Search Results

Longitudinal excursion and strain in the median nerve during novel nerve gliding exercises for carpal tunnel syndrome. Coppieters, M. W., & Alshami, A. M. (2007) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 Type of study: Therapeutic Topic: Nerve gliding - Median nerve This is an experimental study assessing median nerve excursion and strain with different exercises in cadavers. Six cadavers' arms were prepared for this study. To measure strain, two displacement tansducers were applied to the median nerve just proximally to the wrist at 12cm proximal to the medial condile of the humerus. To measure excursion, a high precision caliper assessed displacement of the median nerve at the wrist and at the humerus. The median nerve strain and excursion was measured under six different conditions. These included a median glider (wrist flexion-elbow extension and vice versa), median tensioner (wrist and elbow extension and vice versa), wrist motion (extension-neutral) in elbow extension or flexion, elbow motion (flexion-extension) with wrist in extension or neutral. The study needs to be considered in the context of a few limitations. The experiment was performed in cadavers and in vivo studies may show different results. The cadavers did not have a history of carpal tunnel syndrome, which may change the ability of the median nerve to glide within the carpal tunnel. The results showed that there was a statistically significant greater excursion (nerves usually like excursion or gliding but not straining) of the median nerve during the median glider exercise (wrist flexion-elbow extension and vice versa) compared to all the other exercises. The absolute excursion for the glider exercise ranged betweeen 3 to 9 mm which may be clinically relevant. The median nerve strain was statistically significant higher (the median nerve was under greater tension) in the exercises combining wrist and elbow extension in any order compared to the other exercises. The strain increased by 2% with these exercises. Interestingly, the overall strain never exceded 4% of the initial length (6% of strain may be deleterius if held for a prolonged period of time - see Wall et al. 1992). Clinical Take Home Message: Median nerve gliders appear to be safe for use in carpal tunnel syndrome. Hand therapists may avoid combining wrist and elbow extension exercises, which have been shown to to reduce nerve excursion and increase nerve strain. Median nerve gliding exercises do not appear to reduce symptoms in people with carpal tunnel syndrome when added to a splinting regime. However, they may be used in patient prone to develop stiffness. Open Access: https://onlinelibrary.wiley.com/doi/epdf/10.1002/jor.20310

Overuse syndrome of the hand and wrist in musicians: a systematic review. Betzl, J., Kraneburg, U., & Megerle, K. (2020) Level of Evidence: 5 Follow recommendation: 👍 Type of study: Aetiology, Preventative, Therapeutic Topic: Musicians – Overuse syndromes This is a systematic review on epidemiology, pathophysiology, symptoms, and treatment of overuse syndromes in the upper limb of musicians. Forty-two studies were included for a total of more than 1300 musicians. The methodology of the studies varied significantly with a combination of case studies, retrospective studies, and prospective studies. Overuse syndrome was defined as a specific or non-specific painful condition which was aggravated by playing an instrument. The results indicated that the point prevalence for overused syndrome (prevalence measured at one time point) in musicians ranges between 40% to 50%. The lifetime prevalence for overuse syndrome (percentage of musicians who will experience an overuse syndrome at some point in their lifespan) in musicians ranges between 70% to 90%. Very limited research assessed the pathophysiology of overuse syndromes in musicians, with results showing muscle fibre changes as well as local muscle edema in participants with pain compared to controls. Symptoms may be present during practice and at rest. Forced rest appears to be useful in a small subgroup of patients only. An individualised rehabilitation plan with a biopsychosocial approach appears to be more effective in a greater number of musicians. This biopsychosocial approach includes mind-body interventions (e.g. yoga, mindfulness) as well as physical treatments aiming at increasing the general level of fitness of musicians. Clinical Take Home Message: Hand therapists may take a biopsychosocial approach in the treatment of muscians with overuse syndrome. Forced rest does not appear to be a very effective approach. Increasing the overall fitness of musicians and reducing stress may be helpful in reducing pain associated with overuse syndromes of the hand. URL: https://journals.sagepub.com/doi/10.1177/1753193420912644

Mindful body scans and sonographic biofeedback as preparatory activities to address patient psychological states in hand therapy: A pilot study. Roll, S. C., Hardison, M. E., Vigen, C., & Black, D. S. (2020) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 Type of study: Therapeutic Topic: Mindfulness - Pain and anxiety This is a randomised crossed-over single-blind control trial assessing the effectiveness of mindfulness body scan, sonographic biofeedback, and standard care on pain and anxiety in paticipants attending hand therapy sessions. Participants (N=19) were included if they were referred for hand therapy and if they presented with unilateral hand pathology. Participants were excluded if they were in a cast, if they presented with openn wounds, or if they attended hand therapy less than twice a week. Pain was assessed through the visual analogue scale (VAS), and anxiety was measured through the state-trait anxiety inventory (STAI). All the measurements were taken immediately before and after the hand therapy sessions. After inclusion in the study, participants were allocated to standard care for the first visit and subsequently randomised to either mindfulness body scan (n=10) or Biofeedback (n=10). They were then crossed over to the other group in the following two sessions. Standard care, which was provided at the first appointment, included an assessment and treatment selected by the treating hand therapist. The mindfulness body scan was delivered for 20 minutes through an audio-guided meditation. The sonographic biofeedback provided participants with an understanding of tendon movements within the affected and unaffected hand before therapy. Participants in the biofeedback group were also asked to think about their tendons gliding during the hand therapy treatment. The results showed that all the interventions reduced pain and anxiety, although the changes were not clinically relevant. There were no statistically or clinically significant differences in pain or anxiety between the experimental groups (Mindfulness and biofeedback) and the standard care group. It is possible that this study was underpowered to identify any difference between groups. The washout period for the cross-over was short (2-3 days) and it is possible that the carryover effect of standard care or mind-body intervention was still present when the assessment was taking place. Clinical Take Home Message: Hand therapists should not expect a change in pain or anxiety in patients undergoing a brief mindfulness practice or biofeedback intervention. A 10 weeks mindfulnes-based stress reduction program may be required to induce clinically and statistically significant changes in pain and anxiety in selected patients presenting with significant anxiety. URL: https://journals.sagepub.com/doi/abs/10.1177/1758998320930752

Splinting versus extension-block pinning of bony mallet finger: A randomized clinical trial. Thillemann, J. K., Thillemann, T. M., Kristensen, P. K., Foldager-Jensen, A. D., & Munk, B. (2020) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 Type of study: Therapeutic Topic: Bony mallet - Conservative vs surgical treatment This is a randomised single-blind controlled trial assessing the effectiveness of surgery vs splinting in participants bony mallet greater than 1/3 of the articular surface. Participants (N=28) were diagnosed with bony mallet through lateral radiographs. Participants were excluded if the bony mallet fragment was less than 1/3 of the dipj articular surface or if the dipj presented with volar subluxation. Participants with bony mallet of the thumb were excluded. Effectiveness of treatment was assessed by extension lag of the dipj and subluxation of the distal phalanx. Extension lag was assessed at baseline and at 6 months. Subluxation of the distal phalanx was assessed before treatment, immediately after surgery or immobilisation, at 6 weeks, and 6 months. After inclusion in the study, participants were randomised to surgical treatment through extension block pinning (n=14) or splinting (n=14). The extension block pinning group was treated with two k-wire to avoid extensor tendon traction on the bony fragment and distal phalanx subluxation. K-wire were removed after 6 weeks. The splinting group was immobilised in dipj extension with an aluminium splint fixed in place with tape. This had to be worn 24/7 for 6 weeks with regular changes of padding and tape. Care was taken to avoid loss of dipj extension during tape changes, although the process was not supervised. In both groups, the pipj of the affected finger was free to move. Correct position of the distal phalanx was assessed for both groups after immobilisation with a lateral x-ray and revealed good alignment in all participants. Rehabilitation was initiated for both groups after 6 weeks and it included active dipj extension/flexion and a static night splint. This was progressed to loaded dipj extension/flexion and night splint at 8 weeks. At 12 weeks, patients resumed their normal activities without limitations. The results showed that there was no difference in dipj lag at 6 months between the two groups (splint: 12°, range: 8-16; surgery: 10, range: 4-16). Three participants in the splinting group vs no participants in the surgical group presented with distal phalanx subluxation at six months. This difference was not statistically signifcant (I performed a Fisher t-test), although it is possible that the study was underpowered to detect differences. Clinical Take Home Message: Hand therapists may expect similar treatment outcomes when bony mallet greater than 1/3 of the articular surface (without subluxation) are treated conservatively or surgically. However, follow up x-rays during conservative treatment may be required to exclude distal phalanx subluxation. URL: https://journals.sagepub.com/doi/abs/10.1177/1753193420917567

Current methods, outcomes and challenges for the treatment of hand fractures. Boeckstyns, M. E. H. (2020) Level of Evidence: 5 Follow recommendation: 👍 Type of study: Therapeutic Topic: Hand fractures - Surgical vs conservative treatment This is a narrative review on treatment of metacarpal, carpometacarpal, and phalangeal fractures. Most metcarpal fractures can be treated conservatively with good outcomes. Surgey is required if dorsal angulation is greater than 20-40° is present or if there is an open or unstable fracture. Carpometacarpal fractures can be managed conservatively when no dislocation is present. Phalangeal shaft fractures can be treated conservatively with splinting if there is no rotational deformity (scissoring). If rotation deformity is identified, this requires surgical correction. Phalangeal base fractures can be managed conservatively with close monitoring of rotational malunion (scissoring). Salter-Harris type 2, commonly seen in kids, can be managed conservatively. Intrarticular pipj fractures are the most challenging fractures to treat and there is an ongoing debate on what is the most appropriate line of treatment. Intrarticular pipj fractures often involve either the volar or dorsal aspect of the distal phalanx. For volar fractures, surgical treatment is required if a "V" sign is identified on the dorsal apsect of the pipj on a lateral view. Dorsal fractures usually requires surgical intervention. Bony Mallet is often treated conservatively and a recent study has suggested that even with bony fragments greater than 1/3 of the articular surface, conservative treatment is feasible. During conservative treatment, it is advisable to perform radiographic controls the to assess the development of distal phalanx subluxation. Thumb bony avulsion of ucl of mcpj associated with Stener lesion (interposition of adductor pollicis) usually requires surgical intervention. This condition can be identified on x-ray if a bony fragment is present. Bennett's fracture is a fracture of the proximal metacarpal of the thumb, which extends into the cmcj of the thumb. No research has shown better outcomes with either conservative or surgical management in Bennett's fracture. Clinical Take Home Message: Hand therapists should be able to treat most hand fractures conservatively. A few exceptions include open and/or unstable fractures, metacarpal fractures with severe angulation, metacarpal or phalangeal fractures associated with scissoring of fingers, pipj intrarticular fractures, bony mallet with subluxation, and Stener's lesions of the thumb. When in doubt a second opinion from a hand surgeon is always indicated. URL: https://journals.sagepub.com/doi/abs/10.1177/1753193420928820

Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): A prospective cohort study. Yusuf, S., Joseph, P., Rangarajan, S., Islam, S., Mente, A., Hystad, P., . . . Dagenais, G. (2020) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 Type of study: Prognostic Topic: Grip strength - Mortality prediction This is a prospective cohort study assessing the effectiveness of a series of risk factors for mortality in countries with high, middle, and low income. In this synopsis we only considered grip strength as a risk factor. A total of 155,722 participants were included at baseline. Participants were followed up for 12 years. Participants were on average 50.2 (SD: 10) years old. High income countries included Saudi Arabia, United Arab Emirates, Canada, and Sweden. Middle income countries included South Africa, Argentina, Chile, Brazil, Colmbia, Iran, Palestine, Poland, Turkey, Malaysia, and Philippines. Low income countries included Zimbawe, Tanzania, India, Pakistan, and Bangladesh. Grip strength was measured through a Jamar hand dynamometer. The results showed that participants with a grip strength below 15-20 kg (1st quintile - calculated based on mean and SD reported) were 1.6 (95%CI: 1.4 to 1.8) times more likely to die compared to participants with greater grip strength within the study time (12 years). This correlation does not suggest causation and there may be other factors that explain this association. Clinical Take Home Message: Mortality appears to be higher in adults with lower grip strength (below 15-20kg). Hand therapists may refer or prescribe whole body exercise (e.g. aerobic, strength training) for patients who present with low grip strength reduce frailty in their patients. URL: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32008-2/fulltext

Nonsurgical treatment of De Quervain tenosynovitis: a prospective randomized trial. Ippolito, J. A., Hauser, S., Patel, J., Vosbikian, M., & Ahmed, I. (2018) Level of Evidence: 2b Follow recommendation: 👍 👍 Type of study: Therapeutic Topic: De Quervain tenosynovitis - Conservative management This is a randomised controlled trial assessing the effectiveness of immobilisation following cortisone injection in participants with De Quervain tenosynovitis. Participants (N = 20) were diagnosed with De Quervain if they had pain on the radial side of the wrist, pain greater than 4/10 (VAS), positive Finkelstein test, tenderness on palpation at the first dorsal compartment of the wrist. Participants were excluded if they had a previous cortisone injection within the last 6 months, carpal tunnel syndrome, radiculopathy, or previous infection at the treatment site. Effectiveness of treatment was assessed through the VAS for pain anf the DASH score for function. These outcomes were assessed before treatment, at 3 weeks post treatment, and at 6 months post treatment. Participants and assessors were not blinded to treatment allocation. Participants were randomised to a cortisone injection only (n = 9) or a cortisone injection and splinting for 3 weeks (n = 11). Participants in both groups were advised to rest and limit exercise as much as possible for three weeks. The results showed no difference between the two groups on pain or function at 3 and 6 months. Clinical Take Home Message: Hand therapists should advise their patients to rest their hand as much as possible for 3 weeks following a cortison injection for De Quervain tenosynovitis. Immobilisation does not appear to add any benefit in terms of pain and function at short and long term follow-up. URL: https://journals.sagepub.com/doi/full/10.1177/1558944718791187

Clinical management of tendinopathy: A systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments. Irby, A., Gutierrez, J., Chamberlin, C., Thomas, S. J., & Rosen, A. B. (2020) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 👍 Type of study: Therapeutic Topic: Tendinopathies – Conservative and surgical interventions This is a systematic review of systematic reviews assessing the effectiveness of conservative and surgical treatments for symptomatic tendinopathies irrespective of location. Twenty-five systematic reviews (Total of 228 RCTs) were included for a total of 15,000 participants. All the systematic reviews included randomised controlled trials (RCT) only. No systematic reviews on pharmacological intervention (e.g. NSAIDs) were included. All the systematic reviews included were assessed through the Assessment of Multiple Systematic Reviews (AMSTAR), which is scored on a scale from 0 to 11 (higher scores reflect higher study quality). Efficacy of intervention was assessed through changes in pain. The visual analogue scale (VAS) was the most common pain outcome recorded (n=22). The average quality score of the reviews was 9 (SD:1), suggesting that more than 50% of the studies were of high quality. Most of the reviews focused on Achilles and patella tendinopathy (n=23) followed by lateral elbow tendinopathy (n=11) and rotator cuff tendinopathy (n=10) (some of the studies included more than one tendinopathy type). Exercise was the only intervention that was shown to consistently reduce pain in tendinopathy. Heavy eccentric exercises appeared to be particularly effective in reducing pain. Low level laser therapy and extracorporeal shock wave therapy showed some effectiveness in the treatment of symptomatic tendinopathies. Injections, needling, and surgery provided mix results for the treatment of tendinopathies. 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, exercise is an important aspect of tendinopathy treatment. Findings across different body sites consistently suggest that "heavy eccentric exercises" are helpful in reducing pain. It is however not clear what "heavy eccentric exercises" represent in terms of exercise intensity. By considering other research in the field of upper limb tendinopathy, a graded approach to resistance training may be the most appropriate, with eccentric exercises providing potential greater analgesia in lateral epicondylalgia. It is important to remember that resistance training for tendinopathy may be most effective in the sub-acute or chronic phase (disrepair and degenerative stage), while reduction in tendon loading (e.g. rest) may be most suitable for an acute reactive tendinopathy (look at synopsis on staging and treatment of tendinopathies). Open Access URL: https://onlinelibrary.wiley.com/doi/epdf/10.1111/sms.13734 Abstract While the pathoetiology is disputed, a wide array of treatments are available to treat tendinopathy. The most common treatments found in the literature include therapeutic modalities, exercise protocols, and surgical interventions, however their effectiveness remains ambiguous. The purpose of this study was to perform a systematic review of systematic reviews to determine the ability of therapeutic interventions to improve pain and dysfunction in patients with tendinopathy regardless of type or location. Five databases were searched for systematic reviews containing only randomized control trials to determine the effectiveness of treatments for tendinopathies based on pain and patient-reported outcomes. Systematic reviews were assessed via the Assessment of Multiple Systematic Reviews (AMSTAR) for methodological quality. From the database search, 3,295 articles were found, 107 passed the initial inclusion criteria. After further review, 25 systematic reviews were included in the final qualitative analysis. The AMSTAR scores were relatively high (8.8±1.0) across the 25 systematic reviews. Eccentric exercises were the most common and consistently effective treatment for tendinopathy across systematic reviews. Low-level laser therapy and extracorporeal shockwave therapy demonstrated moderate effectiveness, while platelet-rich plasma injections demonstrated inconclusive evidence on their ability to decrease tendinopathy related pain and improve function. Corticosteroids also showed some effectiveness for short-term pain, but for the long-term use deemed ineffective and at times contraindicated. Regarding surgical options, minimally invasive procedures were more effective compared to open surgical interventions. When treating tendinopathy regardless of location, eccentric exercises were the best treatment option to improve tendinopathy related pain and improve self-reported function. 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 is the incidence of complex regional pain syndrome (CRPS) Type I within four months of a wrist fracture in the adult population? A systematic review. Rolls, C., McCabe, C., Llewellyn, A., & Jones, G. T. (2020) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 👍 Type of study: Prognostic Topic: CRPS I - Incidence after wrist fracture This is a systematic review assessing the incidence of complex regional pain syndrom (CRPS) following a wrist fracture. Nine prospective cohort trials were included for a total of 2465 participants. Studies were only included if CRPS type I (no nerve damage) was assessed. All papers included were scored on the Newcastle-Ottowa Scale for cohort study (0 lowest score, 6 highest score). The diagnosis of CRPS was made through the Budapest Criteria in most studies (n=6). Incidence of CRPS was assessed at 4 months post wrist fracture. Data were extracted from the highest quality studies only (n=3). Wrist fractures included distal radius fractures, ulnar fractures, and carpal fractures (e.g. scaphoid). The pooled results showed that 7% (95%CI: 2% to 13%) of participants with a distal radius fracture developed CRPS type I at 4 months (An incidence meta-analysis was completed for this synopsis as the authors of the study only provided a range). Of interest, one of the studies with the greatest sample size (n=1506), identified pain greater than 5/10 within the first week after trauma as a prognostic factor for the development of CRPS. Clinical Take Home Message: Hand therapists should be aware of the possibility of CRPS type I following wrist fracture. The condition appears to develop in 1 person out of 20 at four months after injury. Moderate to high levels of pain in the first week after trauma may predispose to the development of CRPS type I. URL: https://journals.sagepub.com/doi/abs/10.1177/1758998320910179

A systematic review of musculoskeletal disorders related to mobile phone usage. Zirek, E., Mustafaoglu, R., Yasaci, Z., & Griffiths, M. D. (2020) Level of Evidence: 3a Follow recommendation: 👍 Type of study: Symptoms prevalence study Topic: Mobile phone use - Association with MSK pain This is a systematic review assessing the effect of mobile phones on musculoskeletal (MSK) pain conditions. Eighteen studies were included for a total of 36,243 participants. Of these, 15 were cross-sectional studies, 2 were case-control studies, and 1 was a prospective cohort study. The Scottish Intercollegiate Guidelines Network (SIGN) checklist was utilised to assess study quality. The overall strength of evidence was assessed through the GRADE approach ("low", "very low", "moderate", "high"), which is suggested by the Cochrane group for systematic reviews. The results show that there was overall a low and very low quality of evidence supporting the findings of this review. The prevalence of MSK pain was 19% to 53% in the thumb, 15% in the elbow, and 13% to 32% in the wrist and hand. One of the limitations of this review was that the prevalence of MSK pain in people not using mobile technology was not reported. In addition, most of the studies reported correlations between mobile technology use and MSK pain. Correlation does not equate to causation and there may be other factors (e.g. amount of physical activity, mental helath) that contribute to these pain presentations. Clinical Take Home Message: Hand therapists should not advise their patients against the use of mobile technology to avoid MSK pain conditions. Instead, hand therapists may invite patients to be physically active and vary their movements and physical activity during the day. URL: https://www.sciencedirect.com/science/article/abs/pii/S2468781220300114

The effectiveness of physical therapies for patients with base of thumb osteoarthritis: Systematic review and meta-analysis. Ahern, M., Skyllas, J., Wajon, A., & Hush, J. (2018) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 👍 Type of study: Therapeutic Topic: Thumb OA – Unimodal and multimodal treatments This is a systematic review and meta-analysis assessing the effectiveness of unimodal and multimodal treatments for symptomatic thumb osteoarthritis (OA) on pain and function. Five randomised controlled trials were included for a total of 198 participants. All the studies included were assessed through the risk of bias tool suggested by the Cochrane review group (higher scores reflect higher study quality). The active treatments for the studies included varied from mobilisation of the 1st cmcj and surrounding tissues (exercises, neurodynamic exercises, manual therapy) to splinting for the 1st cmcj. Pain was assessed at rest or after pinching through a visual analogue scale (0 to 10). Function was measured through the QuickDASH and the AUSCAN questionnaires. The results showed that four studies scored 5/6 on the study quality score (high quality studies), while one study scored 4/6 (moderate quality study). Pain improved to a clinically and statistically significant level in both multimodal (mean difference 2.9: 95%CI: 2.8 to 3) and unimodal interventions (mean difference 3.1: 95%CI: 2.5 to 3.8) when compared to either a control group or sham treatment. Function improved to a statistically but not to a clinically significant level in the unimodal intervention (mean difference 6.8: 95%CI: 1.7 to 11.9) compared to the control group or sham intervention (no function was reported for multimodal interventions). Clinical Take Home Message: Hand therapists may use manual therapy, exercise, neurodynamic exercise, or splinting to reduce pain for 1st cmcj OA. These interventions do not appear to improve function to a clinically relevant level. URL: https://www.sciencedirect.com/science/article/abs/pii/S2468781218300456

Effects of yoga on depressive symptoms in people with mental disorders: a systematic review and meta-analysis. Brinsley, J., Schuch, F., Lederman, O., Girard, D., Smout, M., Immink, M. A., Stubbs, B., Firth, J., Davison, K., & Rosenbaum, S. (2020) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 👍 Type of study: Therapeutic Topic: Depression - Yoga vs treatment as usual This is a systematic review and meta-analysis assessing the effectiveness of yoga on depressive symptoms. Thirteen randomised controlled trials were included for a total of 1080 participants. Studies were included if at least 50% of each yoga session included a movement component - the rest of the yoga session could include breathing control exercises, or mindfulness. The control group underwent either standard care, or were put on a waitlist. The effectiveness of the interventions was assessed by measuring changes in depressive symptoms. Out of the studies included, nine studies included participants with depressive disorders, five included participants with schizophrenia and depression, three included participants with post-traumatic stress disorder and depression, one included participants with substance dependence and depression, and another one included participants with a mix of mental health conditions and depression. The frequency of yoga sessions varied from 1-3 sessions per week with a variable duration between 20-90 minutes. Out of all the studies included, 53% were of high quality and 47% were of fair quality (PEDro scale). The results showed that yoga had a moderate effect (Standardised mean difference=−0.41; 95%CI −0.65 to -0.17) in reducing depressive symptoms compared to all the control groups. The effectiveness of yoga was correlated with the number of sessions attended each weak, with higher number of sessions attended resulting in greater reduction of depressive symptoms. The remission rates (number of participants who were no longer diagnosed as depressed after the intervention) ranged between 39% to 60% in the yoga group compared 10% to 24% in the control group. This difference was statistically significant. No adverse events were reported. Clinical Take Home Message: Hand therapists may suggest the attendance of yoga classes to patients presenting with depressive symptoms. Considering the relationship between depressive symptoms and upper limb recovery as well as mental health and post surgical satisfaction in CTS, it may be worthwile to help patients improving their depressive symptoms. URL: https://bjsm.bmj.com/content/early/2020/04/05/bjsports-2019-101242