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  • What is the average infection rate of patients post hand surgery?

    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

  • Are wrist manipulations more effective than other interventions for pain in lateral epicondylalgia?

    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

  • Blood flow restriction training for your patients: Why would you use it?

    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

  • Is US imaging a proxy for nerve conduction studies in cubital tunnel syndrome?

    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

  • Have you ever used a neoprene orthosis for pipj flexion deformity?

    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

  • Through what mechanism does exercise reduce depression and anxiety?

    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

  • Distal humerus fracture in people over 60: Total elbow arthroplasty or hemiarthroplasty?

    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

  • How much does the posterolateral ligament of the elbow contribute to stability?

    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

  • What factors are associated with hand and wrist osteoarthritis?

    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

  • Are the outcomes of trapeziectomy and cmcj arthroplasty similar at one year post-op?

    Total joint arthroplasty versus trapeziectomy in the treatment of trapeziometacarpal joint arthritis: A randomized controlled trial. de Jong, T. R., et al. (2023) Level of Evidence: 1b- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Thumb OA surgery – Trapeziectomy vs joint arthroplasty This randomised trial compared the outcomes of trapeziectomy and total joint arthroplasty for the treatment of 1st cmcj OA in postmenopausal women. A total of 62 women aged 40 and over with stage II or III osteoarthritis were included. The primary outcome was the total score of the Michigan Hand Outcomes Questionnaire (MHOQ). The results showed no superiority of total joint arthroplasty over trapeziectomy regarding the primary outcome. However, the arthroplasty group showed a significant advantage in strength and range of motion at the three months follow-up compared to the trapeziectomy group. Complications were more common in the arthroplasty group, but were mild and resolved within 1 year. 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, total joint arthroplasty and trapeziectomy are both viable treatment options for 1st cmcj osteoarthritis, with TJA showing a slight advantage in strength and range of motion at three months post-surgery. However, it is important to consider the potential risks and complications associated with each procedure, as well as the patient's individual needs and preferences. More complex operations tend to have a higher rate of complications. For example, suspension arthroplasty has been shown to have a higher number of complications compared to simple trapeziectomy and it is possible that similar findings will be identified at longer-term follow-up. URL: https://doi.org/10.1177/17531934231185245 Abstract The aim of this double anonymized, randomized controlled trial was to determine whether total joint arthroplasty has superior outcomes than trapeziectomy 1 year after surgery for trapeziometacarpal osteoarthritis. A total of 62 women aged 40 years and older, scheduled for surgery for stage II or III osteoarthritis of the trapeziometacarpal joint, were included and randomized to trapeziectomy or total joint arthroplasty. The primary outcome was the total score of the Michigan Hand Outcomes Questionnaire. Secondary outcomes were the Michigan Hand Outcomes Questionnaire subscale scores, Disability of the Arm, Shoulder and Hand Questionnaire, active range of motion, strength, return to work, patient satisfaction and complications. Data were collected at baseline and at 3 and 12 months. At 1 year, we found no superiority of total joint arthroplasty over trapeziectomy regarding the total score of the Michigan Hand Outcomes Questionnaire. The total joint arthroplasty did show a significant advantage in strength and range of motion. 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

  • Can you calculate bone mass density from a hand x-ray?

    Assessing bone mineral density using radiographs of the hand: A multicenter validation. Burton, H., Bodansky, D., Silver, N., Yao, J. and Horwitz, M. (2023) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic: Bone mass density - Use of hand x-rays This reliability and validity study assessed whether bone mineral density can be accurately predicted using plain radiographs of the hand, as an alternative to the current gold standard of dual-energy X-ray absorptiometry. A total of 188 patients who had an x-ray due to a suspected radius fracture were included. The results showed that the second metacarpal cortical percentage score had a strong correlation with BMD t-scores at the femoral neck in both urban and suburban cohorts. This score can be used as a surrogate marker for BMD and is a viable alternative to the current reference standard of measuring BMD. The score was calculated by measuring the transverse thickness of the second metacarpal at the narrowest point of the diaphysis (A) and the thickness of the medullary canal at the same point (B). To obtain the score, the following formula was used (A-B)/A x 100. A score of less than 60% had high specificity and sensitivity for osteopenia/osteoporosis. 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, it is possible to measure bone mass density from hand x-rays in people who have had a distal radius fracture. The second metacarpal cortical percentage score has a strong correlation with BMD t-scores at the femoral neck. A simple PA x-ray of the hand is sufficient to get this score. This is important as people who have had a low-energy trauma leading to a distal radius fracture should be screened for osteoporosis. URL: https://doi.org/10.1016/j.jhsa.2023.08.009 Abstract Purpose: Osteoporosis and fragility fractures incur substantial costs to quality of life and global health care systems. The current gold standard for quantifying bone density is dual-energy X-ray absorptiometry. Our hypothesis is that bone density can be accurately predicted with a simpler method using plain radiographs of the hand. Methods: This retrospective cohort study was undertaken in two centers in the United Kingdom, where the second metacarpal cortical percentage (2MCP) scores were calculated from radiographs. This study included patients who had sustained a distal radius fracture between 2020 and 2022 and had received both a posteroanterior radiograph of the hand and a dual-energy X-ray absorptiometry scan within 12 months of their radiograph and fracture. The Pearson correlation coefficient was calculated to determine the correlation between 2MCP scores and t-scores of the femoral neck on dual-energy X-ray absorptiometry scans. Results: Of the 188 patients, the 2MCP score significantly correlated with bone density t-scores of the femoral neck. A 2MCP score <50% demonstrated 100% sensitivity and 100% specificity for differentiating osteoporotic from normal subjects, whereas a 2MCP score <60% demonstrated 94.4% sensitivity and 83.0% specificity in differentiating osteopenic from normal subjects. Conclusions: These data confirm that the likelihood of osteoporosis being present can be determined via the 2MCP score. 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

  • Are collagenase and needle fasciotomy equally effective for Dupuytren?

    Collagenase treatment versus needle fasciotomy for single-digit dupuytren contractures: A meta-analysis of randomized controlled trials. Zhang, D., Earp, B. E. and Blazar, P. (2023) Level of Evidence: 1a- Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Dupuytren – Collagenase vs needle fasciotomy This meta-analysis compared needle fasciotomy and collagenase treatment for single-digit Dupuytren contracture with a minimum of 3-year follow-up. A total of 347 participants across four randomised controlled trials were included in the present review. The Cochrane risk of bias tool was utilised to assess each individual study. The results showed that there were no significant differences between the two treatments in terms of contracture recurrence, final fixed flexion contracture, and QuickDASH scores. When complication rates were assessed, it appeared that needle fasciotomy had a lower number compared to collagenase treatment. 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, needle fasciotomy and collagenase treatment have similar outcomes with regards to contracture recurrence, final flexion contracture, and QuickDASH scores when a single digit is treated. Factors such as surgeon and patient preferences should be taken into account when selecting the treatment. We can reassure our patients that both treatments are equally effective. URL: https://doi.org/10.1016/j.jhsa.2023.08.008 Abstract Purpose: The objective of this systematic review and meta-analysis was to synthesize the available randomized controlled trial data comparing needle fasciotomy and collagenase treatment for single-digit Dupuytren contractures with a minimum of 3-year follow-up and determine whether one treatment is superior regarding contracture correction and functional outcomes. Methods: A systematic review and meta-analysis was conducted by searching four databases for randomized controlled trials investigating the single-digit treatment outcomes for Dupuytren contracture comparing collagenase treatment and needle fasciotomy with a minimum of 3-year follow-up. The risk of bias of included studies was assessed using the Cochrane risk-of-bias tool. A meta-analysis was performed using a random effects model in anticipation of unobserved heterogeneity. The primary outcome measure was contracture recurrence. Secondary outcome measures included final fixed flexion contracture (FFC), Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) scores, and Unité Rhumatologique des Affections de la Main (URAM) scores. Results: After screening 264 articles, 4 randomized clinical trials were eligible for final inclusion. One trial had a high risk of bias, and two trials had some concern for bias. The final meta-analysis included 347 patients, 169 who underwent collagenase treatment and 178 who underwent needle fasciotomy. No significant differences were noted between the groups in contracture recurrence, FFC, and URAM scores. The pooled data showed a higher QuickDASH score in the collagenase treatment group compared with the needle fasciotomy group, but the observed difference was less than what would be expected to be clinically relevant. Conclusions: Needle fasciotomy and collagenase treatment have similar outcomes with regards to contracture recurrence, final FFC, QuickDASH scores, and URAM scores for the single-digit treatment for Dupuytren contracture at a minimum of 3-year follow-up. Relevant factors that may be considered during the shared decision-making process for treatment selection include surgeon and patient preferences, costs of treatment, and the disparate complication profiles of these two treatments. 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

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