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Can surgeons or patients predict the likelihood of improvement with nonoperative treatment of chronic tennis elbow? Karjalainen, et al. (2025) Level of Evidence : 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Surgeon - Tennis elbow recovery prediction This longitudinal study investigated whether surgeons or patients can effectively predict improvement in individuals with chronic tennis elbow. Out of 97 patients recruited, 89% initially agreed to persist with nonoperative care. Over a two-year period, only 9% of these patients required surgical intervention. Initial mean scores on the Oxford Elbow Score improved significantly without surgery, challenging the presumption that persistent tennis elbow symptoms necessitate surgical resolution. Surgeons’ predictions did not align with actual patient outcomes, suggesting a limited ability to predict who might recover without surgery. Notably, patients with more optimistic views of their recovery had slightly better outcomes. Interestingly, prior or planned injection therapy increased patients' optimism despite limited evidence supporting its effectiveness. The study implies that patient-centric predictions might offer some prognostic value, but the default approach should remain nonoperative, given the generally favorable natural course of the condition. 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, persistent tennis elbow symptoms often resolve without surgical intervention, challenging the notion that surgery is necessary when nonoperative treatments 'fail.' Most patients demonstrate considerable recovery over time with continued nonoperative care. Surgical intervention should therefore not be driven by the duration of symptoms or perceived failures of conservative management. As shown by previous research, tennis elbow resolves in 90% of people within 12 months and longer symptoms duration is not associated with worse outcomes . URL : https://doi.org/10.1097/CORR.0000000000003425 Abstract Background: Persisting symptoms after an attempt of nonoperative treatment represents one of the most common indications for surgery in many musculoskeletal conditions, such as tennis elbow. The rationale behind the practice of resorting to surgery in individuals with long-standing symptoms is that resolution of symptoms is believed to be unlikely without surgery after a certain period, and surgeons can identify a subgroup to benefit from surgery. For this approach to be sound, surgeons must be able to reliably distinguish between patients unlikely to improve without surgery and those who are likely to benefit from it. Questions/purposes: (1) Do patients with persistent tennis elbow symptoms (lasting > 10 months) who are referred to a surgeon improve without surgery over a 24-month follow-up period? (2) Are surgeons’ or patients’ predictions about improvement associated with actual improvement? (3) What patient characteristics, if any, are associated with predictions of improvement made by either surgeons or patients? Methods: Between 2016 and 2018, we prospectively recruited 97 patients with persistent tennis elbow symptoms (> 10 months) who were dissatisfied with nonsurgical treatment and referred for surgical consultation at five secondary or tertiary public hospitals. Of these, 89% (86 of 97) agreed to continued nonoperative treatment and were included in this observational cohort study. To evaluate the outcomes of continued nonoperative treatment, we measured the Oxford Elbow Score (OES) and global improvement at 6 weeks and at 3, 6, 12, and 24 months. To assess whether either the surgeons or the patients could predict the likelihood of symptom improvement, we asked both parties at baseline to predict whether each patient would be satisfied with their symptom state without surgery within the next 6 months. We then evaluated the prognostic value of these predictions by comparing the OES and global improvement scores between (1) patients who believed that they would improve versus patients who did not and (2) patients whom the surgeons predicted would improve versus those whom the surgeons predicted would not. To explore factors that might explain the predictions, we assessed the correlation between the predictions and baseline characteristics, including age, sex, affected side, smoking status, duration of symptoms, disability (OES score), Pain Catastrophizing Scale score, prior corticosteroid injections, and any planned injection treatments. Data from patients who underwent surgery during the follow-up period were included only up to the time of surgery. The mean ± SD age of the patients was 49 ± 5.4 years, and prior to the initial consultation, they had had symptoms for a mean ± SD of 20 ± 12 months. One-half of the patients were female. Results: Nine percent (8 of 86) of patients eventually underwent operation during the 2-year follow-up period. The mean total OES of the cohort (range 0 to 100, with higher scores indicating better outcomes) increased from approximately 50 points at baseline to 80 points at the final 24-month follow-up visit. Surgeons’ predictions about likelihood of improvement were not associated with the observed improvement, while patients who were more pessimistic about their likelihood of recovery at baseline had slightly inferior outcomes compared with patients who were more optimistic about their likelihood of recovery. As for factors associated with patients’ predictions of recovery, both patients who had previously received corticosteroid injections (relative risk [RR] 1.4 [95% confidence interval (CI) 1.1 to 1.7]; p = 0.03) and those scheduled to receive botulinum toxin or platelet-rich plasma injections (RR 3.8 [95% CI 2.0 to 7.3]; p < 0.001) were more likely to predict improvement compared with those who opted to wait and see. Surgeons’ predictions about the recovery were not associated with any of the measured patient characteristics, indicating that the predictions were based on heuristics, that is, mental shortcuts or rules of thumb that clinicians commonly use in clinical decision-making. Conclusion: Our findings suggest that persistent tennis elbow symptoms are a poor indication for surgery, as the majority of patients experience symptom resolution without it, and surgeons are unable to reliably predict who will or will not improve with nonoperative treatment. Therefore, treatment decisions should not be based on the clinician’s perception of the disease course. Patients’ predictions, especially more pessimistic views, were found to more accurately reflect the likely recovery trajectory. Finally, despite evidence demonstrating the ineffectiveness of injections, they elevated patients’ expectations for improvement. 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

Incidence of carpal tunnel syndrome requiring surgery may increase in patients treated with trigger finger release: A retrospective cohort study. Hsieh, et al. (2022) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic / Prognostic Topic : Trigger finger - Incidence of CT release This retrospective study explores the potential increase in carpal tunnel syndrome (CTS) requiring surgery following trigger finger (TF) release surgery. Utilising a retrospective cohort dataset from Taiwan’s National Health Insurance Research Database, a comparative analysis of patients who underwent TF surgery against those who did not was completed. Findings showed that post-surgical TF patients had a higher adjusted hazard ratio of 1.51 for developing severe CTS. Despite this difference between groups, the risk is unlikely to be clinically relevant. Risk factors identified include being female, aged over 65, having diabetes mellitus, or suffering from chronic renal failure. The research underscores the importance of considering CTS risk in post-TF release management, especially in identified high-risk groups. Limitations noted involve lack of detailed clinical symptom data and specific work condition assessments. 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, patients undergoing surgical release of trigger finger (TF) may face an increased risk of subsequent carpal tunnel syndrome (CTS) necessitating surgery. Despite them presenting a higher risk the increase in probability appears to be less than 0.5%, which is unlikely to be relevant. This small risk increase is higher in females and individuals over the age of 65. Furthermore, chronic conditions such as diabetes mellitus and chronic renal failure further exacerbate the risk of developing severe CTS after TF surgery. It is possible that this small subgroup of people requiring both TF release and CTS may be presenting with a connective tissue disease called amyloidosis . URL : https://doi.org/10.2147/CLEP.S383397 Abstract Purpose: The correlation between carpal tunnel syndrome (CTS) surgery and trigger finger (TF) surgery is unclear; we conducted this nationwide population-based study to assess the development of severe CTS requiring surgery after TF surgery. Patients and Methods: This retrospective cohort study used the data of patients diagnosed as having TF between January 1, 2001, and December 31, 2017, and they were divided into two comparative groups. Patients who underwent surgical release within 1 year of diagnosis were included in the TF-OP group, and those who did not undergo TF release during the same period were included in the TF-NOP group. The primary outcome was the new incidence of CTS release (CTR), and data on the related risk factors were collected for analysis. Results: A total of 8232 patients each were enrolled into the TF-OP and TF-NOP groups and were 1:1 propensity score matched (mean patient age, 54.7 ± 10.1 years; mean follow-up duration, 6.58 years). The incidence rate of CTR was 1.1 per 1000 person-years in the TF-OP group and 0.7 per 1000 person-years in the TF-NOP group. The adjusted hazard ratio of TF surgery was 1.51. The factors significantly correlated with an increased incidence of CTR were age, female sex, diabetes mellitus, and chronic renal failure. In subgroup analysis, patients aged > 65 years and female patients in the TF-OP group were still at significantly higher risks of CTR than were their counterparts in the TF-NOP subgroups. The cumulative incidence of CTR after TF surgery linearly increased with time in both groups. Conclusion: Patients undergoing TF release may have a higher incidence of CTR 1 year later, especially women and patients aged > 65 years. Diabetes mellitus and chronic renal failure may be risk factors. 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

Incidence and predictors of subsequent triggering requiring treatment after trigger finger release. Pohl, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Aetiologic / Prognostic Topic : Trigger finger - Additional interventions This retrospective study investigated the incidence and predictors of subsequent treatment following an initial trigger finger release. Conducted on 1,715 patients between 2015 and 2017, the results showed that 40% of people required additional treatment with either steroid injection or further surgical release for the same finger or other fingers. Notably, smoking and high comorbidity burden were linked to increased subsequent treatment. Moreover, patients with higher body mass index (BMI) and comorbidity burden had heightened chances of needing additional surgery. See graph below for an estimate of time in relation to the need for additional 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, whilst trigger finger release is effective, additional treatment is required in a significant proportion of patients, especially those with higher body mass index or comorbidities. It is essential to inform patients that 40% of people may require additional procedures, such as steroid injections or further surgeries for the same or different finger. Current smokers appear to be at higher risk for needing subsequent interventions, reinforcing the importance of discussing lifestyle modifications with patients as part of their treatment plan. For additional research on trigger finger, have a look at the whole dataset . URL : https://doi.org/10.1016/j.jhsa.2025.02.009 Abstract Purpose: To assess the incidence of subsequent treatment of trigger finger in the same or additional digits after the initial trigger finger release, as well as identify patient characteristics associated with the need for subsequent treatment. Methods: This study retrospectively analyzed 1,715 patients with a trigger finger who underwent surgical release from 2015 to 2017. Bivariate analysis was performed to determine the percentage of patients requiring further trigger finger treatment by either steroid injection or operative release. Patient factors were then compared in those who did and did not undergo subsequent treatment. Cox proportional hazards models and survival analysis were performed to identify patient characteristics associated with requiring subsequent treatment, injection, and surgery. Results: Overall, 690 (40.2%) patients required subsequent treatment with either steroid injection or surgical release in either the same or an additional finger. Four hundred sixty patients (26.8%) underwent at least one subsequent injection, with 36 (2.1%) of these on the same finger. Additionally, 230 (13.4%) patients received at least one subsequent first annular pulley release, with 14 (0.8%) on the same finger as the initial release. Cox proportional hazards models showed patients with a higher comorbidly burden and current smoking status were more likely to receive subsequent treatment. Higher body mass index and greater comorbidity burden were also associated with requiring subsequent surgery. Additionally, current smokers or patients with a greater comorbidity burden had a higher risk of requiring subsequent treatment in an additional digit not initially released. Conclusions: Subsequent release or injection in the same or another digit was common following an initial trigger finger release. Patient characteristics such as higher body mass index and greater comorbidity burden were associated with requiring subsequent surgery, and smoking status as well as comorbidity burden were associated with subsequent treatment in an additional digit not initially released. 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

Testosterone replacement therapy and associated rates of trigger finger, de quervain tenosynovitis, and their subsequent management. Barhouse, et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic Topic : Anabolic steroids - Upper limb tendinopathies This retrospective cohort study examined the association between testosterone replacement therapy (TRT) and the development of hand conditions like trigger finger and de Quervain tenosynovitis. Using a large insurance claims database from 2010 to 2019, researchers compared patients who had filled TRT prescriptions for at least three months to those who had not, controlling for various factors such as age, sex, and comorbidities. The findings indicated that TRT patients had a higher likelihood of developing these hand conditions and were more likely to undergo steroid injections or surgical procedures for treatment (see graph below). The study highlights concerns regarding TRT's impact on tendon health, aligning with prior research linking high-dose steroids to tendon injuries. Limitations include the lack of stratification by physical activity levels, which may contribute to the results reported. 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 a significant association between testosterone replacement therapy (TRT) and the increased likelihood of developing tenosynovitis in the hand, including conditions like trigger finger and de Quervain tenosynovitis. Patients undergoing TRT are not only more prone to these conditions but also demonstrate a higher probability of requiring steroid injections or surgical interventions. These findings are in line with previous studies, which have shown a correlation between TRT use and distal biceps ruptures . Other risk factors for the onset of hand and elbow tendinopathies include the use of statins for cholesterol control. URL : https://doi.org/10.1016/j.jhsa.2024.01.018 Abstract Purpose: Anabolic steroid therapy has been associated with tendon injury, but there is a paucity of evidence associating physiologic testosterone replacement therapy (TRT) with tenosynovitis of the hand, specifically trigger finger and de Quervain tenosynovitis. The purpose of this study was to evaluate the relationship between TRT and tenosynovitis of the hand. Methods: This was a one-to-one exact matched retrospective cohort study using a large nationwide claims database. Records were queried between 2010 and 2019 for adult patients who filled a prescription for TRT for 3 consecutive months. Rates of new onset trigger finger and de Quervain tenosynovitis and subsequent steroid injection or surgery were identified using ICD-9, ICD-10, and Current Procedural Terminology billing codes. Single-variable chi-square analyses and multivariable logistic regression were used to compare rates in the TRT and control cohorts while controlling for potential confounding variables. Both unadjusted and adjusted odds ratios (OR) are reported for each comparison. Results: In the adjusted analysis, patients undergoing TRT were more than twice as likely to develop trigger finger compared to their matched controls. TRT was also associated with an increased likelihood of experiencing de Quervain tenosynovitis. Of the patients diagnosed with either trigger finger or de Quervain tenosynovitis over the 2-year period, patients with prior TRT were roughly twice as likely to undergo steroid injections or surgical release for both trigger finger and de Quervain tenosynovitis compared to the controls. Conclusions: TRT is associated with an increased likelihood of both trigger finger and de Quervain tenosynovitis, and an increased likelihood of requiring surgical release for both conditions. 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

Imaging on the painful and compressed nerve: Upper extremity. Bordalo, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Entrapment neuropathies - Upper limb This is an expert opinion on compressive neuropathies in the upper extremities. As we are aware, these pathologies can lead to pain, weakness, and reduced functionality due to the entrapment of peripheral nerves in osteofibrous tunnels and muscular pathways. Traditional diagnostic techniques like clinical assessments and electrophysiological studies are important but have limitations in pinpointing lesion locations. Recent advances in ultrasonography (US) and magnetic resonance imaging (MRI) have enhanced nerve visualisation, improving diagnostic accuracy and treatment planning. These imaging methods are critical in managing neuropathies affecting various nerves such as the brachial plexus, axillary, median, ulnar, suprascapular, and radial nerves (see pictures below). They help identify key features like nerve thickening and muscle changes (e.g. fat atrophy), aiding in both diagnosis and surgical strategies. 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, integration of advanced imaging techniques such as ultrasonography and MRI, including MR neurography is pivotal in the management of upper extremity compressive neuropathies. By providing high-definition visualisation of nerve anatomy and pathological manifestations like thickening and signal abnormalities, these techniques enhance diagnostic precision and therapeutic effectiveness. Ultrasound imaging is truly a useful imaging technique and there are plenty of examples on how you could use it to aid your practice . URL : https://doi.org/10.1007/s00264-025-06436-0 Abstract Compressive neuropathies of the upper extremity are a common cause of pain, weakness, and functional impairment, often resulting from chronic mechanical compression or entrapment of peripheral nerves in anatomical regions such as osteofibrous tunnels, fibrous bands, or muscular pathways. While traditional diagnostic methods, including clinical evaluation and electrophysiological studies, are essential, they are limited in localizing lesions and identifying underlying causes. Advances in ultrasonography (US) and magnetic resonance imaging (MRI), particularly MR neurography and high-resolution 3D volumetric imaging, have significantly improved the evaluation of peripheral nerves by enabling detailed visualization of nerve anatomy, adjacent structures, and muscle denervation patterns. This article reviews the role of these imaging techniques in diagnosing and managing compressive neuropathies affecting the brachial plexus, suprascapular, axillary, median, ulnar, and radial nerves, highlighting key imaging findings such as nerve thickening, signal abnormalities, and muscle changes. The integration of advanced imaging modalities into clinical practice enhances diagnostic accuracy, facilitates surgical planning, and improves treatment outcomes for patients with peripheral nerve compression. 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

Extensor mechanism dysfunction and hand deformities caused by dupuytren’s disease: Surgical and rehabilitation perspectives. Brutus, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Splinting - Post-surgical Dupuytren's This is an expert opinion on Dupuytren's disease surgical and post-surgical management. Traditionally associated with palmar flexion contractures due to palmar aponeurosis involvement, Dupuytren's disease also impacts the hand's extensor mechanism, potentially leading to deformities such as boutonniere and swan-neck deformities. This condition can severely impair hand function, necessitating surgical and therapeutic interventions. Surgical treatments may include addressing forces causing volar migration of the lateral bands and tendon repairs for specific deformities. Post-surgical rehabilitation emphasises static and dynamic splinting, pain management, and maintaining soft tissue flexibility through various strategies, including vibration therapy and elastic therapeutic taping. Understanding these surgical and rehabilitation modalities can improve patient outcomes, restoring hand functionality and reducing deformities caused by Dupuytren's. 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 : Base on what we know today, common extensor mechanism imbalances, such as boutonniere and swan-neck deformities are common following surgery for Dupuytren. Incorporating personalised therapy and splinting pre- and post-surgery may enhance recovery. However, if no surgery is done to release structures (e.g. pipj) that present with a fixed deformity, it is unlikely that splinting would have a very large therapeutic effect. Thus, it appears that splinting is most effective in correcting joint deformities following an acute injury/tissue lesion . If you would like further information on splinting effect for fixed deformities, have a look at the whole database . URL : https://doi.org/10.1016/j.jht.2024.12.017 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

Customized 3-dimensional-printed finger splints for mallet finger. Hou, et al. (2025) Level of Evidence: 4 Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Mallet Finger - 3D splinting The study assessed the effectiveness of customised 3D-printed finger splints compared to traditional ones in managing mallet finger injuries. Twenty-one patients were retrospectively analysed and divided into two groups: those treated with traditional splints (aluminium and foam bracing) and those with 3D-printed splints. While no significant difference in treatment success rates was observed, customised splints provided a superior fit, comfort, and increased treatment compliance. Notably, 3D splints minimised the incidence of skin complications and discomfort, enhancing patient satisfaction. 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 : B ased on what we know today, customised 3D-printed finger splints provide a more comfortable and tailored treatment option for mallet finger compared to an aluminium and foam splint. Their effectiveness is equal to more traditional splinting. Nevertheless, the thermoplastic splints that we currently utilise, are faster to create and can equally adapt to the patient's finger as a 3D printed one. URL : https://doi.org/10.1097/SAP.0000000000004190 Abstract We aimed to evaluate the feasibility and effectiveness of customized 3-dimensional (3D)-printed finger splints in the treatment of mallet fingers. We categorized 21 patients into those who received the traditional finger splint (group A) and those treated with a customized 3D-printed finger splint (group B). We retrospectively analyzed the functional outcomes and patient satisfaction in the 2 groups. During the follow-up period, 3 patients in group A failed treatment, of which 2 underwent extended immobilization and one 1 transferred to surgery. All 3 patents in group B who failed treatment received extended immobilization and did not require transfer to surgery. In patient satisfaction assessments, group B patients scored better in dimension and comfort than did group A patients. Customized 3D-printed finger splints provided a more comfortable and fitting treatment option for mallet finger. Although they did not result in a significant difference in treatment success rate, these splints significantly improved patient compliance with treatment and wearing. 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

Os Styloideum and third metacarpal partial coalition nonunion after traumatic fracture: A report of three cases. Azócar, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Os Styloideum - Fracture The paper discussed three cases presenting with dorsal wrist pain alongside swelling and tenderness on palpation following some form of wrist trauma. Conservative treatment including immobilisation did not resolve symptoms. Given the persistent pain presentation, advanced imaging was completed (see images below) and these identified an Os Styloideum, an accessory carpal bone located on the wrist's dorsal aspect. This is commonly asymptomatic until a traumatic event triggers symptoms. The study highlights how in certain cases the Os Styloideum presents with a partial coalition with the third metacarpal bone, which in case of a fracture non-union it can lead to persistent pain. Two patients underwent successful surgical excision under local anesthesia, leading to complete recovery, while conservative treatment with platelet-rich plasma injection and shock wave therapy was less effective in another case. 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 Os Styloideum (OS) is a rare anatomical variation that can lead to chronic pain in the dorsal aspect of the hand and wrist, especially after trauma. If non-surgical treatments, such as immobilisation and injections, fail to alleviate symptoms, surgical excision can lead to complete and rapid recovery. If you would like to challenge your diagnostic skills with another dorsal aspect pain presentation, you can have a look at this synopsis or the whole database . URL : https://doi.org/10.1177/15589447251317232 Abstract The Os Styloideum (OS) is an accessory carpal bone located in the dorsal aspect of the wrist between the base of the second and third metacarpal bones and the trapezoid and the capitate. It is frequently partially coalited with the metacarpal bones and is usually asymptomatic. It may become symptomatic after a traumatic fracture, developing swelling, edema, and pain. We report 3 cases with a fracture of an OS partial coalition with the third metacarpal bone with signs of delayed consolidation. They all complain of persistent pain at the dorsal aspect of the hand that increased with activity. One patient rejected surgery, had a platelet-rich plasma injection, shock wave therapy, and afterward did physiotherapy rehabilitation without complete solution; the other two patients underwent surgical excision with local anesthesia and had a complete recovery after 2 months of follow-up. The OS is an infrequent entity yet must be correctly diagnosed as a possible cause of dorsal pain in the hand and wrist. If symptoms are refractory to medical treatment, surgical excision should be considered. Open excision under local anesthesia is a simple, reproducible procedure with excellent results. 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

Malignant melanoma in the hand: Current evidence and recommendations. Blessley-Redgrave, et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Skin melanoma - Hand lesions This expert opinion article addresses challenges surrounding the diagnosis and management of malignant melanoma, especially in the hand. Despite advancements like sentinel lymph node biopsy and targeted therapies, worldwide death rates from melanoma have escalated. Melanomas on the hand, particularly subungual melanomas, are often diagnosed late, leading to poor prognoses. The paper emphasises that clinicians should approach pigmented hand lesions with vigilance. The article elaborates on melanoma's presentation and investigation processes, highlighting the significance of early diagnosis for effective treatment options, including surgery and systemic therapies. The ABCD (Asymmetry, Irregular Border, variable Colour, Diameter >7mm, Evolution over time) objective changes should be utilised to increase or reduce our index of suspicion. 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 crucial that clinicians maintain a high level of suspicion when evaluating pigmented lesions on the hand, especially considering the potential for malignant melanoma. Early diagnosis and intervention are key to improving outcomes. If you would like to refresh your memory on malignant tumors of the hand , have a look at this synopsis. As clinians we should remember the basic ABCD: Asymmetry Irregular Border variable Colour Diameter >7mm Evolution over time URL : https://doi.org/10.1177/17531934241245028 Abstract Malignant melanoma is the leading cause of death from skin cancer. In spite of significant advances in the management of melanoma with the advent of sentinel lymph node biopsy (SLNB) and adjuvant oncological therapies, the death rate continues to increase worldwide. Melanoma in the hand poses additional diagnostic and management challenges. Consequently, these tend to present at a later stage and are associated with a poorer prognosis. It is imperative that hand surgeons treat any pigmented hand lesion with suspicion to ensure rapid diagnosis and treatment. This article outlines the presentation of melanoma, and how to investigate suspicious pigmented lesions of the hand and digits. It guides hand surgeons in their approach to melanoma of the hand, outlining the multidisciplinary team approach as well as current standard surgical and reconstructive options to optimize 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

Literature review of postoperative distal radius fracture immobilization recommendations. Cevetello, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Distal radius fracture - Immobilisation This literature review assessed postoperative immobilisation recommendations for distal radius fractures (DRFs) ORIF. It highlights the lack of consensus on the ideal postoperative care, including whether immobilisation is necessary and the optimal method and duration for it. The review analyses various immobilisation techniques such as splints, removable wrist braces, and soft dressings, and their effects on functional outcomes like range of motion and patient quality of life. Some findings suggest that early mobilisation and the use of removable braces or soft dressings may promote faster recovery of strength and motion, although these benefits can level out over time when compared to prolonged immobilisation. However, the type of immobilisation often depends on patient-specific factors and surgeon preference rather than standardised guidelines. 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, following a distal radius fracture ORIF, a short period of immobilisation has been shown to provide quicker functional recovery and improved grip strength without a significant increase in complications. Evidence suggests that immobilisation should be limited to no more than three weeks. This is consistent with previous evidence that you can find on the topic . Additionally, engaging in daily activities and personal occupations can significantly aid in the recovery process by promoting wrist movement and providing psychological benefits . URL : https://doi.org/10.7759/cureus.78349 Abstract Distal radius fractures (DRFs) are a commonly treated injury in orthopedics. DRFs have a high incidence across patient demographics, including pediatrics, young patients in high-energy trauma, and geriatric patients in low-energy trauma. While DRFs occur across a large range of age groups, they are especially consequential in geriatric patients with osteoporosis. Management of DRFs has extensive variability, ranging from conservative casting to surgical interventions, such as open reduction and internal fixation surgical procedures. The diversity of treatment options for DRFs is due to a consideration of factors, such as fracture characteristics, time to presentation with an orthopedic surgeon, age of the patient, and medical comorbidities of the patient. Despite being a common fracture type, there remain discrepancies in the nonpediatric literature regarding postoperative recommendations, such as the timing and methods of immobilization. There is also debate regarding whether postoperative immobilization in adult DRFs has clinical benefit. Some of this variability depends on the type of fixation utilized, such as a volar locking plate, dorsal locking plate, and dorsal wrist-spanning fixation. This literature review examines recommendations and outcomes of postoperative splinting (supination, pronation, or neutral rotation of the forearm) versus removable wrist brace versus soft dressings only for DRFs with both intra-articular and extra-articular fracture patterns with operative fixation. Postoperative care is imperative to study as it carries long-term effects on patients’ quality of life, as their range of motion and strength can be dictated by the methodology of this care. Studies have been conducted comparing the outcomes of early mobilization versus prolonged immobilization after surgical intervention. This literature review analyzes these studies to understand which methods carry better outcomes with respect to the range of motion and quality of life of patients for operatively treated DRFs in non-pediatric 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

Diagnostic accuracy of point-of-care ultrasound of the posterior fatpad in elbow fractures. Haak, et al. (2025) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Diagnostic Topic : Ultrasound - Elbow fracture detection This diagnostic study evaluates the diagnostic accuracy of point-of-care ultrasound (POCUS) for detecting elbow fractures in adults by examining the posterior fatpad. Conducted across four emergency departments, the multicentre prospective study involved 215 patients with elbow injuries who required X-rays. Emergency physicians, trained in POCUS, performed the ultrasounds, which showed a sensitivity of 91% and a specificity of 93% for identifying fractures, with improvements seen upon expert review. The study's findings suggest that POCUS, in conjunction with physical examination, could reduce the need for X-ray imaging by efficiently ruling out fractures, particularly when the fatpad is not elevated. While POCUS demonstrated high reliability, its diagnostic performance improves with the operator's experience and further training, indicating its potential as a critical adjunct in managing elbow injuries by minimising radiation exposure and healthcare costs. 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 of the posterior fatpad is a valuable tool in triaging adult patients with elbow injuries. Thus, US imaging completed in clininc with a portable probe alongside physical tests , can increase or decrease our suspicion of an elbow fracture. Ultrasound imaging is becoming more and more relevant in upper limb diagnosis as shown by other studies on cubital tunnel syndrome , distal biceps tendinopathy/tears , and carpal tunnel syndrome . URL : https://doi.org/10.1136/emermed-2024-214448 Abstract Background: Point-of-care ultrasound (POCUS) can potentially be used in the triage of patients with elbow injuries. However, the diagnostic accuracy of POCUS performed by non-radiologists for the exclusion of elbow fractures is yet unknown. This study aimed to investigate the diagnostic potential of POCUS of the posterior fatpad performed by non-radiologists in the workup of adult patients presenting with elbow injuries. Methods: A multicentre, prospective cohort study was conducted between January 2021 and August 2022 in four EDs to determine the diagnostic accuracy of an elevated posterior fatpad on POCUS to demonstrate or exclude an elbow fracture in patients presenting with elbow injuries to the ED. The study population consisted of a convenience sample. In patients ≥16 years of age with an elbow injury for which an X-ray was ordered, POCUS was performed by emergency physicians trained in ultrasound. POCUS (index test) results were compared with X-ray outcomes (reference standard) to determine the diagnostic accuracy of POCUS. Results: A total of 215 patients were included, 143 (67%) of whom had a fracture confirmed on X-ray. POCUS was positive based on a visualised elevated posterior fatpad in 127 (59%) patients. An elevated posterior fatpad on POCUS had a sensitivity of 91% (95% CIs 85% to 95%), a specificity of 93% (95% CI 85% to 98%), a negative likelihood ratio of 0.10 (95% CI 0.06 to 0.16) and a positive likelihood ratio of 13.09 (95% CI 5.61 to 30.54) for the presence of an elbow fracture. Post hoc review of the images by expert sonographers improved sensitivity to 96% (95% CI 91% to 99%). Conclusion: POCUS of the posterior fatpad is a promising adjunct to physical examination to determine the need for further diagnostic studies in the triage of patients with elbow injuries. Sensitivity after a limited training is high, but not perfect, and can likely further be improved with additional training. 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: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic The paper discussed three cases presenting with dorsal wrist pain alongside swelling and tenderness on palpation following some form of wrist trauma. Conservative treatment including immobilisation did not resolve symptoms. Given the persistent pain presentation, advanced imaging was completed (see images below). What do you think we have going on here?