Search Results

Upper limb neurodynamic mobilization disperses intraneural fluid in cervical nerve roots: A human cadaveric investigation. Burgess, N. E., et al. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Median nerve mobilisation - cervical radiculopathy This study examined the effects of median nerve-biased neurodynamic mobilisation on intraneural fluid dispersion in the C5, C6, and C7 cervical nerve roots of cadavers. A total of eight cadavers were included in the study. Dye was injected into C5-C6 roots. A period of time with no upper limb movement was utilised to act as a control for dye dispersion. The experimental intervention consistend in five minutes of median nerve tensioner exercise with the movement occurring at the elbow only (2 seconds for elbow extension and return to flexion). Results showed that neurodynamic mobilisation resulted in significant intraneural longitudinal dye spread at C5, C6, C7 nerve roots, with the most movement occurring at C6. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, median nerve-biased neurodynamic mobilization (NDM) may reduce nerve root swelling in people with cervical radiculopathy involving C6. Previous research has shown that neurodynamic exercises are helpful for people with radiculopathy, however, they do not appear to be more effective than other form of exercise. It is possible that most form of exercise are effective in reducing intraneural swelling and they may not need to be very specific. If you are interested in reading more about cervical radiculopathies, have a look at the whole database. URL: https://doi.org/10.1016/j.msksp.2023.102876 Abstract Background: Cervical radiculopathy is a common cause of neck pain with resultant intraneural edema and impaired nerve function. One strategy to treat radiculopathy is neurodynamic mobilization (NDM); however, little is known about the effect of this treatment on nerve tissue fluid dynamics. Objective Investigate the impact of upper limb, median nerve-biased NDM on longitudinal intraneural fluid dispersion in the C5,C6,C7 nerve roots in un-embalmed cadavers. Design In situ repeated measures. Methods: Human cadavers (n = 8) were dissected to expose and inject C5,C6,C7 cervical nerve roots with a dying agent. Initial longitudinal dye spread was recorded after dye spread stabilization. Cadavers were taken through 150 repetitions of upper limb, median nerve-biased NDM followed by dye spread re-measurement. Paired-samples t-tests with Bonferroni correction (α = 0.017) were used to compare pre-vs post-NDM dye spread measurements at C5,C6,C7 nerve roots; a one-way repeated measures ANOVA (α = 0.05) was used to examine differences between change scores for C5,C6,C7 nerve roots. Results: Median nerve-biased NDM resulted in significant intraneural longitudinal dye spread at C5 and C6 nerve roots of 0.6 ± 0.6 mm and 3.4 ± 3.9 mm, respectively (p < 0.014). Dye spread was not significant at C7 nerve root (0.4 ± 0.7 mm). There was no between root difference in change of longitudinal dye spread between C5, C6, and C7 nerve roots. Conclusions: The results of this study show median nerve-biased NDM produced internal fluid movement within C5 and C6 cervical nerve roots. Results provide insight regarding possible mechanism of action and feasibility of NDM in treatment of patients with cervical radiculopathy. 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

Type 2 diabetes and fasting glycemic are causal factors of frozen shoulder: A two-sample mendelian randomization analysis. Xu, T., Xia, Q., Zhang, L., Yang, X. and Fu, W. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Aetiologic, Therapeutic Topic: Frozen shoulder - Diabetes This is a retrospective analysis of existing genetic data assessing whether there is a causal relationship between type 2 diabetes, glycemic traits (fasting glucose, fasting insulin, glycated hemoglobin, and 2-hour postprandial glucose) and frozen shoulder. A total of 48,286 people with frozen shoulder and 250,671 controls were included in the study. The results showed a genetic causal relationship between type 2 diabetes, fasting glucose and frozen shoulder, but no evidence for a causal correlation between fasting insulin, glycated hemoglobin, 2-hour postprandial glucose and frozen shoulder. 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, diabetes and fasting glucose levels may be causal factors of frozen shoulder. Controlling glucose levels may be a potential avenue for the prevention and mitigation of frozen shoulder. This may be relevant in our clients who have had a FOOSH, have shoulder pain, and also present with type 2 diabetes. Thus, they may be more likely to develop a frozen shoulder. URL: https://doi-org.ezproxy.aut.ac.nz/10.1016/j.jse.2023.08.006 Abstract Background: The causal relationship between type 2 diabetes (T2D) and frozen shoulder (FS) is unclear. This study aims to explore the genetic causal association between type 2 diabetes (T2D) and glycemic traits (fasting glucose [FG], fasting insulin [FI], glycated hemoglobin [HbA1c] and 2hGlu [2-hour postprandial glucose]) on FS. Methods: Using two-sample Mendelian randomization (MR), we analyzed non-confounded estimates of the effects of T2D and glycemic traits on FS. Single nucleotide polymorphisms (SNPs) strongly associated (p<5×10-8) with exposures from genome-wide association studies (GWAS) were identified. We employed fixed effect mode inverse variance weighting (IVW-FE), random effect mode IVW (IVW-MRE), MR-Egger, weighted median to assess the association of exposures and outcome. Sensitivity analysis was conducted to test for heterogeneity and multi-directionality bias in MR. Results: We found a significant genetic causal correlation between T2D (IVW-MRE P = 0.00697, odds ratio [OR] (95% confidence interval [CI]) = 1.093 (1.03-1.16)), FG (IVW-FE p = 0.000351, OR (95% CI) = 1.455 [1.173-1.806]) and FS, but no evidence for causal correlation between FI, HbA1c, 2hGlu and FS. Although there was certain heterogeneity, sensitivity analysis reveals no deviation from the MR assumptions. Conclusion: This study supports a genetic causal relationship between T2D, FG and FS. 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

Patient perspectives on cognitive behavioral therapy for thumb, hand, or wrist pain and function: A survey of 98 patients. Imbergamo, C. M., Durant, N. F., Giladi, A. M. and Means, K. R., Jr. (2023). Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Hand pathology - Cognitive behavioral therapy This survey investigated the use of Cognitive Behavioral Therapy (CBT) to help manage thumb, hand, or wrist pain or dysfunction. Of the 327 patients surveyed, 98 responded, with 17% (17/98) reporting they had participated in CBT. Of this group, 15/17 felt that CBT had been helpful for them, while 75% (60/81) of those who had not used CBT were neutral. The findings suggest that increased CBT utilisation in this setting could positively affect patient outcomes, set realistic expectations, and ultimately improve satisfaction with care. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, there is an opportunity to increase awareness and recommendations of Cognitive Behavioral Therapy (CBT) as a non-medication option to help manage thumb, hand, or wrist pain. Patients who have used CBT reported favorable results, and those without direct experience were open to considering it. Increasing utilization of CBT in this setting could positively affect patient outcomes, set realistic expectations, and ultimately improve satisfaction with care. URL: https://doi.org/10.1016/j.jhsa.2023.08.002 Abstract Purpose: Cognitive behavioral therapy (CBT) is an established option to improve pain and function for many orthopedic conditions. Our purpose was to obtain patient perspectives regarding CBT for thumb, hand, or wrist pain and function. Methods: Between March and April 2022, we distributed an electronic survey via email to patients in our institution’s health system with a diagnosis of arthritic or non-specific thumb, hand, or wrist pain. The survey included the opening statement “Cognitive Behavioral Therapy (CBT) is a non-medication option to help manage pain and improve function” and up to 13 questions pertaining to patients’ experiences and perceptions regarding CBT. The survey was anonymous and did not collect protected health information. We used descriptive statistics for the findings. Results: We distributed the survey to 327 patients, yielding a 30% response rate (98/327). Of the respondents, 17 reported already using CBT to specifically help with pain/function. Of these, 15 felt it was helpful and agreed it could help others. Of the subset that used CBT for arthritis, all felt it was helpful. Of the 75 respondents with no CBT experience, 42 indicated “I’ve never heard of it,” 28 responded “I never had it recommended as an option,” and 16 marked “I don’t know enough about it.” Small subsets noted potential personal barriers to CBT implementation, such as cost, time involved, or perceived lack of potential efficacy for themselves. Conclusions: A small proportion of patients from our institution with thumb, hand, or wrist pain are utilizing CBT, and the majority finds it helpful. Clinical relevance: While some patients are already substantially benefiting from CBT to improve their thumb, hand, or wrist pain or function, there is a notable opportunity for providers to increase awareness and recommendations for this option. 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

Surgical site infection following surgery for hand trauma: A systematic review and meta-analysis. Wormald, J. C., et al. (2023) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Symptoms prevalence Topic: Hand surgery – Infection rate This systematic review and meta-analysis assessed the incidence of infections following surgery for hand trauma. A total of 201 study, which included RCTs, prospective cohort, retrospective, and case studies, were included. A total of 315,618 participants were included across all the studies. The results showed that the overall risk of surgical site infection was 5%, with RCTs showing a 10% risk of infection. The reason for this disparity is likely due to poorly reported records analysed by retrospective studies compared to RCTs. Subgroup analysis by clinical factors showed that the risk of surgical site infections varied according to type of intervention, with ORIF having the lowest risk of all surgical interventions. 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 site infection is a rare complication of hand trauma surgery, with an overall risk of 5-10%. The risk of post-surgical infection may double in those patients who are smokers/diabetics and/or who work in high-risk environments (e.g. fisherman, aquarist). If you have an open hand fracture, you can calculate the risk of developing an infection through the criteria in this synopsis. If you suspect an infection, x-rays and US are useful investigations to request. URL: https://doi.org/10.1177/17531934231193336 Abstract Surgical site infection is the most common healthcare-associated infection. Surgical site infection after surgery for hand trauma is associated with increased antibiotic prescribing, re-operation, hospital readmission and delayed rehabilitation, and in severe cases may lead to amputation. As the risk of surgical site infection after surgery for hand trauma remains unclear, we performed a systematic review and meta-analysis of all primary studies of hand trauma surgery, including randomized controlled trials, cohort studies, case-control studies and case series. A total of 8836 abstracts were screened, and 201 full studies with 315,618 patients included. The meta-analysis showed a 10% risk of surgical site infection in randomized control trials, with an overall risk of 5% when all studies were included. These summary statistics can be used clinically for informed consent and shared decision making, and for power calculations for future clinical trials of antimicrobial interventions in hand trauma. 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 systematic review of the effectiveness of wrist manipulative therapy in patients with lateral epicondylitis. Eapen, C., Rosita, R., Sohani, M. S. and Patel, V. D. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Lateral epicondylalgia – Wrist manipulations This is a systematic review assessing the effectiveness of wrist manipulation in the treatment of lateral epicondylitis. A total of four randomised controlled trials were included in the review. The manipulation was described as a repetition of forced passive extension of the wrist or extension of the wrist against resistance (20 repetitions). The duration of each intervention was 15 to 20 minutes. This wrist manipulation group was compared to ultrasound, laser, friction massage, MWMs, or resistance exercises. The results showed that wrist manipulations provided some sort term reduction in pain compared to other treatments, however, it is not clear whether the difference was clinically relevant. There was no consisten effect on grip strength or ROM. Given the lack of significant pain changes and the inexistence of an explanation for such findings, wrist manipulations do not appear to have a large effect compared to other interventions. 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, wrist joint manipulations may be beneficial in reducing pain in lateral epicondylitis, however, they are unlikely to provide larger effect sizes compared to other interventions. Other conservative interventions that may provide temporary relief for lateral epicondylalgia include MWMs. If you are interested in lateral epicondylalgia, have a look at the full database. URL: https://doi.org/10.1016/j.jht.2022.10.002 Abstract Study design: Systematic review. Introduction: Several treatment methods treat lateral epicondylitis, but there is no consensus regarding the most effective method. Research has suggested that joint mobilizations may help recover patients with lateral epicondylitis. Purpose of the study: To determine if wrist joint manipulations effectively improve pain, grip strength, ROM, and functional outcome in adults with lateral epicondylitis. Methods: Searches were performed in 6 databases to identify relevant clinical trials. Three reviewers independently extracted data and assessed the methodological quality using the PEDro scale. Standard data were extracted and summarized. Results: A total of 4 studies met the inclusion criteria. A best-evidence synthesis was used to summarize the results. The included studies found effectiveness in favor of wrist manipulations given for at least 3 weeks to reduce pain in lateral epicondylitis against comparison groups comprising ultrasound, laser, friction massage, and exercises. Functional outcomes varied considerably among studies. Grip strength showed varied results, and no effect was seen on wrist ROM. Conclusion: The evidence is convincing that wrist joint manipulations positively affect pain in the short term, compared to comparison groups in the management of lateral epicondylitis. Future high-quality studies are recommended. 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

Where does blood flow restriction fit in the toolbox of athletic development? A narrative review of the proposed mechanisms and potential applications. Davids, C. J., et al. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Blood flow restriction training - Athletes This is a narrative review on Blood Flow Restriction (BFR) training for the application in athletes. Blood flow restriction training is a novel model of exercise which has been shown to improve aerobic capacity and muscular endurance performance. It has been suggested that BFR may be used to target either type I fibres when compared with conventional high-load resistance training. For athletes, BFR may reduce the risk of injury, reduce the time needed to reach a certain level of fitness, and be used to target specific physiological adaptations. Blood flow restriction can be used to supplement or de-load from traditional high-intensity training, or to accelerate recovery from musculoskeletal injury. It can also be used to improve sport-specific tasks, such as sprinting, change of direction, and agility. Blood flow restriction has been shown to induce robust activation of skeletal muscle stem cells and improve oxidative capacity and local muscular endurance. Blood flow restriction is recommended to be used to maintain muscle mass rather than increase it, and should be carefully considered in sports due to the potential for muscle damage and prolonged stress. 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, Blood Flow Restriction (BFR) training is a promising strategy to accelerate the regeneration of musculoskeletal injuries, such as muscle strains. It can also be used to increment the effect of light resistance training when increasing loading is not possible due to pain or surgical restrictions. I currently use in some case presenting with common extensor origin tendinopathy and in those patients that want to have an expedite recovery following distal biceps repair but cannot load their biceps beyond light weight. The feasibility of blood flow restriction training has also been trialled in symptomatic hand OA and has shown some good success. URL: https://doi.org/10.1007/s40279-023-01900-6 Abstract Blood flow-restricted exercise is currently used as a low-intensity time-efficient approach to reap many of the benefits of typical high-intensity training. Evidence continues to lend support to the notion that even highly trained individuals, such as athletes, still benefit from this mode of training. Both resistance and endurance exercise may be combined with blood flow restriction to provide a spectrum of adaptations in skeletal muscle, spanning from myofibrillar to mitochondrial adjustments. Such diverse adaptations would benefit both muscular strength and endurance qualities concurrently, which are demanded in athletic performance, most notably in team sports. Moreover, recent work indicates that when traditional high-load resistance training is supplemented with low-load, blood flow-restricted exercise, either in the same session or as a separate training block in a periodised programme, a synergistic and complementary effect on training adaptations may occur. Transient reductions in mechanical loading of tissues afforded by low-load, blood flow-restricted exercise may also serve a purpose during de-loading, tapering or rehabilitation of musculoskeletal injury. This narrative review aims to expand on the current scientific and practical understanding of how blood flow restriction methods may be applied by coaches and practitioners to enhance current athletic development models. 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

Mechanisms linking physical activity with psychiatric symptoms across the lifespan: A systematic review. Ho, P. T. N., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Depression and anxiety - Hoe does exercise help? This is a systematic review assessing scientific evidence on the mechanisms through which physical activity might reduce psychiatric symptoms. A total of 22 studies, which included both experimental and observational articles were included. The results showed that physical activity has a small-to-moderate effect on mental health. It appears that self-esteem, self-concept, and self-efficacy were the only consistent mechanism through which physical activity appears to influences psychiatric symptoms (specifically depressive and anxiety symptoms). There were insufficient studies to determine the role of neurobiological mechanisms. 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, physical activity has a small-to-moderate effect on anxiety and depression. Self-esteem, self-concept, and self-efficacy are the only consistent pathways through which physical activity appears to influence psychiatric symptoms. Reminding our patients with depression and anxiety about the importance of being active may therefore be beneficial. Have a look at the entire database on the benefits of physical activity for our patients with hand and upper limb conditions. URL: https://doi.org/10.1007%2Fs40279-023-01895-0 Abstract Background: Physical activity has been suggested as a protective factor against psychiatric symptoms. While numerous studies have focused on the magnitude of physical activity’s effect on psychiatric symptoms, few have examined the potential mechanisms. Objective: The current review aimed to synthesize scientific evidence of the mechanisms through which physical activity might reduce psychiatric symptoms across the lifespan. Methods: We included articles that were published before March 2022 from five electronic databases (MEDLINE, Web of Science, PsycINFO, Embase, and Cochrane). A qualitative synthesis of studies was conducted. The risk of bias assessment was performed using The Joanna Briggs Institute Critical Appraisal Tool for Systematic Reviews. Studies were included if they explored the possible mechanisms through which physical activity influences psychiatric symptoms (i.e., internalizing and externalizing symptoms) across the lifespan. Results: A total of 22 articles were included (three randomized controlled trials, four non-randomized controlled trials, three prospective longitudinal studies, and 12 cross-sectional studies). Overall, most of the studies focused on children, adolescents, and young adults. Our findings showed that self-esteem, self-concept, and self-efficacy were the only consistent paths through which physical activity influences psychiatric symptoms (specifically depressive and anxiety symptoms) across the lifespan. There were insufficient studies to determine the role of neurobiological mechanisms. Conclusions: Overall, future physical activity interventions with the purpose of improving mental health should consider these mechanisms (self-esteem, self-concept, self-efficacy) to develop more effective interventions. 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

Diagnosis of ulnar neuropathy at the elbow using ultrasound: A comparison to electrophysiologic studies. Carroll, T. J., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic: Cubital tunnel – US and Nerve conduction studies This retrospective study assess the accuracy of ultrasound imaging (US) compared to nerve conduction studies (NCS) studies in diagnosing cubital tunnel syndrome. A total of 89 participants (115 ulnar nerves) were included in the present study. Participants were included if they reported that they presented with motor/sensory loss of ulnar innervated muscles/skin areas or paraesthesias in the ulnar distribution at the hand. The results showed that US was an effective alternative to NCS, with 91% of patients with clinically diagnosed cubital tunnel syndrome having positive NCS. There was also a correlation between US imaging and NCS severity. 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, ultrasound imaging could be utilised as an alternative to nerve conduction studies for the diagnosis of ulnar neuropathy at the elbow. The benefit of US imaging is that it's less expensive, faster, and less invasive compared to NCS. Considering that we cannot refer for nerve conduction studies, the use of US imaging may be a handy alternative. The use of US imaging may also be useful in excluding a space invading lesion or the presence of anconeus epitrochlearis, which may require surgical intervention. URL: https://doi.org/10.1016/j.jhsa.2023.08.014 Abstract Purpose: Given the relatively high false negative rate of electrodiagnostic studies (EDX) in patients with clinically diagnosed ulnar neuropathy at the elbow (UNE), we sought to determine whether an alternative objective test could more effectively detect UNE. Additionally, we proposed to determine the relationship between the cross-sectional area (CSA) of the ulnar nerve on ultrasound (US), EDX, and clinical symptoms. Methods: This was a retrospective study of patients presenting with symptomatic UNE. The performance characteristics of EDX versus ultrasound were calculated using the clinical diagnosis of UNE as the reference standard. Standard EDX studies and US of the ulnar nerve were analyzed. Maximal CSA of the ulnar nerve and EDX severity were analyzed for patients with each combination of US-positive/negative and EDX-positive/negative findings. Results: Analysis was performed on 89 patients and 115 nerves with signs and symptoms of cubital tunnel syndrome. In total, 56 (49%) nerves were diagnosed as mild UNE, 32 (28%) nerves were diagnosed as moderate UNE, 17 (15%) nerves were diagnosed as severe UNE, and 10 (8%) nerves were negative for UNE by EDX. Maximal–maximal CSA was highly correlated with disease severity as determined by nerve conduction studies/electromyography. Compared with EDX+/US+, patients with EDX−/US+ showed higher rates of ulnar sensory loss and elbow tenderness with similar rates of positive Tinel and intrinsic muscle atrophy. In this sample of patients with clinically diagnosed UNE, 91.3% of the patients demonstrated positive EDX studies, whereas 94.8% had a positive US. Conclusions: Ultrasound is an alternative to EDX that could be incorporated clinically in the diagnosis and management of UNE. Ultrasound was able to consistently detect clinically positive cubital tunnel syndrome demonstrating its utility as a confirmatory or supplemental test to the clinical assessment if one is required. Ultrasound additionally may be able to better identify patients with early stages of UNE with negative EDX findings. 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

Case report illustrating use of serial elastic tension digital neoprene orthoses (ETDNO) protocol in the treatment of proximal interphalangeal joint flexion contracture. Punsola-Izard, V., et al. (2022) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Pipj flexion deformity - Neoprene splint This case study presents the use of a serial elastic tension digital neoprene orthosis protocol to treat a patient with a 45º proximal interphalangeal joint (pipj) flexion contracture caused by a finger crush injury. After seven days of orthosis use, the pipj extension improved 20º of passive pipj extension and after 15 weeks, the patient achieved 0º of passive pipj extension. After this time, the patient was able to maintain the 0º of passive pipj extension without the use of the orthosis. This research provides some evidence that custom, circumferential, neoprene-based orthoses may improve flexion contractures of the pipj. This neoprene orthosis maybe utilised as an alternative to static progressive or dynamic splinting. 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, custom, circumferential, neoprene-based splints can be an effective treatment for pipj flexion deformities. These findings are in line with previous research showing that pipj felxion deformity can improve with splinting. It is important to remember that no specific splint appears to provide better outcomes and that splint wearing for a maximum of 11 hrs/day seems to be enough to obtain positive outcomes. Improvements in pipj flexion deformity are usually achieved if patient are treated early post-injury. URL: https://doi.org/10.1016/j.jht.2022.06.003 Abstract Introduction: This case report details the application of a treatment regimen using a serial elastic tension digital neoprene orthosis (ETDNO) protocol for a patient with an eight-month-old finger crush injury who experienced recurrence of a 45 ºproximal interphalangeal joint (PIPJ) flexion contracture two months after arthrolysis. Purpose of the Study: To illustrate how the application strategy of ETDNO can increase the daily total end range time (TERT) and modify finger stiffness. Results: The patient reached full extension following 15 weeks of ETDNO treatment. The six-month follow-up evaluation revealed that the PIPJ was stable with full flexion and extension. The joint did not require continued orthosis use. Discussion: The literature describes orthosis application as the treatment of choice for PIPJ flexion con- tracture, but no study has described an ideal program for use nor the full and stable resolution of the flexion contracture. The current literature describes a maximum daily total end range time (TERT) of 12 hours a per day. The serial ETDNO protocol that this study described increased the daily TERT to nearly 24 hour per day and demonstrated an excellent result in the treatment of PIPJ flexion contracture Conclusion: This outcome suggests that clinicians will want to consider this new orthosis design and management protocol as a novel option for the treatment of PIPJ flexion contracture. We need future research to better define the optimum number of hours of daily TERT for the effective treatment of PIPJ flexion contracture. In addition, we will also benefit from the exploration of the optimum orthosis design to enable the highest amount of TERT. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Elbow hemiarthroplasty and total elbow arthroplasty provided a similar functional outcome for unreconstructable distal humeral fractures in patients aged 60 years or older: A multicenter randomized controlled trial. Jonsson, E. Ö., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Total elbow arthroplasty - Hemi vs total arthroplasty This randomised trial compared the outcomes of elbow hemiarthroplasty and total elbow arthroplasty for the treatment of unreconstructable distal humeral fractures in elderly patients. A total of 40 participants were included in the present study. The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcomes included range of motion (ROM), grip strength, and patient-reported outcome measures. The results showed that both hemiartroplasty and total arthroplasty of the elbow were succesful approaches at a minimum of 2 years of follow-up, with no statistically significant differences between groups. Adverse events occurred in 33% and 35% of the hemiarthroplasty and total arthroplasty cases respectively. 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, hemiartroplasty and total elbow arthroplasty are viable treatment options for unreconstructable distal humeral fractures in elderly patients, with similar functional outcomes at 2 years of follow-up. Adverse events occurred in approximately one-third of both treatment groups, and within the first year post-surgically as suggested by previous research. URL: https://doi.org/10.1016/j.jse.2023.08.026 Abstract Background: Semiconstrained total elbow arthroplasty (TEA) is an established treatment for elderly patients with distal humeral fractures not amenable to stable internal fixation (unreconstructable). In recent years, there has been increasing interest in elbow hemiarthroplasty (EHA), a treatment option which does not entail restrictions in weight-bearing as opposed to TEA. These two treatments have not been compared in a randomized controlled trial (RCT). The aim of this study was to compare the functional outcome of EHA and TEA for the treatment of unreconstructable distal humeral fractures in elderly patients. Material and methods: This was a multicenter RCT. Patients were included between January 2011 and November 2019 at one of 3 participating hospitals. The inclusion criteria were an unreconstructable distal humeral fracture, age ≥ 60 years and independent living. The final follow-up took place after ≥ 2 years. The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcome measures were the Mayo Elbow Performance Score (MEPS), the EQ-5D index, range of motion (flexion, extension, pronation and supination) and grip strength. Results: 40 patients were randomized to TEA (n = 20) and EHA (n = 20). Five patients died before completing the final follow-up, leaving 18 EHA and 17 TEA patients for analysis. There were 31 women. The mean age was 74.0 (SD, 8.5) years in the EHA group and 76.9 (SD, 7.6) in the TEA group (P = 0.30). The mean DASH score was 21.6 points in the EHA group and 27.2 in the TEA group (P = 0.39), a difference of −5.6 points (95% CI: −18.6-7.5). There were no differences between treatment with EHA and TEA for the mean values of the MEPS (85.0 vs. 88.2, P = 0.59), EQ-5D index (0.92 vs. 0.86, P = 0.13), extension (29° vs. 29°, P = 0.98), flexion (126° vs. 136°, P = 0.05), arc of flexion-extension (97° vs. 107°, P = 0.25), supination (81° vs. 75°, P = 0.13), pronation (78° vs. 74°, P = 0.16) or grip strength (17.5 kg vs. 17.2 kg, P = 0.89). There were 6 adverse events in each treatment group. Conclusion: In this RCT, both elbow hemiarthroplasty (EHA) and total elbow arthroplasty (TEA) resulted in a good and similar functional outcome for unreconstructable distal humeral fractures in elderly patients at a minimum of 2 years of follow-up. 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 posterolateral ligament of the elbow – anatomy and clinical relevance. Rotman, D., Bokhari, N., Wright, A. and Watts, A. C. (2023) Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Anatomical Topic: Posterolateral elbow ligament – Anatomy This is an anatomical study discussing the role of the posterolateral ligament (PLL) in elbow stability. The authors describe the PLL as a thickening of the joint capsule and as an important stabilizer of the ulno-humeral joint against external rotation (supination). The anatomy and clinical relevance of such ligament was assessed by completing six cadaveric dissections and reporting on five case studies. Despite having an intact lateral ulnar collateral ligament, lesion of the PLL could lead to instability. This was shown both when performing the dissection and in the surgical interventions for the patients presented. 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 posterolateral ligament of the elbow is an important structure for elbow stability and contributes to the stability of the ulno-humeral joint against external rotation (supination). To help diagnose lesions of the PLL and/or LUCL, the Posterolateral Rotatory Drawer (PLRD) test has been shown to be very useful. URL: https://doi.org/10.1016/j.jse.2023.08.033 Abstract Introduction: The posterolateral capsule was recognized in the past as an important structure for elbow stability but was later disregarded. Two recent biomechanical papers demonstrated its role in preventing posterolateral instability, and thus it should be identified as a distinct ligament: the posterolateral ligament (PLL). This study includes two parts: an anatomic study of the PLL's footprint; and 5 cases of pathological lesions of the PLL. Methods: Six cadaveric upper limbs were assessed. The attachments of PLL were dissected, and the footprints were marked, photographed, and measured for the 2-dimensional area and length. Results: Mean proximal attachment dimensions were a length of 13 mm and an area of 101 mm2, and mean distal attachment dimensions were 19 mm and 111 mm2 respectively. Cases (a) Two cases of posterolateral elbow pain in professional cricket bowlers, diagnosed radiographically as enthesopathy of the PLL's proximal attachment on the posterior capitellum, probably due to repeated forced hyperextension of the elbow. Both were treated by débridement of the posterior capitellum and reattachment of the PLL, with complete resolution of symptoms. (b) Three cases of clinical PLRI in young patients. Two athletes had an isolated acute tear of the PLL, and on physical examination both had positive posterior draw test but negative pivot shift test. Both underwent elbow arthroscopy and repair of the PLL with resolution of symptoms. The third case is of a long-standing recurrent elbow instability, following a failed LUCL reconstruction, in the presence of an Osborn-Cotterill lesion. He underwent revision LUCL reconstruction, bone grafting of the bony lesion, and re-attachment of the PLL, with complete resolution of symptomatic PLRI. Conclusions: The posterolateral ligament of the elbow has a significant role in the elbow's posterolateral stability. Its footprints were described, and its clinical significance was demonstrated in cases of elbow instability caused by acute ligament tear, and elbow pain due to ligament enthesopathy. Surgeons should be aware of this structure and potential pathology related to its 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

Prevalence and associated factors for primary osteoarthritis of the scaphotrapeziotrapezoid, radiocarpal, and distal radioulnar joints in the Japanese general elderly population. Kitamura, Y., et al. (2023) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Aetiologic Topic: Hand and wrist osteoarthritis – Factors associated with OA This study examined the prevalence and factors associated with primary wrist osteoarthritis in a Japanese general elderly population. A total of 338 participants were included. Radiographic osteoarthritis was diagnosed via x-ray. The results showed that the prevalence of OA in the scaphotrapeziotrapezoid joint (STTJ), radiocarpal joint, and distal radioulnar joint (DRUJ) was 5.3%, 1.5%, and 21.2% respectively. Factors associated with STTJ OA were 1st cmcj OA, female sex, and increasing age. Factors associated with DRUJ OA were increasing age, male sex, greater body mass index, smoking history, heavy manual work, and use of vibrating tools. Positive Ulnar Variance and elbow OA were also found to be associated with DRUJ OA. 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, primary radiographic wrist osteoarthritis is most common in the distal radioulnar joint, followed by the scaphotrapeziotrapezoid joint, and least common in the radiocarpal joint. It is important to remember that evidence of radiographic OA does not imply that patients are symptomatic. Factors associated with primary wrist osteoarthritis include increasing age, female sex, thumb carpometacarpal joint osteoarthritis, positive ulnar variance, use of vibrating tools, and elbow osteoarthritis. URL: https://doi.org/10.1016/j.jhsa.2023.05.009 Abstract Purpose: The incidence and etiology of primary osteoarthritis (OA) of the scaphotrapeziotrapezoid joint (STTJ), radiocarpal joint (RCJ), and distal radioulnar joint (DRUJ) remains unknown. The purpose of this study was to evaluate the prevalence and factors associated with primary wrist OA in a cross-sectional study of a basic resident registry. Methods: A total of 1,297 residents between the ages of 50 and 89 years were randomly sampled from the registry of a Japanese town. A questionnaire was administered to all subjects, and each of them underwent radiographs of the bilateral hands, wrists, and elbows. STTJ, RCJ, and DRUJ radiographic osteoarthritis (ROA) were evaluated according to a previously described method. Associated factors for STTJ and DRUJ ROA were recorded. Associations between the incidence of ROA of the DRUJ, ulnar variance, and severity of elbow ROA were investigated. Results: A total of 676 wrists (162 men and 176 women; mean age of 69.0 years) were investigated. The prevalence of STTJ, RCJ, and DRUJ ROA was 5.3%, 1.5%, and 21.2%, respectively. Factors associated with STTJ ROA were thumb carpometacarpal joint ROA, female sex, and increasing age. Factors associated with DRUJ ROA were elbow ROA, use of vibrating tools, increasing age, and positive ulnar variance. Prevalence of DRUJ ROA was 54.4% in wrists with severe-grade elbow ROA. Ulnar variance of the wrist in severe-grade elbow ROA was significantly larger than that in mild-grade or nonelbow ROA. Conclusions: The prevalence of ROA was highest in the DRUJ, followed by the STTJ, and lowest in the RCJ. The occurrence of ROA of the STTJ and DRUJ was affected by the presence of ROA of the adjacent joint. Clinical relevance: Primary DRUJ ROA occurs at a moderate frequency, similar to primary ROA of other extremity joints; however, primary STTJ and RCJ ROA is rare. 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