Search Results

Ultrasound evaluation shows increase in laxity after partial common extensor origin detachment but not after additional lesion of the radial band of the lateral collateral ligament. Arrigoni, P., et al. (2021) Level of Evidence: 3b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : CEO - Varus stability This cadaver study investigated the impact of sequential lateral releases on lateral elbow stability using dynamic ultrasound. A total of nine cadavers were included. The common extensor origin (CEO) was the first to be released, followed by the radial band of the lateral collateral ligament (RCL). Upon releasing the CEO, a significant increase of 200% in lateral joint line widening was observed, indicating increased compartmental laxity. However, the additional release of the LCL did not significantly alter joint laxity. This suggests that the CEO has an important stability role in elbow varus stability. 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 CEO tendon has a central role in varus stability of the elbow. It is therefore likely that trauma to the CEO (partial/full avulsion) can lead to laxity of the elbow. Alternatively, traumatic tendinopathy could develop if CEO is subjected to varus traumatic events. URL : https://doi.org/10.1007/s00167-021-06711-8 Abstract Purpose: The lateral elbow musculature conveys a dynamic valgus moment to the elbow, increasing joint stability. Muscular or tendinous lesions to the anterior half of the common extensor origin (CEO) may provoke a deficiency in the elbow dynamic stabilizers, regardless of their traumatic, degenerative, or iatrogenic aetiology. Furthermore, a role for the radial band of the lateral collateral ligament (R-LCL) has been postulated in the aetiology of lateral elbow pain. This study aimed to evaluate the effects of sequential lateral releases with dynamic ultrasound, evaluating its capability to detect lesions of the CEO and of the R-LCL. Methods: Ultrasound investigation of the lateral compartment of the elbow was performed on nine cadaveric specimens with a 10 MHz linear probe in basal conditions, after the release of the anterior half of the CEO and after complete R-LCL release. The lateral joint line widening (λ) was the primary outcome parameter, measured as the linear distance between the humeral and radial articular surfaces. Results: The release of the anterior half of the CEO significantly increased λ by 200% compared to the starting position (p = 0.0008) and the previously loaded position (p = 0.0015). Conversely, further release of the R-LCL caused only a marginal, non-significant increase in λ. Conclusions: Ultrasound evaluation can detect changes related to tendon tears or muscular avulsions of the CEO and can depict lateral elbow compartmental patholaxity by assessing articular space widening while scanning under dynamic stress. However, it cannot reliably define if the R-LCL is injured. Iatrogenic damage to the CEO should be carefully avoided, since it causes a massive increase in compartmental laxity. 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

Who crashes their car following wrist fracture? Stinton, S. B., et al. (2024). Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic / Prognostic Topic : Distal radius fracture - car crash This retrospective study assessed the occurrence of car crashes in individuals with wrist fractures. A total of 37,107 participants with either a carpal, radius, or combined radius and carpal bone fracture were included in the present study. Results revealed a 3.3% decrease in car crashes within two years post-fracture compared to pre-fracture. Of note, individuals with severe wrist injuries exhibited a 79% higher crash likelihood in the first 3 months post-fracture. Employed individuals were also at greater risk. These findings underscore the need for targeted education for those with complex injuries to mitigate crash risk. Contrary to initial assumptions, no increased crashes were observed in the early post-fracture period, potentially due to reduced driving exposure or increased cautiousness. 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, whilst having had a wrist fracture (i.e. radius/carpal bones/both) is overall protective for car crashes, those patients with a severe injury patterns or who have to return to work earlier, are more likely to have a car crash. This is in line with previous evidence showing that within the first few weeks after a distal radius fracture, people tend to be less accurate in their driving skills . If you are interested in knowing how much range of movement is required for driving, have a look at this other synopsis . URL : https://doi.org/10.1016/j.jht.2023.09.002 Abstract Background: Wrist fractures are common injuries associated with high disability in the early recovery period. The impact of wrist fractures on safe return to drive is not understood. Purpose: (1) To compare the proportion of adults who were drivers in car crashes before and after wrist fracture; (2) To examine potential factors (demographic and/or clinical) associated with increased odds of being a driver in a car crash following wrist fracture. Study Design: Retrospective cohort study. Methods: Three state-wide government datasets (MainRoads Western Australia [WA], Hospital Morbidity Data Collection and the Emergency Department Data Collection) were used to obtain and link demographic, clinical and car crash information relating to adults with a wrist fracture sustained between 2008 and 2017. McNemar’s tests were used to compare the proportion of drivers in a car crash within the 2 years prior to and following the fracture date. Multivariable logistic regressions were used to identify if any variables were associated with increased odds of crashing in the post-fracture period. Results: Data relating to 37,107 adults revealed a 3.3% (95% CI 3.0%–3.6%, p < 0.05) decrease in the proportion of drivers in a car crash following wrist fracture, persisting for the entire 2 years post-fracture, when compared to the proportion who crashed before their fracture. Those with more severe wrist fracture injury patterns had 79%(95% CI 1.07–3.0, p = 0.03) higher odds of having a crash in the first 3 months following their injury, compared to those with isolated wrist fracture injuries. Conclusions: These results inform and update return to drive recommendations. The reduced proportion of drivers involved in crashes following wrist fracture persisted for 2 years; longer than the expected physical recovery timeframe. It is important that hand therapists actively educate the sub-group of adults with more severe wrist fracture injury patterns of the increased likelihood of car crash for the 3 months following their fracture. 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

Dorsal blocking orthoses for proximal interphalangeal joint volar plate injuries: A retrospective cohort study investigating the impact of joint angle on patient outcomes. Papatolicas, K. A., Clingin, J. E. and Nicks, R. J. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : pipj volar plate injuries - neutral vs flexes immobilisation This retrospective study investigated the impact of joint angle in the treatment of proximal interphalangeal joint (PIPJ) volar plate injuries using dorsal blocking orthoses. Clinically, we have used varying flexion angles, but the optimal remains unclear. A total of 110 patients were included and splinting in neutral vs 25-30° flexion was compared. The results showed that those with the splint in neutral required fewer hand therapy appointments, with no statistically significant differences in developing a fixed flexion deformity (FFD) or achieving full flexion at discharge compared to those positioned in flexion. One of the limitations of the study is that due to its retrospective nature, it is not possible to determine whether a lower number of sessions was due to the different injury severity or the actual 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, proximal interphalangeal joint volar plate injuries can be immobilised in either a neutral or flexed dorsal blocking splint. Hence, if the patient is comfortable being immobilised in pipj neutral, there is no reason to keep them flexed. If you are interested in pipj treatment of flexion deformity/stiffness, have a look at the whole database . URL : https://doi.org/10.1016/j.jht.2024.06.002 Abstract BACKGROUND: Injuries to the proximal interphalangeal joint (PIPJ) of the fingers are commonly treated in hand therapy departments. Conservative management for PIPJ volar plate injuries typically involves a dorsal blocking orthosis and flexion exercises. Historically hand therapists have placed the PIPJ in varying degrees of flexion but the optimal angle is unknown. PURPOSE: To compare the outcomes of two treatment groups who received dorsal blocking orthoses: Those who the orthosis was positioned in neutral compared to those in 25-30° of flexion. STUDY DESIGN: Retrospective cohort study. METHOD: Patients treated by the hand therapy service at a major metropolitan hospital network in Melbourne, Australia, for conservative management of a PIPJ volar plate injury over a three-year period were included in our study. Data regarding patient demographics, digits affected and injury type were collected. Outcomes included presence of a fixed flexion deformity (FFD), amount of hand therapy received and total active flexion at the PIPJ. RESULTS: One hundred and eleven participants were included in our study. The mean age was 26 and 59 (53%) were males. Seventy two (64%) participants received a dorsal blocking orthosis positioned in neutral and 39 (35%) were positioned in 25-30° flexion at the PIPJ. Participants whose orthosis was positioned at 25-30° had an average of 24 more minutes in hand therapy (which equates to approximately one appointment) compared to those whose PIPJ was positioned in neutral (p=0.006, d=0.5). Eight percent less participants developed a FFD (p = 0.24) and 13% more participants achieved full flexion (p = 0.06) in the group who received a dorsal blocking orthosis in neutral, however these results were not statistically significant. CONCLUSION: PIPJ volar plate injures treated in an orthosis positioned in neutral required fewer hand therapy appointments. There was no statistically significant difference between groups regarding development of a FFD or full flexion. 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

Range of motion following flexor tendon repair: Comparing active flexion and extension with passive flexion using rubber bands followed by active extension. Renberg, M., Svingen, J., Arner, M. and Farnebo, S. (2024). Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Flexor tendon repair - EAM vs passive flexion This retrospective study assessed the effects of early active motion (EAM) and passive flexion with rubber bands followed by active extension on finger/hand range of motion (ROM) following flexor tendon repair in fingers and thumbs. Utilising data from the Swedish HAKIR registry, the study analyzed 702 injured fingers and 126 thumbs at 3 and 12 months post-surgery with lacerations in Zone I and II. The results showed no significant difference in total ROM between the groups at 12 months. Both groups showed similar results in achieving good or excellent outcomes based on the Strickland classification. Despite potential limitations such as non-randomisation, the study presented with a large cohort size. 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, managing post-operative flexor tendon repair in zones I and II with either Early Active Motion (EAM) or passive motion regimens demonstrate similar long-term outcomes in terms of range of motion (ROM). However, EAM may offer advantages in quicker short-term recovery of grip strength and patient-reported outcomes. A joined decision which takes into account patient's and clinician's preferences is therefore appropriate. URL : https://doi.org/10.1016/j.jhsa.2024.08.003 Abstract Purpose: This study aimed to compare the outcome in terms of range of motion between early active flexion and extension (early active motion, [EAM]) and passive flexion using rubber bands followed by active extension (sometimes referred to as a Kleinert regimen) after flexor tendon repair in zones 1 and 2. Methods: Data were collected from the Swedish national health care registry for hand surgery (HAKIR). Rehabilitation regimens were decided by the preference of each caregiver. At 3 months, 828 digits (656 EAM and 172 passive flexion) and at 12 months, 448 digits (373 EAM and 75 passive flexion) were available for analysis. Thumbs were analyzed separately. Results: No notable difference in total active motion was found between the groups at 12 months of follow-up. Conclusions: This large registry study supports the hypothesis that EAM rehabilitation may not lead to better range of motion long-term than passive motion protocols. 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

Examining the flexural behavior of thermoformed 3d-printed wrist-hand orthoses: Role of material, infill density, and wear conditions. Vlăsceanu, D., Popescu, D., Baciu, F. and Stochioiu, C. (2024) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic : 3d printed splints - biomechanical properties This lab based study investigated the mechanical properties (flexibility) of 3D-printed wrist-hand splints made from polylactic acid (PLA) and polyethylene terephthalate glycol (PETG). In particular, the study focused on how the material type and density impacted the splint flexibility. Results indicated that both PLA and PETG splints maintain suitable rigidity, with PETG showing better elasticity and less degradation over time. PLA orthoses are easier to create, while PETG orthoses offer better stability. 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, 3D-printed wrist-hand splints made from PLA and PETG materials reveals promising results for daily use in orthopedic/hand therapy applications. Despite a reduction in mechanical properties over time, both materials maintain sufficient rigidity for wrist immobilisation, with PETG demonstrating superior resistance. 3D printed splints have already been shown as to be useful following distal radius fracture . However, at the moment, thermoplastic splint are still the easiest and fastest to create. URL : https://doi.org/10.3390/polym16162359 Abstract This paper examined the mechanical properties of wrist–hand orthoses made from polylactic acid (PLA) and polyethylene terephthalate glycol (PETG), produced through material extrusion with infill densities of 55% and 80%. These orthoses, commonly prescribed for wrist injuries, were 3D-printed flat and subsequently thermoformed to fit the user’s hand. Experimental and numerical analyses assessed their mechanical resistance to flexion after typical wear conditions, including moisture and long-term aging, as well as their moldability. Digital Imaging Correlation investigations were performed on PLA and PETG specimens for determining the characteristics required for running numerical analysis of the mechanical behavior of the orthoses. The results indicated that even the orthoses with the lower infill density maintained suitable rigidity for wrist immobilization, despite a decrease in their mechanical properties after over one year of shelf life. PLA orthoses with 55% infill density failed at a mean load of 336 N (before aging) and 215 N (after aging), while PETG orthoses did not break during tests. Interestingly, PLA and PETG orthoses with 55% infill density were less influenced by aging compared to their 80% density counterparts. Additionally, moisture and aging affected the PLA orthoses more, with thermoforming, ongoing curing, and stress relaxation as possible explanations related to PETG behavior. Both materials proved viable for daily use, with PETG offering better flexural resistance but posing greater thermoforming challenges. 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

Evening regular activity breaks extend subsequent free-living sleep time in healthy adults: A randomised crossover trial. Gale, J. T., Haszard, J. J., Wei, D. L., Taylor, R. W. and Peddie, M. C. (2024) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Evening exercise - sleep This randomised crossover study assessed the impact of evening regular physical activity vs sedentary behavior on sleep. In particular, participants engaged in regular three-minute resistance exercise breaks every 30 minutes over a four-hour evening session and were compared to a period of prolonged sitting. A total of 28 healthy participants were included in the study. The results demonstrated an increase in time to sleep and total sleep time by approximately 29 minutes and 28 minutes respectively for those performing the activity breaks, with no disruption to sleep quality. These findings suggest that regular evening resistance exercises, despite traditional recommendations against nighttime workouts, may enhance total sleep time without disrupting sleep quality or daily activity levels. 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, body weight exercises performed prior to sleep can extend sleep duration without affecting overall sleep quality. In contrast with previous evidence , it appears that resistance training has a positive effect on sleep. It is possible that exercise sessions closer to the evening period, may have an effect on sleep compared to earlier in the day resistance training sessions. If you are interested in other activities to improve your clients' sleep, have a look at the whole database . URL : https://doi.org/10.1136/bmjsem-2023-001774 Abstract Objective: To determine if performing regular 3-min bouts of resistance exercise spread over 4 hours in an evening will impact subsequent sleep quantity and quality, sedentary time and physical activity compared with prolonged uninterrupted sitting. Methods In this randomised crossover trial, participants each completed two 4-hour interventions commencing at approximately 17:00 hours: (1) prolonged sitting and (2) sitting interrupted with 3 min of bodyweight resistance exercise activity breaks every 30 min. On completion, participants returned to a free-living setting. This paper reports secondary outcomes relating to sleep quality and quantity, physical activity and sedentary time which were assessed using wrist-worn ActiGraph GT3+ accelerometers paired with a sleep and wear time diary. Results A total of 28 participants (women, n=20), age 25.6±5.6 years, body mass index 29.5±6.7 kg/m2 (mean±SD) provided data for this analysis. Compared with prolonged sitting, regular activity breaks increased mean sleep period time and time spent asleep by 29.3 min (95% CI: 1.3 to 57.2, p=0.040) and 27.7 min (95% CI: 2.3 to 52.4, p=0.033), respectively, on the night of the intervention. There was no significant effect on mean sleep efficiency (mean: 0.2%, 95% CI: −2.0 to 2.4, p=0.857), wake after sleep onset (1.0 min, 95% CI: −9.6 to 11.7, p=0.849) and number of awakenings (0.8, 95% CI: −1.8 to 3.3, p=0.550). Subsequent 24-hour and 48-hour physical activity patterns were not significantly different. Conclusions Performing bodyweight resistance exercise activity breaks in the evening has the potential to improve sleep period and total sleep time and does not disrupt other aspects of sleep quality or subsequent 24-hour physical activity. Future research should explore the longer-term impact of evening activity breaks on sleep. 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

Climbing while healing: An orthotic intervention for rock climbers with a low- grade A2 pulley injury, a case series. Hartnett, E., Bondoc, S. and Feretti, A. M. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : A2 pulley injury - Splint This case series investigated whether the use of a pulley ring orthosis (PRO) among rock climbers with low-grade A2 pulley injuries, allowed people to continue climbing. Four patients with grade I to III A2 pulley injuries followed a 12-week protocol involving consistent use of a custom-fitted PRO during climbing. They trained at least 3 times per week for 2-3 hrs each time. Weekly evaluations measured strength, pain, and functional outcomes. Results indicated enhanced that strength increased and pain reduced over time, without increasing edema. By the end of the study, all participants showed full healing and maintained their climbing activities. Of note, the splint was weakened on the dorsal aspect to avoid degloving of the finger in the event it got caught whilst climbing. 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, for rock climbers with A2 pulley injuries, using a Pulley Ring Orthosis (PRO) may help continuing rock climbing whilst the injury heals. Based on previous biomechanical studies, it is however unlikely that this splint would reduce loading through the A2 pulley . If you are interested in the classification of A2 pulley injuries, have a look at this other synopsis . URL : https://doi.org/10.1016/j.jht.2023.08.005 Abstract Background: Pulley injuries are common among rock climbers, which is a growing population. Hand therapists need a therapeutic intervention which promotes healing and enables participation. Purpose: The purpose of this case series is to detail the functional outcomes of a 12-week protocol using a pulley ring orthosis (PRO) among rock climbers with a grade I, II, or III pulley injury. Study Design: A prospective repeated measures case series followed the healing timeline of four participants who rock climbed while wearing the invervention device, the PRO, with weekly measurements to monitor healing. Methods: Participants with a grade I, II, or III A2 pulley injury were custom fitted for a PRO, which they wore while rock climbing a minimum of 3 times per week for 12 weeks. Weekly check-ins were scheduled for subjective and objective measurements. Results: All participants demonstrated indicators of full healing, which, in this study, is defined as progressive improvement in strength, function, and pain, without interruption of their typical rock climbing schedules. Conclusions: Providers should consider the use of a PRO as a protective orthosis for rock climbing patients with a low-grade A2 pulley injury who want to continue rock climbing while they are healing. 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

Stress fracture of capitate bone—A case report of an unusual fracture. da Silva, M. O., Duarte, M. L., Passarelli, F. A. F. and Gobbo, D. K. P. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Capitate - Stress fractures A 23-year-old mechanic, experienced pain and swelling in the left wrist for two months, without relief with over the counter anti inflammatories. The pain initiated after changing work place and having to repeatedly perform specific mechanical repairs (e.g. using pneumatic wrench). Objectively, they presented with mild edema on the dorsal aspect of the affected wrist and there was tenderness on palpation of the central-dorsal aspect of the wrist. Radiographs were impeccable. Additional imaging was completed and magnetic resonance imaging (MRI) showed a stress fracture of the capitate. Conservative treatment, include immobilisation of the wrist for eight weeks, analgesics, and subsequent physical therapy. This course of action led to symptoms resolution and the patient's ability to return to work, albeit in a new role. 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, stress fractures of the capitate bone are uncommon and therefore often missed. While stress fractures elsewhere are commonly linked to weight-bearing and high-impact activities, capitate fractures usually arise from repetitive wrist movements, often going unrecognised initially. Radiographs are often inconclusive. Magnetic Resonance Imaging (MRI) is the preferred modality due to its superior sensitivity in detecting stress fractures and associated bone marrow edema. Conservative treatment involving immobilisation and rest for around six weeks to three months is generally effective. If you are interested in another case of hand bones stress fracture, have a look at this synopsis . URL : https://doi.org/10.1016/j.jht.2023.09.006 Abstract Introduction: The capitate is the largest, most central bone and the first to ossify in the wrist. It has a well-protected anatomic location, making traumatic or stress fractures extremely rare in clinical practice. Isolated fractures of the capitate bone are very uncommon and often without displacement due to the great stability provided by the intracarpal ligaments. Purpose of the study: This study aimed to report a case of isolated stress fracture of the capitate related to the work activity of a mechanic. Case report: We report the case of a 23-year-old patient complaining of pain and swelling in the left wrist for 2 months without improvement after using analgesics. On physical examination, he presented pain on palpation in the central region of the wrist, pain when performing flexion and extension movements of the wrist, and frustrated edema. Magnetic resonance imaging diagnosed a stress fracture of the capitate bone. Conservative treatment with forearm-palmar immobilization for 2 months, analgesic medication, and physical therapy rehabilitation after immobilization were performed. After the complete resolution of the symptoms, the patient started to work in a new role. Discussion: There are five case reports of stress fractures in the capitate—two in teenagers and three in adults, but none of them was a mechanic. Clinical suspicion can be formulated when repetitive activity is associated with the wrist in extension and specific location of pain and swelling. Individuals with an immature skeleton are more susceptible. The development of occupational disease should be considered in similar cases of insidious and persistent pain in the palm of people with high work demands. Conclusion: Stress fractures of the capitate bone are a disease that must be suspected in insidious and persistent pain in the palm of the hand. Magnetic resonance imaging is the best image test to diagnose this disorder, and conservative treatment is indicated. 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

Relevance of the scaphoid shift test for the investigation of scapholunate ligament injuries. Schmauss, D., et al. (2022) Level of Evidence: 3b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Scaphoid shift test - Diagnostic accuracy This retrospective study assessed the diagnostic value of the scaphoid shift test (SST - Watson test) for scapholunate ligament (SLL) injuries. A total of 447 patients who underwent wrist arthroscopy were included. Of this group, 153 patients had evidence of injury during artroscophy. The SST showed low sensitivity (0.50) and moderate specificity (0.78). In patients specifically referred for suspected SLL injury, sensitivity increased to 0.61, but specificity dropped to 0.62. The SST was more sensitive (0.66) for severe SLL lesions. Despite these findings, the SST alone is insufficient for a definitive diagnosis, especially for lower-grade lesions. 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 scaphoid shift test (Watson test) should be considered alongside history and other objective findings when making a diagnosis of scapholunate ligament (SLL) injury. Its sensitivity and specificity are limited, particularly for lower-grade lesions. Nevertheless, the test can be useful for an initial assessment, but a negative test result should not exclude the need for further diagnostic evaluations. If you are interested in what imaging would be useful for this condition, have a look at this synopsis . URL : https://doi.org/10.3390/jcm11216322 Abstract Background: Although it is part of the common clinical examination of scapholunate ligament pathologies, there are only little data on the diagnostic value of the scaphoid shift test. The aim of this study was to evaluate the scaphoid shift test in a large cohort of patients. Materials and Methods: We retrospectively analysed 447 patients who underwent the scaphoid shift test and wrist arthroscopy because of various suspected injuries of the wrist, correlating the results of clinical examination with data obtained during the wrist arthroscopy. Sensitivity, specificity, and positive and negative predictive values were calculated and evaluated. Results: The sensitivity of the scaphoid shift test was low (0.50) when examining the whole cohort. In a subgroup of patients specifically referred for suspected scapholunate ligament injury, the sensitivity was higher (0.61), but the specificity was low (0.62). In detecting more serious lesions (Geissler 3 + 4), the scaphoid shift test demonstrated higher sensitivity (0.66). Conclusions: An isolated scaphoid shift test may only be of limited value in the diagnosis of scapholunate ligament lesions and should, therefore, be viewed as a useful tool for a preliminary assessment, but a negative test should not prevent the surgeon from indicating a more extensive diagnostic workup. 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 A 23-year-old mechanic, experienced pain and swelling in the left wrist for two months, without relief with over the counter anti inflammatories. The pain initiated after changing work place and having to repeatedly perform specific mechanical repairs (e.g. using pneumatic wrench). Objectively, they presented with mild edema on the dorsal aspect of the affected wrist and there was tenderness on palpation of the central-dorsal aspect of the wrist. Radiographs were impeccable. What is it?

Soft bandage, splint or cast as the treatment of distal forearm torus fracture in children: A systematic review and meta-analysis. Pakarinen, O., et al. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Torus fractures - Splinting vs casting This systematic review and meta-analysis compared the effectiveness of soft bandage, splint, and cast for treating distal forearm torus fractures in children. Seven randomised controlled trials involving, 1550 participants, were included. The comparisons that the meta-analysis focused on were splinting vs casting and bandage vs rigid immobilisation (splinting/casting). The primary outcomes measured were pain, clinical healing (based on absence of pain on palpation), and return to activities. Secondary outcomes included adverse events and patient/parental satisfaction. The results suggested higher pain scores with splint in the early stages but faster return to activities when compared to casting. All fractures healed clinically within 3-4 weeks. In addition, when bandaging was compared to rigid immobilisation, participants had higher pain on the first day, however, no study comparing these interventions reported on clinical healing or return to activities. 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, splinting appears to be as effective as casting for distal forearm torus fractures in children. Unfortunately, we don't have much information regarding clinical healing and return to activities with bandaging, hence splinting is the safest option at this stage. In specific instances where splinting may be presenting with low compliance, a shared decision-making process involving the patient's parents can be beneficial in offering bandaging instead of splinting. URL : https://doi.org/10.1038/s41598-024-71970-7 Abstract A meta-analysis including all relevant randomized controlled trials was conducted to compare soft bandage, splint and cast as the treatment of torus fracture. PubMed, Scopus, and Web of Science databases were searched in January 2023. Two comparisons were made: (1) splint versus cast, and (2) bandage versus rigid immobilization (i.e. splint or cast). Main outcomes were pain, clinical healing of the fracture and return to activities. Secondary outcomes were adverse events (skin issues, problems with cast/splint/bandage) and patient/parental satisfaction. Seven studies with 1550 patients were included. Splint was associated with higher pain scores at 3 days compared to cast (Mean difference [MD] 1.00, CI 0.06–1.94) and at 1 week (MD 1.46, CI 0.84–2.08, moderate-certainty evidence), but faster return to activities (at 3 weeks RR 1.77, CI 1.09–2.88, at 4 weeks RR 1.44, CI 1.11–1.82, moderate-certainty evidence). All torus fractures heal clinically within 3–4 weeks (low-certainty evidence). Bandage may lead to slightly higher pain score (MD 0.35, CI 0.04–0.66, moderate-certainty evidence) at first day after treatment compared to rigid immobilization, but no evidence of a difference was found in later time points. In conclusion, soft bandage or removable wrist splint seem to be optimal first-line treatment of distal forearm torus fracture. 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

Efficacy of hydrodilatation in frozen shoulder: A systematic review and meta-analysis. Poku, D., Hassan, R., Migliorini, F. and Maffulli, N. (2023) Level of Evidence: 1a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Frozen shoulder - hydrodilatation This systematic review and meta-analysis assessed the efficacy of hydrodilatation in treating frozen shoulder compared with other conservative management options (e.g. cortisone injections). The review includes data from 39 studies involving 2623 participants. Outcomes measured included pain, upper limb function, range of movement (e.g. shoulder flexion, external rotation, internal rotation). The results showed that hydrodilatation provides transient improvements in shoulder disability and passive external rotation compared to intra-articular corticosteroid injections, although no long-term superiority in pain relief was observed. Significant improvements in passive external rotation were noted at both early and late follow-ups. The procedure did not show significant differences when compared with other treatments like manipulation under anesthesia (MUA) and arthroscopic capsular release (ACR), but it remains a less invasive and more cost-effective alternative. Keep in mind that around 18 comparisons were made and only three were statistically significant, suggesting that there is 30% chance of these findings being significant due to chance. 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, hydrodilatation is a promising conservative treatment for patients suffering from frozen shoulder. It leads to short-term pain relief and significant improvements in shoulder disability and passive external rotation compared to intra-articular corticosteroid injections. The confidence in these findings is however limited due to the multiple statistical comparisons made. If you are interested in additional information on shoulder assessment and management, have a look at the whole database . URL : https://doi.org/10.1093/bmb/ldad018 Abstract Introduction: It is unclear whether hydrodilatation is beneficial in the management of frozen shoulder compared with other common conservative management modalities. This systematic review evaluates the efficacy of hydrodilatation for the management of frozen shoulder. Sources of data: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An extensive search of PubMed, Embase, Scopus, Cochrane Central, Web of Science and CINAHL databases using multiple keyword combinations of ‘shoulder’, ‘rotator’, ‘adhesive capsulitis’, ‘hydrodilatat*’, ‘distension’ since inception of the databases to June 2023 was implemented. Areas of agreement: Hydrodilatation leads to at least transient more marked improvements in shoulder disability and passive external rotation compared with intra-articular corticosteroid injections. Areas of controversy: Hydrodilatation improves passive external rotation in the longer term. Moreover, hydrodilatation may be a preferable option over manipulation under anaesthesia, given its lower cost and better patient convenience. Growing points: Intensive mobilization after hydrodilatation is a promising adjuvant treatment option for patients suffering from a frozen shoulder. Areas timely for developing research: Although current evidence suggests that hydrodilatation provides a transient improvement in disability in patients with frozen shoulder, its clinical relevance remains unclear. Further research is necessary to establish its role in the management of the condition. 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