Search Results

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

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

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

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

Endoscopic versus open carpal tunnel surgery: Risk factors and rates of revision surgery. Carroll, T. J., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Carpal tunnel release revision - Endoscopic vs open procedures This retrospective study assessed the rate of revision following endoscopic and open release for carpal tunnel syndrome (CTS). A total of 4,388 participants took part in the study. Several additional variables were collected and they included demographic information, comorbidities, and lifestyle factors. The results showed that endoscopic CTS was associated with 3 times greater odds of requiring revision surgery within one year, compared to open carpal tunnel release. In addition, male sex, concurrent cubital tunnel syndrome, tobacco use, and diabetes were also associated with a greater risk of needing revision. 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, endoscopic carpal tunnel release is associated with a higher risk of revision surgery within one year compared to open carpal tunnel release. Other factors associated with a greater risk of revision included concurrent cubital tunnel syndrome, tobacco use, and the presence of diabetes. These findings appear to be in contrast with other minimally invasive procedures such as the percutaneous release of A1 pulley for trigger finger which present with good long-term outcomes. URL: https://doi.org/10.1016/j.jhsa.2023.05.002 Abstract Introduction: The purpose of our study was to compare the 1-year revision surgery rates and outcomes of open versus endoscopic carpal tunnel release. Our hypothesis was that, compared to open release, endoscopic carpal tunnel release was an independent risk factor for revision surgery within 1-year. Methods: This was a retrospective cohort study of 4338 patients undergoing isolated endoscopic or open carpal tunnel release. Demographic data, medical comorbidities, surgical approach, need for revision surgery, hand dominance, history of prior injection, and Patient Reported Outcomes Measurement Information System upper extremity (UE), pain interference (PI) and physical function scores were analyzed. Multivariable analysis was used to identify the risk factors for revision surgery within one year of the index procedure. Results: In total, 3280 patients (76%) underwent open and 1058 (24%) underwent endoscopic carpal tunnel release. Within one year of the index procedure, 45 patients required revision carpal tunnel release. The average time to revision was 143 days. The rate of revision carpal tunnel release in the open group was 0.71% compared to 2.08% in the endoscopic group. Multivariable analysis demonstrated that endoscopic surgery, male sex, cubital tunnel syndrome, tobacco use, and diabetes were associated independently with revision surgery. Conclusions: In this study, we found that endoscopic carpal tunnel release was associated independently with a 2.96 times greater likelihood of requiring revision carpal tunnel release within one year, compared to open carpal tunnel release. Male sex, concurrent cubital tunnel syndrome, tobacco use, and diabetes also were associated independently with greater risk of needing revision carpal tunnel release within one year. 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

Comparison of immobilization periods following open reduction and internal fixation of distal radius fracture: A systematic review and meta-analysis. Ghaddaf, A. A., et al. (2021) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic: Radius fracture ORIF – Early mobilisation This systematic review aimed at comparing functional outcomes, pain, and adverse events between different periods of immobilization following open reduction and internal fixation (ORIF) of distal radius fractures (DRF) (volar locking plate). Seven randomised controlled studies, for a total of 469 participants were included in the study. Participants were randomised to either undergo immobilisation for 5-6 weeks or less than 3. The results showed that surgeons preferred to immobilise a DRF ORIF for 1-2 weeks after fixation. The number of adverse events did not differ between the two immobilisation durations and shorter immobilisation presented with functional and grip strenght benefits. 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, limited immobilisation (i.e. max 3 weeks) after distal radius fracture ORIF does not lead to more adverse events. This concept is supported by another review, making the decision on longer or shorter immobilisation dependent on clinicians' and patients' preferences. Shorter periods of immobilisation are not only appropriate following DRF ORIF but also for the conservative treatment of undisplaced/minimally displaced DRF. URL: https://doi.org/10.1016/j.jht.2021.06.004 Abstract Introduction: The use of volar locking plate (VLP) in the fixation of fracture fragments promised a new era in the management of distal radius fracture (DRF). Purpose of the Study: To compare the patient-reported outcomes, functional outcomes, pain, and adverse events between the different periods of immobilization following open reduction and internal fixation of DRFs with VLP. Methods: We searched Medline/Pubmed, Web of Science, Ovid, and CINAHL. The inclusion criteria was randomized controlled trials that compared different immobilization periods after open reduction and internal fixation of DRFs with VLP. The last search was performed on 2 June 2020. The different immobilization periods were divided into the following 3 groups: ≤1-week group, 2-3-week group, and 5-6-week group. Results: Seven eligible randomized controlled trials provided data on 509 patients. We found that compared to 5-6-week group, ≤1-week and 2-3-week groups showed a reduction in overall Patient-Reported Wrist Evaluation score (SMD = –0.48, 95% CI –0.73 to –0.22, P < .001; SMD = –0.69, 95% CI –0.97 to –0.41, P < .001, respectively). We also found that there were improvements in the other patient-reported outcomes including overall Disabilities of the Arm, Shoulder, and Hand score and pain; and functional outcomes including overall grip strength and range of motion measures in favor of ≤1-week and 2-3-week groups. Conclusion: This systematic review and meta-analysis showed that compared to immobilization for 5 to 6 weeks after DRF repair, immobilization for ≤1 week or 2-3 weeks showed improvements in the patients-reported outcomes and functional outcomes. The differences between the 3 immobilization groups may not be clinically important considering the small changes as follow up progresses. 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

A meta-synthesis of carpal tunnel syndrome treatment options: Developing consolidated clinical treatment recommendations to improve practice. Baker, N. A., J. Dole and S. C. Roll (2021) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic: Thermal modalities - Carpal tunnel syndrome This article provides a comprehensive overview of treatments for carpal tunnel syndrome (CTS). After reviewing 30 professional or clinical sources, 6 primary guidelines were identified and rated according to a modified GRADE approach, which was originally suggested by the Cochrane group for systematic reviews. This resulted in 52 different CTS treatment recommendations. The overall ratings for individual treatments were strongly support (6), conditionally support (15), conditionally against (13), strongly against (3), and no consensus (9). The overall rating of each individual intervention was based on the information provided by the guidelines. Thermal modalities appeared to be either conditionally supported or advised against (see tables 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, carpal tunnel syndrome (CTS) has been treated with a multitude of approaches. Surgery, splinting, and steroids are currently strongly supported. Thermal modalities are currently conditionally supported or advised against. In the future, the integration of precision medicine will allow the selection of the best treatment given patients' characteristics/findings from subjective and objective assessments. For further information on carpal tunnel syndrome, refer to the whole database. URL: https://doi.org/10.1016/j.apmr.2021.03.034 Abstract Carpal tunnel syndrome (CTS) treatment contains ambiguities across and within disciplines. This meta-synthesis of professional guidelines consolidates clinical treatment recommendations for CTS treatment and classifies them by strength of evidence. We conducted a search of Google, Google Scholar, and PubMed for published clinical treatment recommendations for CTS. A systematic hand search was completed to identify additional professional organizations with published recommendations. We extracted any mentioned treatment from all sources but developed our final consolidated clinical treatment recommendations only from select rigorous guidelines based on the Institute of Medicine (IOM) criteria for trustworthy guidelines. We translated rating systems of the primary guidelines into a universal rating system to classify recommendations for consolidated clinical treatment recommendations. Our search yielded 30 sources that mentioned a total of 55 CTS treatments. Six of the sources met the IOM inclusion criteria. These primary guidelines provided recommendations for 46 of the 55 treatments, which were consolidated into 12 broad treatment categories. Surgery, positioning, and steroids were strongly supported. Conservative treatments provided by rehabilitation professionals were conditionally supported. Pharmaceuticals, supplements, and alternative treatments were not generally supported. CTS is a complex condition with a wide variety of treatments provided by a multitude of disciplines. Our consolidated clinical treatment recommendations offer a comprehensive outline of available treatments for CTS and contributes to the process of developing best practices for its treatment. 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

Randomized controlled trial of an internet-based self-guided hand exercise program to improve hand function in people with systemic sclerosis: the Scleroderma Patient-centered Intervention Network Hand Exercise Program (SPIN-HAND) trial. Kwakkenbos, L., et al. (2022). Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Scleroderma - Hand Therapy This is a randomised controlled trial assessing the effectiveness of the SPIN-HAND Program for people with systemic sclerosis. The SPIN-HAND Program is an online self-guided exercise program freely available to anybody signing up. A total of 466 participants were randomized to either receive access to the program or usual care. The primary outcome was the Cochin Hand Function Scale, which was assessed at baseline and 3 months post-randomization. The results showed that offering access to the program did not improve hand function, likely due to low offer uptake, program access, and minimal usage among those who accessed the program. Despite these findings, you can still use the website to learn more about Scleroderma and get ideas for hand and upper limb exercises for these patients. https://tools.spinsclero. com 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, offering access to an online self-guided hand exercise program may not improve hand function in people with Scleroderma. To improve engagement with your patients, it may be best to see patients face to face and work through the online programme together. There are a lot of resources available on the website, including goal setting, which has been shown as an important aspect to increase exercise completion in our patients. URL: https://doi.org/10.1186/s13063-022-06923-4 Abstract Background: Systemic sclerosis (scleroderma; SSc) is a rare autoimmune connective tissue disease. Functional impairment of hands is common. The Scleroderma Patient-centered Intervention Network (SPIN)-HAND trial compared effects of offering access to an online self-guided hand exercise program to usual care on hand function (primary) and functional health outcomes (secondary) in people with SSc with at least mild hand function limitations. Methods: The pragmatic, two-arm, parallel-group cohort multiple randomized controlled trial was embedded in the SPIN Cohort. Cohort participants with Cochin Hand Function Scale (CHFS) scores ≥ 3 and who indicated interest in using the SPIN-HAND Program were randomized (3:2 ratio) to an offer of program access or to usual care (targeted N = 586). The SPIN-HAND program consists of 4 modules that address (1) thumb flexibility and strength; (2) finger bending; (3) finger extension; and (4) wrist flexibility and strength. The primary outcome analysis compared CHFS scores 3 months post-randomization between participants offered versus not offered the program. Secondary outcomes were CHFS scores 6 months post-randomization and functional health outcomes (Patient-Reported Outcomes Measurement Information System profile version 2.0 domain scores) 3 and 6 months post-randomization. Results: In total, 466 participants were randomized to intervention offer (N = 280) or usual care (N = 186). Of 280 participants offered the intervention, 170 (61%) consented to access the program. Of these, 117 (69%) viewed at least one hand exercise instruction video and 77 (45%) logged into the program website at least 3 times. In intent-to-treat analyses, CHFS scores were 1.2 points lower (95% CI − 2.8 to 0.3) for intervention compared to usual care 3 months post-randomization and 0.1 points lower (95% CI − 1.8 to 1.6 points) 6 months post-randomization. There were no statistically significant differences in other outcomes. Conclusion: The offer to use the SPIN-HAND Program did not improve hand function. Low offer uptake, program access, and minimal usage among those who accessed the program limited our ability to determine if using the program would improve function. To improve engagement, the program could be tested in a group format or as a resource to support care provided by a physical or occupational therapist. 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

Impact of bracing and therapy services on perioperative costs for patients undergoing distal biceps tendon repair. Baylor, J. L., Kloc, A., Delma, S., Foster, B. K. and Grandizio, L. C. (2023) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Distal biceps repair - Splinting and rehabilitation This retrospective study assessed the cost of distal biceps tendon repair with or without bracing and rehabilitation. A total of 36 participants were included. Of these 36 participants, eight had neither rehab nor bracing, 11 had both bracing and rehab, 17 received either a brace or rehab. The results showed that the inclusion and bracing contributed to 20% of the total costs. A case series presented by one of the authors suggests that most patients had an optimal recovery when following an immediate range of movement and no bracing. 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, postoperative bracing and rehabilitation for distal biceps repair account for 20% of the total perioperative charges. It is possible that these costs may not be justified given the positive outcomes associated with no bracing and early movement. However, it is possible, that for those people involved in manual work, further guidance is beneficial. In addition, this study did not take into consideration the potential benefit of a pre-surgical physio/OT session to set goals and expectations, which could improve satisfaction with surgery. URL: https://doi.org/10.1016/j.jhsa.2023.04.019 Abstract PURPOSE: This study aimed to quantify and assess perioperative costs in an integrated healthcare system for patients undergoing distal biceps tendon (DBT) repair with and without the use of postoperative bracing and formal physical (PT) or occupational (OT) therapy services. In addition, we aimed to define clinical outcomes after DBT repair using a brace-free, therapy-free protocol. METHODS: We retrospectively reviewed all cases of DBT repairs within our integrated system from 2015 to 2021. We performed a retrospective review of a series of DBT repairs utilizing the brace-free, therapy-free protocol. For patients with our integrated insurance plan, a cost analysis was conducted. Claims were subdivided to assess total charges, costs to the insurer, and patient costs. Three groups were created for comparisons of total costs: (1) patients who had both postoperative bracing and PT/OT, (2) patients who had either postoperative bracing or PT/OT, and (3) patients who had neither postoperative bracing nor PT/OT. RESULTS: A total of 36 patients had our institutional insurance plan and were included in the cost analysis. For patients using both bracing and PT/OT, these services contributed 12% and 8% of the total perioperative costs, respectively. Implant costs accounted for 28% of the overall cost. Forty-four patients were included in the retrospective review with a mean follow-up of 17 months. The overall QuickDASH was 12; two cases resulted in unresolved neuropraxia, and there were no cases of re-rupture, infection, or reoperation. CONCLUSIONS: Within an integrated healthcare system, postoperative bracing and PT/OT services increase the cost of care for DBT repair and account for 20% of the total perioperative charges in cases where bracing and therapy are used. Considering the results of prior investigations indicating that formal PT/OT and bracing offer no clinical advantages over immediate range of motion (ROM) and self-directed rehabilitation, upper-extremity surgeons should forego routine brace and PT/OT utilization after DBT repair. 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

Duration of cast immobilization in distal radial fractures: A systematic review. van Delft, E. A., van Gelder, T. G., de Vries, R., Vermeulen, J. and Bloemers, F. W. (2019). Level of Evidence: 2a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Distal radius fracture – Short period of immobilisation This systematic review examined the duration of immobilization for nonoperatively treated distal radial fractures (DRF). A total of 12 trials with 1063 patients were included. Results showed that grip strength was better in the short term in those patients treated with a shorter period of immobilisation. There was no difference in fracture positioning (x-ray), range of motion, and pain between different periods of immobilisation. As a results, a shorter period of immobilisation for conservatively treated DRF is not inferior to longer periods of immobilisation. 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 shorter period of immobilization (three weeks) should be considered for nonoperatively treated distal radial fractures. This message appears to be consistent across the literature. Remember that utilising tenderness on palpation for fracture healing may be misleading and a time-based approach to return to activities may be more appropriate. URL: https://doi.org/10.1055%2Fs-0039-1683433 Abstract Objective: The duration of immobilization in distal radial fractures is disputed in the current literature. There are still no long-term superior outcomes of operative treatment in comparison to nonoperative treatment. A systematic review was initiated to assess the clinical controversy on the duration of the immobilization period for nonoperatively treated distal radial fractures. Materials and Methods: A comprehensive search was performed in the PubMed, Embase, and Wiley/Cochrane Library databases and a manual reference check of the identified systematic reviews and meta-analyses was executed. Eligible studies were randomized controlled trials that compared two periods of immobilization, with reported functional, patient-reported, and radiological outcomes. Two reviewers independently agreed on eligibility, and assessed methodological quality and extracted outcome data. Results: The initial search yielded 3.384 studies. Twelve trials, with 1063 patients, were included in this systematic review. Grip strength and patient-reported outcome were better in patients treated by a shorter period of immobilization. There was no difference in pain, range of motion, or radiological outcome between different periods of immobilization. Owing to heterogeneity of studies, data were unsuitable for pooling. Conclusion: Included studies showed that there might be a preference for a shorter period of immobilization in nonoperatively treated distal radius fractures. Therefore, shortening the period of immobilization in distal radial fractures to a maximum of three weeks should be considered. Future research should include homogeneous groups of patients to draw valid conclusions on the appropriate period of immobilization for nonoperatively treated distal radial fractures. 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