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Level of Evidence: 5 Type of study: Therapeutic This case report explores the management of a challenging unstable proximal phalanx fracture in a 56-year-old male, with a focus on patient-centered care. After a football injury (see x-ray below), the patient underwent two local anesthetic and manipulation procedures (LAMP). Following reduction, the patient was placed in hand based splint. Despite the advice, the patient went to the gym, utilised their hand and took place into all their activities whilst wearing the splint. Due to objective evidence of ulnar deviation of the little finger at follow up, an additional x-ray was completed and showed loss of reduction (see figure below). What would you do?

Impact of collagen peptide supplementation in combination with long-term physical training on strength, musculotendinous remodeling, functional recovery, and body composition in healthy adults: A systematic review with meta-analysis. Bischof, et al. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Collagen peptides - Effect on tendon This systematic review and meta-analysis assessed the impact of long-term collagen peptide (CP) supplementation on musculoskeletal health in healthy adults undergoing physical training. A total of 9 studies with 768 participants, assessed the effects on strength, musculotendinous remodeling, functional recovery, and body composition. Evidence suggests that CP intake significantly enhances fat-free mass, tendon morphology, muscle architecture, and maximal and reactive strength following exercise. Though findings show low to moderate certainty, they highlight CP’s potential as an effective supplement for improving musculoskeletal performance. Optimal results seem to require at least an 8-week daily intake of 15 grams of CP. 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, collagen peptide supplementation, when combined with regular physical training, shows potential in enhancing tendon health. This regimen appears to improve fat-free mass, tendon morphology, and muscle architecture, while also aiding in maximal strength and recovery following exercise-induced muscle damage. However, it is also possible that taking enough daily protein provides similar effects to what is provided by taking collagen peptides . URL : https://doi.org/10.1007/s40279-024-02079-0 Abstract Introduction: Over the past decade, collagen peptide (CP) supplements have received considerable attention in sports nutrition research. These supplements have shown promising results in improving personal health, enhancing athletic performance, and preventing injuries in some but not all studies. Objective: A systematic review and meta-analysis of randomized controlled trials (RCTs) has been conducted to investigate the effects of long-term daily collagen peptide (CP) supplementation on strength, musculotendinous adaptation, functional recovery, and body composition in healthy adults, both with and without concurrent exercise interventions over several weeks. Methods: The PRISMA with PERSiST guidelines were followed for this systematic literature review, which was conducted in December 2023 using PubMed, Scopus, CINAHL, and SPORTDiscus databases. Eligible studies included healthy, normal to overweight adults over 17 years of age who engaged in exercise and daily collagen peptide (CP) supplementation for a minimum of 8 weeks (except one 3-week trial only included for maximal strength). Studies examining recovery-related outcomes were also eligible if they included a 1-week supplementation period without exercise. Methodological study quality was assessed using the PEDro scale. A random-effects model with standardized mean differences (SMD) of change scores was chosen to calculate overall effect sizes. Results: Nineteen studies comprising 768 participants were included in both the systematic review and meta-analysis. Results indicate statistically significant effects in favor of long-term CP intake regarding fat-free mass (FFM) (SMD 0.48, p < 0.01), tendon morphology (SMD 0.67, p < 0.01), muscle architecture (SMD 0.39, p < 0.01), maximal strength (SMD 0.19, p < 0.01), and 48 h recovery in reactive strength following exercise-induced muscle damage (SMD 0.43, p = 0.045). The GRADE approach revealed a moderate certainty of evidence for body composition, a very low certainty for tendon morphology and mechanical properties, and a low certainty for the remaining. Conclusion: This systematic review and meta-analysis represents the first comprehensive investigation into the effects of long-term CP supplementation combined with regular physical training on various aspects of musculoskeletal health in adults. The findings indicate significant, though of low to moderate certainty, evidence of improvements in fat-free mass (FFM), tendon morphology, muscle mass, maximal strength, and recovery in reactive strength following exercise-induced muscle damage. However, further research is required to fully understand the mechanisms underlying these effects, particularly regarding tendon mechanical properties and short-term adaptations to collagen peptide (CP) intake without exercise, as observed in recovery outcomes. Overall, CP supplementation appears promising as a beneficial adjunct to physical training for enhancing musculoskeletal performance in adults. 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

Kinesiophobia, catastrophizing, and the duration of immobilization: A prospective study on factors associated with shoulder disability following wrist-hand injuries. Cantero-Téllez, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic Topic : Wrist immobilisation - Shoulder disability This prospective study assessed factors contributing to shoulder disability following wrist-hand injuries, focusing on the role of immobilisation duration, kinesiophobia (fear of movement), and pain catastrophizing. A total of107 participants with wrist fractures requiring immobilisation were included. The results showed that longer immobilisation time was significantly associated with increased shoulder pain and disability. Additionally, higher levels of kinesiophobia were linked to greater shoulder impairment. Wrist immobilisation duration appeared to have the most substantial impact on shoulder pain and disability, with a marked 10.2 points increase in disability index for each week of immobilization. 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, prolonged immobilisation after a wrist-hand injury can significantly contribute to shoulder pain and disability. A proactive approach involving early rehabilitation and addressing psychological factors like kinesiophobia and pain catastrophising could improve outcomes. Considering that immobilisation often is prolonged unnecessarily (e.g. scaphoid fractures ), it's worth thinking twice when extending splint/cast usage. URL : https://doi.org/10.1016/j.jht.2024.08.004 Abstract Background: Shoulder pain is a major musculoskeletal problem after wrist-hand immobilization. There is limited evidence regarding the relationship of kinesiophobia or pain catastrophizing with shoulder pain and disability after wrist-hand injury. Purpose: To explore associations between kinesiophobia and pain catastrophizing with ipsilateral persistent shoulder disability in patients with wrist-hand injury after 6 months. Study Design: Prospective study. Methods: Participants aged ≥18 years referred to hand therapy after wrist-hand injury requiring wrist-hand immobilization were recruited and completed the Numeric Pain Scale, Shoulder Pain and Disability Index, Pain Catastrophizing Scale (PCS), and Tampa scale for kinesiophobia (TSK) at baseline, after an immobilization period, and after 6 months. Results: A total of 107 patients were included in the study. Scaphoid fractures were found in 49 (45.8%) of patients, and 58 (54.2%) had distal radius fractures. For each week of increased time spent in immobilization, the Shoulder Pain and Disability Index score increased by 10.2 points, 95% confidence interval (CI) [6.76, 13.57], with higher levels of immobilization being associated with increased shoulder pain and disability. The baseline TSK score was 17.4 and 11.2 at follow-up. The PCS score was initially 14.8 and decreased to 9.3 at follow-up. The addition of TSK and PCS to the predictive model led to a statistically significant increase in R2 of 0.163, F(2,100) = 47.471, p < 0.001. Conclusions: The duration of wrist immobilization following an injury may play a crucial role in the level of shoulder disability experienced at the 6-month mark post-injury. This shoulder disability may be influenced by factors such as fear of movement. 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

Is kinesio taping an alternative to static wrist orthosis in patients with carpal tunnel syndrome? A randomized clinical trial. İnceboy, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Carpal tunnels syndrome - Kinesiotape vs splint This randomised trial compared the effectiveness of kinesiotaping (KT) to static wrist splints for managing idiopathic carpal tunnel syndrome (CTS). Sixty patients with mild to moderate CTS were divided into two groups: one received static wrist splint, while the other received KT, both supplemented with tendon and median nerve gliding exercises. The results showed that both KT and splinting were effective for alleviating pain, enhancing grip, and pinch strength, improving symptom severity, and functional status. Of note, there were statistically significant but not clinically relevant difference on the Visual Analog Scale (VAS), Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) function, and SF-36 mental health scores. 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, kinesiotaping is as effective as static wrist splints for patients with mild to moderate carpal tunnel syndrome . Currently, this therapeutic option is not in the guidelines, however, you could try it if patients cannot cope with a rigid night splint. You may also want to consider utilising a soft wrist splint as these appear to be as effective as rigid ones . If you want to read more about carpal tunnel syndrome, have a look at the whole database . URL : https://doi.org/10.1016/j.jht.2024.08.002 Abstract Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. Conservative treatments are effective for treating mild and moderate CTS. There is still a need for studies to investigate the superiority of conservative treatments over each other. Purpose: The aim of our study was to compare the efficacy of orthosis treatment and Kinesio taping (KT) treatment on pain, functional status, and grip strength in patients with idiopathic CTS. Study Design: Randomized clinical trial. Methods: Sixty patients (90% women) who were diagnosed with mild or moderate CTS by electroneuromyography were included in this study. Patients were randomized into two groups: the orthosis and KT groups. Hand grip, and three-point pinch strength measuring with a dynamometer and a pinch meter, Visual Analog Scale (VAS), Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS), and Short Form-36 Health Survey Questionnaire (SF-36) were used in clinical assessment. Clinical evaluations were made baseline and at the end of 4 weeks of treatment. Results: Both KT and static wrist orthosis were found to be effective on SF-36 pain, VAS rest, VAS activity, LANSS, grip strength, three-point pinch strength, BCTQ symptom, and functional scores. The changes in VAS activity (between-group mean difference [MD] = −0.93; CI = −1.83:−0.03; p < 0.05; d = 1.74), BCTQ function scores (MD = −2.60; CI = −5.39:0.19; p < 0.05, d = 5.40), and SF-36 mental health scores (MD = 5.87; CI = 1.15:10.59; p < 0.05; d = 9.13) were significantly higher in the KT group compared to the orthosis group. Conclusions: KT, which is a straightforward and safe treatment that does not restrict daily activities, may offer a beneficial alternative to restrictive and uncomfortable orthosis therapy for treating mild to moderate CTS in those leading active daily lives. 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

Combined home and clinic-based therapy versus home-based exercise programme after distal radial fracture: A randomized controlled study. Sakurai, et al. (2024) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Distal radius fracture - Treatment frequency This randomised study assessed the effectiveness of combining home-based and clinic-based hand therapy after ORIF for distal radial fractures. A total of 102 participants were randomised into three groups: home-based exercises alone, exercises with low-frequency clinic sessions, and exercises with high-frequency clinic sessions. At 6 weeks, the group undergoing more clinic sessions showed better Patient-Rated Wrist Evaluation (PRWE) scores and grip strength compared to those with home exercises alone, although this advantage was not sustained at 12 weeks. The findings suggest that combined clinic and home-based therapy facilitates earlier functional recovery, particularly in grip strength. Despite enhanced outcomes in the short term, the long-term benefits of increased clinic-based therapy frequency remain inconclusive, with no significant differences observed at 12 weeks. 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, combining home-based exercise programs with clinic-based hand therapy sessions can enhance early functional recovery in patients following distal radial fractures. Specifically, high-frequency clinic-based therapy appears to be more effective in improving wrist function and grip strength within the first six weeks post-surgery. However, at three months, a higher frequency in person approach is not superior to a home exercise program. It may be worth reducing early hand therapy appointments and spread them over a year to reduce the possibility of grip strength impairment . URL : https://doi.org/10.1177/17531934241231709 Abstract We investigated outcomes of clinic-based hand therapy combined with a home-based exercise programme after anterior plating for distal radial fractures. A total of 102 patients were randomly assigned to one of three groups: a home-based exercise programme alone; a home-based exercise programme combined with four hand therapy sessions in the clinic; and a home-based exercise programme with seven sessions in the clinic. Mean Patient-Rated Wrist Evaluation scores at 6 weeks were significantly better for the group of patients with seven sessions in the clinic than in those with only home exercises (12 vs. 30), but the difference was no longer significant at 12 weeks. Grip strength was significantly better at 6 and 12 weeks. Combined home- and clinic-based hand therapy may facilitate an earlier return of function after anterior plating for distal radius fractures. Level of evidence: II 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

Does lidocaine reduce pain intensity during corticosteroid injection? A double-blind randomized controlled equivalence trial. Teunis, et al. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Anaesthetic - CSI injection pain This randomised study assessed the effects of using lidocaine alongside corticosteroid injections to alleviate pain in hand and wrist conditions. A total of 39 participants with De Quervain, 1st cmcj OA, and trigger finger, were randomised to receive 0.5 mL triamcinolone (cortisone) with or without 0.5 mL lidocaine. Results indicated that co-injection with lidocaine led to a median reduction of 2.4 points in pain intensity on a 0–10 scale with a 95% probability of at least a 1-point decrease. While lidocaine lowered immediate pain intensity effectively, its benefits on pain reduction at 5 minutes and 4 hours post-injection were less pronounced, not meeting the pre-set 95% probability threshold. Despite some limitations like potential unblinding of surgeons (higher injection volume in the lidocaine group), findings challenge previous studies suggesting higher pain with lidocaine. 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, lidocaine significantly reduces pain intensity when used alongside corticosteroid injections for hand and wrist conditions. In particular, there is a 95% probability that lidocaine reduces pain by 1 point out of 10 or more during injection, providing a clear advantage in terms of patient comfort compared to corticosteroids alone. Have a look at these links if you are interested in the effectiveness of injection for radial tunnel syndrome , 1st cmcj OA , or tennis elbow . URL : https://doi.org/10.1177/17531934241245036 Abstract Of the strategies considered to limit the discomfort of corticosteroid injection, one is to inject without lidocaine to reduce the total volume and avoid acidity. In a Bayesian trial, adults receiving corticosteroid injections were randomized to receive 0.5 mL of triamcinolone with or without 0.5 mL of lidocaine. Serial analysis was performed until a 95% probability of presence or absence of a 1.0-point difference in pain intensity on the 0–10 Numerical Rating Scale was reached. Injections with lidocaine were associated with a median of 2.4-point lower pain intensity during injection with a 95% probability of at least a 1-point reduction. The 95% probability was confirmed in 90% of the repeated analysis (36/40). Lidocaine is associated with lower immediate pain intensity during corticosteroid injection for hand and wrist conditions. Level of evidence: I 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

Evaluating the efficacy of hinged elbow braces in reducing passive valgus forces after ulnar collateral ligament injury: A biomechanical study. Hoffeld, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Elbow ROM splint - Ligament protection This biomechanical study assessed the efficacy of hinged elbow braces in reducing passive valgus forces after ulnar collateral ligament (UCL) injuries. Eight cadaveric elbow specimens were included and three scenarios were tested: intact ligaments, simulated UCL rupture, and the application of a hinged elbow brace following a UCL rupture. All the three conditions were assessed in 90deg of elbow flexion. Intraclass correlation (ICC) calculations validated the testing setup's reliability. The results showed that hinged elbow splints do not significantly reduce passive valgus forces when the ucl is ruptured. 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 hinged elbow orthosis does not significantly reduce passive valgus forces in the elbow following ulnar collateral ligament (UCL) injuries. However, what you could do with a hinge brace is limit the range of movement of the elbow in extension and flexion, which has the potential to limit stress on healing ligaments . URL : https://doi.org/10.1002/jeo2.70094 Abstract Purpose: This biomechanical study aimed to investigate the effectiveness of a hinged elbow orthosis in reducing passive valgus forces following medial ulnar collateral ligament (UCL) injuries of the elbow joint. The hypothesis tested was that a hinged elbow orthosis reduces these passive valgus forces. Methods: Eight fresh frozen cadaveric elbow specimens were prepared and tested under three scenarios: intact ligaments, simulated UCL rupture and application of a hinged elbow brace after simulated UCL rupture. Valgus instability was assessed using a custom testing set‐up and the Optotrak motion capture system. Statistical analysis was conducted to compare the results across scenarios. Results: Intraclass correlation (ICC) calculation showed that the testing set‐up was reliable in investigating valgus deflection across all levels of applied force. The hinged elbow brace reduced passive valgus forces after UCL rupture. The reduction in valgus instability was consistent with close approximation to the native state, although not reaching its level. Conclusion: The hypothesis—that a hinged elbow orthosis significantly reduces passive valgus forces in the elbow following UCL injuries—is not supported by the data and therefore has to be rejected. Nevertheless, the study demonstrates a tendency that a hinged elbow brace could mitigate these forces, at least in an experimental cadaveric model with static study conditions. 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

Serial range of motion and grip strength measurements, patient-reported outcomes, and radiographic thresholds associated with less satisfactory outcomes after low-energy distal radius fracture in women aged 50 years and older. Johnston, et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Distal radius fracture - Recovery This retrospective study aimed to assess the clinical recovery and patient-reported outcomes after distal radius fracture (DRF) in women aged 50 and older, treated either non-surgically or surgically. The analysis included 1,319 women, predominantly managed nonoperatively. The results showed that by 12 months, there was notable recovery in wrist motion, grip strength, and Patient-Rated Wrist Evaluation (PRWE). In addition, radiographic thresholds critical for favorable outcomes were volar/dorsal tilt, ulnar variance, and radial inclination. Outcomes were generally satisfactory when these parameters were within identified limits; exceeding these limits was associated with poorer recovery. This highlights the potential benefit of early surgical intervention in selected cases. 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, patients presenting with excessive dorsal tilt, increased ulnar variance, or reduced radial inclination, may benefit from early surgical intervention. Furthermore, following a low energy distal radius fracture, assessing bone density should be a priority to prevent future fragility fractures . It is also important to consider psychological factors and promote positive behavior changes as these can enhance clinical outcomes . URL : https://doi.org/10.1016/j.jhsa.2024.01.012 Abstract Purpose: To document the change of clinical (wrist motion and grip strength) measurements and Patient-Rated Wrist Evaluation (PRWE) scores at 9 weeks and 3, 6, and 12 months after distal radius fracture (DRF) in women 50 years and older with exclusively isolated, displaced, and low-energy DRFs treated by either closed and/or open reduction and to relate these outcomes to their radiographic results. Methods: In this retrospective single-institution cohort study, patients’ post-DRF clinical measurements and PRWE scores were prospectively collected from December 2007 through September 2018 and stratified according to their final radiographic values of volar/dorsal tilt, ulnar variance, and radial inclination. Results: Of the 1,319 women identified, 1,126 (85%) were treated nonsurgically, and 193 (15%) were treated operatively. At 12 months, patients averaged restoration (ratio of injured and uninjured sides’ values) of 96% pronation, 95% extension, 91% supination, 81% flexion, and 80% (77% nondominant, 85% dominant) grip strength. The mean PRWE score was 39.5 at week 9 and 14.4 at 12 months with 54% of patients scoring <10 and 13% scoring zero. The mean volar/dorsal tilt, ulnar variance, and radial inclination values in those treated nonsurgically were 1.4° dorsal, +3.9 mm, and 18.0°, respectively. Analogous values in patients treated surgically were 6° volar, +2.6 mm, and 22°, respectively. Volar tilt ≥25°, dorsal tilt >10°, ulnar variance >+7.5 mm, and radial inclination ≤13° were thresholds beyond which motion and grip strength were reduced and/or PRWE scores increased. In general, older patients experienced more residual deformity and were less likely to have undergone surgery. Conclusions: Generally, outcomes were satisfactory for patients with radiographic results within identified thresholds for acceptable fracture reduction. Outcomes were significantly less favorable for patients with radiographic results beyond these thresholds; for these patients, early surgical intervention should be considered. Low-energy DRFs should prompt bone density investigation. 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

Long-term leisure-time physical activity intensity and all-cause and cause-specific mortality: A prospective cohort of us adults. Lee, et al. (2022) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Physical activity - Mortality This prospective study assessed the long-term impact of leisure-time physical activity on mortality among US adults. The study classified physical activity as moderate (MPA) and vigorous (VPA) using data from the Nurses’ Health Study and Health Professionals Follow-up Study. A cohort of 116,221 participants was followed for 30 years, during which 47,596 deaths were recorded. Results showed that meeting the upper bound of the recommended 75-149 minutes per week of VPA or 150-299 minutes per week of MPA was associated with a 19% and 20% reduction in all-cause mortality, respectively. Surprisingly, higher levels of activity did not yield additional mortality benefits. Furthermore, individuals with lower MPA who engaged in VPA saw improved mortality outcomes, but additional VPA did not benefit those already achieving higher MPA levels. Based on this study, achieving a 150-300 minutes of VPA or 300-600 minutes of MPA weekly is optimal for mortality risk reduction. 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, engaging in long-term leisure-time physical activity at moderate or vigorous intensities significantly reduces all-cause, cardiovascular, and non-cardiovascular mortality. The maximum benefit can be obtained by achieving 150–300 minutes of vigorous or 300–600 minutes of moderate physical activity per week, or a combination of both. If you believe that physical activity only reduces mortality, think again. Higher levels of physical activity appear to be associated with lower levels of symptoms in people with carpal tunnel syndrome . URL : https://doi.org/10.1161/CIRCULATIONAHA.121.058162 Abstract Background: The 2018 physical activity guidelines for Americans recommend a minimum of 150 to 300 min/wk of moderate physical activity (MPA), 75 to 150 min/wk of vigorous physical activity (VPA), or an equivalent combination of both. However, it remains unclear whether higher levels of long-term VPA and MPA are, independently and jointly, associated with lower mortality. Methods: A total of 116 221 adults from 2 large prospective US cohorts (Nurses’ Health Study and Health Professionals Follow-up Study, 1988–2018) were analyzed. Detailed self-reported leisure-time physical activity was assessed with a validated questionnaire, repeated up to 15 times during the follow-up. Cox regression was used to estimate the hazard ratio and 95% CI of the association between long-term leisure-time physical activity intensity and all-cause and cause-specific mortality. Results: During 30 years of follow-up, we identified 47 596 deaths. In analyses mutually adjusted for MPA and VPA, hazard ratios comparing individuals meeting the long-term leisure-time VPA guideline (75–149 min/wk) versus no VPA were 0.81 (95% CI, 0.76–0.87) for all-cause mortality, 0.69 (95% CI, 0.60–0.78) for cardiovascular disease (CVD) mortality, and 0.85 (95% CI, 0.79–0.92) for non-CVD mortality. Meeting the long-term leisure-time MPA guideline (150–299 min/wk) was similarly associated with lower mortality: 19% to 25% lower risk of all-cause, CVD, and non-CVD mortality. Compared with those meeting the long-term leisure-time physical activity guidelines, participants who reported 2 to 4 times above the recommended minimum of long-term leisure-time VPA (150–299 min/wk) or MPA (300–599 min/wk) showed 2% to 4% and 3% to 13% lower mortality, respectively. Higher levels of either long-term leisure-time VPA (≥300 min/wk) or MPA (≥600 min/wk) did not clearly show further lower all-cause, CVD, and non-CVD mortality or harm. In joint analyses, for individuals who reported  ≥300 min/wk of long-term leisure-time MPA, additional leisure-time VPA was associated with lower mortality; however, among those who reported ≥300 min/wk of long-term leisure-time MPA, additional leisure-time VPA did not appear to be associated with lower mortality beyond MPA. Conclusions: The nearly maximum association with lower mortality was achieved by performing ≈150 to 300 min/wk of long-term leisure-time VPA, 300 to 600 min/wk of long-term leisure-time MPA, or an equivalent combination of both. 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

Does a distal radial fracture lead to osteoarthritis? Re-examining the evidence for early treatment. Warwick, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic : Distal radius fracture - Post traumatic osteoarthritis This narrative review assessed whether distal radial fractures lead to symptomatic osteoarthritis, examining current evidence and clinical experiences. It challenges the belief that distal radial fractures inherently cause osteoarthritis, asserting that both literature and clinical insights do not support this notion. Despite the common treatment aim to prevent osteoarthritis, the evidence indicates that the condition is often asymptomatic post-fracture. The review highlights that many fractures can be effectively managed non-operatively, especially in less active elderly patients, with surgery offering no significant long-term benefits. The paper also points out the issues of study biases and variations in outcome measures, urging for more comprehensive research. Consensus exists regarding better early outcomes in younger, functional demographics with surgical intervention. However, the article concludes that symptomatic osteoarthritis is uncommon following a distal radius fracture, advocating for an informed and cautious therapeutic approach without overstating surgical 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, whilst osteoarthritis is commonly detected on x-rays after such fractures, it seldom correlates with clinical symptoms. Thus, it may not be justifiable to perform surgery solely to prevent osteoarthritis, especially given the lack of strong evidential support that untreated fractures significantly predispose to symptomatic osteoarthritis. Overall, surgical intervention may provide better outcomes only in those people presenting with severely displaced fractures, as shown by a recently published study . URL : https://doi.org/10.1177/17531934241265839 Abstract There are many good reasons to improve the anatomy of a distal radius fracture, such as early return to function and avoidance of sigmoid notch incongruity or ulnocarpal impaction. It is often feared by patients, and portrayed by some authors of scientific articles and medicolegal reports, that a fracture of the distal radius has a propensity to cause symptomatic osteoarthritis. This article examines some of the current evidence and shares the authors’ experience. Critical questions are asked to direct our observations and guide future research questions. We propose that both clinical experience and a literature analysis do not support the commonly held assumption that untreated distal radial fractures lead to symptomatic osteoarthritis. Level of evidence: V 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

Production time and practicability of 3d-printed wrist orthoses versus low temperature thermoplastic wrist orthoses. von Haller, et al. (2024) Level of Evidence: 2b. Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Economic Topic : 3D vs Thermoplastic splints - Production time This economic study assessed the production time and practicality of three-dimensional (3D) printed wrist splints with those made from low-temperature thermoplastic (LTTO). In particular, the production time of 17 splints was assessed (8 were 3D printed and 9 were LTTOs). The results showed that 3D-printed orthoses required significantly more time to produce (over 12 hours total, and 44 minutes of active production time) compared to LTTOs, which took approximately 14 minutes overall. 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, whilst 3D-printed splints offer high levels of customisability and potential for patient-specific designs, their long production time limits their widespread clinical adoption. In addition, 3D-printed splints do not appear to have significantly better outcomes for hand related conditions . Therefore, low-temperature thermoplastic splints remain the best option for splinting at this stage. URL : https://doi.org/10.1177/17589983241287069 Abstract Introduction: In recent years, three-dimensional (3D) printing has emerged as a new manufacturing technique for orthoses, showing comparable stability and wearing comfort to traditional orthoses. However, the lengthy designing and printing process is assumed to take more time than the common practice of manufacturing low-temperature thermoplastic orthoses (LTTOs). The aim of this prospective cross-sectional study was to compare the production time of 3D-printed orthoses (3DPO) to LTTOs. Methods: The active and passive time needed to manufacture the orthoses was measured in a clinical setting. 17 orthoses (8 3DPOs and 9 LTTOs) were included in the data analysis. Results: The mean total production time of a 3DPO (12:14:50h total time; 0:44:35h active production time) was significantly longer than in LTTOs (0:14:14h; p < 0.001). Discussion: The longer production time might be a hurdle regarding the implementation of 3DPOs in hand therapy. Although 3D-printing might become more cost- and time-efficient due to future developments in technology and growing experience, some practical advantages of LTTOs prevail, such as the fast and efficient provision of orthoses and the adaptability of the material if subsequent changes are needed. A combination of both manufacturing techniques may be a feasible solution to provide patient-centred orthosis provision in future hand therapy practice. 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

Misinformation about upper extremity conditions in guidelines for clinicians. Tonnel, et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic : Guidelines - Are they up to date? This expert opinion assessed the presence of potential misinformation in clinician guidelines concerning upper extremity conditions. The analysis focuses on sections from the BMJ Best Practice Guidelines, Up-To-Date, and DynaMed. The results showed that approximately 53% of the statements could potentially reinforce unhelpful thinking or provide misleading information, with specific conditions like rotator cuff tendinopathy and elbow tendinopathy having particularly high percentages of potential misinformation. The types of incorrect information identified include statements that encourage kinesiophobia or catastrophic thinking, provide false hope, or misrepresent the natural history or necessity of treatments. The research suggests this misinformation feels intuitive due to its alignment with common misconceptions. To counteract this, a checklist for potential misinformation is proposed as a debiasing tool for authors and editors. The paper underscores the need for accurate and beneficial information to ensure better health outcomes and avoid promoting harmful misconceptions. 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, clinicians should be aware of the significant potential for reinforcement of unhelpful thinking patterns through guideline recommendations. The study identifies that over half the statements from prominent clinical resources for upper extremity conditions contain language potentially reinforcing kinesiophobia, false hope, or misconceptions about treatment necessity. For a large list of studies showing the effect of mental health on hand therapy related presentations, have a look at the database . URL : https://doi.org/10.1177/17531934241270348 Abstract The potential for reinforcement of unhelpful thinking and feelings of distress was present in half the sentences from the general description of the condition and management recommendation sections in three sources of information describing upper extremity conditions for clinicians. 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