, local injection therapy may be preferable, as it avoids surgery. Among a number of local injections, platelet-rich plasma has been used successfully to treat lateral elbow tendinosis. The purpose of this study was to compare the outcomes in patients treated with either platelet-rich plasma injections or surgery for lateral elbow tendinosis using a systematic literature review and meta-analysis. Methods MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 1, 2021, that compared platelet-rich plasma with operative treatment for lateral elbow tendinosis. The pooled analysis was designed to compare the visual analog scale scores and the Patient-Related Tennis Elbow Evaluation scores between the platelet-rich plasma and surgical treatment groups at serial time points. Results We included five studies involving 340 patients with lateral elbow tendinosis, comprising of 154 patients treated with platelet-rich plasma and 186 patients who underwent surgical treatment. The pooled analysis showed no statistically significant differences in the visual analog scale scores at any of the follow-up time points, namely post-intervention 2 months (mean difference = 1.11, 95% confidence interval: −2.51 to 4.74, P = 0.55, I2 = 94%), 6 months (mean difference = 0.80, 95% confidence interval: −2.83 to 4.42, P = 0.67, I2 = 92%), and 12 months (mean difference = −0.92, 95% confidence interval: −4.63 to 2.80, P = 0.63, I2 = 93%) and in the Patient-Related Tennis Elbow Evaluation scores at post-intervention 12 weeks (mean difference = −1.86, 95% confidence interval: −22.30 to 18.58, P = 0.86, I2 = 81%), 24 weeks (mean difference = −3.33, 95% confidence interval: −21.82 to 15.17, P = 0.72, I2 = 74%), and 52 weeks (mean difference = −3.64, 95% confidence interval: −19.65 to 12.37, P = 0.66, I2 = 69%). Conclusions Local platelet-rich plasma injections and surgical treatment produced equivalent pain scores and functional outcomes in patients with lateral elbow tendinosis. Thus, platelet-rich plasma injections may represent a reasonable alternative treatment for patients who are apprehensive to proceed with surgery or for poor surgical candidates. 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

Adhesions as a component of the trigger finger: A dynamic sonographic study. Ling Chuang, X. and D. A. McGrouther (2020) Level of Evidence: 3b Follow recommendation: 👍 👍 Type of study: Aetiologic Topic: Trigger finger - Is there scar tissue? This is a case series assessing trigger finger pathology through ultrasound imaging. A total of 20 participants, took part in this study. Participants were included if they presented with a Green's grade 1 to 3 (I - intermittent, II - actively correctable, III - passively correctable, IV fixed flexion deformity). Adhesions, defined as lack of differential movement between FDS and FDP during passive joint movement, were assessed through ultrasound imaging. During the assessment, isolated dipj movement was completed. In normal subjects, isolated passive dipj movement should lead to movement of FDP only. The results showed that 10 out of 20 participants lost independent movement between FDP and FDS upon passive dipj flexion and extension. The number of participants with tendon gliding impairments reported in the abstract was larger because they accounted for other US imaging findings such as a lack of clear demarcation between tendons and surrounding tissues. One of the limitations of this study is that the differential movement assessed was completed during passive movement of the dipj rather than active movement. 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, around 50% of our clients with trigger finger may lack differential movement between FDS and FDP. This is a potential biomechanical contributing factor to trigger finger development and/or maintenance. It is possible that our splinting interventions may help to differentiate FDS and FDP movement. If you would like to know when your clients with trigger finger should be referred to a hand surgeon or which of your clients are at higher risk of post-surgical infection after a trigger finger release, click on the links. URL: https://doi.org/10.1177/1753193420969293 Available through EBSCO Health Databases for PNZ members. Abstract We performed a detailed dynamic high-resolution ultrasound examination of the flexor tendons in trigger fingers and compared this with normal contralateral digits. There was a loss of defined linear tendon margins and/or traction of the flexor tendons on the surrounding soft tissue during passive flexion of the distal interphalangeal joint in 17 out of 20 trigger fingers, which indicated adherence to the surrounding tissues. The differential motion between the flexor digitorum profundus tendon and the flexor digitorum superficialis tendons was also lost in ten trigger fingers, which suggested adherence between the tendons. No signs of peritendinous or intertendinous adhesions were found in the healthy control fingers. We conclude that tendon adhesions are present in the majority of trigger fingers. We could not determine a relationship between the severity of triggering and the presence of adherence due to limited sample size. 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

Impairments in grip and pinch force accuracy and steadiness in people with osteoarthritis of the hand: A case-control comparison. Magni, N. E., P. J. McNair and D. A. Rice (2021) Level of Evidence: 3b Follow recommendation: 👍 👍 Type of study: Aetiologic Topic: Force control - Hand osteoarthritis This is a case-control study assessing impairments in motor control as well as their associations with function in people with hand OA. A total of 88 participants were included in the study. Hand OA (n = 62) was diagnosed through the American College of Rheumatology (ACR) criteria and confirmed through x-ray. Healthy participants (n = 26) were age and gender matched to the hand OA participants. Motor control was assessed by measuring participants ability to maintain a steady grip and pinch, self-reported hand function was assessed through the Functional Index of Hand Osteoarthritis (FIHOA) and the Disability of the Arm, Shoulder, and Hand (DASH). The results showed that participants with hand OA had significant lower levels of motor control (2% deficit in force steadiness) during gripping and pinching. Most of these differences between groups resolved with practice. It is unclear whether these differences between groups are clinically relevant as no study has assessed the minimal clinically important difference for this test. There was a small correlation between motor control and functional impairments. Overall, due to multitude of statistical tests performed (26 tests - ANOVAs and post hoc tests) and the number of significant findings (13 test) there is a 10% probability that the results are just due to chance. Clinical Take Home Message: Based on what we know today, clients with hand OA may present with motor control impairments that contribute to functional impairments. These impairments in ability to fine tune force levels appear to resolve with a few practice trials. If clients with symptomatic hand OA report difficulty performing precise pinch or grasp activities where force modulation is important, a series of submaximal warm up exercises may be useful to reduce impairments. We currently do not know whether these impairments are caused by pain or contribute to pain. Currently, a multidisciplinary approach to symptomatic hand OA is supported by higher quality evidence, and may be implemented first. Also, this is a synopsis of our own research group. I have tried to be critical towards what we have done. However, if you find additional limitations or have comments, please do not hesitate in posting them below! If you are interested in knowing more about the involvement of the brain in symptomatic hand OA, have a look at this previous synopsis. Open access URL: Abstract Background Symptomatic hand osteoarthritis (OA) is severely disabling condition. Limited evidence has focused on force control measures in this population. Objectives It was the aim of the present study to determine whether force matching accuracy and steadiness are impaired in people with hand OA. In addition, the relationship between force control measures (accuracy and steadiness) and measures of hand function and pain in people with symptomatic hand OA was explored. Design Case-control study. Method Sixty-two participants with symptomatic hand OA and 26 healthy pain-free controls undertook an isometric grip and pinch force matching task at 50% of their maximum voluntary contraction. Average pain hand pain was recorded. In addition, the Disability of the Arm Shoulder and Hand Questionnaire (DASH), and the Functional Index of Hand Osteoarthritis were collected. Results Grip force-matching accuracy and steadiness were significantly impaired in the hand OA group compared to controls (P < 0.05). Pinch force-matching error was greater in people with hand OA (P < 0.05), however, pinch force steadiness was not different between groups. There was a learning effect in people with hand OA, with resolution of force matching impairments with task repetition. A small positive correlation was identified between grip force control and the DASH. No association was found between other measures of force control and self-reported measures of function or pain. Conclusions People with hand OA presented with greater impairments in measures of submaximal force control. These were correlated with self-reported hand function but not pain. Future studies may wish to examine whether objective measures of functional performance are related to force-matching error and steadiness. 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

Comparison of 2 postoperative therapy regimens after trapeziectomy due to osteoarthritis: A randomized, controlled trial. Hermann-Eriksen, M., et al. (2021) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 Type of study: Therapeutic Topic: Thumb osteoarthritis - Post-surgical management This is a randomised, single-centre, non-inferiority trial assessing the results of an early vs delayed thumb motion approach following trapeziectomy. Participants (N = 55) were randomised to either standard care (n = 27) or the experimental intervention (n = 28). The experimental intervention was equal to the standard care except that thumb mobilisation started 3 weeks earlier (at 3 weeks post-op in the experimental group compared to 6 weeks post-op in the standard care group). The primary outcomes included function and satisfaction with surgery at 3, 6, and 12 months. The exercises were initiated at 3 weeks in the experimental group and included thumb opposition, abduction, mcpj and ipj flexion/extension, and wrist extension/flexion. Two to five repetitions for each exercise were performed at least 3 times per week. The results showed that participants in both groups improved to a similar extent. 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 thumb mobilisation post trapeziectomy is safe. Active range of movement exercises can be initiated at 3 or 6 weeks post surgery without significant differences. Keep in mind that if your clients with trapeziectomy had a cortisone injection 3 months prior to surgery, they are at greater risk of wound complications. Considering that cortisone injections are not more effective then placebo for thumb OA, the risks vs benefits should be shared with your clients. Prior to surgery, a conservative intervention trial may be worth it! Open access URL: https://doi.org/10.1016/j.jhsa.2021.08.015 Abstract Purpose: The main aim of the present study was to evaluate whether early mobilization after trapeziectomy in the first carpometacarpal joint is noninferior to a postoperative regimen comprising the use of a rigid orthosis and mobilization after 6 weeks, with regards to patient-reported activity performance and the effect of surgery in patients with first carpometacarpal osteoarthritis. Methods: In this prospective, randomized, controlled noninferiority trial, participants were assessed at baseline (before group allocation) and at 3, 6, and 12 months after surgery. The primary outcomes were activity performance, measured using the Canadian Occupational Performance Measure (1-10, where 1 = unable to perform), and the patient-reported effect of surgery on a 6-point scale ranging from "much worse" to "completely recovered." A change of 2.0 points in the Canadian Occupational Performance Measure was used as a noninferiority margin. Secondary outcomes included hand function (patient-reported in the Measure of Activity Performance of the Hand questionnaire), pain on a numeric rating scale, grip and pinch strengths, and joint mobility. We performed both intention-to-treat and per-protocol analyses. Results: Of the 59 participants (88% women) with a mean age of 65 years, 55 (93%) completed all assessments. We found no differences between the groups in primary or secondary outcomes at any time point, except for more decreased pain at rest in the intervention group (n = 28) compared with the control group (n = 27) after 12 months. The per-protocol analyses did not change these results. Fifteen participants experienced 1 or more adverse events during the first 3 months, but the types and frequencies of adverse events were similar between the 2 groups. Conclusions: A postoperative regimen with early mobilization after trapeziectomy is as safe and effective as a postoperative regimen with longer immobilization in patients with first carpometacarpal osteoarthritis. 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