Search Results

Response to conservative treatment for thumb carpometacarpal osteoarthritis is associated with conversion to surgery: A prospective cohort study. Tsehaie, J., et al. (2019) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Thumb OA conservative treatment - Rates of surgery This prospective cohort study assessed the effectiveness of conservative treatment in patients with thumb carpometacarpal joint (cmcj) osteoarthritis (OA) and its association with subsequent surgical intervention. The study was conducted at the Xpert Clinic in the Netherlands, and 701 patients who underwent hand therapy and splint treatment for three months were included. Pain and function were assessed using the Michigan Hand Questionnaire (MHQ) at the outset, mid-treatment, and post-treatment. The results showed that reductions in pain during conservative treatment significantly correlated with decreased likelihood of elective surgery, whereas changes in functional scores did not show such an association. Notably, only 15% of patients transitioned to surgery after conservative treatment. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, carefully monitoring pain responses during conservative treatments is important to determine whether escalation to surgery is required. Thus, reductions in pain are strongly linked to a decreased necessity for surgical intervention in people with thumb OA. These findings are in line with previous research showing that conservative treatment for thumb OA can reduce the need for surgical interventions . Interestingly, changes in functional outcomes alone do not predict surgical conversion, highlighting pain relief as a pivotal target for conservative management. URL : https://doi.org/10.1093/ptj/pzz009 Abstract Background: The current guidelines for treatment of carpometacarpal osteoarthritis recommend starting with conservative treatment before a surgical procedure is considered. Objective: The objective was to investigate how response to conservative treatment, in terms of pain and hand function, influences the hazard that patients convert to surgical treatment. Design: This was a multicenter, prospective cohort study. Methods: Participants comprised 701 patients who received 3 months of hand therapy and an orthosis. Pain and function were measured with the Michigan Hand Questionnaire (MHQ) at baseline and at 6 weeks and 3 months follow-up. Conversion to surgical treatment was recorded from clinical records. Joint modeling (a statistical method of combining prediction models) was used to perform the analysis and to calculate hazard ratios (HRs). Results: The joint analytical model showed that both MHQ pain score at a certain point (HR = 0.93; 95% confidence interval [CI] = 0.92–0.94) and change in MHQ pain score (HR = 1.07; 95% CI = 1.06–1.09) during conservative treatment was significantly associated with conversion to surgical treatment. The joint analytical model between functional outcome and conversion to surgical treatment showed only a significant association between MHQ function at a certain point (HR = 0.97; 95% CI = 0.95–0.99), and no significant association between the change in MHQ score for function (HR = 1.0; 95% CI = 1.0–1.0) and conversion to surgical treatment. Limitations: Missing data might have resulted in biased estimates. Conclusions: Self-reported pain and function, as well as change in self-reported pain during treatment, were associated with the hazard of conversion to surgical treatment, whereas change in self-reported functioning was not associated with conversion. Because a reduction in pain during conservative treatment appears to decrease the rate of conversion to surgical treatment, it is advised to structurally monitor pain levels during 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

Buddy taping after reduction of displaced extra-articular phalangeal finger fractures in children: a randomized controlled trial. Weber, D. M., et al. (2024) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic : Phalanx fracture - Taping This randomized controlled assessed the outcomes of taping or forearm and hand casting for children with displaced extra-articular phalangeal finger fractures. After reduction, a total of 81 children were randomised to either taping of the fingers or casting of the forearm/hand (see picture below). The primary outcome was the rate of fracture displacements, while secondary outcomes included patient comfort, analgesic use, and range of motion six months after injury. The results showed that five fracture displacements occurred in the casting group, compared to three in the taping group. As a result taping was deemed non inferior compared to casting. Patient comfort and the other secondary outcomes were comparable 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, buddy taping provides a non-inferior alternative to casting of forearm and hand in displaced extra-articular phalangeal finger fractures in children. Buddy splinting appears also to be more comfortable, less expensive, and would take less time compared to casting. Other fractures that only require buddy taping in adults are neck of the 5th metacarpal fractures . URL : https://doi.org/10.1177/17531934241293338 Abstract In this randomized controlled trial, we assessed the non-inferiority of buddy taping to splinting after reduction of displaced extra-articular proximal and middle phalangeal finger fractures in children. The primary outcome was the rate of secondary fracture displacements; the secondary outcomes were patient comfort, analgesic efficacy and total range of active motion 6 months after injury. Eighty-one patients participated: 43 with taping and 38 with splinting. Secondary displacement occurred in eight patients: five in the splinting group and three in the taping group. Risk difference was below the predefined non-inferiority of 10%. Patient comfort was significantly higher in the taping group, with no group differences for other parameters. Our previous study recommended taping for undisplaced finger fractures in children. With the current data, we recommend taping these finger fractures irrespective of displacement or need for reduction. We are encouraged to propose taping as an alternative to splinting for increased patient comfort, lower cost, and shorter application 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

Too much is too little: Estimating the optimal physical activity level for a healthy mental state. Shimura, A., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (/4 Thumbs up) Type of study: Aetiologic / Prognostic Topic : Physical activity - Mental health This cross-sectional study assessed the relationship between physical activity and mental health, hypothesising a U-shaped dose-response curve, suggesting that both too little and too much physical activity can negatively impact mental health. A total of 526 Japanese adult participants who completed self-administered questionnaires on physical activity and mental health factors like depression, anxiety, resilience, and insomnia. The results that no significant linear relationships between physical activity and mental health measures existed. As expected by the authors, a significant U-shaped relationship was instead observed. Optimal physical activity levels were identified as 6,953 MET-minutes for depression and 9,152 MET-minutes for insomnia. These numbers equate to 17 to 30 hours of moderate or vigorous physical activity per week. Further large-scale and intervention studies are required to assess the causality between these variables. 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, engaging in physical activities within the recommended range of 5.3 to 9.2 k METs-minutes per week, or 21 to 31 hours per week, is associated with improved mental health for depression, anxiety, and insomnia, along with enhanced resilience. This range is much higher than the WHO guidelines for physical activity, which suggest 75 minutes/week of vigorous or 150 minutes/week of moderate exercise . It is possible that the WHO wanted to indicate levels that appear to be achievable by people rather than the optimal amount of physical activity. It is also important to remember that association is not causation and experimental studies randomising patients to different levels of physical activity are needed to clarify any causative effect. URL : https://doi.org/10.3389/fpsyg.2022.1044988 Abstract Introduction: Although physical activity and exercise are generally thought to have favorable effects on mental health, excessive physical activity may have unfavorable effects. In this study, the associations between physical activity and the states of mental health with U-shaped dose–response curves were hypothesized, and the ranges of physical activity resulting in optimal effects on mental health were investigated. Methods: A cross-sectional survey was conducted on 1,237 adult volunteers in 2017 and 2018. Of these volunteers, 526 participants validly answered the self-administered questionnaires asking about physical activity, depression, anxiety, resilience, insomnia vulnerability, and life events. A comparison of mental health measures by physical activity levels and quadratic equation model regressions were performed. Results: No significant linear associations between physical activity levels and mental health measurements were observed; however, the U-shaped, quadratic equation models indicated a significance. The following levels of physical activity per week optimized the mental health measurements values of the participants: 6,953 MET-minutes and 25.70 h for depression, 5,277 MET-minutes and 21.60 h for state anxiety, 5,678 MET-minutes and 22.58 h for trait anxiety, 25.41 h for resilience, and 9,152 MET-minutes and 31.17 h for insomnia vulnerability. Conclusion: Physical activities in the optimal range were associated with more favorable mental health measurements. Physical activities that were too much or too long and outside of the optimal range were associated with less favorable mental health measurements. 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

Pain and instability ascribed to the distal radioulnar ligaments and central disc as part of the triangular fibrocartilage complex: a round table discussion. Teunis, T., Burnier, M., Chin, A. Y. H. and Ring, D. (2024) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : DRUJ & TFCC - Is surgery required? This expert opinion assessed the complexities surrounding pain and instability attributed to the triangular fibrocartilage complex (TFCC), focusing on the distal radioulnar joint (DRUJ) and the central disc. Four surgeons, were asked their opinions and answers from all were reported. What the article highlighted was the inconsistent interpretations of MRI findings (incidental vs symptoms related) among surgeons, leading to potential over or under-treatment. The discussion led by Teun Teunis, featuring experts Drs. Chin, Ring, and Burnier, uncovered varied opinions on diagnosing and treating ulnar wrist pain. While some experts argue for the reliability of surgical interventions following clinical tests like the ballottement test, others caution against overdiagnosis, noting the prevalence of age-related changes in the DRUJ and central disc. The article underscores the need for objective validation of surgical benefits over natural recovery and placebo effects, advocating for evidence-based approaches to manage ulnar sided wrist pathologies. 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, identifying the line between normal variations and symptomatic pathologies in TFCC and DRUJ is challenging and continues to evolve. Clinicians should be cautious in attributing pain and instability solely to these structures without comprehensive diagnostic corroboration. As current debates indicate, the correlation between MRI findings or arthroscopic observations and symptomatic presentations remains less than reliable. The uncertainty appears to be substantiated by multiple research papers suggesting that there is poor agreement between objective/imaging findings and symptoms reported by patients . URL : https://doi.org/10.1177/17531934241254705 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

Hand grip strength in senior athletes: Normative data and community-dwelling comparisons. Jordre, B. and Schweinle, W. (2020) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic, Prognostic Topic : Grip strength - Senior athletes This cross-sectional study assessed hand grip strength in senior athletes and compared it to community-dwelling older adults. Previously published normative data for hand grip strength have been collected from largely inactive participants. The novelty of this paper is that, senior athletes participating in the National Senior Games from 2011 to 2017, for a total of 2,333 participants, were included in this study. Male senior athletes demonstrated 9 to 11 kg greater dominant hand grip strength, while females showed an increase of 6 to 9 kg compared to their sedentary counterparts. These differences were statistically significant with large effect sizes. Notably, the hand grip strength levels of senior athletes ages 80-85 aligned more closely with younger community-dwelling adults aged 60-64. The findings underscore the need for specific normative values to accurately assess the health and capabilities of this physically active older population, challenging assumptions of age-related decline seen in the general older population. 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, regular participation in athletic activities significantly enhances hand grip strength among older adults, aligning their physical capacity with much younger community-dwelling adults. This insight suggests that senior athletes and similarly active older individuals can maintain a functional ability that defies conventional age-related declines. In line with previous findings, engaging in resistance training and other targeted exercises not only improves overall muscle strength but also acts as a protective measure against age-related conditions. Have a look at the WHO guidelines for physical activity and remind your patients of staying as active as possible! URL : https://doi.org/10.26603/ijspt20200519 Abstract Hand grip strength is supported as a valid physical capacity measure in older adults. Normative values for community-dwelling older adult hand grip strength were recently updated. With the majority of community-dwelling older adults identified as sedentary, it is likely that current norms represent a group that is relatively inactive. A sub-population of senior athletes who actively engage in exercise and competitive sport have consistently demonstrated superior performance on measures of physical capacity when compared to the general population. Normative values for hand grip strength have not been established for this unique group of aging athletes. The purpose of this study was to establish hand grip strength norms for senior athletes and to compare these outcomes to available normative data in community-dwelling older adults.  Measures of hand grip strength were taken on 2,333 senior athletes registered to compete in the National Senior Games between 2011 and 2017. Findings were divided into age and gender categories consistent with community-dwelling norms. Student t tests were used to compare senior athlete means to community-dwelling norms. Cohen’s d was calculated to estimate the effect size of each comparison. Normative values for senior athlete hand grip strength are reported in kilograms by age, gender and hand dominance. For each age and gender category tested, senior athletes demonstrate dominant hand grip strength that ranges from 8.6-11.1 kg higher for males and 5.5 to 8.9 kg higher for females (p values<.0001) than published community-dwelling norms. Non-dominant grip strengths were also significantly higher (p values<.0001). Effect sizes were medium to large (Cohen’s ds = 0.44-1.5). Senior athletes demonstrate hand grip strength that is significantly higher than their community-dwelling peers and more similar to a younger community-dwelling population. The population-specific norms presented here will assist health care providers in more accurately assessing this high-functioning subset of aging 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

What are the barriers to upper limb splint adherence, and how is adherence measured? A systematic review. Bamford, E., et al. (2024) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Splint wearing - Adherence and barriers This systematic review assessed the barriers to splint wearing and methods of measuring adherence to upper limb splint usage after traumatic injuries. A total of 16 articles were included in the present study. The results showed that methods used for assessing adherence varied, lacking a standardised approach. Patients' or therapists' reports were the most commonly utilised aproaches to measure adherence, with electronic sensors being utilised less frequently. Barriers to splint adherence identified by patients included the limitations caused by splinting in daily function (e.g. hygiene, caring for baby), patients' perception of clinical improvement. In contrast, increase adherence was associated with patients' perception that the splint was aiding their recovery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, non-adherence to upper limb splint regimens following traumatic injuries can adversely affect recovery outcomes and increase healthcare costs. Common barriers to splint adherence include limitations in function and perception of low injury severity by the patient. Another factor that appears to negatively impact splinting adherence is depression , which may be explained by lower levels of patients' perception of improvement with splint wearing. URL : https://doi.org/10.1177/17589983241268069 Abstract Introduction: Non-adherence to splint wearing following an upper limb traumatic injury is a significant medical issue. Optimal outcome following such injuries relies on people adhering to the prescribed splint, and a failure to do so can negatively impact outcome and increase healthcare burden and costs. This systematic review aims to compare and synthesise the evidence related to measuring adherence to wear recommendations and the barriers to splint wearing following upper limb trauma in adults. Methods: Databases (EBSCO, PubMed, EMBASE and Science Direct) were systematically searched for articles that met the pre-agreed eligibility criteria between February and May 2023. Data on study characteristics and reported outcomes relating to measuring and quantifying splint adherence and barriers to adherence were extracted. Results: A total of 16 articles were included for final review. Several methods were used to measure adherence, with no single tool used predominantly. These included patient or therapist reported data, preexisting classification systems and an electronic device. Methods used to quantify adherence was also heterogenous in nature, and a range of investigator and patient reported barriers to splint wearing were reported. Conclusion: This review demonstrates heterogeneity in both classifying and measuring splint adherence, as well as in the barriers to splint wearing reported. Moving forward, using agreed measurement and reporting practices for splint adherence will enable researchers to complete high quality trials to determine splinting outcomes, and may ultimately enable health care professionals to improve adherence and, subsequently, outcomes in clinical 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

Prevalence and practice characteristics of advanced practice providers in upper-extremity surgery. Das, R. K., Bittles, O., Thayer, W. P. and Drolet, B. C. (2024) Level of Evidence: 3b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Economic Topic : Advanced practice providers - Hand Therapy The study conducted a retrospective analysis from 2013 to 2021 to assess the prevalence and characteristics of advanced practice providers (APPs), such as nurse practitioners and physician assistants, in upper-extremity care, based on Medicare data. Findings revealed a 170.9% increase in APPs billing for upper-extremity services, with the number rising from 1,965 to 5,324 over the period. In contrast, the numbers for upper-extremity surgeons decreased by 5.2%. APPs, predominately women, were more likely to operate in rural areas compared to surgeons. The role of APPs in enhancing accessibility to care appears to be important, especially as surgeon numbers decline. This study highlights the growing reliance on APPs for future healthcare resilience. The graph below shows the number of surgeon vs APP in the past 10 years. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, there is a rapidly growing reliance on Advanced Practice Providers, such as nurse practitioners and physician assistants, in the field of upper-extremity care. With the anticipated shortage of surgeons, especially in rural areas, APPs are key in ensuring accessible, efficient, and high-quality care. URL : https://doi.org/10.1016/j.jhsa.2024.08.015 Abstract Purpose: This study evaluated the prevalence, characteristics, and reimbursement of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to the diagnosis and treatment of diseases and conditions of the hand, wrist, and upper extremities in the United States from 2013 to 2021. Methods: Our analysis was a retrospective cohort study evaluating the diagnostic, procedural, and therapeutic services provided by advanced practice providers from 2013 to 2021 using the Medicare Provider Utilization and Payment Data Public Use Files from the Centers for Medicare and Medicare Services. The reported provider type and billing codes were used to identify health care professionals providing upper-extremity care such as ordering radiographs, applying casts and splints, and performing procedures on the hand, wrist, or other anatomic regions of the upper extremity. Trends over the study period and available data about services provided were analyzed. Results: From 2013 to 2021, providers of upper-extremity care included 19,525 (64.7%) doctor of medicine or doctor of osteopathic medicine upper-extremity surgeons, 7,612 (25.2%) physician assistants, and 3,042 (10.1%) nurse practitioners. The nonsurgeon providers were more likely to be women and provide care in micropolitan areas with less than 50,000 people compared with upper-extremity surgeons. Overall, the number of advanced practice providers who billed for upper-extremity care increased by 170.9% from 1,965 in 2013 to 5,324 in 2021. Based on these trends, the growth of APPs providing upper-extremity care is expected to continue. Conclusions: There is a growing prevalence of advanced practice providers in upper-extremity care, and this trend is expected to continue. Clinical relevance: With a growing need for upper-extremity care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation. 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

Provocative wrist tests and MRI are of limited diagnostic value for suspected wrist ligament injuries: A cross-sectional study. Prosser, R., et al. (2011) Level of Evidence: 3b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : MRI and special tests - Very useful? This cross sectional study assessed the diagnostic accuracy of provocative wrist tests and MRI in diagnosing wrist ligament injuries. A total of 105 participants with wrist pain (at least four weeks) were included. Seven provocative tests and MRI findings were compared against wrist arthroscopy (gold standard). The results reveal that most provocative tests and MRI findings have limited diagnostic value. Notably, the scaphoid shift test (SS), midcarpal test (MC), and distal radioulnar joint test (DRUJ) exhibited mild usefulness when diagnosing specific ligament injuries. MRI showed moderate utility for diagnosing injuries to the triangular fibrocartilage complex (TFCC), scapholunate ligament, and lunate cartilage damage. Combining MRI with provocative tests provided slight diagnostic improvement for TFCC injuries and lunate cartilage damage. 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 provocative wrist tests are commonly used in clinical settings, their diagnostic accuracy for wrist ligament injuries is limited. These results are in line with additional research suggesting that the Watson test or the fovea sign have got limited diagnostic utility. One test that seems to have reasonable reliability and validity for the wrist appears to be the DRUJ ballottement test . URL : https://doi.org/10.1016/S1836-9553(11)70055-8 Abstract Question: What is the diagnostic value of provocative wrist tests and magnetic resonance imaging (MRI) for suspected wrist ligament injuries? Design: Cross-sectional study. Participants: 105 people presenting to hand clinics with wrist pain and suspected wrist ligament injuries were evaluated prospectively. Outcome measures: The integrity of wrist ligaments was tested with seven provocative tests. The results were compared to the reference standard of arthroscopy. In a subgroup of 55 participants, MRI findings were also compared to arthroscopy. The provocative tests were the scaphoid shift test (SS test), lunotriquetral test (LT test), midcarpal test (MC test), distal radioulnar joint test (DRUJ test), triangular fibrocartilage complex (TFCC) stress test (TFCC test), TFCC stress test with compression (TFCC comp test), and the gripping rotatory impaction test (GRIT). Results: Most provocative tests and MRI findings were of little or no value for diagnosing wrist ligament injuries. Exceptions were the SS test (+ve LR 2.88 and –ve LR 0.28), MC test (+ve LR 2.67) and DRUJ test (–ve LR 0.30), all of which were of mild diagnostic usefulness. MRI was moderately useful for diagnosing TFCC injuries (+ve LR 5.56, –ve LR 0.15), and was mildly useful for diagnosing scapholunate (SL) ligament injuries (+ve LR 4.17, –ve LR 0.32) and lunate cartilage damage (+ve LR 3.67, –ve LR 0.33). Adding MRI to provocative tests improved the accuracy of diagnosis of TFCC injuries slightly (by 13%) and lunate cartilage damage (by 8%). Conclusion: Provocative wrist tests of SL ligament injuries and midcarpal ligament injuries are mildly useful for diagnosing wrist injuries. MRI diagnostic findings of SL ligament injuries, lunate cartilage damage, and TFCC are mildly to moderately useful. MRI slightly improves the diagnosis of TFCC injury and lunate cartilage damage compared to provocative tests alone. 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-analysis of randomized clinical trials on the impact of oral vitamin C supplementation on first-year outcomes in orthopedic patients. Hung, K.-C., et al. (2021) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Vitamin C - CRPS post surgery The meta-analysis investigated the effects of oral vitamin C supplementation on orthopedic patients' recovery, particularly focusing on functional outcomes and complex regional pain syndrome type I (CRPS I). A total of seven randomised controlled trials comprising 1,361 participants, the study found that vitamin C supplementation did not significantly improve functional outcomes or reduce pain severity within the first year post-procedure. However, it notably diminished the risk of developing CRPS I, regardless of the dosage administered. The analysis also highlighted the biochemical properties of vitamin C, such as its role in collagen formation, bone development, and its antioxidant effects on reducing reactive oxygen species, which are implicated in inflammatory and neuropathic pain. Despite the observed benefits concerning CRPS I, the limited number of trials suggests the need for further clinical research to refute these findings. The forest plot below shows the risk of developing CRPS in people taking vitamin C compared to placebo. 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, oral vitamin C supplementation, at a dosage of 500mg to 1g daily for 40-50 days,could significantly reduce the risk of developing Complex Regional Pain Syndrome Type I (CRPS-I) in orthopedic settings. However, it does not appear to improve functional outcomes such as pain severity or range of motion. Keep in mind that we need large scale RCTs to better assess the effect of Vitamin C post-surgery. Considering the low cost and risk associated with this supplement, it may be worth suggesting to our patients. URL : https://doi.org/10.1038/s41598-021-88864-7 Abstract This meta-analysis aimed at investigating the impact of oral vitamin C supplementation on the post-procedural recovery of orthopedic patients, including functional outcomes and complex regional pain syndrome type I (CRPS I). Literature search using the Medline, Cochrane Library, and Embase databases from inception till March 2021 identified seven eligible randomized controlled trials with 1,361 participants. Forest plot revealed no significant difference in the functional outcomes at 6–12 months [standardized mean difference (SMD) = −0.00, 95% CI − 0.19 to 0.18, 467 patients], risk of overall complications (RR = 0.98, 95% CI 0.68 to 1.39, 426 patients), and pain severity at 3–6 months (SMD = − 0.18, 95% CI − 0.49 to 0.12, 486 patients) between patients with and without oral vitamin C supplementation. Pooled analysis showed that vitamin C treatment reduced the risk of CRPS I regardless of dosage (RR = 0.46, 95% CI 0.25 to 0.85, 1143 patients). In conclusion, the current meta-analysis demonstrated that oral vitamin C supplementation may reduce the risk of complex regional pain syndrome type I but did not improve the functional outcomes in orthopedic patients. Nevertheless, because of the small number of trials included in the present study, further large-scale clinical studies are warranted to support our findings. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Guideline on managing thumb ulnar collateral ligament injuries: The british society of surgery for the hand evidence for surgical treatment (BEST) findings and recommendations. Dean, B., et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : ULC injury - management This article discusses the development of guidelines for managing thumb ulnar collateral ligament (UCL) injuries. These guidelines were created by the British Society of Surgery for the Hand by synthesise evidence from systematic reviews on diagnostic and therapeutic approaches for these injuries. The guidelines created recommend that acute UCL injuries of the thumb should be initially assessed through history, physical examination, and radiographs. For patients with significant joint instability, a decision between non-surgical immobilisation and surgery should be made collaboratively within two weeks. The guideline development process involved multiple stakeholders, emphasising the need for future research to enhance the understanding of the natural history, diagnostics, and treatment effectiveness of UCL injuries. 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, clinical examination is crucial for initial assessment of thumb UCL injuries, particularly to identify significant joint laxity. Radiographs may be used to evaluate for any fractures or subluxations. In cases of significant laxity, a shared decision-making process should occur to decide between early surgical intervention or non-surgical immobilization. Despite this recommendation, it appears that early or delayed ucl repair provide similar long term outcomes . If you are interested in more research on thumb ucl, have a look at the whole database . URL : https://doi.org/10.1177/17531934241274612 Abstract The development of the ulnar collateral ligament (UCL) guideline was undertaken in accordance with the British Society for Surgery of the Hand Evidence for Surgical Treatment (BEST) Process Manual, which has been accredited by the National Institute for Health and Care Excellence, UK. This review article serves as a summary of the systematic reviews and the final guideline. The group included two patients, a radiologist, a commissioner, an emergency medicine doctor, hand therapists and hand surgeons. The group’s recommendations are that patients with acute UCL injuries should be assessed with a history, clinical examination and radiographs. Patients without significant joint laxity can be treated non-surgically. Patients with significant joint laxity on clinical examination may be treated with non-surgical joint immobilization or surgical repair and should reach a shared decision with their clinician about the definitive treatment within 2 weeks of presentation. 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 the ulnar fovea sign positive only in foveal tears of the triangular fibrocartilage complex? Choudhury, M. M., Ling, A. A. A. and Yap, R. T. J. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Ulnar sided wrist pain - Fovea sign This was a short report assessing the specificity of the ulnar fovea sign, which is traditionally associated with tears in the distal radioulnar ligaments of the triangular fibrocartilage complex (TFCC). A retrospective review of 73 patients with positive ulnar fovea signs revealed that only 21 had foveal tears upon arthroscopic examination. Instead, many displayed dorsal peripheral tears, suggesting that the ulnar fovea sign can indicate both foveal and dorsal tears. Keep in mind that the patient cohort mostly comprised of young, right-handed males, often affecting the dominant hand, which may not be applicable to all the patients we see in clinical practice. 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 positive ulnar fovea sign, which has been suggested to be associated with foveal tears of the TFCC, is also frequently observed in dorsal peripheral tears. Remember that the number of TFCC "abnormalities" increases with age, and that splinting of the wrist is not the only treatment approach available for this condition . URL : https://doi.org/10.1177/17531934241279921 Abstract A positive ulnar fovea sign is usually considered to be specific for foveal disruption of the distal radioulnar ligaments. A retrospective review was done of 73 patients with a positive ulnar fovea sign. Only 21 patients had a foveal tear on arthroscopic examination. 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

Ultrasonography of the median nerve before removal of anterior locking plates from the distal radius. Hosokawa, T., et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic, Therapeutic Topic : Median nerve morphology - distal radius fracture ORIF This retrospective study assessed the median nerve's positioning and morphology following distal radial fractures open reduction and internal fixation (ORIF). A total of 36 participants were included in the study. The median nerve morphology and position was assessed via ultrasound. The results showed that the median nerve was shifted more radially in the operated arm compared to the healthy arm, showing hypertrophy and flattening at the distal radius. It appears that such positional and morphological change was caused by adhesions and scar around the median nerve. 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, following a distal radial fractures treated with anterior ORIF, the median nerve is likely to be positioned more radially and undergo morphological changes. It is possible that following such changes, traditional treatment approaches including cortisone injection / splinting may be less effective. URL : https://doi.org/10.1177/17531934241280184 Abstract Both forearms of 36 patients who had been treated with an anterior locking plate using the trans-flexor carpi radialis approach for unilateral distal radial fractures were investigated by ultrasonography from the distal end of the radius to 5 cm proximally before plate removal. After fixation of the anterior locking plate, the median nerve was significantly more radially located to the flexor carpi radialis tendon than on the healthy side and showed hypertrophy and flattening at the distal end of the radius. In six cases, the median nerve on the plate side lay radial to the flexor carpi radialis tendon. The median nerve after plate fixation may lie more radially than its original position. Confirming the radial deviation of the median nerve by ultrasonography before removal of the anterior locking plate is useful to prevent the complication of median nerve injury. 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