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When the diagnosis is in the patient’s hand and in the neurologist’s eye. Bertini, A., et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Focal hand dystonia - Mimickers This narrative review described common movement disorders of the hand that could mimic focal hand dystonias. The authors report that careful observation of hand patterns can differentiate between neurological and non-neurological conditions, central and peripheral etiologies, and organic versus functional disorders. Important differential diagnoses for movement disorders of the hand include Amyotrophic Lateral Sclerosis (ALS), strokes, and various syndromes like Alien Hand and Striatal Hand. Making sure that we refer people on when we are not sure whether their presentation is due to a focal benign hand dystonia is paramount. 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, careful observation of hand postures can be a useful diagnostic tool for clinicians. An important presentations that may show early to our clinic presenting as an entrapment neuropathy includes ALS . We should therefore maintain a high index of suspicion when patients present with unfamiliar movement disorders of the hand. URL : https://doi.org/10.1007/s10072-024-07626-1 Abstract The objective of this study was to encompass current knowledge about pathophysiological mechanisms of those specific hand postures or deformities caused by central nervous system disorders. In the era of high-resolution neuroimaging and molecular biology, clinicians are progressively losing confidence with neurological examination. Careful hand observation is of key importance in order to differentiate neurological from non-neurological conditions, central from peripheral aetiologies, and organic from functional disorders. Localizing the potential anatomical site is essential to properly conduct subsequent exams. We provided a practical guide for clinicians to recognize hand patterns caused by central nervous system disorders, avoiding mimicking conditions, thus optimizing and prompting the diagnostic pathway. 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

Management of the spastic elbow deformity in adult patients with upper motor neuron syndrome. Israel, J., Fahrenkopf, M. and Rhee, P. C. (2024) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic : Post surgical splinting - Elbow spasticity This is an expert opinion on the management of spastic elbow deformities in people with upper motor neuron lesions. These central nervous system lesions can lead to elbow deformities associated with muscle spasticity, myostatic contracture, or joint contracture. In these instances, the elbow typically resting in a flexed position. Surgical interventions are often discussed with patients as an option. Surgical approaches include selective nerve resection, tendon lengthening, muscle origin release, myotomy, tenotomy, and/or periarticular soft tissue release if the deformity has been present for a long period of time. Postoperative management involves splinting and therapy. For splinting, these are usually worn full time except for hygiene for the first six weeks. Following this period of time, splints are worn at night only for another six weeks. The picture above is from another study covered in a previous synopsis . 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, splinting is utilised in the post-surgical management of patients presenting with elbow spasticity. This usually involves a full time splint for six weeks followed by a night splint only for another six weeks. Treatment will likely need to be individualised based on the surgical intervention utilised as the tissues released may need protection for a period of time (e.g. tendon lengthening) or not less so if periarticular structures were the main limiters (e.g. capsular release). If you are interested in the use of splinting to correct other upper limb deformities (e.g. pipj), have a look at the database . URL : https://doi.org/10.1016/j.jhsa.2023.09.015 Abstract Spastic elbow deformity in patients with upper motor neuron injuries results from an imbalance of flexor and extensor forces across the ulnohumeral joint. Although not all deformities reflect the same underlying imbalances, the elbow most commonly rests in a flexed position. Patients may present with a combination of muscle spasticity, myostatic contracture, and/or joint contracture. A focused history and physical examination are essential for developing individualized surgical plans that account for variations in deformity severity and patient goals. Patients may present with or without volitional control; goals and treatment options differ depending on the degree of control present. Techniques include hyperselective neurectomy, tendon lengthening, muscle origin release, myotomy, tenotomy, periarticular soft tissue release, and skin rearrangement. This article presents a comprehensive review of the surgical approach to the volitional and nonvolitional spastic elbow deformities. 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: 4 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic, Therapeutic A 55-year-old woman had a twisting injury of their right index finger which had not resolved with four months of conservative management. At their first appointment, they reported pain and stiffness of the mcpj. In particular, they had full mcpj extension, but flexion was limited to 35 degrees. There was tenderness on palpation and swelling at the affected mcpj, however, there was no ligament laxity. What is it?

Isolated post-traumatic osteoarthritis of the middle carpometacarpal joint: A report of two cases. Huang, H.-K., Wu, C.-H. and Wang, J.-P. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Symptoms prevalence Topic : Middle finger cmcj - Osteoarthritis This report describes two cases of isolated post-traumatic osteoarthritis of the middle finger carpometacarpal joint (cmcj). The first case involved a 34-year-old deliveryman who sustained a hand injury in a traffic accident, which presented with dorsal hand pain and swelling. He sought medical help 10 months post-injury due to worsening pain and hand weakness, which impaired their work performance. Radiographs and a CT scan showed middle finger cmcj OA, which was successfully managed with arthrodesis. The second case was a 53-year-old stock trader who injured their hand as a result of a FOOSH. Six months later, persistent symptoms led to the further investigations, which revealed a third cmcj OA, which was managed surgically with good results. Despite its rarity, isolated osteoarthritis in the third cmcj can cause significant functional impairment. 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, isolated post-traumatic osteoarthritis of the third cmcj can occur in absence of dislocation but as a result of high energy trauma. It is possible that such injuries may initially lead to cmcj instability , which then develop into post-traumatic osteoarthritis. URL : https://doi.org/10.1177/17531934241245830 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

Treatment of wrist stiffness through posture orthosis and active exercise: A case report. Boccolari, P., et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Static progressive splint - Wrist ROM This is a case study reporting on the use of static progressive splinting and exercise to treat wrist stiffness following a distal radius fracture in a 64-year-old woman. The patient was initially treated with ORIF. Post-surgery, the wrist was immobilised for twenty days. The subsequent rehabilitative strategy included a combination of custom splinting and active exercises for both wrist flexion and extension. Range of movement in both extension and flexion doubled over the course of 12 weeks, starting from 20deg and 30deg at baseline for flexion and extension respectively. It therefore appears that for this specific patient such approach had some benefit. 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, progressive static splints and exercises may be useful in the management of stiffness following ORIF for distal radius fractures. However, to prevent the onset of stiffness, it would be useful to avoid immobilising distal radius fracture ORIFs beyond a reasonable amount of time. Thus, mobilisation within two weeks from surgery appears to provide better outcomes, including wrist ROM . An additional factor that appears to contribute to stiffness includes pain catastrophising . If you are interested in reading more about distal radius fractures ORIF, have a look at the whole database . URL : https://doi.org/10.1016/j.tcr.2024.101068 Abstract Introduction: Wrist fractures, particularly the distal radius, can result in significant stiffness and hand dysfunction if not mobilized early. The variable immobilization period post-fracture depends on fracture type, location, stability, and surgical intervention. Inadequate early mobilization typically leads to structured stiffness, influenced by patient health, injury mechanism, joint surface involvement, associated tissue injuries, and patient motivation. Case presentation: A 64-year-old female in good health suffered a distal radius fracture, treated with open reduction and internal fixation. A modified treatment plan, including custom orthosis and active wrist exercises, was initiated after the standard immobilization phase to enhance the range of motion while accommodating the patient's daily activities. Clinical discussion: The patient underwent 15 evaluations of active range of motion (AROM) using a goniometer, guided by the American Society of Hand Therapists. A Tissue Composition Analysis (TCA) was performed to guide the orthosis-treatment choice. Despite consistent improvement shown in AROM, it was inconclusive whether the modified treatment contributed significantly beyond the standard approach. Conclusions: While the patient's AROM improved, the treatment's effect on this single case cannot definitively confirm the efficacy of the modified approach. A more extensive study is necessary to evaluate the conservative treatment strategy's validity for such fractures in high-demand patients, considering the biomechanical complexity of the injury and the patient's professional needs. 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

Effect of cervical contralateral lateral flexion on the median nerve and fascia at the wrist – Cadaveric study. Pérez-Bellmunt, A., et al. (2024) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Cervical movement - Median nerve movement This study investigates the effect of cervical contralateral lateral flexion (CCLF) on the median nerve versus fascia at the wrist during the median nerve neurodynamic test. A total of five cadavers were included in the study. The main goal was to assess whether CCLF could mechanically differentiate nerve movement from fascial tissues. Measurements of excursion and strain were recorded using the KINOVEA software. The results showed a significant proximal excursion in the median nerve without significant changes in strain, while neither superficial nor deep fascia exhibited any significant excursion or strain alterations. These findings suggest that CCLF can effectively differentiate median nerve movement from local tissues at the wrist, potentially aiding in the diagnosis of wrist 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, cervical contralateral lateral flexion (CCLF) as a structural differentiation maneuver during median nerve neurodynamic testing induces movement of the median nerve at the wrist. In contrast, the superficial and deep fascia in the wrist did not move. This study is a nice addition to growing evidence showing the effect of neurodynamic interventions/diagnostic procedure on the peripheral nervous system . URL : https://doi.org/10.1016/j.msksp.2024.103146 Abstract Background: Neurodynamic tests are an essential aspect of the physical examination of the patient when suspicion of neural involvement exists. A manoeuvre that is hypothesised to move nerves differentially relative to other structures (structural differentiation) has been proposed as a necessary part of neurodynamic testing for differential diagnosis. However, although the specificity of structural differentiation for peripheral nerve over muscle has been demonstrated in some body regions, no study has tested specificity of nerve movement relative to fascia. Objectives: The aim of this study was to measure the effect of the cervical contralateral lateral flexion (CCLF) as an structural differentiation manoeuvre for the median nerve compared to fascia (superficial and deep) at the wrist during the upper limb neurodynamic test 1 (ULNT1). Design: A cross-sectional study was performed in 5 fresh frozen cadavers. Methods: Excursion and strain in the fascia (superficial and deep) and the median nerve were measured at the wrist with structural differentiation during the ULNT1. KINOVEA software was used to measure kinematic parameters. Results: CCLF resulted in significant proximal excursion in the median nerve (p < 0.001*) but not in the strain. CCLF neither produced changes in strain nor excursion in the superficial and deep fascia (p > 0.05). Conclusion: This study showed that CCLF produced significant differential excursion in the median nerve at the wrist compared to the local superficial and deep fascia during the ULNT1. The data support CCLF in mechanical differentiation between nerve and fascia in this area in diagnosis of local sources of wrist pain. 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

Sustained increase of pinch strength after traction treatment for symptomatic distal interphalangeal joint osteoarthritis. Saito, S., Makino, A. and Morimoto, N. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Hand OA - Traction splint This longitudinal study explored the efficacy of traction treatment for symptomatic distal interphalangeal (dipj) joint osteoarthritis (OA). A total of 18 participants completed a daily, 15-minute, home-based joint traction routine utilising a finger trap splint. Pinch strength measured between the affected finger and thumb was the primary outcome. Results showed a significant improvement in pinch strength by one month, maintained at six months. Compared to untreated contralateral digits, treated digits consistently displayed improved pinch strength over all time points. A clear limitation of the study is that there was no control group or placebo intervention. 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, joint traction treatment may improve pinch strength in patients with symptomatic distal interphalangeal joint (dipj) osteoarthritis. Nevertheless, there is currently insufficient evidence to use this as a routine approach for symptomatic dipj OA. It is however possible that sensory information caused by the joint traction may induce an illusory perceptual resizing, which has been previously shown to induce pain-relief in some people with hand OA . URL : https://doi.org/10.1016/j.heliyon.2024.e32830 Abstract Background: Symptomatic distal interphalangeal joint osteoarthritis is a common joint disease that causes hand disability and reduces quality of life. There are few conservative treatment options for this condition. The purpose of this study was to investigate the effect of traction treatment on symptomatic distal interphalangeal joint osteoarthritis. Methods: This prospective, longitudinal study involved multiple time-series observations and within-subject controls. The most painful distal interphalangeal joints in patients with hand osteoarthritis were treated by daily, 15-min joint traction at home using a finger trap orthosis. The corresponding contralateral digits were used as within-subject controls. The primary outcome measure was two-point pinch strength, and the secondary outcome measures were radiographic findings and treatment adherence. Longitudinal and pairwise comparison analyses of the treated and control digits examined improvements in two-point pinch strength at months 1, 3, and 6 from baseline. The durability of treatment effects after treatment discontinuation was investigated at month 12. Results: Eighteen treated digits and 18 corresponding control digits were eligible for analysis. There was a significant increase in two-point pinch strength after 1-month traction, and this increase was maintained until month 6 despite the absence of radiographic changes. Compared to controls, significant improvement in two-point pinch strength relative to baseline was seen at every observation time point, with a moderate to large effect size. There was no time–treatment interaction. Treatment adherence was high. At months 3 and 6, around 60–80 % of digits were voluntarily treated. Pinch strength was comparable between months 6 and 12, with greater improvement than in the control group. Conclusion: Joint traction treatment can improve pinch strength in symptomatic distal interphalangeal joint osteoarthritis. Larger, randomized studies on traction treatment and the effect on hand function are warranted. 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

Round table discussion: The management of idiopathic cubital tunnel syndrome. McEachan, J. E., Dahlin, L. B., Ng, C. Y., Ring, D. and Ruettermann, M. (2024) Level of Evidence: 5 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Cubital tunnel syndrome - Management The paper discusses the contemporary management of idiopathic cubital tunnel syndrome (CuTS) from the perspective of four surgeons. The authors agree that early CuTS should be managed non-operatively using an elbow splint and ergonomic advice, with surgery reserved for cases with evident impairments on Nerve Conduction Studies (NCS). The are different opinions on timing and type of surgery, with a consensus on keeping procedures minimally invasive when possible. Overall, the authors stress the importance of individualised assessment and the use of non-surgical approaches in the early stages of the disease. 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 management of idiopathic cubital tunnel syndrome (CuTS) should be non-surgical, especially in the initial stage of the condition and when patients report intermittent paraesthesia. Ergonomic modifications , elbow splints , and nerve gliding exercises are recommended to manage symptoms. Surgical options should be considered if NCS identified significant impairments and if conservative treatments failed. Imaging such as ultrasound has been suggested as a useful adjunct to subjective and objective examination for cubital tunnel syndrome to exclude the presence of space invading lesions or anatomical variations. URL : https://doi.org/10.1177/17531934241238942 Abstract Idiopathic cubital tunnel syndrome is the second most common neuropathy in the upper limb. Best evidence regarding the surgical management of this condition has evolved from anterior or submuscular transposition as the former reference standard, to in situ simple release. Differences of opinion remain regarding the timing of surgery, type of surgery and adjunctive surgery. Four surgeons with Level 5 expertise were asked to answer specific questions regarding this condition. 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

Taking 200 mg vitamin C three times per day improved extraction socket wound healing parameters: A randomized clinical trial. Pisalsitsakul, N., Pinnoi, C., Sutanthavibul, N. and Kamolratanakul, P. (2022) Level of Evidence: 1b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Vitamin C - Wound healing This randomised placebo controlled trial assessed the impact of different oral doses of vitamin C on the healing of oral wounds following tooth extraction. Despite this study being completed in the oral health field, there is some research suggesting that vitamin C may help with healing of wounds in general. A total of 42 patients undergoing symmetric bilateral non-infected premolar extractions were included. Participants were randomised into three groups: placebo vs. 600 mg vitamin C/day, placebo vs. 1,500 mg vitamin C/day, and 600 mg vs. 1,500 mg vitamin C/day. The results indicated that a 600 mg/day dose significantly reduced wound size and improved pain to a clinically relevant level compared to placebo. There was no significant difference in wound size reduction between 600 mg and 1,500 mg doses. 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, oral administration of 600 mg of vitamin C daily may help with wound healing and pain. This may be particularly true for those people who have a poor diet and low levels of vitamin C availability through their diet. Considering the low cost of multivitamin supplements, it may be useful to get them using them in the peri-operative period. In addition, it appears that aerobic exercise is useful for wound healing, and our patients are likely to benefit from it . In addition, the use of vitamin C may reduce the risk of persistent pain following surgery . URL : https://doi.org/10.1155/2022/6437200 Abstract Vitamin C is essential for wound healing. However, there are no reports concerning the effect of a different dose of vitamin C on extraction wound size clinically. Therefore, the aim of this study was to investigate the effect of different oral vitamin C doses on extraction wound healing. A split-mouth, double-blind randomized clinical trial was performed in 42 patients who underwent symmetric bilateral noninfected premolar extraction. The patients were randomly divided into 3 groups, namely, P/600, P/1,500, and 600/1,500 (14 patients for each group); P/600: placebo vs. 600 mg vitamin C/d, P/1,500: placebo vs. 1,500 mg vitamin C/d, and 600/1,500: 600 mg vitamin C/d vs. 1,500 mg vitamin C/d. Patients were prescribed placebo or/and vitamin C three times a day for 10 days after each tooth extraction. Extraction wound size and pain score were evaluated. The wound assessment was performed on day 0, 7, and 21; and then the tooth on the other side was extracted using the same protocol. Pain score was recorded on the first three days after extraction. The reduced size of mesiodistal extraction wound in percentage reduction between day 0 and 7 of teeth receiving vitamin C 600 mg/d was more than that in placebo (P < 0.05). Pain scores on day 1–3 of teeth receiving vitamin C 600 mg/d were significantly lower than the placebo side (P < 0.05). Taking oral vitamin C 600 mg/d over three doses for 10 days after tooth extraction enhances extraction wound healing by reducing mesiodistal extraction wound and reduces postoperative pain. 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

Daytime functional usage versus nighttime wearing: Identifying the optimal wearing regimen for a custom-made orthosis in the treatment of trapeziometacarpal osteoarthritis. Silva, F. C., da Silva, R. V. T., Meireles, S. M., Fernandes, A. and Natour, J. (2024) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Splinting for thumb OA - Night or day splint This randomised controlled single-blind study aimed to compare daytime use versus nighttime use of a custom-made splint for the treatment of thunb OA. A total of sixty participants from were randomised to either a functional group (FG) or a nighttime group (NG). The primary outcome was pain at the base of the thumb on numerical rating scale (NRS, 0-10 points), while secondary assessments included hand pain, thumb range of motion (ROM), grip and pinch strength, and manual dexterity. The results showed that both groups experienced statistically and clinically relevant improvements in pain. However, there was no differences between night or day use of the splint. 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, for patients with 1st cmcj OA, both daytime functional use or nighttime wearing of a custom-made orthosis can significantly reduce pain and improve hand function over a one-year period. Clinicians can thus recommend either regimen based on patient preference and lifestyle, as no significant differences were found between the two options. The use of a multimodal approach for 1st cmcj OA appears to be useful , however, the effect of splinting vs no splinting appears to be of little importance . URL : https://doi.org/10.1016/j.apmr.2024.06.013 Abstract Objective: To compare the functional (daytime) use to the nightly use of an orthosis for patients affected by trapeziometacarpal osteoarthritis (OA). Design: Randomized, controlled single-blind trial. Setting: The rheumatology outpatient clinic of the University. Participants: Sixty participants diagnosed with trapeziometacarpal OA. Interventions: Participants were randomly assigned into 2 groups: a functional group that used a functional hand-based thumb immobilization orthosis during activities of daily living and a night-time group that used the same orthosis at night. Main Outcomes Measures: The patients were evaluated at baseline and after 45, 90, 180, and 360 days considering: pain at the base of the thumb and in the hand, range of motion of the thumb, grip, and pinch strength, manual dexterity, and hand function. Results: The groups were homogeneous at the beginning of the trial. No statistically significant difference was observed between groups over time for trapeziometacarpal pain (P=.646). For general hand pain, no statistically significant difference was found between groups over time (P=.594). Although both groups improved from baseline, there were no statistically significant differences between the groups in the vast majority of the assessed parameters. Statistically significant differences between the groups were found only in the following outcomes: thumb palmar abduction of the right hand (P=.023), pick-up test with closed eyes of the right hand (P=.048), and tripod grip strength of the right hand (P=.006). Conclusions: Both groups showed improvement in pain and function from baseline to the end of the intervention. However, there were no reported differences in these outcomes after a 1-year follow-up between the functional (daytime) and night-time use of orthosis in patients with trapeziometacarpal OA. This suggests that both types of usage can be offered to patients. 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

Long-term clinical outcomes following nonsurgical management of Salter-Harris type II fractures of the proximal phalanx of the small finger: A prospective cohort study. Wood, L., Malin, L., Robb, J., Ward, C. and Bohn, D. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Salter-Harris type II fractures - Conservative management This prospective cohort study evaluates the efficacy of nonsurgical management of Salter-Harris Type II fractures at the base of the proximal phalanx of the small finger with angulation (coronal plane) in pediatric patients. Using data from a hospital archive of children aged 8 to 16 years, the authors calculated radiographic measurements and surveyed function at an average of seven years post injury. A total of 80 participants were included, with 38 children/teenagers reporting subjective outcomes. The results showed that conservative management was appropriate in patients with up to 26 degrees of coronal plane angulation. Up to that level of angulation, function, satisfaction with appearance, and pain were equal to a reference group of healthy children/teenagers. 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, nonsurgical management appears to be highly effective for the majority of children with Salter-Harris Type II fractures of the proximal phalanx of the small finger. Coronal plane angulation of up to 26 degrees seems to be the cut off to obtain good outcomes in the long term. Beyond that level of angulation, involvement of a hand surgeon is highly advisable. URL : https://doi.org/10.1016/j.jhsa.2024.04.002 Abstract Purpose: Juxta-physeal fractures at the base of the proximal phalanx (FBPP) of the small finger are one of the most common hand fractures in children. Although many of these fractures are treated nonsurgically, it is unclear which fractures benefit from surgery or the degree of acceptable angulation appropriate for nonsurgical management. Our study aimed to assess long-term, patient-reported outcomes regarding function, appearance, and pain after nonsurgical management of FBPP of the small finger in a pediatric population. Methods: Our hospital Picture Archiving and Communication Systems database was queried to identify radiographs of the small finger of children between the ages of 8 and 16 years old taken from 2011 to 2021. Displacement on initial injury radiographs was calculated using the diaphyseal–metacarpal head angle. Patient-reported function, appearance, and pain were measured using standardized assessment tools sent to patients and parents electronically. Optional clinical photographs were uploaded by parents and assessed for residual clinical deformity. Results: One hundred eighty-one eligible subjects were identified. Eighty (44%) agreed to participate, and 40 (22%) parent and 38 patient surveys were completed. The mean age at the time of injury was 11 years old (8–14 years), and the mean age at the time of survey completion was 17 years old (11–23 years). Patient T-scores were higher than the average reference T-score on the Patient-Reported Outcomes Measurement Information System Short Form v2.0—Upper Extremity. Overall, greater than 78% of patients and parents reported appearance as 8/10 or above on a VAS. Ninety-five percent (108/114) of patients reported no pain (0/10) for pain during activities and at rest. Conclusions: Children with up to 26° of initial coronal plane angulation reported better function than a reference population, good appearance, and no pain, at a mean of 6 years after injury. Our findings support nonsurgical management of most FBPP of the small finger in children. 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

Do maladaptive imaging beliefs predict self-reported pain interference and physical function in patients with musculoskeletal disorders? Plante, J., Kucksdorf, J., Ruzich, J., Young, J. L. and Rhon, D. I. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Imaging beliefs - Pain interference and function This study explores the correlation and predictive value of maladaptive imaging beliefs on pain interference and physical function in patients with musculoskeletal disorders. A total of 152 participants with musculoskeletal conditions were included, and they were asked to fill out a set of questionnaire to assess their beliefs about the necessity of imaging for ruling out serious conditions, guiding treatment, determining diagnosis, and validating symptoms. The results showed that participants believing that imaging had a high relevance in the rehabilitation process were more likely to present with higher levels of pain interference and lower physical function. This correlation was not only obesrved at baseline but also after six 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, maladaptive imaging beliefs are significantly correlated with increased pain interference and decreased physical function in patients with musculoskeletal disorders. Educating patients about the appropriate use of imaging and addressing these beliefs through a biopsychosocial approach may help improving clinical outcomes. In particular, it may be relevant to probe patients' understanding of pain and assess whether we can help them navigating management of this unpleasant perception. URL : https://doi.org/10.2519/jospt.2024.12625 Abstract OBJECTIVE: To determine if maladaptive imaging beliefs correlated with, and predicted pain interference and physical function outcomes in people with musculoskeletal pain disorders. DESIGN: A prospective cohort study of patients with musculoskeletal disorders receiving outpatient physical therapy from April 2022 to August 2023. METHODS: Four questions about imaging were asked to assess maladaptive beliefs, the need to rule out serious conditions, guide treatment, determine diagnosis, and validate symptoms. Correlations with beliefs and outcomes were assessed using Kendall’s tau rank and Spearman’s rho correlation coefficients. Generalized linear models determined if these beliefs predicted outcomes at baseline and 6 weeks. RESULTS: The cohort included 152 participants (mean [standard deviation] age: 56.13 [15.13]; 32.2% male). Maladaptive imaging beliefs correlated positively with pain interference and negatively with physical function. The need to rule out serious conditions and validate symptoms correlated with pain interference (range: τb = 0.17, 0.20; P = .003, .0121) and physical function (range: ρ = −0.22, −0.22; P = .006, .008). All but 1 belief correlated with pain interference (range: τb = 0.19, 0.24; P<.001, .004) and physical function (range: ρ = −0.26, −0.21; P = .001, .009) at 6 weeks. Each additional belief slightly increased pain interference at 6 weeks (β = 0.01; 95% CI: 0.001, 0.03; P = .04) and lowered physical function at both baseline (β = −0.97; 95% CI: −1.66, −0.28; P = .01) and 6 weeks (β = −0.76; 95% CI: −1.37, −0.15; P = .02). CONCLUSION: Maladaptive imaging beliefs were significantly (albeit weakly) correlated with pain and physical function. Each additional maladaptive imaging belief increased pain interference at 6 weeks and lowered physical function at baseline and 6 weeks. Beliefs about the necessity of imaging to properly manage musculoskeletal disorders may influence outcomes. 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