Search Results

Design and fabrication of the Cubital Tunnel Control Orthosis (CTCO). Cancio, J. M., Jones, K. A., Stanley, B., Truax, C. and Nuelle, J. A. V. (2021) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic: Cubital tunnel – Dynamic splint This paper described the creation of a custom dynamic splint for Cubital tunnel syndrome. The splint aims at alleviating pressure on the ulnar nerve at the cubital tunnel level, whilst allowing for 90 degrees of elbow flexion and passive extension. Materials used for fabrication include Aquatube, thermoplastic, and soft padded elastic bands for to provide an extension component to the splint. Two separate thermoplastic sheets were created. One for the arm and the other for the forearm. The two thermoplastic splints were joined with aquatube, which were positioned along the centre of rotation of the elbow, which contributed to providing an extension torque. In addition, soft elastic bands of velcro loop were utilised to provide additional elbow extension torque (see pictures below). 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, a dynamic splint may be a useful alternative to a static extension night splinting for cubital tunnel syndrome. Overall it appears that cubital tunnel splints are useful and the choice of static vs dynamic splints are a matter of clinician's and patient's preference. If you are interested in other cubital tunnel synopses, have a look at the entire database. URL: https://doi.org/10.1016/j.jht.2020.05.005 No Abstract available publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Diagnostic performance of artificial intelligence for detection of scaphoid and distal radius fractures: A systematic review. Oeding, J. F., et al. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic: Artificial intelligence – Scaphoid and distal radius fracture detection The systematic review assessed the effectiveness of artificial intelligence (AI) in detecting scaphoid and distal radius fractures compared to human experts. A total of 21 studies, which included 55,541 participants (with associated x-rays) were included. The results showed that AI models present with promising diagnostic performance, with high accuracy and area under the curve values. AI models performed comparably or better than human experts in most cases, especially for occult fractures when they were trained on that. The study suggests that AI can assist in detecting subtle fractures and improve diagnostic efficiency. 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, articificial intelligence (AI) models demonstrated good performance, with high accuracy and area under the receiver operator characteristic curve (AUROC) values. It appears that radiology clinics have already started using AI, as I have seen x-rays images with the GLEAMER (one of the AI softwares) on several occasions when reviewing my patients' imaging through inteleviewer. If you are interested in the use of AI for hand surgery/therapy, have a look at this synopsis. URL: https://doi.org/10.1016/j.jhsa.2024.01.020 Abstract Purpose: To review the existing literature to (1) determine the diagnostic efficacy of artificial intelligence (AI) models for detecting scaphoid and distal radius fractures and (2) compare the efficacy to human clinical experts. Methods: PubMed, OVID/Medline, and Cochrane libraries were queried for studies investigating the development, validation, and analysis of AI for the detection of scaphoid or distal radius fractures. Data regarding study design, AI model development and architecture, prediction accuracy/area under the receiver operator characteristic curve (AUROC), and imaging modalities were recorded. Results: A total of 21 studies were identified, of which 12 (57.1%) used AI to detect fractures of the distal radius, and nine (42.9%) used AI to detect fractures of the scaphoid. AI models demonstrated good diagnostic performance on average, with AUROC values ranging from 0.77 to 0.96 for scaphoid fractures and from 0.90 to 0.99 for distal radius fractures. Accuracy of AI models ranged between 72.0% to 90.3% and 89.0% to 98.0% for scaphoid and distal radius fractures, respectively. When compared to clinical experts, 13 of 14 (92.9%) studies reported that AI models demonstrated comparable or better performance. The type of fracture influenced model performance, with worse overall performance on occult scaphoid fractures; however, models trained specifically on occult fractures demonstrated substantially improved performance when compared to humans. Conclusions: AI models demonstrated excellent performance for detecting scaphoid and distal radius fractures, with the majority demonstrating comparable or better performance compared with human experts. Worse performance was demonstrated on occult fractures. However, when trained specifically on difficult fracture patterns, AI models demonstrated improved performance. Clinical Relevance: AI models can help detect commonly missed occult fractures while enhancing workflow efficiency for distal radius and scaphoid fracture diagnoses. As performance varies based on fracture type, future studies focused on wrist fracture detection should clearly define whether the goal is to (1) identify difficult-to-detect fractures or (2) improve workflow efficiency by assisting in routine tasks. 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

Advancements in De Quervain tenosynovitis management: A comprehensive network meta-analysis. Chong, H. H., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: De Quervain tenosynovitis - Therapeutic options This is a systematic review and meta-analysis assessing nonsurgical treatment options for De Quervain tenosynovitis. Fourteen studies for a total of 823 participants were included in this review. The interventions assessed included cortisone injections, splinting, and extracorporeal shock wave therapy. The results showed that extracorporeal shockwave therapy was most effective in the short and medium term, while corticosteroid injections with immobilisation were ideal for long-term relief. Other treatments like acupuncture and splinting alone showed limited benefits. The study suggests corticosteroid injections with short immobilisation as the primary treatment, with extracorporeal shockwave therapy as an adjunct therapeutic option. 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, corticosteroid injections with short-duration immobilisation should be considered the primary therapeutic option for De Quervain tenosynovitis, especially for long term outcomes. Extracorporeal shockwave therapy could be utilised as an adjunct therapeutic option. Splinting alone did not appear to provide large benefits in the treatment of this condition. This seems to be in line with a study published in the past. If you are interested in providing exercises for people with De Quervain tenosynovitis, they appear to be safe and they do not exacerbate patients' symptoms. URL: https://doi.org/10.1016/j.jhsa.2024.03.003 Abstract Purpose: This study presents a network meta-analysis aimed at evaluating nonsurgical treatment modalities for De Quervain tenosynovitis. The primary objective was to assess the comparative effectiveness of nonsurgical treatment options. Methods: The systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Searches were performed in multiple databases, and studies meeting predefined criteria were included. Data extraction, risk of bias assessment, and statistical analysis were carried out to compare treatment modalities. The analysis was categorized into short-term (within six weeks), medium-term (six weeks up to six months), and long-term (one year) follow-up. Results: The analysis included 14 randomized controlled trials encompassing various treatment modalities for De Quervain tenosynovitis. In the short-term, extracorporeal shockwave therapy demonstrated statistically significant improvement in visual analog scale pain scores compared with placebo. Extracorporeal shockwave therapy also ranked highest in the treatment options based on its treatment effects. Corticosteroid injections (CSIs) combined with casting and laser therapy with orthosis showed favorable outcomes. Corticosteroid injection alone, platelet-rich plasma injections alone, acupuncture, and orthosis alone did not significantly differ from placebo in visual analog scale pain score. In the medium-term, extracorporeal shockwave therapy remained the top-ranking option for visual analog scale pain score, followed by CSI with casting. In the long-term (one year), CSI alone and platelet-rich plasma injections demonstrated sustained pain relief. Combining CSI with orthosis also appeared promising when compared with CSI alone. Conclusions: Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for De Quervain tenosynovitis. Extracorporeal shockwave therapy can be considered a secondary option. Alternative treatment modalities, such as isolated therapeutic injection, should be approached with caution because they did not show substantial benefits over placebo. 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

Cervical manipulation versus thoracic or cervicothoracic manipulations for the management of neck pain. A systematic review and meta-analysis. Carrasco-Uribarren, A., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Neck pain – Cervical vs thoracic manipulation This systematic review and meta-analysis assessed the effectiveness of cervical thrust or non-thrust manipulations versus thoracic or cervicothoracic manipulations for treating neck pain. The review included six studies and found no significant differences between the two types of manipulations in terms of pain intensity, disability, and cervical range of motion. The certainty of evidence varied from very low to moderate, suggesting that both types of manipulations are equally effective in improving pain, disability, and range of motion in patients with neck pain. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, there is no significant difference in effectiveness between cervical thrust or non-thrust manipulations and thoracic or cervicothoracic manipulations for improving pain, disability, and range of motion in patients with neck pain. Considering that cervical manipulation have a greater risk of adverse events, the use of cervicothoracic mobilisation/manipulations may be safer. URL: https://doi.org/10.1016/j.msksp.2024.102927 Abstract Background: Cervical and thoracic thrust or non-thrust manipulations have shown to be effective in patients with neck pain, but there is a lack of studies comparing both interventions in patients with neck pain. Objective: To investigate the effects of cervical thrust or non-thrust manipulations compared to thoracic or cervicothoracic manipulations for improving pain, disability, and range of motion in patients with neck pain. Design: Systematic review and meta-analysis. Method Searches were performed in PubMed, PEDro, Cochrane Library, CINHAL, and Web of Science databases from inception to May 22, 2023. Randomized clinical trials comparing cervical thrust or non-thrust manipulations to thoracic or cervicothoracic manipulations were included. Methodological quality was assessed with PEDro scale, and the certainty of evidence was evaluated using GRADE guidelines. Results: Six studies were included. Meta-analyses revealed no differences between cervical thrust or non-thrust manipulations and thoracic or cervicothoracic manipulations in pain intensity, disability, or cervical range of motion in any plane. The certainty of evidence was downgraded to very low for pain intensity, to moderate or very low for disability and to low or very low for cervical range of motion. Conclusion: There is moderate to very low certainty evidence that there is no difference in effectiveness between cervical thrust or non-thrust manipulations and thoracic or cervicothoracic manipulations for improving pain, disability, and range of motion in patients with neck pain. 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

The aetiology of fracture and nonunion in the hook of the hamate. Campbell, F. C., Jones, S. W. and Campbell, D. A. (2024) Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic, Therapeutic Topic: Hook of hamate fractures - Diagnosis and treatment This expert opinion discusses fractures of the hook of the hamate bone in the hand. The authors explains the anatomy and vascular supply of the hook of hamate, highlighting its function as a pulley for the flexor digitorum profundus of the little and ring finger. This pulley feature of the hook of hamate is suggested as one of the reasons why traumatic fractures of the hook often develop into non-union. The authors also challenge the traditional belief of direct trauma as the primary cause of hook of hamate fractures, suggesting that tendon-induced bone stress may contribute to a higher predisposition to fractures. 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, fractures of the hook of the hamate may require immobilisation of the wrist and ulnar two digits to attempt reducing loading forces through the hook of the hamate. However, considering that these fractures are often missed by primary care provider and they are seen later in the recovery phase, ORIF or excision may be required. If you are interested in further information on the diagnosis and treatment of hook of hamate fractures, have a look at this synopsis. URL: https://doi.org/10.1177/17531934241235803 Abstract Fractures of the hook of the hamate are traditionally thought to be caused by direct trauma. A review of the anatomy and function of the hamate hook suggests that fracture is more likely as a result of a fatigue response that develops in the hook from repetitive load applied by the adjacent deep flexor tendons. Additional vascular compromise, from direct pressure of the tendons on critical local vessels, reduces blood flow leading to both mechanical and vascular effects that create pathological osseous change and weakening. These changes are likely to predispose to stress fracture and nonunion in repetitive gripping activities and are consistent with radiological findings. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Ultrasound examination of acute soft tissue lesions in the elbow has good intra rater reliability and acceptable agreement with MRI. Hallgren, H. B., Nicolescu, D., Törnqvist, L., Casselgren, M. and Adolfsson, L. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: Ultrasound imaging vs MRI – Elbow This diagnostic study assessed the diagnostic agreement between ultrasound (US) and MRI imaging in the assessment of acute soft tissue lesions of the elbow. A total of 116 participant underwent US imaging. Of these, 58 agreed to undergo further MRI imaging. The results showed that agreement between US and MRI results indicated good agreement for soft tissue injuries. A problem with the present study is that only a subgroup of participants underwent MRI imaging as well. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, ultrasound imaging shows good reliability and agreement with MRI in diagnosing soft tissue injuries following acute elbow. US is therefore a valuable and accessible imaging modality for hand therapists in the acute setting, particularly for assessing ligament injuries. If you are interested in the use of US imaging in hand therapy setting, have a look at the entire database. URL: https://doi.org/10.1016/j.jse.2024.01.050 Abstract Background: Ultrasound (US) has been suggested a valuable complement to clinical and radiological examinations in elbow trauma. Magnetic resonance imaging (MRI) has been the method of choice, despite fair to moderate interrater reliability (IRR). US has potential advantages but is assessor dependent and IRR scarcely examined. The primary aim of the present study was to investigate IRR for US and secondarily inter-observer agreement (IOA) between US and MRI in the acute phase after elbow trauma. Acute phase was defined as 2 weeks and, if applicable, the following weekend. The hypothesis was that US reliability would be at least substantial for complete muscle or ligament lesions. Methods 116 patients (50 men, median age 47 [range 19-87] years) suffering an elbow trauma with dislocation and/or fracture were included. Exclusion criteria were prior injury to the same elbow, and US and/or MRI not possible within 16 days. During US the condition of muscle origins at the epicondyles and collateral and annular ligament complexes was recorded in a pre-designed protocol, with the alternatives intact, partially or completely torn. 72 patients had a second US examination the same day by an independent upper extremity surgeon. 58 of the 116 patients underwent an MRI before or after the US, evaluated by 2 radiologists using the same protocol. IOA and IRR between assessors and modalities were analyzed with kappa statistics and interpreted according to Landis and Koch. Perfect agreement (PA) was reported in percent. Results: US examination within 2 weeks was feasible with tolerable discomfort. Defining muscle origins and ligaments as intact or completely torn the US IRR ranged from substantial to near perfect (kappa 0,63-1; PA 93-100%). Intact tissues vs tear (partial and complete tear combined) or intact vs partial vs complete tear resulted in kappa values from moderate to substantial and PA 74%-96% with lowest reliability for the muscle origins. The IOA between MRI and US ranged from fair to near perfect for no tear vs complete tear (kappa 0,25-1; PA 65-100%). Agreement between no tear and tear (partial and complete together) ranged from fair to substantial (0,25-0,66; PA 63-89%) and no tear vs partial or complete tear ranged from fair to moderate (0,25-0,53; PA 50-79%). Conclusion: US in the acute setting is suitable and reliable for diagnosis of ligament injuries in the elbow and is in addition fast, cheap and easily accessible. The agreement with MRI seems to vary with the structure assessed and severity of the lesions, ranging from fair to near perfect. 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

Tin ring splint treatment for osteoarthritis of the distal interphalangeal joints. Tada, K., et al. (2019) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Dipj osteoarthritis - figure 8 splint This case series assessed the use of a tin ring splint for treating osteoarthritis in the distal interphalangeal joint. A total of 30 participants were included in the study and they were asked to wear the splint as needed for pain relief, with follow-up assessments completed at 1, 3, and 6 months. The results indicated clinically relevant pain reduction and high patient satisfaction with the splint's usability and appearance. Participants reported a reduction in wearing frequency of the splint over time. Unfortunately, the study did not include a control group. 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 use of a splint to limit distal interphalangeal joint motion may help reducing pain in people with osteoarthritis. It is however possible that people's symptoms would improve over time independently of splint wearing (no control group in this study). Other alternatives to immobilisation for hand osteoarthritis include resistance training for the hands or the use of topical cannabinoids. If you are interested in hand osteoarthritis assessment and treatment, have a look at the full database. URL: https://doi.org/10.1177%2F1558944718760003 Abstract Background: We made a tin ring splint for osteoarthritis of the distal interphalangeal joint that looks attractive and is easy to wear. We report the treatment results with this splint. Methods: We enrolled 30 patients with painful osteoarthritis of the distal interphalangeal joint in this study. A tin ring splint was made with tin alloy containing small quantities of silver. Patients were instructed to wear the splint when they felt pain. Patients were assessed before splint use and after 1, 3, and 6 months of splint use. Endpoints included the numeric pain scale, active arc of motion of the distal interphalangeal joint, Hand 20, functional assessment criteria of the upper extremities, and treatment satisfaction. In addition, data were collected on time to symptom relief and satisfaction related to usability and appearance of the splint (0 = dissatisfied, 10 = satisfied). Results: The numeric pain scale showed significant pain improvement from 58.4 ± 4.1 at baseline to 33.1 ± 4.5 at 1 month, and the Hand 20 score also showed significant improvement from 35.0 ± 4.3 at baseline to 20.2 ± 3.2 after 6 months. Active arc of motion were not changed significantly. Most patients responded that symptoms were relieved by the 10th day after treatment. Satisfaction related to usability was 8.9 ± 0.3, and appearance was 7.6 ± 0.4. Conclusions: A tin ring splint quickly reduced pain, and satisfaction related to usability and appearance was high. This splint could be one choice for conservative treatment of osteoarthritis of the distal interphalangeal joint. 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

Minimalist training: Is lower dosage or intensity resistance training effective to improve physical fitness? A narrative review. Behm, D. G., et al. (2023) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic: Resistance training - For beginners This narrative review explored the effectiveness of minimalist training, focusing on lower dosage resistance training to improve physical fitness. It discusses literature on optimal dosage effects, suggesting lower resistance training can still enhance muscle strength and endurance for sedentary individuals or beginners. The review recommends multi-joint exercises, which seem to be more effective than single-joint exercises. To prevent progressing plateau, the authors suggest increasing training volume over time. In terms of training frequency, it appears that for beginners, training 2 days vs 3 days per week does not make much difference. 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, minimal resistance training can lead to improvements in physical fitness, particularly for sedentary individuals or beginners. A single weekly resistance training session, with lower sets and intensity, appears to provide some benefits during the first 8-12 weeks. Once people reach 8-12 weeks of light training, a short but more intense workout is likely to provide additional benefits. This approach will still save people lots of time whilst providing 80% of resistance training benefit. URL: https://doi.org/10.1007/s40279-023-01949-3 Abstract Background: Findings from original research, systematic reviews, and meta-analyses have demonstrated the effectiveness of resistance training (RT) on markers of performance and health. However, the literature is inconsistent with regards to the dosage effects (frequency, intensity, time, type) of RT to maximize training-induced improvements. This is most likely due to moderating factors such as age, sex, and training status. Moreover, individuals with limited time to exercise or who lack motivation to perform RT are interested in the least amount of RT to improve physical fitness. Objectives: The objective of this review was to investigate and identify lower than typically recommended RT dosages (i.e., shorter durations, lower volumes, and intensity activities) that can improve fitness components such as muscle strength and endurance for sedentary individuals or beginners not meeting the minimal recommendation of exercise. Methods: Due to the broad research question involving different RT types, cohorts, and outcome measures (i.e., high heterogeneity), a narrative review was selected instead of a systematic meta-analysis approach. Results: It seems that one weekly RT session is sufficient to induce strength gains in RT beginners with < 3 sets and loads below 50% of one-repetition maximum (1RM). With regards to the number of repetitions, the literature is controversial and some authors report that repetition to failure is key to achieve optimal adaptations, while other authors report similar adaptations with fewer repetitions. Additionally, higher intensity or heavier loads tend to provide superior results. With regards to the RT type, multi-joint exercises induce similar or even larger effects than single-joint exercises. Conclusion: The least amount of RT that can be performed to improve physical fitness for beginners for at least the first 12 weeks is one weekly session at intensities below 50% 1RM, with < 3 sets per multi-joint exercise. 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

The use of non-invasive skin traction orthosis in managing phalangeal fractures. Yang, Z., Ong, C. X. L. and Jiang, J. K. H. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Phalanx fracture - Traction splint This retrospective study assessed the use of non-invasive skin traction splints for the management of phalangeal fractures. A total of fourteen participants with proximal or middle phalanx, intra-articular or extra-articular fractures were included. These participants were provided with hand-based and forearm-based splints, which allowed the application of finger traction distally to the fracture by using strapping tape. This splint in combination with traction was utilised for 3 weeks followed by the use of splinting only for the remaining weeks of immobilisation. The strapping tape was changed every week during the hand therapy review. Have a look at the picture below to see what the splint and traction system looks like. Unfortunately, the study did not provide a control group assessing the benefit of adding traction compared to no traction. 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, non-invasive skin traction splints may be useful in treating phalangeal fractures which are borderline surgical candidates. It is however unclear whether this approach provides better fracture alignment compared to a traditional splinting approach due to the lack of a control group in this study. URL: https://doi.org/10.1016/j.jht.2023.12.012 Abstract Background: Phalangeal fractures are amongst the most challenging injuries that hand surgeons and hand therapists treat. Traditionally, these have been managed operatively, but are often fraught with potential problems including contractures, deformities and loss of motion. Purpose: To provide evidence supporting the use of non-invasive skin traction orthosis as an effective treatment option. Study design: Retrospective cohort. Methods: We performed a retrospective review of outpatients with phalangeal fractures treated with non-invasive skin traction orthoses in our institution from January 2021 till June 2022. Demographic information, injury specifics and radiological findings were extracted from medical records. Outcome measures included total arc of motion (TAM) and dorsal angulation angles. Results: Fourteen patients (17 fractures) with a mean age of 48 years (SD21.3) were included. Ten patients had single digit injuries, while four patients had two digits in traction within the same splint. 70.6% were proximal phalangeal fractures. 76.5% of the fractures were extra-articular and 58.8% non-comminuted. Median duration of orthosis use was 18 days (IQR 8–21). Patients with forearm-based orthoses had significantly longer traction time. There was a significant improvement (p = 0.001) from median baseline TAM (124°) to final TAM readings (245°). Younger patients with ulnar digit fractures or extra-articular fractures had a shorter rehabilitation period. There is no significant difference in clinical outcomes between the use of forearm-based or hand-based orthoses. Conclusion: We recommend the use of the hand-based non-invasive skin traction orthosis as an option in managing phalangeal fractures as it is a simple, inexpensive and non-invasive procedure with promising results. Care must be taken to ensure frequent change of traction tapes to maintain good skin integrity, and to avoid loss of tension. Radiological imaging should be performed after each traction tape change to ensure good alignment is maintained. 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 intra-articular corticosteroid injection for nonsurgical management of trapeziometacarpal osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Krez, A. N., et al. (2024) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: 1st cmcj OA – injectables This systematic review and meta-analysis assessed the efficacy of intra-articular corticosteroid injections for 1st carpometacarpal joint osteoarthritis (1st cmcj OA) compared to hyaluronic or platelet-rich plasma (PRP) injections alternative. A total of six randomised controlled trials were included in the present study. The results showed that corticosteroid injections provided short-term symptom improvement without significant differences in pain and functional outcomes compared to hyaluronic acid or PRP injections. 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, intra-articular corticosteroid injections have been shown to be as effective as hyluronic acid or PRP injections. Despite findings indicating no significant difference in pain and functional outcomes compared to hyaluronic acid or platelet-rich plasma injections, corticosteroids are favored due to their affordability, and ease of administration. These findings appear to be in line with previous research on the topic. Keep in mind that if patients are about to have surgery to their thumb, having a cortisone or hyaluronic injection increases their risk of post-surgical infection. Have a look at the database on injectables for hand conditions if you are interested in the topic. URL: https://doi.org/10.1016/j.jhsa.2024.02.001 Abstract Purpose: As osteoarthritis (OA) of the trapeziometacarpal (TMC) joint leads to a high degree of disease burden with compromises in rudimentary and fine movements of the hand, intra-articular injections may be a desirable treatment option. However, because there are no evidence-based guidelines, the choice of intra-articular injection type is left to the discretion of the individual surgeon in collaboration with the patient. The purpose of our study was to perform a systematic review and meta-analysis using level I studies to compare outcomes following corticosteroid and alternative methods of intra-articular injections for the management of TMC OA. Our hypothesis was that intra-articular corticosteroid injections were no more effective than other methods of intra-articular injections for the management of TMC OA. Methods: A systematic literature search was performed. Eligible for inclusion were randomized control trials reporting on intra-articular corticosteroid injection for the management of TMC OA. Clinical outcomes were recorded. Results: The 10 included studies comprised 673 patients. The mean age was 57.8 ± 8.3 years, with a mean follow-up of 6.4 ± 2.7 months. There was no significant difference in visual analog scale scores, grip strength and tip pinch strength between corticosteroids and hyaluronic acid at short- and medium-term follow-up. Further, there was no difference in visual analog scale pain scores at rest at medium-term follow-up between corticosteroids and platelet-rich plasma. Conclusions: Despite short-term improvement with intra-articular corticosteroid injections, there was no significant difference in pain and functional outcomes following intra-articular corticosteroid injections compared to hyaluronic acid or platelet-rich plasma administration. Given the affordability, ease of administration, and efficacy associated with corticosteroids, they are a favorable option when considering the choice of intra-articular injection for the management of TMC OA. 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

Steroid versus placebo injections and wrist splints in patients with carpal tunnel syndrome: A systematic review and network meta-analysis. Adindu, E., Ramtin, S., Azarpay, A., Ring, D. and Teunis, T. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 thumb up) Type of study: Therapeutic Topic: Carpal tunnel syndrome - cortisone injections vs saline This is a systematic review and network meta-analysis comparing the effectiveness of corticosteroid injections, placebo injections (e.g. saline, dextrose), and wrist splints in patients with carpal tunnel syndrome (CTS). A total of 10 randomised controlled trials were included. Amongst all of the trials, 776 participants were included. Studies presented with a low risk of bias suggesting that the pooled results are likely to be realistic. The results showed that Corticosteroid injections provided modest and transient improvement in symptom relief within 3 months compared to placebos and splints, but did not meet the clinically important difference threshold. 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, corticosteroid injections may offer modest and transient improvement in symptoms for patients with carpal tunnel syndrome within 3 months compared to placebo injections and wrist splints. However, the difference between these interventions does not appear to be clinically relevant. Like for splinting and exercises, we should provide patients with realistic expectations about the effectiveness of these interventions. If you would like to know who is more likely to respond to CSI for carpal tunnel syndrome, have a look at this synopsis. You can also find the entire collection on carpal tunnel syndrome in our database. URL: https://doi.org/10.1177/17531934241240380 Abstract A network meta-analysis of randomized controlled trials compared the effectiveness of corticosteroid injections with placebo injections and wrist splints for carpal tunnel syndrome, focusing on symptom relief and median nerve conduction velocity. Within 3 months of the corticosteroid injection, there was a modest statistically significant difference in symptom relief compared to placebo injections and wrist splints, as measured by the Symptom Severity Subscore of the Boston Carpal Tunnel Questionnaire; however, this did not meet the minimum clinically important difference. Pain reduction with corticosteroids was slightly better than with wrist splints, but it also failed to reach clinical significance. Electrodiagnostic assessments showed transient changes in distal motor and sensory latencies in favour of corticosteroids at 3 months, but these changes were not evident at 6 months. The best current evidence suggests that corticosteroid injections provide minimal transient improvement in nerve conduction and symptomatology compared with placebo or wrist splints. 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

Weight-bearing test of traumatic triangular fibrocartilage complex lesion with unstable radioulnar joint. Kim, S., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Diagnostic Topic: TFCC and weight bearing test - Is it valid? This prospective study assessed the diagnostic accuracy of the weight-bearing test in identifying traumatic triangular fibrocartilage complex (TFCC) lesions and instability of the distal radioulnar joint (DRUJ) from other causes of ulnar sided wrist pain. A total of 48 participants were included and tested prior to diagnostic arthroscopy. Patients with traumatic TFCC lesion and DRUJ instability were found to have a higher weight-bearing capacity compared to all other cases suggesting that the test was unable to identify those with traumatic lesions of TFCC/DRUJ and those without it. 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, reduced weight bearing capacity cannot discriminate between patients with traumatic TFCC lesion or DRUJ instability compared to those without this pathology. We should therefore complete a comprehensive clinical evaluation including range of motion, strength assessments, and stability tests in conjunction with weight-bearing testing to get further information about the potential differential diagnosis and treatment. That being said, the weightbearing test may be useful to assess whether the WristWidget could reduce our patients' symptoms. URL: https://doi.org/10.1016/j.jht.2023.08.002 Abstract BACKGROUND: Ulnar-sided wrist pain might be caused by a lesion of the triangular fibrocartilage complex (TFCC). Patients with TFCC lesion may show an instability of the distal radioulnar joint (DRUJ). Before arthroscopic assessment, conservative therapy using a brace or splint may result in alleviation of symptoms. The results of our previous study showed that patients with a traumatic TFCC lesion and instability of the DRUJ had the smallest weight-bearing capacity and had the largest increase in application of the wrist brace (WristWidget). PURPOSE: In this prospective study, we wanted to test if the weight-bearing capacity with and without the wrist brace can be used as a diagnostic tool to differentiate between patients with traumatic TFCC lesion and instability of the DRUJ. We tested if patients with traumatic TFCC lesion and instability of the DRUJ (1) have a lower weight-bearing capacity and (2) show a higher increase of weight-bearing capacity after application of a wrist brace compared to all other types of injury. STUDY DESIGN: This was a prospective cohort study. METHODS: Forty-eight patients presented to an outpatient clinic with suspected TFCC lesion. We measured the dynamic weight-bearing capacity of both hands with and without the wrist brace (WristWidget) by letting the patients lean on an analog scale with extended arm and wrist. The stability of the DRUJ was assessed by clinical examination by a hand surgeon preoperatively and intraoperatively. Forty-five patients received an arthroscopy and were included in the analysis. During arthroscopy, the surgeon determined if there was a traumatic TFCC lesion and DRUJ instability. Patients with a traumatic lesion of the TFCC and DRUJ instability were compared to all other cases. We used the t-test for normally distributed values, Mann-Whitney U test for nonnormally distributed values, and the Chi-square test for categorical variables, respectively Fisher's exact if the expected cell count was less than five. RESULTS: Patients with a traumatic TFCC lesion and DRUJ instability had a higher weight-bearing capacity (22.8 kg) than all other cases (13.8 kg; p < 0.01). This is in contrast to our previous study, in which patients with a traumatic lesion of the TFCC had the tendency to show lower values of weight-bearing capacity than those with a degenerative lesion. While the wrist brace was worn, the relative gain was not significantly lower in patients with traumatic TFCC lesions and DRUJ instability compared to all other cases (21% vs 54%, p = 0.16). All included cases showed the same absolute increase of about 4 kg in weight-bearing capacity with the wrist brace (p = 0.93) CONCLUSIONS: The weight-bearing test cannot be used to identify patients with traumatic TFCC lesion and DRUJ instability among those with suspected TFCC lesion. The results of our previous study could be confirmed that the weight-bearing capacity on the injured side was higher with brace than without. 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