Search Results

Potential effects of dynamic stretching on injury incidence of athletes: A narrative review of risk factors. Behm, D. G., Alizadeh, S., Daneshjoo, A. and Konrad, A. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Dynamic stretching - Injury reduction This narrative review assessed the effect of dynamic stretching (DS) on variables such as range of motion (ROM), strength, balance, proprioception, muscle morphology, psycho-physiological responses, and injury prevention. It was found that DS alone does not provide additional benefit to static stretching (SS). However, it may be useful for injury prevention in high school boys playing soccer. Additionally, a study in dancers found that DS training significantly improved ankle joint stability. The literature is not consistent on the greater potential of DS versus SS in improving ROM or enhancing performance. Finally, there is evidence that incorporating DS into warm-up routines can be effective for injury prevention. Multi-faceted exercise programs, such as the FIFA 11+, FIFA 11+ Kids, FIFA 11+ S, HarmoKnee, Knäkontroll, SISU Idrottsböcker, Neuromuscular Training (NMT) program and bounding exercise program, have been found to be effective in reducing injury incidence. 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, dynamic stretching can be an effective tool for injury prevention when incorporated into warm-up routines. This may be useful information to provide our patients if they ask our opinion on "stretching". Several studies have assessed warm-up programs (e.g. FIFA 11+), which include dynamic stretching, and they seem to reduce injury incidence by up to 68-77%. Most of these studies have been assessing lower limb injury rates, however, it is possible that dynamic warm-up in the upper limb may provide similar injury reduction effects. URL: https://doi.org/10.1007/s40279-023-01847-8 Abstract The use of dynamic stretching as a replacement for static stretching in the warm-up is widespread based on the reports of static stretching-induced performance impairments. While acute and chronic static stretching has been reported to reduce musculotendinous injuries, especially with explosive and change of direction actions, the influence of dynamic stretching on injury incidence lacks a similar volume of literature for acute and chronic responses. It was the objective of this narrative review to examine the acute and training effects of dynamic stretching on injury incidence and possible moderating variables such as dynamic stretching effects on range of motion, strength, balance, proprioception, muscle morphology, and psycho-physiological responses. One study demonstrated no significant difference regarding injury incidence when comparing a dynamic stretching-only group versus a combined dynamic stretching plus static stretching group. The only other study examined functional dynamic stretching training with injured dancers and reported improved ankle joint stability. However, several studies have shown that dynamic activity with some dynamic stretching exercises within a warm-up consistently demonstrates positive effects on injury incidence. Regarding moderating variables, while there is evidence that an acute bout of dynamic stretching can enhance range of motion, the acute and training effects of dynamic stretching on strength, balance, proprioception, and musculotendinous stiffness/compliance are less clear. The acute effects of dynamic stretching on thixotropic effects and psycho-physiological responses could be beneficial for injury reduction. However, the overall conflicting studies and a lack of substantial literature compared with SS effects points to a need for more extensive studies in this area. 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 Boyd approach: A valuable alternative to treating simple to complex elbow fractures & dislocations. Ayala, A. E., Kim, K., Romero, B. A. and Kam, G. S. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Elbow dislocations - Surgical management This study summarises a case series of 44 patients who underwent surgery for elbow instability. The most common mechanism of injury was a fall, resulting in a Monteggia fracture-dislocation (32% of cases). Postoperative complications were recorded, and the average final follow-up was 8 months. The average elbow active range of motion was between 20 degrees of extension and 124 degrees of flexion. Heterotopic ossification was noted in nine patients, and this contributed to less than functional elbow ROM in two patients. There were no cases of proximal radioulnar postoperative elbow instability reported. Surgical management was found to be a safe and effective technique for the treatment of simple to complex elbow fractures and dislocations. 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, surgical management of simple to complex elbow fractures and dislocations is safe and effective. Although there is a risk of postoperative stiffness, the outcome of conservative management for these injuries is far worse. If you are interested in this topic, we have synopses on the diagnosis of elbow dislocations, imaging, and the conservative treatment of simple elbow dislocations. URL: https://doi.org/10.1016/j.jse.2023.06.005 Abstract Background: The Boyd approach is a single-incision posterior approach to the proximal radius and ulna based on a lateral anconeous muscle reflection and release of the lateral collateral ligamentous complex. This approach remains a lesser-utilized technique following early reports of proximal radioulnar synostosis and postoperative elbow instability. Although limited by small case series, recent literature does not support these early reported complications. This study presents a single surgeon’s outcomes utilizing the Boyd approach for the treatment of simple to complex elbow injuries. Methods: Following Institutional Review Board approval, a retrospective review of all patients with simple to complex elbow injuries treated consecutively using a Boyd approach by a Shoulder and Elbow surgeon was conducted from 2016 to 2020. All patients with at least one postoperative clinic visit were included. Data collected included patient demographics, injury description, postoperative complications, elbow range of motion, and radiographic findings including heterotopic ossification and proximal radioulnar synostosis. Categorical and continuous variables were reported using descriptive statistics. Results: A total of 44 patients were included with an average age of 49 years old (range 13-82 years old). The most commonly treated injuries were Monteggia fracture-dislocations (32%) and terrible triad injuries (18%). Average follow-up was 8 months (range 1-24 months). Final average elbow active arc of motion was from 20 degrees (range 0-70 degrees) of extension to 124 degrees (range 75-150 degrees) of flexion. Final supination and pronation were 53 degrees (range 0-80 degrees) and 66 degrees (range 0-90), respectively. There were no cases of proximal radioulnar synostosis. Heterotopic ossification contributing to less than functional elbow ROM occurred in two (5%) patients who elected conservative management. There was one (2%) case of early postoperative posterolateral instability due to repair failure of injured ligaments which required revision using a ligament augmentation procedure. Five (11%) patients experienced postoperative neuropathy, including four (9%) with ulnar neuropathy. Of these, one underwent ulnar nerve transposition, two were improving, and one had persistent symptoms at final follow-up. Conclusions: This is the largest case series available demonstrating the safe utilization of the Boyd approach for the treatment of simple to complex elbow injuries. Postoperative complications including synostosis and elbow instability may not be as common as previously understood. 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

Repetitive pitching decreases the elbow valgus stability provided by the flexor-pronator mass: The effects of repetitive pitching on elbow valgus stability. Nara, M., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Anatomical Topic: Elbow ucl - Effect of repetetive pitching on its properties This lab-based experimental study investigated the effects of repetitive baseball pitching on elbow valgus stability. A total of 15 male pitchers were included in the study. The valgus range of their picthing elbow was assessed under no load, 3 kg valgus stress, and 3 kg valgus stress whilst gripping. These tests were completed before and after 100 fastball pitches. The elbow valgus measurements were taken by assessing medial joint gapping with an ultrasound machine. The results showed that in the loaded test without grip contraction, there was no difference in elbow valgus gapping between baseline and after pitching measurements. However, due to grip strength fatigue after training, the ability of flexors muscles to reduce valgus whilst gripping was reduced after the pitching session. 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 single session of 100 fastball pitches does not affect elbow ucl integrity. This is in contrast with lab-based results where UCL was cyclically loaded. The likely reason is that when performing cadaveric studies there is no active component limiting the stress on UCL. Nevertheless, if forearm flexors get fatigued over longer pitching or exercise sessions, it is more likely that a greater load will be placed on passive structures, including the UCL ligament. URL: https://doi.org/10.1016/j.jse.2023.03.026 Abstract Background: Baseball pitching induces a large elbow valgus load, stressing the ulnar collateral ligament. Flexor-pronator mass contraction contributes to valgus stability; however, repetitive baseball pitching may weaken the flexor-pronator mass contractile function. The present study investigated the effects of repetitive baseball pitching on the medial valgus stability measured using ultrasonography. We hypothesized that repetitive pitching would decrease elbow valgus stability. Methods: This was a controlled laboratory study. Fifteen young male baseball players at the collegiate level (age: 23.0 ± 1.4 years) were enrolled. The medial elbow joint space was measured using ultrasonography (B-mode, 12-MHz linear array transducer) in the following three conditions: at rest (unloaded), under 3 kg valgus load (loaded), and under valgus load with maximal grip contraction to activate flexor-pronator mass (loaded-contracted). All measurements were performed before and after the pitching tasks, which comprised five sets of 20 pitches. Two-way repeated-measures analysis of variance was applied to determine changes in the medial elbow joint space. The post-hoc test with Bonferroni adjustment was applied to assess the changes within the time and condition. Results: The medial elbow joint space was significantly greater under the loaded than the unloaded and loaded-contracted conditions both before- and after- pitching (p < 0.001). In the loaded-contracted condition, the medial elbow joint space significantly increased after repetitive baseball pitching (p < 0.001). Conclusions: The results of the present study indicated that repetitive baseball pitching reduced the elbow valgus stability. This reduction could be attributed to the decreased flexor-pronator mass contractile function. Insufficient contraction may increase the tensile load on the ulnar collateral ligament with pitching. Flexor-pronator mass contraction plays a role in narrowing the medial elbow joint space; however, repetitive baseball pitching reduced the elbow valgus stability. It has been suggested that sufficient rest and recovery of the flexor-pronator mass function are required to reduce the ulnar collateral ligament injury risk. 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

Sensitivity & specificity of the posterolateral rotatory drawer test in the diagnosis of lateral collateral ligament insufficiency of the elbow. Stone, A., Venkatakrishnan, S. and Phadnis, J. (2023) Level of Evidence: 1b- Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Diagnostic Topic: Posterolateral rotatory drawer test – Sensitivity and specificity This study assessed the diagnostic accuracy of the Posterolateral Rotatory Drawer Test (PLRD) compared to elbow arthroscopy. A total of 78 patients with lateral and posterior elbow pain were assessed prior to surgery. Patients with post-traumatic osteoarthritis or inflammatory arthritis were excluded. The results showed that the PLRD test had a sensitivity of 88% and specificity of 98% when compared to arthroscopic findings. In particular, the test identified correctly most of the people who had a lateral collateral ligament lesion (16 out of 78) and those who did not (62/78). The results also showed that the test results were highly consistent both with the patient awake and under anaesthesia. 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 Posterolateral Rotatory Drawer (PLRD) test is a reliable and accurate diagnostic tool for Lateral Collateral Ligament (LCL) insufficiency of the elbow. This test should be incorporated when assessing people with traumatic injuries presenting with pain at the lateral and posterior aspects of the elbow. However, this test may not be useful in people with rheumatic conditions. If you are interested in posterolateral rotatory instability, have a look at this synopsis. If you would like to learn how to perform this test, have a look at the video below. URL: https://doi.org/10.1016/j.jse.2023.05.032 Abstract Background: Numerous clinical tests are described for the diagnosis of chronic Lateral Collateral Ligament (LCL) insufficiency of the elbow, however none of these tests have been adequately assessed for sensitivity with at most, eight patients included in previous studies. Furthermore, no test has had specificity assessed. The Posterolateral Rotatory Drawer (PLRD) test is thought to have improved diagnostic accuracy over other tests in the awake patient. The aim of this study is to formally assess this test using reference standards in a large cohort of patients. Methods: 106 eligible patients were identified for inclusion from a single surgeon database of operative procedures. Examination under anesthetic (EUA) and arthroscopy were chosen as the reference standards to compare the PLRD test against. Only patients with a clearly documented PLRD test finding performed preoperatively in the clinic, and a clearly documented EUA and/or arthroscopic findings from surgery were included. 102 patients underwent EUA, 74 of which also underwent arthroscopy. 28 patients had EUA then an open procedure without arthroscopy. 4 patients had arthroscopy without a clearly documented EUA. Sensitivity, specificity, positive and negative predictive values (PPV/NPV) were calculated with 95% confidence intervals. Results: 37 Patients had a positive PLRD test and, 69 had a negative test. Compared to the reference standard of EUA (n=102), the PLRD test had a sensitivity of 97.3% (85.8% - 99.9%) and a specificity of 98.5% (91.7% - 100%) (PPV = 0.973, NPV = 0.985). Compared to the reference standard of arthroscopy (n=78), the PLRD test had a sensitivity of 87.5% (61.7% - 98.5%) and a specificity of 98.4% (91.3% - 100%) (PPV = 0.933, NPV = 0.968). Compared to either reference standard (n=106), the PLRD test has a sensitivity of 94.7% (82.3% - 99.4%) and a specificity of 98.5% (92.1% - 100%) (PPV = 0.973, NPV = 0.971). Conclusion: The PLRD test demonstrated an overall sensitivity of 94.7% and specificity of 98.5% with high positive and negative predictive value. This test is recommended as the primary diagnostic tool for LCL insufficiency in the awake patient and should be widely incorporated into surgical training. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Stability of the distal radioulnar joint with and without activation of forearm muscles. Weber, A., Reissner, L., Friedl, S. and Schweizer, A. (2023) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic: DRUJ - Forearm stabiliser This lab-based experimental study investigated the contributions of extensor carpi ulnaris (ECU) and flexor carpi ulnaris (FCU) to the stability of the distal radioulnar joint (DRUJ). A total of 40 healthy participants aged between 22 and 58 were assessed using ultrasound and electromyography. A force of 5 kg was applied to the distal aspect of the ulna in all participants. The ultrasound imaging was utilised to assess DRUJ movement. The results showed that co-activation of ECU and FCU resulted in 70% less anteroposterior ulnar head translation and greater distal radioulnar joint stability. The study also found that co-activation of these muscles had a greater stabilizing effect than activation of either muscle alone. 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, activation of the flexor carpi ulnaris and extensor carpi ulnaris muscles resulted in 70% less ulnar head translation and greater distal radioulnar joint stability. Strengthening these muscles may be beneficial for patients with chronic distal radioulnar joint instability, and should be considered as part of a comprehensive treatment plan. This approach may be particularly useful following distal radius fractures associated with DRUJ instability. URL: https://doi.org/10.1177/17531934231168299 Abstract The purpose of this study was to quantify the effect of the flexor carpi ulnaris and the extensor carpi ulnaris muscles on distal radioulnar joint stability. The anteroposterior ulnar head translation in relation to the radius was measured sonographically when the forearm was in a neutral resting position and when the hand was actively pressed on to a surface, with and without intentional flexor carpi ulnaris and extensor carpi ulnaris activation, while also being monitored by an electromyogram. Data on 40 healthy participants indicated a mean anteroposterior translation in the distal radioulnar joint of 4.1?mm (SD 1.08) without and 1.2?mm (SD 0.54) with muscle activation. Our results indicate that intentional ulnar forearm muscle activation results in 70% less anteroposterior ulnar head translation and greater distal radioulnar joint stability. Therefore, the flexor carpi ulnaris and extensor carpi ulnaris muscles serve as dynamic stabilizers of the distal radioulnar joint. This finding may be clinically significant since ulnar forearm muscles strengthening may increase distal radioulnar joint stability. 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

Immediate return to normal after releasing nerve entrapment and rebound phenomenon. Tang, J. B. (2023). Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Therapeutic Topic: Release of nerve compressions - Long term outcomes This is a letter to the editor suggesting that the true effectiveness of surgical release for nerve entrapment should be evaluated both in the short and long term. Their reason for suggesting such follow-ups is that a rebound or recurrence of previous symptoms may be common in people undergoing surgical release of entrapment neuropathies. Surgical reports should include a follow-up of a few months to years, as it is possible that a subclinical compression of a more proximal site, could cause recurrence. This appears to be especially true for middle-aged patients. 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, recurrence of symptoms (rebound phenomenon) following nerve entrapment release can occur in patients over 50 years old, who are more likely to have multiple compression sites (e.g. carpal tunnel plus cervical spine). This might be the reason why treatment of peripheral and more proximal areas of compression has shown good potential in people with carpal tunnel syndrome when compared to surgery. In addition, this paper reminds us that it is important to set realistic expectations for our patients to improve their post-surgical satisfaction. URL: https://doi.org/10.1177/17531934231177831 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

Cervicogenic headache. Jull, G. (2023) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic: Cervicogenic headache – Can physiotherapy help? This is a narrative review on the diagnosis and management of cervicogenic headache, a type of headache caused by a primary cervical musculoskeletal disorder. It is suggested that a skilled physical examination can identify and differentiate this type of headache, and that multimodal treatment including manipulative therapy and exercise can be effective in the long term. Research has identified physical impairments such as reduced cervical motion, altered motor control of the neck flexors, and reduced strength of flexor and extensor muscles as contributors to this presentation. A large multicentre clinical trial determined that a combined program of manipulative therapy and motor control exercise is effective in the management of cervicogenic headaches. Clinical Take Home Message: Based on what we know today, cervicogenic headaches are caused by a musculoskeletal disorder of the cervical spine. We may encounter these presentations in people who have had a FOOSH or a fall presenting with both upper limb and cervical injuries. A skilled physical examination is needed to accurately diagnose this condition and a combined program of manipulative therapy and motor control exercise is effective in reducing symptoms. Hence, referral of these patients to our physiotherapy colleagues may be appropriate. URL: https://doi.org/10.1016/j.msksp.2023.102787 Abstract Introduction: Cervicogenic headache, first proposed as a distinct headache in 1983, is a secondary headache to a primary cervical musculoskeletal disorder. Research into physical impairments was integral to clinical diagnosis and to develop and test research informed conservative management as the first line approach. Purpose: This narrative presents an overview of the body of cervicogenic headache research from our laboratory which was undertaken in the context of a broad program of research into neck pain disorders. Implications: Early research validated manual examination of the upper cervical segments against anaesthetic nerve blocks, which was vital to clinical diagnosis of cervicogenic headache. Further studies identified reduced cervical motion, altered motor control of the neck flexors, reduced strength of flexor and extensor muscles, and occasional presentation of mechanosensitivity of the upper cervical dura. Single measures are variable and not reliable in diagnosis. We proved that a pattern of reduced motion, upper cervical joint signs and impaired deep neck flexor function accurately identified cervicogenic headache and differentiated it from migraine and tension-type headache. The pattern was validated against placebo controlled diagnostic nerve blocks. A large multicentre clinical trial determined that a combined program of manipulative therapy and motor control exercise is effective in the management of cervicogenic headache and outcomes are maintained in the long term. More specific research into cervical related sensorimotor controlled is warranted in cervicogenic headache. Further adequately powered clinical trials of current research informed multimodal programs are advocated to further strengthen the evidence base for conservative management of cervicogenic headache. 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

Are the outcomes of relative motion extension orthoses non-inferior and cost-effective compared with dynamic extension orthoses for management of zones V-VI finger extensor tendon repairs: A randomized controlled trial. Bűhler, M., et al. (2023) Level of Evidence: 1b- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: RME and Dynamic Finger splint - Zone V and VI extensor repair This is a non-inferiority randomised controlled trial comparing the use of Relative Motion Extension (RME) plus wrist splint and dynamic Wrist Hand Finger Orthoses (WHFO) in the management of zones V-VI finger extensor repairs. A total of 37 participants (RME = 19; WHFO = 18) were included in the present study. Participants were randomised to receive either RME or WHFO (see picture below). The primary outcome was Total Active Finger Motion (TAM) and secondary outcomes included patients' satisfaction, QuickDASH, quality of life, complications, grip strength, and cost of each treatment. The results showed that RME plus wrist splint was non-inferior to WHFO for all outcomes. In addition, there was no significant difference in the cost of treatment between groups. 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, relative motion extension (RME) plus wrist splint is non-inferior to dynamic Wrist Hand Finger Orthoses (WHFO) for the management of zones V-VI finger extensor tendon repairs. These results are useful as we can include patients' and clinicians' preferences in the choice of splints/rehabilitation approach without compromising outcomes/costs. If you are interested in the topic, we have additional synopses on RME for zone V-VI extensor tendons and RMF for flexor tendons repair. URL: https://doi.org/10.1016/j.jht.2023.02.010 Abstract Introduction: There is no comparative evidence for relative motion extension (RME) orthosis with dynamic wrist-hand-finger-orthosis (WHFO) management of zones V-VI extensor tendon repairs. Purpose of the study: To determine if RME with wrist-hand-orthosis (RME plus) is noninferior to dynamic WHFO for these zones in clinical outcomes. Study design: Randomized controlled non-inferiority trial. Methods: Skilled hand therapists managed 37 participants (95% male; mean age 39 years, SD 18) with repaired zones V-VI extensor tendons randomized to RME plus (n = 19) or dynamic WHFO (n = 18). The primary outcome of percentage of total active motion (%TAM) and secondary outcomes of satisfaction, function, and quality of life were measured at week-6 and -12 postoperatively; percentage grip strength (%Grip), complication rates, and cost data at week-12. Following the intention-to-treat principle non-inferiority was assessed using linear regression analysis (5% significance) and adjusted for injury complexity factors with an analysis of costs performed. Results: RME plus was noninferior for %TAM at week-6 (adjusted estimates 2.5; 95% CI -9.0 to 14.0), %TAM at week-12 (0.3; -6.8 to 7.5), therapy satisfaction at week-6 and -12, and orthosis satisfaction, QuickDASH, and %Grip at week-12. Per protocol analysis yielded 2 tendon ruptures in the RME plus orthoses and 1 in the dynamic WHFO. There were no differences in health system and societal cost, or quality-adjusted life years. Discussion: RME plus orthosis wearers had greater injury complexity than those in dynamic WHFOs, with overall rupture rate for both groups comparatively more than reported by others; however, percentage %TAM was comparable. The number of participants needed was underestimated, so risk of chance findings should be considered. Conclusions: RME plus management of finger zones V-VI extensor tendon repairs is non-inferior to dynamic WHFO in %TAM, therapy and orthotic satisfaction, QuickDASH, and %Grip. Major costs associated with this injury are related to lost work time. 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

New evidence exploring the mechanism of metacarpal joint locking of the thumb. Xiong, G., Zheng, W. and Guo, Z. (2023) Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic Topic: Mcpj hyperextension deformity - Sesamoid dislocation This is the answer to last week's Sherlock Handy. The patient was a 26 years old office worker who had undergone a hyperextension injury of their right thumb whilst playing basketball. Objectively, their mcpj was in slight hyperextension. Actively, they were unable to flex the mcpj of the thumb, but still retained the ability to hyperextend further the mcpj joint as well as e/f of the ipj of the thumb. Passive range of movement of the mcpj in e/f was -30/25. A closed reduction was attempted in ED however, it failed. The patient was asked to wear a thumb splint for one month. After this period of immobilisation, the patient was referred for AROM exercises. After a 4 months trial of exercises, there had been no change in their ability to flex the mcpj. Further imaging was therefore completed and this included MRI and CT scans (these are shown below). An open reduction was completed. The sesamoid bone was reduced and the volar ligaments were repaired. The patient had full ROM in the mcpj post the open reduction rehabilitation. 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, thumb mcpj flexion block could be caused by a displaced sesamoid bone. In these instances, conservative treatment is unlikely to provide any improvement and open reduction is required. Imaging techniques easily obtainable such as x-ray and US would be a good starting point for the acute assessment of these injuries. URL: https://doi.org/10.1177/17531934231166866 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

Five-year follow-up of adolescent gymnasts after surgical treatment of osteochondritis dissecans of the elbow. Yehyawi, S., Zielinski, E. M., Bartkiw, M., Peck, K. and Hastings, H., II (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Prognostic Topic: Osteochondritis dissecans gymnasts - Return to competition This is a retrospective study assessing adolescent gymnasts with elbow osteochondritis dissecans (OCD) who were treated surgically. A total of 55 participants were included. The results showed that 90% of the patients returned to competitive gymnastics at or above the same level as before surgery, however, 97% reported difficulty when doing so. Out of the whole sample, 78% of the elbows were treated with debridement with microfracture and 22% with debridement back to a stable base without microfracture. The Modified Andrews Elbow Scoring System (see graph below) showed that 70% of the scores were good or excellent, with 48% being excellent. Uneven bars (see video below) were the most challenging event for patients, with 70% reporting difficulty. 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, elbow OCD lesions are not career-ending injuries for adolescent gymnasts, and most patients can return to competitive gymnastics at or above their pre-surgical level. However, gymnasts should not expect a fully asymptomatic return to sport. In particular, uneven bars may be the most challenging exercise for patients. These results are similar to what has been published by other authors with even longer follow-up times. URL: https://doi.org/10.1016/j.jhsa.2022.12.009 Abstract Purpose: Elbow osteochondritis dissecans (OCD) is well-studied in throwing athletes; however, there are limited data regarding gymnasts with capitellar OCD lesions. We aimed to determine the overall rate of return to competition following surgical treatment of capitellar OCD lesions and to determine the relationship, if any, between arthroscopic grade of lesion and ability to return to competition. Methods: A medical chart Current Procedural Terminology query from 2000 to 2016 yielded data on 55 competitive adolescent gymnasts who were treated surgically for elbow OCD lesions in a total of 69 elbows. Retrospective chart review was used to collect data on preoperative and postoperative symptoms and surgical treatment. Patients were contacted to complete questionnaires (Modified Andrews Elbow Scoring System, Disabilities of the Arm, Shoulder, and Hand) on return to sport. Current elbow function and follow-up data were available for 40 of 69 elbows. Results: Average age at time of surgery was 12.1 years with 18 of 55 (33%) of patients competing at a pre-elite level of gymnastics (level 9 or 10 of 10) before surgery. Nine out of 31 gymansts (29%) underwent bilateral surgery for OCD lesions. Average OCD lesion size was 10 mm. Thirty-one of 40 elbows (78%) were treated with debridement back to a stable cartilage rim with microfracture, and nine of 40 elbows (22%) were treated with debridement alone. Thirty-six of 40 patients (90% returned to competitive gymnastics with all returning patients competing at or above the same level after surgery. Among the patients who were followed up, 29 of 30 patients (97%) reported some difficulty with specific events on return to competition. Conclusions: The rate of return to sport for gymnasts at 90% is similar to that observed in other sports. This study suggests that elbow OCD lesions are not career-ending injuries for adolescent gymnasts; however, gymnasts should not expect a fully asymptomatic return to all events in a sport. 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: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic Have a think about this case study. Leave a diagnostic comment if you like. The patient was a 26 years old office worker who had undergone a hyperextension injury of their right thumb whilst playing basketball. Objectively, their mcpj was in slight hyperextension. Actively, they were unable to flex the mcpj of the thumb, but still retained the ability to hyperextend further the mcpj joint as well as e/f of the ipj of the thumb. Passive range of movement of the mcpj in e/f was -30/25. A closed reduction was attempted in ED, however, it failed. The patient was discharged from ED and asked to wear a thumb splint for one month. After this period of immobilisation, the patient was referred for AROM exercises. Following a 4 months trial of exercises, there had been no change in their ability to flex the mcpj. Further imaging was therefore completed and this included MRI and CT scans (these are shown below). What's the cause?

Day-by-day symptom relief after corticosteroid injection for trigger digit: A randomized controlled study of two techniques. Bitar, H., Zachrisson, A. K., Byström, M. and Strömberg, J. (2023) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Trigger finger - Cortisone injections This study compared two injection techniques for the treatment of trigger finger and assessed participants' recovery time. A total of 106 participants took part in the study. The primary outcome measured was the number of days to complete relief of pain, stiffness and triggering. The results showed that there was no significant difference between the two injection techniques. On average, it took 10 days for the pain to settle and 20 days for the triggering to resolve. No additional treatment was required in 91% of all participants at six months. 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, cortisone injections for trigger finger take 10 days to relieve pain and 20 days for triggering to subside. This is important information to share with our patients, who might expect all the symptoms to resolve immediately. If cortisone injections are not effective, surgical release may be useful. Interestingly, similar to cortisone injections, recovery from trigger finger release takes more time than expected. URL: https://doi.org/10.1177/17531934231177422 Abstract This prospective randomized controlled study compared two injection techniques for trigger digit: either dorsal to the tendons in the proximal phalanx (PP group) or anterior to the tendons at the A1 pulley level (A1 group) in 106 patients. The primary outcome was the number of days to total relief of pain, stiffness and triggering, as recorded by the patients on visual analogue scales day-by-day for 6 weeks. The median number of days to complete symptom relief was 9 days in the PP group and 11 days in the A1 group for pain, 11 days and 15 days for stiffness and 21 and 20 days for triggering, respectively. Ninety-one per cent of all patients did not require any additional treatment, but 11 patients in both groups reported some remaining symptoms at 6 weeks. This study did not detect any significant difference between the two injection techniques, but provides detailed data of the rate and order of symptomatic relief after corticosteroid injection for this common 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