Search Results

Counterforce bracing of lateral epicondylitis: A prospective, randomized, double-blinded, placebo-controlled clinical trial. Kroslak, M., Pirapakaran, K., & Murrell, G. A. (2019) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 Type of study: Therapeutic Topic: Counterforce brace - Real vs Placebo brace on pain and function This is a randomised double-blind placebo controlled trial assessing the effectiveness of counterforce brace on pain frequency and intensity in participants with lateral epicondylalgia (LE). Participants (N = 31) were diagnosed with LE if they presented point tenderness at the lateral epicondyle of the elbow and if they reported localised elbow pain with maximal grip strength testing. In addition, they had to present with a history of LE between 4 weeks and 6 months. Participants were excluded if they had sensory or motor changes distally to the elbow, if they had previous elbow surgery, or if they had a cortisone injection in the elbow within the past three months. Pain frequency and intensity during manual activities, during sleep, and at rest was assessed through a 5-points likert scale. Outcomes were assessed at 2, 6,12, and 26 weeks. Treatment allocation was randomised. No information on allocation concealment was provided. Participants and assessors were blinded to treatment allocation. The trial protocol was not registered a-priori. Participants were provided with a counterforce brace which was tightened around the proximal forearm (n = 17) or a strap withouth padding which was applied with a very low tension to the proximal forearm (sham) (n = 14). Both groups were provided with a resistance training program for the affected upper limb. The results showed that both groups reported lower pain frequency and intensity at 6 weeks and subsequent follow ups. Between groups differences were limited and a high number of statistical tests were performed. This increased the likelihood of a type II error (identification of statistically significant findings due to the high number of tests performed). It is not possible to comment on the clinical relevance of these findings because pain intensity was measured on a 5-points likert scale, which is rarely used in clllinical practice. Overall, the counterforce brace appeared to consistently provide greater improvements compared to the sham. Clinical Take Home Message: Hand therapists may provide a counterforce brace to clients affected by LE. This brace appears to reduce the frequency and intensity of pain to a greater extent compared to a placebo brace. URL: https://www.jshoulderelbow.org/article/S1058-2746(18)30733-X/fulltext Available through EBSCO Health Databases if you have access (PNZ)

Early mobilization after volar locking plate osteosynthesis of distal radial fractures in older patients: A randomized controlled trial. Sørensen, T. J., Ohrt-Nissen, S. M. D., Ardensø, K. V., Laier, G. H. M. S., & Mallet, S. K. M. D. (2020). Level of Evidence: 1b Follow recommendation: 👍 👍 👍 Type of study: Therapeutic Topic: Distal radius fracture - Early vs delayed mobilisation This is a randomised single-blind placebo controlled trial assessing the effectiveness of early mobilisation vs late mobilisation on grip strength, range of movement, and function. Participants (N = 85) were treated with volar open reduction and internal fixation (ORIF) of a distal radius fracture. Participants were excluded if they were younger than 50 years old, if they presented with an open fracture, neurological defficits, or if surgery was dealayed more than 14 days. Grip strength was assessed through a hand-held dynamometer, range of movement in pronation-supination, flexion-extension, and radial-ulnar deviation of the wrist was measured through a goniometer. Function was measured through the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. Outcomes were assessed at 4 weeks, 3, 6, and 12 months post surgery. Treatment allocation was randomised. No information on allocation concealment was provided. Assessors were blinded to treatment allocation. Participants were provided with either early mobilisation (n = 42) or late mobilisation (n = 43). The early mobilisation group initiated wrist and finger exercises the day after surgery and received a removable wrist splint. The late mobilisation group was put in a dorsal cast for two weeks, which was followed by wrist and finger exercises with intermittent immobilisation through a removable wrist splint. Exercise adherence was not measured. The results showed that both groups improved to a statistically and clinically significant level on grip strength, range of movement, and function at six months. However, there were no differences between groups. Clinical Take Home Message: Hand therapists may elect to immobilise clients for two weeks following distal radius fracture or initiate them on early mobilisation. No differences have been shown between the two modalities. However, it is possible that early mobilisation may increase the risk of plate loosening in older people. This may be due osteoporosis and additional screening should be performed in this group of clients. URL: https://www.jhandsurg.org/article/S0363-5023(20)30276-8/fulltext

Flexor digitorum profundus with or without flexor digitorum superficialis tendon repair in acute Zone 2B injuries. Sadek, A. F. (2020) Level of Evidence: 3b Follow recommendation: 👍 👍 Type of study: Therapeutic Topic: Zone 2 flexor tendon repair - FDP and FDS vs FDP only repair This is a retrospective study assessing the outcomes of zone 2 flexor tendon repairs with or without FDS repair. A total of 53 patients underwent repair of FDP only (n=23), or FDP plus FDS (n=30). The surgical outcome was assessed through total active/passive range of movement in the operated digit/s and grip strength. Both outcomes were reported and analysed as a percentage of the controlateral healhy limb. Wide awake surgery with no tourniquet was used for 30 patients. The decision to repair or not FDS was based on FDP ease of gliding after the 6 strands repair. A2 pulley was resected or vented in all cases. Independently of repair completed, the postoperative care included a dorsal blocking wrist splint (50° mcpj flexion and ipj/dipj extension) and rubber band attached to the nail to provide passive finger flexion. During the first week, patients performed active finger flexion and extension exercises (as tolerated by pain) once a day for 5 minutes. Between week 2 and 4, patients performed passive finger extension/flexion exercises followed by pain free active extension and flexion twice a day for five minutes. In week 2 to 4 patients were also encouraged to perform dipj and pipj passive and active movements, flat fist and hook fist exercises. During this phase, patients were also asked to practice grasping, without lifting, objects of large diameter (e.g. water bottle) followed by a progression to small diameter objects. This was gradually progressed until in week 6 they were able to obtain a full fist. Between week 4 and 5 the wrist splint was discarded and the only protection left was an elastic band to provide passive flexion of the operated finger. Between week 5 and 6 full active range of movement exercises were promoted and participants were asked to exercise three times per day for 15 minutes. At the end of week 6, the elastic band was removed. At 12 weeks, participants initiated resisted exercises. Total active movement and grip strength were assessed with a goniometer and a hand held dynamometer respectively. The assessment time ranged between 12 and 84 months post surgery. The results showed that there was no statistically significant difference between groups in total active/passive range of movement. However, the average pipj flexion deformity was 20° in the FDP only repair group and 5° in the FDP plus FDS repair. Grip strength was statistically and clinically significant different between the two groups. The FDP and FDS repair group presented with 15% greater grip strength (Mean difference: 5kg) compared to the FDP repair only. There was one rerupture (FDP repair: 4%; FDP plus FDS repair: 3%) in each group. Involvement of multiple digits was associated with worse outcomes. Clinical Take Home Message: Hand therapists may expect similar outcomes after a zone 2 flexor tendon repair involving FPD and FDS, or FDP alone. However, it appears that repair of FPD alone leads to lower grip strength levels and greater pipj flexion deformities. URL: https://journals.sagepub.com/doi/abs/10.1177/1753193420932446

Do joint mobilizations assist in the recovery of lateral elbow tendinopathy? A systematic review and meta-analysis. Lucado, A. M., Dale, R. B., Vincent, J., & Day, J. M. (2019) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 👍 Type of study: Therapeutic Topic: Lateral epicondylalgia – Manual therapy This is a systematic review and meta-analysis assessing the effectiveness of elbow Mobilisation With Movements (MWMs) on pain and pain-free grip strength in people with lateral epicondylalgia. Four randomised-controlled studies and one controlled study were included in the meta-analysis, for a total of 407 participants. All the studies were assessed through the PEDro scale (score 0 to 11 with greater scores indicating greater study quality). Efficacy of intervention was assessed through improvements in pain (VAS) and pain-free grip strength. The control groups included either no interventions or other interventions (e.g. ultrasound, exercise) without MWMs. Follow-up periods ranged from one months to one year. The study quality ranged between 5 to 10 and the average quality score was 7. There was a statistically significant but not clinical significant difference in favour of the MWMs group compared to the control group on pain (Mean difference: 0.43; 95%CI: 0.2 to 0.7) and pain-free grip strength (Mean difference: 0.31; 95%CI: 0.11 to 0.51). These differences equated to 0.43/10 point change on VAS and 0.31kg improvements in pain-free grip strength. Clinical Take Home Message: MWMs do not appear to be useful in improving pain or pain-free grip strength in lateral epicondylalgia in the short to long term (4 weeks to one year). These interventions may provide an immediate pain relief which is however quickly lost. Hand therapists may obtain better long term results by reducing extensor tendon loading in the acute phase and provide a graded resistance training program when pain irritability reduces. URL: https://www.jhandtherapy.org/article/S0894-1130(17)30289-2/pdf

Effectiveness of the graded motor imagery to improve hand function in patients with distal radius fracture: A randomized controlled trial. Dilek, B., Ayhan, C., Yagci, G., & Yakut, Y. (2018) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Therapeutic Topic: Radius fracture - graded motor imagery This is a randomised single-blind controlled trial assessing the effectiveness of Graded Motor Imagery (GMI) and traditional rehabilitation in participants with distal radius fracture. Participants (N = 36) were included if they had undergone a closed fracture reduction or an open reduction internal fixation surgery. Participants were excluded if they had bilateral fracture or had any neurological/rheumatological condition. Effectiveness of each intervention was assessed through pain at rest (VAS), range of movement (degrees of wrist movement), and function (DASH). The outcomes were measured at baseline and after 8 weeks of treatment. All participants attended two session (1 hour each) with a physiotherapist each week for 8 weeks. Participants in every group received a home exercise program. Treatment allocation was randomised. The assessor was blind to treatment allocation. Participants were provided with either GMI (n = 17) or traditional rehabilitation (n = 19). Participants in the GMI completled 3 weeks of left/right hand discrimination (10 minutes each waking hour). This was followed by 3 weeks of explicit motor imagery in which participants had to look at a hand picture and imagining moving their own hand (10 minutes each waking hour). The last phase of the GMI (2 weeks) involved mirror therapy (10 minutes each waking hour). The traditional rehabilitation group included a gradual AROM home exercise program which was then progressed into resistance exercises towards the end of the intervention program. There were no differences between groups in the number of participant that undervent a conservative or surgical intervention for their fracture. All the participants reported high adherence to the physiotherapy intervention (100%) and home exercise program (90-100%), although the latter was self-reported. The results showed that GMI improved pain at rest (GMI - Mean difference: 2.2, SD: 2.1; Control - Mean difference: 1,1, SD: 1.2) and function (GMI - Mean difference: 38, SD: 14.3; Control - Mean difference: 27, SD: 17) to a statistically and clinically significant level compared to the traditional rehabilitation group. From a practical poin of view, these results suggest that there is an average improvement in pain at rest of 2 points out of 10 with GMI (clinically significant change) and 1 point out of 10 with traditional physiotherapy (non clinically significant change). For function, there is an improvement of 38 points on the DASH with GMI and 27 points with traditional physiotherapy (both clinically significant changes). Contrasting results were reported in text and in the tables for range of movement. It is therefore not possible to comment on these findings with certainty. 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: Hand therapists may choose GMI training if the main goal of rehabilitation is to reduce pain and improve function. This may be particularly appropriate in patients presenting with high levels of pain within the first week of injury (these patients are also more likely to develop CRPS). It is unclear whether GMI can lead to improvements in range of movement. Open Access URL: https://doi.org/10.1016/j.jht.2017.09.004 Abstract Background: Physiotherapy improves the movement range after the onset of post-traumatic elbow stiffness and reduces the pain, which is a factor limiting elbow range of motion. However, no results have been reported for motor-cognitive intervention programs in post-traumatic elbow stiffness management. The objective was to investigate the efficacy of Graded Motor Imagery (GMI) in post-traumatic elbow stiffness. Methods: Fifty patients with post-traumatic elbow stiffness (18 female; mean age, 41.9±10.9 years) were divided into two groups. The GMI group (n=25) received a program consisting of left/right discrimination, motor imagery, and mirror therapy (twice a week for six weeks); the structured exercise (SE) group (n=25) received a program consisting of the range of motion, stretching, and strengthening exercises (twice a week for six weeks). Both groups received a 6-week home exercise program. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH). The secondary outcomes were the active range of motion (AROM), Visual Analogue Scale (VAS), Tampa Scale for Kinesiophobia (TSK), muscle strength of elbow flexors and extensors, grip strength, left/right discrimination, and Global Rating of Change. Patients were assessed at baseline, at the end of treatment (12 sessions), and a 6-week follow-up. Results: The results indicated that both GMl and SE interventions significantly improved outcomes (p<0.05). After a 6-week intervention, the DASH score was significantly improved with a medium effect size in the GMI group compared to the SE group and improvement continued at the 6-week follow-up (F1,45=3.10, p=0.01). The results with a medium to large effect size were also significant for elbow flexion AROM (p=0.02), elbow extension AROM (p=0.03), VAS-activity (p=0.001), TSK (p=0.01), muscle strength of elbow flexors and elbow extensors (p=0.03) in favor of GMI group. Conclusion: The GMI is an effective motor-cognitive intervention program that might be applied to the rehabilitation of post-traumatic elbow stiffness to improve function, elbow AROM, pain, fear of movement-related pain, and muscle strength. 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

Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: A systematic review and meta-analysis of randomized placebo-controlled clinical trials. Simental-Mendía, M., Vilchez-Cavazos, F., Álvarez-Villalobos, N., Blázquez-Saldaña, J., Peña-Martínez, V., Villarreal-Villarreal, G., & Acosta-Olivo, C. (2020) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 Type of study: Therapeutic Topic: Lateral epicondylalgia – platelet-rich plasma injections This is a systematic review and meta-analysis assessing the effectiveness of platelet-rich plasma (PRP) vs placebo injections for lateral epicondylalgia. Five randomised placebo-controlled trials (RCT) were included for a total of 276 participants (PRP = 153; Placebo injection = 123). All the RCTs were assessed through the Risk of Bias criteria recommended by the Cochrane Review Group. Efficacy of intervention was assessed through improvements in pain (VAS) and function (patient-rated tennis elbow evaluation - PRTEE). To be included in the review, RCTs had to compare PRP injections to placebo injections (saline). Follow-up periods ranged between 2 to 6 months. The results showed that all the RCTs presented a low risk of bias. There was no difference between PRP or placebo injections on pain (Mean difference: -0.51; 95%CI: -1.32 to 0.3) or function (Standardised mean difference: -0.07; 95%CI: -0.46 to 0.33). Pain improved to a clinically significant level in both placebo and PRP injections groups (median reduction in pain of 5 points out of 10 in both groups). Neither the placebo nor the PRP injection group improved to a clinically significant level in the functional outcomes (1 point change on DASH). Clinical Take Home Message: PRP injections do not appear to show any additional benefit on pain or function when compared to placebo (saline) injections. Both interventions appeared to provide a clinically meaningful improvement in pain, which is most likely due to the contextual effect of the injection treatment. URL: https://link.springer.com/article/10.1007/s10067-020-05000-y

Placebo and nocebo effects. Colloca, L., & Barsky, A. J. (2020) Level of Evidence: 5 Follow recommendation: 👍 Type of study: Therapeutic Topic: Placebo and nocebo – What are they? This is a narrative review on placebo and nocebo for clinical practice. Placebo, a positive effect (e.g. pain reduction), and nocebo, a negative effect (e.g. increase in pain), are the result of treatment expectations. Words can induce a placebo or a nocebo effect. Verbal hyperalgesia (hyperalgesia = a nociceptive stimulus usually perceived as a little pain is perceived as a high intensity pain) is an example of nocebo effect. Verbal hyperalgesia is induced in patients when we suggest that something that we are going to do (e.g. ligament testing) or that they are already doing (e.g. activity or movement) will be painful. This nocebo effect has been suggested to be due to an increase in anxiety and inhibition of endogenous analgesic pathways. Classical conditioning (Pavlovian conditioning) is another mechanism that can induce a placebo or nocebo response. For example, repeatedly associating a movement with a highly nociceptive stimulus has been shown to increase the likelihood of perceiving pain in the presence of a mild nociceptive stimulus after the conditioning. In clinical practice, breaking down the association with movement and pain, as well as providing a realistic and positive explanation of the treatment, have both been shown to reduce the pain experience. In addition, an empathetic attitude and smiling have been shown to reduce the experience of pain by improving the endogenous analgesic response of our patients. Clinical Take Home Message: Based on what we know today, the positive attitude of a hand therapist can boost the effect of the treatment provided. It may be useful to avoid suggesting that a specific activity or movement will cause pain. This may set up patients to feel more pain than what they would otherwise experience. Hand therapists should also be aware that patients may associate a specific activity or movement with pain. This may cause ongoing symptoms even after the tissues have healed. URL: https://www.nejm.org/doi/full/10.1056/NEJMra1907805 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 and laboratory workup for hand infections. (2020) Level of Evidence: 5 Follow recommendation: 👍 Type of study: Diagnostic, Therapeutic Topic: Fingertip infections - Diagnostic tests This is a narrative review on epidemiology and treatment of fingertip infections. Finger tip infections included acute and chronic paronychia, felon, and infection mimickers. Acute paronychia often affect the middle 3 digits and should be differentiated from herpetic whitlow. If the condition does not resolve within a few days, oral antibiotics or antibiotic creams should be prescribed. Chronic paronychia is defined as an inflammation of the nail fold that lastes longer than 6 weeks. This condition is not as severe as an acute paronychia and it often develops due to on-going mechanical or chemical insults (e.g. swimmers, homemakers) following an acute paronchia. Felon is an infection of the finger pulp and it represent 15-20% of all the hand infections. These infections are often reported after fingerprick testing for diabetes or splinters' punctures. Felons can be treated conservatively through antibiotics or surgically with incfection evacuation. If not treated appropriately, they may result in osteomylietis, flexor tenosynovitis, and potentially tendon rupture. Mimickers of paronychia or felons include calcific tendinitis, gout, herpetic whitlow, cancer, rheumatologic conditions, and zoonoses. Calcific tendinitis can be easily identified through x-rays and responds well to anti-inflammatories and corticosteroids. Gout may be identified through bony erosions evident on x-ray and it can affect the dipj. Herpetic whitlow is a herpes simplex infection which is extremely contagious during the first two week. The use of gloves by the clinician significantly reduce the risk of them contracting the condition. Oral acyclovir should be prescribed. Cancer can mimick paronychia and treatment depends on the type of malignancy. Rheumatologic conditions such as psoriasis and reactive arthritis may cause nail changes and are usually associated with systemic issues (e.g. conjunctivitis, urethritis). Zoonoses are other fingertip infections which are transferred from vertebrate animals to humans (remember the word "zoo"). Zoonoses require close follow up as they may require hospital admission. Clinical Take Home Message: Hand therapists should monitor patients with a suspected fingertip infection closely. If the condition is not responsive to antibiotics or surgical evacuation an infection mimicker should be considered as a differential diagnosis. The most common mimickers appear to be gout and herpetic whitlow. A thorough subjective examination, including client's occupation, may aid in the diagnosis. URL: https://www.clinicalkey.com.au/#!/content/1-s2.0-S0749071220300317

A novel staged wrist sensorimotor rehabilitation program for a patient with triangular fibrocartilage complex injury: A case report. Chen, Z. B. (2019) Level of Evidence: 5 Follow recommendation: 👍 Type of study: Therapeutic Topic: Triangular Fibrocartilage Complex (TFCC) rehabilitation - Four stages treatment over three months This case study reported the rehabilitation phases of a young patient (20s) presenting with two months’ history of wrist ulnar sided pain in the dominant hand. The pain developed while carrying a heavy object and it impaired their ability to work in a sedentary job (computer typing and answering phone calls). No information was provided on hobbies or sport activities. The patient presented with a pain of 4/10 on wrist movements at baseline. The diagnosis of TFCC was based on a positive fovea sign. The assessment also included self-reported measures of function (QuickDASH and Patient-Related Wrist Evaluation), active range of movement, grip strength, wrist joint position sense, and weight bearing ability through the Push Off test. Treatment was provided in four stages, each lasting one month. In the first stage, active range of movement exercises, splinting, and laser therapy were provided. If pain at rest and during exercises was less than 2/10, the next phases was initiated. This included isometric strengthening of pronator quadratus and extensor carpi ulnaris, light weightbearing wrist extension and flexion, and gradual splint weaning. Progression to the third phase initiated when wrist extension with overpressure was not painful and when pain was less than 2/10 with the exercises. This phase included progression of strength training intensity and introduction of wrist and upper limb perturbations. The fourth and last phase included graded return to functional activities with more complex tasks. 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: Progression of exercises for patients with TFCC injury may be based on symptoms. It appears that 2/10 pain may be the maximum advisable pain for patients to experience during or after exercises. A wrist splint may be worn for the first six weeks, after which a weaning process could commence according to pain irritability. The Push Off test might be a good assessment tool to assess patients at 8 weeks. URL: https://www.jhandtherapy.org/article/S0894-1130(17)30404-0/abstract Available through The Journal of Hand Therapy for HTNZ members. Available through EBSCO Health Databases for PNZ members. Abstract Study Design Case report. Introduction Studies have highlighted the sensory innervations and stabilizing role of forearm muscles on wrist joint and implications to wrist sensorimotor rehabilitation. This case explored the novel incorporation of dart-throwing motion and proprioceptive neuromuscular facilitation in wrist sensorimotor rehabilitation. Purpose of the Study To describe and evaluate a staged wrist sensorimotor rehabilitation program for a patient with triangular fibrocartilage complex (TFCC) injury. Methods The patient participated in the staged program for 9 sessions over a 3-month period. Treatment involved neuromuscular strengthening at the wrist and movement normalization of the upper extremity. Outcome measures were grip strength, visual analog scale, joint position sense, Quick Disabilities of the Arm, Shoulder and Hand, and patient-rated wrist evaluation. Results The patient showed improvement in all outcome measures. Most outcomes exceeded the established minimal clinically important difference values. Discussion The results suggest that dart-throwing motion and proprioceptive neuromuscular facilitation are beneficial in rehabilitation of TFCC injury. Conclusions This is the first study that incorporated dart-throwing motion and proprioceptive neuromuscular facilitation in the sensorimotor rehabilitation of TFCC injury and yielded promising results. There is a need to further evaluate the program in prospective randomized controlled trial recruiting a larger group of patients with TFCC injury.

Imaging and laboratory workup for hand infections. Whitaker, C. M., Low, S., Gorbachova, T., Raphael, J. S., & Williamson, C. (2020) Level of Evidence: 5 Follow recommendation: 👍 Type of study: Diagnostic Topic: Hand infections - Diagnostic tests This is a narrative review on diagnostics for of hand infections. The hand infections included abscesses, cellulitis, septic arthritis, pyogenic tenosynovitis, osteomyelitis, and necrotising fasciitis. X-rays are useful in identifying focal bone erosion, cortical changes, and associated fractures in infections. In addition, they can be useful in excluding differential diagnoses for infections such as gout or calcific tendinitis. US imaging is also useful in identifying non radiopaque foreign bodies. Abscesses often present as soft tissues mass on x-rays associated with an hypoechoic (dark appearance) collection of fluid and increased vascularity on US (US is 97% sensitive for this condition, meaning that a negative finding can exclude this diagnosis). Cellulitis often presents with an increase in subcutaneus edema on x-rays and US, which is common to other conditions and requires clinical confirmation. Septic arthritis consists in an infection limited to the articular joint. X-rays and US are not particularly useful in the initial stages even though they may identify capsular distension. Pyogenic tenosynovitis is an infection of the flexor tendon sheet. Unfortunately, x-rays and US are not often useful in confirming the diagnosis, although they can exclude the presence of a foreign body. Osteomyelitis is an infection of the bone marrow and bone. X-rays are usually negative for 1-3 weeks since onset and US are not useful in identifying this condition. Necrotising fascitis is a potentially fatal infection of the soft tissue which is not easily diagnosed through x-rays or US in the initial stages of the condition. Emergency care is required for this condition. Clinical Take Home Message: Hand therapists should refer patients for x-rays and US when they suspect an infection. These investigations are useful in identifying the presence of foreign bodies and exclude other conditions (e.g. gout, calcific tendinitis), which may mimic infection presentations. Signs of osteomyelitis are not evident on x-ray until 1-3 weeks since onset and x-rays may be repeated to exclude this condition. A prompt referral to ED or hand surgeon may be required. URL: https://www.clinicalkey.com/#!/content/1-s2.0-S0749071220300299

Hand Infections: Epidemiology and Public Health Burden. Gundlach, B. K., Sasor, S. E., & Chung, K. C. (2020) Level of Evidence: 5 Follow recommendation: 👍 Type of study: Aetiologic, Diagnostic, Therapeutic Topic: Hand infections - Epidemiology This is a narrative review on epidemiology, risk factors, diagnosis, and treatment of hand infections. The frequency of hand infections is two times greater in men compared to women, with more than 30% of infections caused by trauma. Animal bites account for a large proportion of hand infections. Hand surgery rarely leads to hand infections (0.17%). Close to 50% of hand infections are caused by staphylococcus aureus. Risk factors for hand infections include diabetes, HIV infection, immunosuppression, and intravenous drug use. In addition, being an horticulturist, fisherman, aquarist, veterinarian, or dentists increases the chances of presenting with a hand infection. The mechanism of injury, symptoms duration as well as hobbies and occupation may help with the diagnosis. Tetanus vaccination may be required following any bite injury or open skin trauma. Patients with hand infections often do not present with fevers or chills and laboratory testing is often normal in the initial stage of infections. Rapid changes in the clinical presentation and pain beyond what is reasonable expected, should hint towards the presence of an infection. The use of radiographs may help exclude the presence of a foreign body or a fracture. Mobilisation of the hand should start as soon as possible and the use of slings avoided. Clinical Take Home Message: Hand therapists should be aware that diabetes and animal bites are risk factors for hand infection. This information is supported by previous evidence as well as one of our synopsis. In addition, occupations where there is close contact with animals or plants (e.g. vets, gardeners/horticulturists) appear to expose people to greater risk of hand infections. URL: https://www.clinicalkey.com/#!/content/1-s2.0-S0749071220300287

The value of magnetic resonance imaging and ultrasound in diagnosing displaced rupture of the thumb ulnar collateral ligament. Hamborg-Petersen, E., Torfing, T., & Viberg, B. (2020) Level of Evidence: 4 Follow recommendation: 👍 👍 Type of study: Diagnostic Topic: Thumb UCL – Ultrasound and MRI diagnostic This is a non-peer reviewed prospective study assessing the usefulness of MRI and Ultrasound (US) in identifying thumb UCL (mcpj) ruptures. A total of 49 participants were included in the study. Only participants with a ruptured UCL identified clinically and with fluoroscopic diagnsosis were included. UCL rupture was confirmed if there was a greater than 35° of mcpj medial gapping on stress test (in 0° to 30° of mcpj flexion) or if there was more than 10° difference between sides. Potential participants were excluded if trauma had occured longer than 6 weeks before assessment. The variables of interest were the sensitivity of MRI and US. If a test is very sensitive and its result is negative, you can be more certain that the patient does not have the condition (good for screening purposes). Diagnostic accuracy of MRI and US was based on the intraoperative findings (gold standard). The results showed that median time from injury to MRI and US was 6 and 9 days respectively (range 1-20). Median time from injury to surgery was 9 days (range 1-33). The sensitivity of MRI was 65% and 73% for UCL rupture and Stener lesion respectively. The sensitivity of US was 65% and 36% for UCL rupture and Stener lesion respectively. Clinical Take Home Message: Hand therapists may not refer patients for US scans to screen for an UCL rupture or a Stener lesion. The sensitivity of this test is too low and does not appear to be useful in excluding these pathologies when the scans are negative. URL: https://journals.sagepub.com/doi/abs/10.1177/1753193420932496