Anatomical reconstruction of the terminal tendon and lateral band for severe chronic tendon mallet injury. Suzuki, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Chronic mallet finger - Surgical intervention This case series discusses various surgical treatments for chronic tendon mallet injuries. Thes surgical interventions were considered after conservative management, such as splinting or pinning, proved ineffective. The article reviews several techniques, including central slip tenotomy and tendon reconstructions. Central slip tenotomy involves releasing the central slip of the extensor tendon to allow dipj extension. Reconstruction of the terminal tendon is often performed with the palmaris longus and a bone anchor can be placed at the distal phalanx. Overall, eight out of eleven patients recovered with excellent to good dipj extension (less than 10deg of extension lag and less than 20deg of flexion loss. 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, surgery for chronic tendon mallet injuries may be valuable option when conservative management fails. Central slip tenotomy or terminal extensor tendon reconstruction with palmaris longus appear to be common surgical approaches . Remember to screen your patients with bony mallet, as not all of them appear to be amenable to conservative treatment. The concentric circle method appears to be feasible to assess these patients . URL : https://doi.org/10.1016/j.jhsa.2025.04.025 Abstract Purpose: This study aimed to evaluate the clinical outcomes of surgical treatment for chronic mallet injury with severe extension lag using an anatomic reconstruction of the terminal tendon and lateral band with a palmaris longus (PL) tendon graft. Methods: Eleven patients with a mean age of 52 years (range, 24–82 years) who underwent surgical reconstruction for chronic tendon mallet injuries using the PL tendon were included. The harvested PL tendon was either folded longitudinally or divided into two slips. The graft was secured to the distal phalanx using a bone anchor and sutured to the soft tissues and remnants of the original terminal tendon distal to the distal interphalangeal (DIP) joint. Each half-slip tendon was passed under the transverse retinacular ligament and sutured side-to-side to the lateral band at approximately the midpoint of the proximal phalanx. The active range of motion of the affected finger was evaluated before and after surgery, and any complications were recorded. Results: Before surgery, the extension of the DIP joint averaged −49.5° (range, −40° to −60°). The postoperative mean lag of the DIP joint improved to −7.8° (range, −20° to +20°). According to the Miller classification, four patients had excellent results, four had good results, and three had fair results. Two patients who underwent folded-PL tendon grafting developed superficial dorsal skin infections on the little finger that resolved with oral antibiotics or removal of the sutures. Conclusions: Anatomical reconstruction of the terminal tendon and lateral bands using a PL tendon graft yielded satisfactory outcomes in chronic tendon mallet injuries. Dividing the PL tendon into two slips is recommended to reduce the risk of postoperative infection. 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

Neck or shoulder? Establishing consensus for spine screening in patients with shoulder pain: An international modified delphi study. Requejo-Salinas, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Cervical vs shoulder pain - Differentiating This expert opinion study utilised a three‑round modified Delphi process with a panel of 25 experienced clinicians to establish a consensus on a comprehensive, multifactorial screening protocol for shoulder and cervical spine disorders. Drawing on contemporary evidence, biomechanical, and neurophysiological concepts, the authors integrated patient history, pain distribution, and physical tests in a potential screening approach. In particular, previous history of neck pain, the presence of numbness in the upper limb, limitations in range of movement of the cervical spine, a positive Spurling test, and modification of upper limb symptoms with cervical positions or mobilisations increases the probability of the presentation being originating from the cervical spine. 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 Spurling test, limitations in cervical range of movement, modification and/or reproduction of upper limb pain with palpation, sustained position, or symptom modification procedure at the cervical spine help in the differentiation between cervical and peripheral origin of symptoms. All these suggestions seem to be in line with previous papers suggesting that sustained end range positions of the neck should be trialed to differentiate between cervical and peripheral origin of symptoms . Remember that if people present upper limb pain alongside numbness or neuropathic pain features, you should probably complete a neurological exam, which would include myotome testing , light touch assessment , deep tendon reflexes, and pinprick assessment . URL : https://doi.org/10.1093/ptj/pzae133 Abstract Objective: There is no established consensus for screening the spine in patients with shoulder pain. The aim of this study was to explore the role of the spine in shoulder pain and generate a set of recommendations for assessing the potential involvement of the spine in patients with shoulder pain. Methods: A modified Delphi study was conducted through use of an international shoulder physical therapist’s expert panel. Three domains (clinical reasoning, history, and physical examination) were evaluated using a Likert scale, with consensus defined as Aiken Validity Index ≥0.7. Results: Twenty-two physical therapists participated. Consensus was reached on a total of 30 items: clinical reasoning ( n  = 9), history ( n  = 13), and physical examination ( n  = 8). The statement that spinal and shoulder disorders can coexist, sometimes influencing each other and at other times remaining independent issues, along with the concept of radiating pain as an explanatory phenomenon for the spine contribution to shoulder pain, achieved the highest degree of consensus. Conclusion: International physical therapists shoulder experts reached consensus on key aspects when screening the spine in people with shoulder pain, including consideration of the distal location of symptoms relative to the shoulder, the presence or previous history of neck pain, the changes in symptoms related to neck movements, and the presence of neuropathic-like symptoms. They also acknowledged the importance of assessing active cervical or cervicothoracic movements and the usefulness of the Spurling test and symptom modification techniques applied to the spine. Impact: This consensus holds implications for both clinical practice and research. In research, applying these considerations may ensure more homogenous samples, thereby enhancing the investigation of outcomes in shoulder pain populations. In clinical practice, determining the need for spine screening and its potential impact on prognosis and management could significantly influence patient care. 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

Changes in hand function and health state utility after cubital tunnel release using the united kingdom hand registry. Teunissen, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Cubital tunnel surgery - Symptomatic relief This prospective study assessed outcomes following cubital tunnel surgery using data from the UK Hand Registry. The researchers focused on improvements in quality of life and hand symptoms. More than 500 participants were included and the surgery performed involved either decompression alone or decompression plus transposition of the ulnar nerve. The results showed that symptom relief was significant at two months, however, after this, no significant changes were noted. In terms of health related quality of life, the surgery did not appear to provide significant benefits and based on these criteria, it would not be justified from a health economics point of view. 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, cubital tunnel surgery appear to provide some immediate improvements in hand symptoms (2 months) after which no major changes are obvious (6 months). It is important to remember that this surgery may be completed to avoid long term intrinsic strength impairments. Thus, people who wait for surgery for longer periods of time tend to present with worse outcomes . Pre-surgical consultations may be beneficial in these people to set their expectations . URL : https://doi.org/10.1177/17531934241275487 Abstract This study aimed to analyse and contrast changes in health-related quality of life (HR-QoL) and hand symptoms in the first 6 months after surgical treatment for primary cubital tunnel syndrome. Data originated from the United Kingdom Hand Registry. HR-QoL was assessed using the generic EuroQol five-dimensional assessment tool (EQ-5D-5L) and hand symptoms using the Patient Evaluation Measure (PEM). In total, 281 patients were included in the statistical analysis. Cubital tunnel release resulted in clinically relevant relief of hand symptoms. However, no improvement in HR-QoL was detected by the EQ-5D-5L. As a result, current health economic models, such as those used by the National Institute for Health Care Excellence (NICE) in the UK, might conclude that cubital tunnel release is not cost-effective. This discrepancy requires exploration, and hand-specific preference-based measures might be needed for value-based healthcare in hand surgery. 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

Postoperative management of total elbow arthroplasty: Results of a European survey among orthopedic surgeons. Dam, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Total elbow replacements - Loading This survey assessed the postoperative management of Total Elbow Arthroplasty (TEA) among 54 orthopedic surgeons across 17 countries. Key findings revealed differences in immobilisation duration, activity restrictions, and protocols for primary versus revision surgeries. Nearly half of the respondents noted variations between primary and revision TEAs, with more restrictive measures often applied post-revision surgery. The research underscores the lack of consensus among surgeons, potentially contributing to low TEA survival rates due to complications like loosening, possibly linked to overloading. Seventy percent of the surgeons suggested a maximum elbow loading of 1-5 kgs and 10% deemed 1 to 10 kg loading being acceptable. 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 significant variability in terms of recommendations for Total Elbow Arthroplasty (TEA) loading. The large majority of surgeon suggest a maximum loading of 1-5 kg with the most adventurous suggesting that loading can reach 10 kg. Overall the survival rate of a TEA is 90% at 10 years . However, for males, it appears that TEA survival is significant lower, with a 50% chance of needing a revision after 10 years . As for the majority of upper limb presentations, those patients with a TEA and lower social determinants of health, tend to have worse outcomes . URL : https://doi.org/10.1371/journal.pone.0277662 Abstract Background: The number of complications after total elbow arthroplasty (TEA) is high and survival rates are low compared to hip and knee arthroplasties. The most common reason for revision is aseptic loosening, which might be caused by overloading of the elbow. In an attempt to lower failure rates, current clinical practice is to restrict activities for patients with a TEA. However, postoperative management of TEA is a poorly investigated topic, as no evidence-based clinical guidelines exist and the aftercare is often surgeon-based. In this study we evaluated the current postoperative management of TEA among orthopedic surgeons. Methods: An online survey of 30 questions was sent to 635 members of the European Society for Surgery of the Shoulder and the Elbow (SECEC/ESSSE), about 10% (n = ± 64) of whom are considered dedicated elbow specialists. The questions were on characteristics of the surgeon and on the surgeon’s preferred postoperative management, including items to be assessed on length of immobilization, amount of weight bearing and axial loading, instructions on lifelong activities, physiotherapy, and postoperative evaluation of the elbow. Results: The survey was completed by 54 dedicated elbow specialists from 17 different countries. Postoperative immobilization of the elbow was advised by half of respondents when using the triceps-sparing approach (52%), and even more with the triceps-detaching approach (65%). Postoperative passive movement of the elbow was allowed in the triceps-sparing approach (91%) and in the triceps-detaching approach (87%). Most respondents gave recommendations on weight bearing (91%) or axial loading (76%) by the affected elbow, but the specification shows significant variation. Conclusion: The results from this survey demonstrate a wide variation in postoperative care of TEA. The lack of consensus in combination with low survival rates stresses the need for clinical guidelines. Further research should focus on creating these guidelines to improve follow-up care for TEA. 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

Zone-specific pitfalls in flexor tendon rehabilitation: Management and prevention. Chinchalkar, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Flexors repair - How to avoid adhesions This is an expert opinion on flexor tendon repair and rehabilitation. The authors highlight the complexity of these injuries and potential for functional impairment due to their intricate anatomy. Adhesions are one of the primary complications, which can hinder tendon gliding and lead to limited finger mobility. Early mobilisation, selective motion blocking splints, and specialised exercises (see figures and ideas below) are critical for restoring function and minimising these issues. Additionally, the article highlights specific complications like the Quadriga phenomenon (gapping of the tendon repair with lag of affected, or adhesion of affect side limiting finger flexion across affected and unaffected fingers), where excessive shortening or adhesions in one digit restricts movement in adjacent fingers, and Lumbrical plus (FDP avulsion/repair failure distal to lumbricals leading to pipj extension during finger flexion) causing paradoxical joint extension during flexion. Once established, this issues can necessitate surgical intervention, however, rehab has the potential to prevent them. ZONE I AND II - SCRATCH YOUR INDEX FINGER! ZONE III - GET THAT HOOK FIST GOING! ZONE IV and V - I AM AN INDEPENDENT FINGER! 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, early mobilisation, splinting, and exercises have all got strong evidence in their support following flexors repair. Early mobilisation (Level 1-2) is supported by numerous studies, including randomised controlled trials, showing effectiveness in preventing adhesion and promoting recovery. Motion-blocking splints (Level 1-2) have also large evidence from clinical studies supporting their protective role in tendon healing. Exercises as well (Level 1-2) are supported by strong evidence from both clinical and experimental studies. Zone-specific rehab protocols have varying level of evidence and there are no specific protocol for all zones. Remember that flexor tendon outcomes tend to be worse in people with lower social determinants of health and that Zone I and II tend to be at greater risk . Hence, we should monitor these people more closely. If you are interested in the topic, have a look at the entire dataset, we have lots of synopses and case reports! URL : https://doi.org/10.1177/17531934241265579 Abstract Despite significant advancements in flexor tendon repair techniques and rehabilitation strategies, achieving complete restoration of digital motion remains a formidable challenge. The most prevalent complications associated with tendon repair are the development of tendon adhesions and joint contractures. Left unaddressed, these complications can further lead to secondary pathomechanical changes, resulting in fixed deformities significantly affecting hand function. This review of zone-specific considerations in flexor tendon rehabilitation provides an in-depth analysis of the dynamics of tendon motion after repair and strategies to minimize common secondary complications. 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

Surgical treatments of post-traumatic elbow stiffness: A systematic review and meta-analysis. Khorram, et al. (2025) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Post-traumatic elbow stiffness - Surgery This systematic review assessed the impact of surgical interventions have on elbow range of movement, pain, function, and complications for people with post-traumatic elbow stiffness. A total of 99 studies were included, with the majority being retrospective studies. The interventions analysed included arthroscopy, open arthrolysis with or without external fixation. The results showed that all interventions provided with statistically and clinically relevant improvement in range of movement, pain, and function. Complications were around 3%, however, open arthrolysis with external fixation had a much greater risk of nerve injury (9%) compared to open arthrolysis alone or arthroscopy. Figure 2. Forest plot of Range of Motion (ROM) improvement Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, surgical interventions such as arthroscopy or open arthrolysis seem to have a large statistically significant and clinically relevant effect on improving pain, range of movement, and function in people with post-traumatic elbow stiffness . Those people undergoing external fixation seem to have a much greater risk of having a nerve lesion and should therefore be followed more closely. If you would like to determine which of your patients are more likely to benefit from this surgery, have a look at this prediction model . Have a look at the entire database on the topic! URL : https://doi.org/10.1016/j.jse.2025.05.004 Abstract Background: Surgeons may choose between open vs. arthroscopic arthrolysis to address a post-traumatic elbow stiffness (PTES) based on their proficiency in elbow arthroscopy, the ulnar nerve condition, the presence and location of heterotopic ossification, the degree of contracture, and the extent of articular surface damage. This systematic review and meta-analysis aims to compare the effectiveness, range of motion (ROM), and complication rates between open and arthroscopic release in patients with PTES. Methods: The Preferred Reporting Item for Systematic Reviews and Meta-Analyses guidelines were utilized to conduct a systematic review and meta-analysis on surgical treatment for PTES. Comprehensive search was conducted in PubMed, Web of Sciences, Medline, and Scopus from their inception to January 2024. A total of 3,278 records were screened, of which 99 studies on the adult population were included. Outcome variables were changes in the ROM, visual analog scale score, Mayo Elbow Performance Index, and complication rate. Surgical techniques were grouped as arthroscopic, open arthrolysis, and open arthrolysis with external fixator. Results: ROM, visual analog scale, and Mayo Elbow Performance Index improved in patients with PTES after all surgical techniques. Open arthrolysis with external fixation had the highest ROM improvement but also the highest rate of nerve injury. Other variables did not show statistically significant differences among the modalities. Conclusion: Since the overall results of open and arthroscopic arthrolysis for PTES are comparable, the surgeon's expertise and the patient's condition are more important factors to consider when choosing a surgical technique over another. 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

Volar plate repair for chronic injury. Buldo-Licciardi, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Chronic volar plate injury - Surgery This retrospective study evaluates the long-term outcomes of volar plate repair for chronic finger injuries, focusing on patient satisfaction, pain relief, and joint mobility. A total of ten patients with an average of 9 years (range 10 months to 30 years) between injury and surgery were included. Results indicated high levels of satisfaction, with nine patients reporting "extremely satisfied" and one "satisfied". Pain was completely alleviated in all participants, and significant improvements were observed in joint function. Pre-surgery, pipj hyperextension ranged from 15 to 60 degrees. Post-surgery, six patients achieved normal extension (0–3 degrees), three had minor flexion contractures (5 to 20 degrees), and one experienced a subsequent injury. Radiographic analysis showed minimal degenerative changes in four patients (not all patients agreed to a follow up x-ray). 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, volar plate repair for chronic finger injuries may be useful in reducing hyperextension, pain, and improve patient's satisfaction . If you would like to know more about the pipj and their management following injury, have a look at the entire database . URL : https://doi.org/10.1016/j.jhsg.2025.100776 Abstract Purpose: The aim of this study was to assess the long-term outcomes of volar plate repair for chronic injury. Methods:Patients who underwent volar plate repair for chronic instability more than 6 months following the initial injury were included. A minimum follow-up of 2 years from time of surgery was required. Outcome measures included range of motion, the upper extremity QuickDASH (Disabilities of the Arm, Shoulder, and Hand) score, return to work, return to sport, and plain radiographs. Results:Ten patients were included. The mean time from injury to repair was 9 years, ranging from 10 months to 30 years. The digits involved included one thumb, four ring fingers, and five small fingers. Nine reported being extremely satisfied, and one reported being satisfied with their outcome at final follow-up. Nine of ten reported pain as their initial symptom, and none reported pain at final follow-up. Prior to surgery, all patients had proximal interphalangeal hyperextension ranging from 15° to 60°, three of which were classified as swan neck deformities. At final follow-up, nine patients had extension ranging from 0° to 3°. In addition, one patient had a hyperextension of 25°, although this patient had a subsequent injury. All had full flexion of their proximal interphalangeal joint at final follow-up. The three subjects who reported occupational impairment prior to surgery had no functional limitations following surgery. Two subjects whose injuries led to sport limitations reported returning to their preinjury level of sport. Conclusions: Volar plate repair for chronic injury resulted in successful outcomes based on satisfaction, QuickDASH score, physical examination, and radiographic images. These benefits were noted in a repairs performed decades after 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

Prognostic factors associated with failure of total elbow arthroplasty. Hamoodi et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic : Total elbow arthroplasty - Failure risk factors This systematic review and meta-analysis assessed prognostic factors associated with failure requiring revision surgery following Total Elbow Arthroplasty (TEA). More than 30,000 patients with TEA across 19 studies were included. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was utilised to assess the overall quality of evidence. The results showed that there was low or very low quality of evidence suggesting that being male and having had TEA following trauma increased the risk of TEA failure. 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, Total Elbow Arthroplasty (TEA) failures may be more likely in males and when TEA was implemented following trauma . The findings from this review appear to be in line with a previous retrospective study showing that TEA following trauma is associate with more complications, including elbow stiffness . Other factors that appear to negatively influence TEA outcomes include lower social determinants of health . For a deep dive on TEA, have a look at the full database . URL : https://doi.org/10.1302/2046-3758.135.BJR-2023-0281.R1 Abstract Aims: The aims of this study were to identify and evaluate the current literature examining the prognostic factors which are associated with failure of total elbow arthroplasty (TEA). Methods: Electronic literature searches were conducted using MEDLINE, Embase, PubMed, and Cochrane. All studies reporting prognostic estimates for factors associated with the revision of a primary TEA were included. The risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool, and the quality of evidence was assessed using the modified Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Due to low quality of the evidence and the heterogeneous nature of the studies, a narrative synthesis was used. Results: A total of 19 studies met the inclusion criteria, investigating 28 possible prognostic factors. Most QUIPS domains (84%) were rated as moderate to high risk of bias. The quality of the evidence was low or very low for all prognostic factors. In low-quality evidence, prognostic factors with consistent associations with failure of TEA in more than one study were: the sequelae of trauma leading to TEA, either independently or combined with acute trauma, and male sex. Several other studies investigating sex reported no association. The evidence for other factors was of very low quality and mostly involved exploratory studies. Conclusion: The current evidence investigating the prognostic factors associated with failure of TEA is of low or very low quality, and studies generally have a moderate to high risk of bias. Prognostic factors are subject to uncertainty, should be interpreted with caution, and are of little clinical value. Higher-quality evidence is required to determine robust prognostic factors for failure of TEA. 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

Brachial artery injury as a complication of closed elbow dislocation, and disguised as compartment syndrome. Khakbaz, et al. (2023) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic Topic : Simple dislocation - Vascular lesions A 53 years old patient presented to ED following an elbow dislocation due to a FOOSH, which spontaneously reduced after standing up from the fall. The patient reported extreme pain, radial artery pulselessness, forearm edema, hand numbness, and no clear fracture signs on X-rays, though CT revealed small non-displaced radial and medial condile fractures. The initial diagnosis was acute compartment syndrome (ACS). Surgical intervention included fasciotomy for suspected ACS. Unfortunately, during fasciotomy, the surgeon realised that there was no increase pressure within the forearm compartment, but there was evidence of a ruptured brachial artery. A repair was attempted but the patient was pulseless on the radial side. They underwent further vascular surgery during which a lower limb vein was utilised for an autologous graft. At two years follow-up, full extension of the elbow was still impaired with ongoing pain at the surgical site and radial hand numbness. 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, despite neurovascular traumatic events being rare following simple elbow dislocations, these should be kept into consideration as differential diagnoses. Another pathology that needs to be considered although rare, is acute compartment syndrome that can be the result of trauma or present with an insidious onset . Ultrasound imaging and x-rays are usually a good place to start for differential diagnoses. If you would like to read about other interesting case reports, have a look at the whole database . URL : https://doi.org/10.1016/j.xrrt.2023.05.010 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

Association between sedentary behavior and dementia: A systematic review and meta-analysis of cohort studies. Luo, et al. (2025) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic Topic : Sedentary behaviour - Dementia This systematic review and meta-analysis assessed the relationship between sedentary behavior and the risk of developing dementia. Ten cohort study for a total of more than 2,500,000 participants were included. Of these participants, 1% presented with dementia. Sedentary activity was also divided in watching TV vs utilising a computer. The results demonstrated that sedentary time spent watching television was linked to a higher risk of dementia (low quality evidence), while sedentary behavior due to computer usage showed no significant association with dementia (very low quality of evidence). (a) Meta-analysis of the association between sedentary behavior (defined by TV viewing time) and dementia (b) Meta-analysis of the association between sedentary behavior (defined by computer using time) and dementia (c) Meta-analysis of the association between sedentary behavior (defined by other methods) and dementia. 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, not all sedentary behavior has the same effect on brain health. In particular, sedentary behavior associated with computer use does not appear to be as detrimental as watching TV . Overall, we know that physical activity is extremely useful for our patients well-being , however, based on this paper, sedentary activity associated with cognitive load (e.g. computer use) may be beneficial for their brain health too. URL : https://doi.org/10.1186/s12888-025-06887-0 Abstract Objective: This study aimed to assess the association between sedentary behavior (SB) and dementia among the general adult population. Methods: We queried PubMed, Web of Science, Embase, and Cochrane Library from their inception to November 3, 2024. Two authors independently extracted the data from included studies, including hazard ratios (HRs) and their 95% confidence intervals (CIs), to assess the risk of dementia among individuals with SB. The quality of included studies was assessed using the Newcastle–Ottawa Scale. We used a random effects model if I2 > 50% and p < 0.10; otherwise, a fixed-effect model was used. In addition, we assessed publication bias by funnel plot, and performed leave-one-out sensitivity analysis. Results: We included ten cohort studies, nine of which were of high quality. Our analysis demonstrated an increased risk of dementia among individuals with SB (pooled HRs, 1.17; 95% CIs, 1.06–1.29). Individuals with high sedentary time (ST), defined by TV viewing, demonstrated a 31% increased risk of dementia compared to those with low ST (pooled HRs, 1.31; 95% CIs, 1.25–1.37). No significantly increased risk for dementia was observed among individuals with high computer usage time (pooled HRs, 0.89; 95% CIs, 0.73–1.09). However, when SB was defined by other methods, individuals with high ST demonstrated a 33% increased risk of dementia compared to those with low ST (pooled HRs, 1.33; 95% CIs, 1.25–1.42). Conclusion: SB increases the risk of dementia, but SB defined by computer usage time has not shown this association. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The concentric circles method to define and assess anterior subluxation in bony mallet finger. Lee, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Mallet finger - Diagnostic circles This study assessed the new circle method against other in assessing anterior subluxation of the distal interphalangeal joint using radiographs in bony mallets. Three techniques were compared: visual inspection, malalignment method (anterior shift of the distal phalanx axis compared to proximal phalanx), and a new concentric circles method. The research involves 114 bony mallets and the diagnostic outcome of inexperience radiologists were compared to two senior hand surgeons. The results showed that the concentric circles method shows the highest agreement with expert assessments, demonstrating its reliability and objectivity. This method simplifies evaluating joint congruency into a reproducible process, by pacing a circle through the proximal phalanx head and a circle aligned with the distal phalanx articular surface (see picture 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, the concentric circles method appears to be valid and reliable way of assessing anterior subluxation of the distal interphalangeal joint in bony mallets. This may be a useful diagnostic approach in those borderline cases where the fracture involves more than 1/3 of the articular cartilage and follow up x-rays are required. Keep in mind that if there is no anterior subluxation of the distal phalanx in bony mallets, conservative management or pinning obtain similar outcomes . If you are interested in the management of mallet fingers, have a look at the entire database on the topic . URL : https://doi.org/10.1177/17531934251348121 Abstract We have described and validated the concentric circles method for assessing anterior subluxation in the bony mallet finger. We retrospectively analysed 114 radiographs from cases of bony mallet finger assessed by four hand surgeons and one radiologist using three approaches: subjective visual inspection, the concentric circles method and the malalignment method. The concentric circles method defines subluxation as a disruption of the normal concentric annulus between the middle phalangeal head and distal phalangeal articular surface on true lateral radiographs. It showed improved accuracy (94%), higher sensitivity (91%) and specificity (97%) compared with the other methods, with excellent inter- and intra-observer reliabilities. 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 A 53 years old patient presented to ED following an elbow dislocation due to a FOOSH, which spontaneously reduced after standing up from the fall. The patient reported extreme pain, radial artery pulselessness, forearm edema, hand numbness, and no clear fracture signs on X-rays, though CT revealed small non-displaced radial and medial condile fractures (see images below). What is it?