Nail bed injury repair: Nail plate replacement versus non-replacement. Rock, et al. (2024) Level of Evidence: 2b Follow recommendation: 👍👍👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Nail plate adults - Replace or discard This randomised controlled study investigated whether replacing the nail plate after nail bed repair affects outcomes such as nail regrowth, cosmetic appearance, and patient satisfaction. A total of 50 participants were randomised to: replacing the nail plate or using substitutes like foil or silicone. The results showed no significant difference between groups in terms of nail regrowth, cosmesis, or patient satisfaction. Both approaches yielded similar outcomes, suggesting that replacing the nail plate may not offer additional 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, replacing the nail plate with substitutes like foil or silicone does not appear to provide significant benefits in terms of nail regrowth, cosmetic appearance, and patient satisfaction. This seems to be in line with a previous retrospective study in children . URL : https://pmc.ncbi.nlm.nih.gov/articles/PMC11367160/ Abstract Background: Although nail bed injuries are common, there is no consensus on the proper course of treatment in regard to nail plate replacement. Nail plate replacement risks infection and injury of the germinal matrix. It is our hypothesis that functional and cosmetic outcomes of the nail will not differ by nail plate replacement following nail bed repair. Methods: This is a single institution, prospective, randomized control study comparing nail plate replacement versus non-replacement in patients undergoing nail bed repair. Primary outcome included nail growth and cosmesis using the Zook classification system. Secondary outcomes were pain, functional limitation, and patient satisfaction. Statistical significance was set at P < .05. Results: Fifty patients were enrolled, 26 (52%) randomized to the non-replacement group and 24 (48%) to the replacement group. All patients who followed up had nail growth by 4 months after nail bed repair (N = 28). In the non-replacement group 4 patients continued to have pain in the affected nail bed compared with 2 patients in the replacement group (P = .66). One patient in each group reported continued functional limitation related to nail pain (P = 1.00). Patient satisfaction was not statistically different between the groups (P = 1.00). As a result of patient follow- up, we have been able to score 17 patients via the Zook criteria. In the non-replacement group, 3 nails were scored as excellent, 3 very good, 3 good, 1 fair, and 2 poor. In the replacement group, the nail was classified as excellent in 4 patients and very good in 1 patient. There was no difference in the likelihood of these outcomes with regard to treatment group (P = .18). There was moderate agreement between patient satisfaction and the Zook criteria scoring (κ = .45, 95% CI: –0.15-1.00). Conclusions: Statistical and clinical differences were not identified in regard to cosmesis, pain, functional use of the hand, or patient satisfaction. There are established risks involved in nail plate replacement such as infection and injury to the germinal matrix. If outcomes are not different based on nail plate replacement following nail bed repair, non- replacement may be the preferable treatment option so as to avoid these 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

Effectiveness of nail bed repair in children with or without replacing the fingernail: Ninja multicentre randomized clinical trial. Jain, et al. (2023) Level of Evidence: 1b- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Nailbed injury children - Replacement This randomised controlled trial named NINJA (Nail bed INJury Analysis) compared two methods for managing nail bed injuries in children: replacing the nail plate versus discarding it after repair. The study involved 440 participants across multiple centers and aimed to assess the effectiveness, safety, and cost-efficiency of these approaches. Both methods resulted in similar satisfaction regarding nail appearance and function. However, discarding the nail plate was associated with fewer complications, such as pain and was also found to be more cost-effective. Importantly, there were no statistical significant differences in infection rates between the two groups. The researchers concluded that discarding the nail plate is generally preferable unless specific clinical circumstances, such as significant alignment issues or reconstructive needs, dictate otherwise. 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, nail replacement in children does not present with benefits compared to discarding the nail in most instances . This seems to be in line with previous evidence from a retrospective pediatric study and a randomised controlled trial in adults . URL : https://doi.org/10.1093/bjs/znad031 Abstract Background: Surgery for nail bed injuries in children is common. One of the key surgical decisions is whether to replace the nail plate following nail bed repair. The aim of this RCT was to assess the clinical effectiveness and cost-effectiveness of nail bed repair with fingernail replacement/substitution compared with repair without fingernail replacement. Methods: A two-arm 1 : 1 parallel-group open multicentre superiority RCT was performed across 20 secondary-care hospitals in the UK. The co-primary outcomes were surgical-site infection at around 7 days after surgery and cosmetic appearance summary score at a minimum of 4 months. Results: Some 451 children presenting with a suspected nail bed injury were recruited between July 2018 and July 2019; 224 were allocated to the nail-discarded arm, and 227 to the nail-replaced arm. There was no difference in the number of surgical-site infections at around 7 days between the two interventions or in cosmetic appearance. The mean total healthcare cost over the 4 months after surgery was €84 (95 per cent c.i. 34 to 140) lower for the nail-discarded arm than the nail-replaced arm (P &lt; 0.001). Conclusion: After nail bed repair, discarding the fingernail was associated with similar rates of infection and cosmesis ratings as replacement of the finger nail, but was cost saving. 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’s new in wound healing: Treatment advances and microbial insights. Beraja, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Wound debridement - Mechanical This narrative review highlights rapid advancements in wound healing therapies, emphasising the importance of wound microbiology and adopting innovative approaches to improve patient outcomes. Key therapies include exosomes, which show promise for burns and ulcers but require further standardisation; low-level light therapy, effective with specific wavelengths and settings; electrical stimulation therapy, demonstrated to significantly reduce ulcer sise and pain; and extracorporeal shock wave therapy, suggested to accelerate healing in burns and diabetic foot ulcers. The authors underscore the importance of wound bed preparation for healing and management of infections. 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, wound bed preparation appears to be an important aspect of wound healing. Mechanical debridement, amongst other more sofisticated options may reduce the likelihood of infection and speed up recovery. Other strategies that appear to be useful in improving wound healing include the assumption of Vitamin C and light aerobic exercise . Whilst it appears that mental stress impairs healing , there is limited evidence suggesting that relaxation approaches can improve wound healing . URL : https://doi.org/10.1007/s40257-025-00953-9 Abstract Recent advancements in wound healing are reshaping clinical practice by integrating dermatology, cutaneous microbiome research, and technology. This article discusses new diagnostic tools, such as imaging devices and microbial composition analysis, that enhance our understanding of wound environments. It highlights the importance of wound bed preparation and explores innovative treatment methods for optimal wound healing, including debridement techniques like ultrasound-assisted methods, hydrosurgery, and larval therapy. The evolution of wound management is further illustrated through the use of cellular and acellular matrix products and cellular therapies involving whole blood products. We also present the latest insights on the wound microbiome and antimicrobial treatments, including advanced dressings and antibiofilm surfactants. Finally, the potential of gene therapy for complex conditions like epidermolysis bullosa is discussed as a promising model for advancing wound healing. This review synthesizes current research to improve dermatological practices and patient outcomes in wound 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

The effect of manual lymphatic drainage on intraneural edema of the median nerve in patients with carpal tunnel syndrome: A randomized controlled trial. Kablan, et al. (2025) Level of Evidence : 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Carpal tunnel syndrome - Lymphatic drainage This study assessed the effect of Manual Lymphatic Drainage (MLD) on patients with Chronic Carpal Tunnel Syndrome (CTS). The hypothesis was that MLD could improve median nerve function by reducing intraneural edema. A total of 27 participants with CTS lasting at least six months with evidence of nerve conduction impairments, were included. Their median nerve cross-sectional area, conduction velocity, and other clinical outcomes were assessed before and after a series of MLD sessions. One arm underwent the experimental MLD whilst the contralateral (control arm) underwent sham MLD. The results showed significant improvements in the cross-sectional area and conduction velocity of the median nerve, across both groups. There was a time and group interaction suggesting that MLD may have an effect on these outcomes. However, if you look at the graphs below, the changes are likely to be clinically irrelevant between groups. suggesting that MLD may contribute to preventing nerve damage by alleviating intraneural edema. 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, Manual Lymphatic Drainage (MLD) may has a small effect on median nerve cross sectional area and conduction velocity in people with Carpal Tunnel Syndrome (CTS) . Based on the current best evidence, it appears that surgery, splinting and exercising, and steroid injections are the best treatments available . Considering that CSI injections have a similar effect to splinting and exercise, this last option could be trialed first . URL : https://doi.org/10.1016/j.jht.2024.10.002 Abstract Background: Intraneural edema is an important factor in the pathophysiology of carpal tunnel syndrome (CTS). Manual Lymphatic Drainage (MLD) is a manual treatment widely used to treat edema in a variety of conditions. Purpose: This study aimed to evaluate the effect of MLD on intraneural edema of the median nerve in CTS patients, as well as its impact on symptom severity and hand function. Study Design: Randomized controlled study. Methods: Twenty-seven patients (aged 48.9 ± 9.9) with mild-to-moderate bilateral CTS were recruited for the study. One hand of each subject was allocated to the experimental group and the other hand in the control group randomly. The experimental group underwent MLD, myofascial release (MFR) therapy and conventional physiotherapy (CP). The control group received sham MLD, MFR and CP. Interventions were performed 2 days a week for 6 weeks. The distal motor latency (DML), motor nerve (MNCV), and sensory nerve (SNCV) conduction velocity of the median nerve were evaluated using electrodiagnostic techniques. As secondary evaluations, grip strength, pressure pain threshold, pain intensity, symptom severity, and hand functions were assessed. The cross-sectional area (CSA) of the median nerve was measured by ultrasound. All assessments were performed at baseline and 6 weeks after intervention. Results: According to the analysis of a two-way repeated measures of ANOVA, the experimental group showed greater improvement in CSA (p < 0.001; η2 = 0.510), DML (p < 0.001; η2 = 0.549), sensory (p < 0.001; η2 = 0.408), and motor conduction velocity (p < 0.001; η2 = 0.419) of the median nerve than the control group. There was no significant difference between the groups in the secondary evaluation results (p > 0.05). Conclusion: MLD may contribute to symptom relief in CTS by reducing intraneural edema in the median nerve. 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

Rehabilitation after total or hemi elbow arthroplasty: A systematic review. Hesseberg, et al. (2024) Level of Evidence: 3a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Total and hemi elbow arthroplasty - Rehabilitation This was a systematic review assessing effectiveness of rehabilitation programs following total or hemi elbow arthroplasty. Only one study was included, which suggested that early mobilisation and adherence to prescribed rehabilitation programs could enhance recovery, with patients often resuming daily activities within a few months. Despite this single study suggesting the potential usefulness of rehabilitation following elbow replacements, there is currently a high degree of uncertainty on its effect size. 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, rehabilitation following total or hemi elbow arthroplasty may have some benefit. What we know is that we can provide patients with education regarding their new joint. In particular, it appears that both total and hemi elbow arthroplasty have an acceptable life expectancy , despite males being at higher risk or requiring an earlier revision . When you see patients with an elbow replacement, keep in mind that those with greater social deprivation, are also at higher risk of complications , hence the need to more closely monitoring their recovery. URL : https://doi.org/10.52965/001c.115597 Abstract Introduction: Total and hemi elbow arthroplasty (TEA/HEA) are relatively uncommon orthopedic procedures, but physiotherapists are involved in both pre- and postoperative treatment of people who undergo TEA/HEA. The purpose of this article is to summarize existing knowledge about the effects of rehabilitation versus standard care after total and hemi elbow arthroplasty (TEA/HEA). Methods: A systematic literature review was conducted searching Ovid MEDLINE ®, SweMED+, Cochrane, Embase, AMED and PEDro. “The Preferred Reporting Items for Systematic Review and Meta-Analysis” was followed. Results: No one has studied the effects of rehabilitation after TEA/HEA. The aim of the only study included was to assess the safety and length of hospital stay (LOS) after omission of casting, start of early mobilization and implementation of functional discharge criteria. Results show that the non-casting cohort had a shorter mean LOS (5.4 days) than the index cohort (6.2 days). The cohort with functional discharge criteria had a shorter mean LOS (3.8 days) than the cohort without functional discharge (5.4 days). Conclusion: Effects of rehabilitation components or programs after TEA/HEA are still unknown. It is important to focus on the lack of evidence in this field, and plan for more studies to come. 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

Pediatric nailbed repair study. Miranda, et al. (2012) Level of Evidence : 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Nailbed injury - Replacement in children This was a retrospective study assessing complications following nailbed repair techniques in pediatric patients. In particular, the study compared nail replacement/foil placement to discarding the nail. A total of 111 preschoolers (age 5 ± 0.5 years) were included. Results indicated that nail replacement/foil placement significantly increased complications (18% vs 5%). Delayed healing occurred in 12% of the nail replacements/foil placement compared to 3%. Similarly, infection rates were higher in the nail replacement/foil placement (8%) compared to no replacement (0%). The reason may be due to difficulty sterilising the nail replacement and the possibility of trapping microorganisms when placing a foil. 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, nail replacement is associated with higher complication rates (18% vs 5%). Hence, if one of your pediatric patients presents with a nail replacement following nail bed repair, you should remove the replacement if this is viable. URL : https://doi.org/10.1097/PRS.0b013e31823af1bb 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

Prevalence of residual limb pain and neuromas after upper extremity amputation: A systematic review and meta-analysis. List, et al. (2025) Level of Evidence: 3a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Symptoms prevalence study Topic : Neuromas - Upper limb amputations This systematic review and meta-analysis assessed the prevalence of residual limb pain (RLP) and symptomatic neuromas after upper extremity amputation. Sixteen studies were included for a total of 1,602 patients being screened for RLP and 215 for symptomatic neuromas. The pooled prevalence of RLP was found to be 60% (95% CI: 51-67). In contrast, neuromas were less common with a 20% (95% CI: 11-40) prevalence. One of the limitation of the study was the high heterogeneity among studies, and a lack of data on sex and upper limb amputation level. Figure 2. Forest plot prevalence of residual limb pain (RLP). Figure 3. Forest plot prevalence of symptomatic neuroma. 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 high prevalence of residual limb pain (RLP) at 60% following an upper limb amputation. Prevalence of neuromas is also high with 1 in 5 people presenting with this painful condition. It therefore appears that postoperative pain management is crucial to prevent chronic RLP. It is possible that managing pain well post-operatively and establishing a light aerobic conditioning program may help with symptoms. URL : https://doi.org/10.1177/17531934251345368 Abstract Residual limb pain (RLP) and symptomatic neuromas are common complications of upper extremity amputation. There is disagreement in the literature about their true prevalence. This systematic review and meta-analysis of the prevalence of RLP and symptomatic neuroma after upper extremity amputation identified relevant studies published between 2000 and 2022 in PubMed, Cochrane and Embase. Random-effects meta-analyses of proportions were performed to determine the prevalence of RLP and symptomatic neuromas. Subgroups were identified and analysed. For RLP, the pooled prevalence was 58% (95% CI: 46 to 68). For symptomatic neuromas, the pooled prevalence was 22% (95% CI: 11 to 40). Residual limb pain was reported less frequently in Europe than in the United States. Knowledge and awareness are important for appropriate treatment and prevention. 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 string test: A novel test for diagnosing extensor carpi ulnaris tendonitis. Cooper, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : ECU tendinopathy - String test This retrospective study assessed the diagnostic accuracy of the "string test" for identifying extensor carpi ulnaris (ECU) tendinopathy in patients with ulnar-sided wrist pain. The test aims at differentiating ECU tendinopathy from other conditions like triangular fibrocartilage complex (TFCC) injuries or dorsal radiocarpal joint issues. A total of 64 patients were divided into three groups: those with confirmed ECU tendonitis and positive string test (true positives), those with negative string test despite having ECU tendonitis (false negatives), and those without ECU tendonitis and a negative string test but with other wrist pathologies (true negatives). The confirmation of ECU tendinopathy/other pathologies was obtained through MRI imaging. The test demonstrated a sensitivity of 86% and specificity of 100%, indicating its potential usefulness in differentiating ECU tendinopathy from other conditions. 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 "string test" may be a useful adjunct when trying to differentiate between ECU tendinopathies and other ulnar-sided wrist conditions. This paper is a nice addition to the one showing that ECU tendinopathy/tenosynovitis is more common in people with TFCC injuries compared to healthy controls . URL : https://doi.org/10.1177/17531934251329775 Abstract The study presents the string test as a novel diagnostic method for extensor carpi ulnaris tendonitis, addressing the complexities of diagnosing ulnar-sided wrist pain. Findings suggest that the test is reliable, reducing misdiagnosis and the need for wrist MRI. 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 outcome difference between acute bony and tendinous mallet fingers treated conservatively in children. Rubin, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Mallet finger - Kids treatment This retrospective study assessed the effectiveness of splinting for both bony and tendinous mallet finger injuries in children. A total of 31 children were included. Splinting was worn for 6 and 4 weeks for tendinous and bony mallet respectively, followed by gradual weaning of the splints. At baseline, the average extension lag was 20 degrees. The results showed that children with bony mallet were older (mean 14 years vs. 12 years). Both injury types showed excellent outcomes after treatment with extension splintage, with no significant differences in residual extension lag. Thus, the extension lag following treatment was 0-10 degrees for both 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, bony or tendinous mallet finger injuries in children can be managed conservatively with splinting. Keep in mind that for tendon injuries, 6 weeks of immobilisation is advised compared to 4 weeks for bony ones. Have a look at the following synopses if you are interested in the management of buckle , phalangeal , or upper limb fractures in children. URL : https://doi.org/10.1016/j.jht.2024.07.004 Abstract Introduction: Tendinous and bony mallet are very different injuries presenting with extensor lag at the distal interphalangeal joint. This study is aimed to evaluate the outcome difference between acute bony and tendinous mallet fingers treated conservatively with a splint in children. Materials and Methods: We collected retrospective data about patients at the time of injury with acute tendinous or bony mallet that were treated conservatively in our occupational therapy clinic. Patients were examined in the outpatient clinic. Pain, extension lag, and flexion loss were documented. Outcomes were classified according to the Crawford’s criteria. Results: We collected data on 31 patients (16 bony and 15 tendinous mallet). We found the bony mallet patients to be older (mean 13.8 vs 11.9 years), We also found that tendinous mallet injuries affected predominantly the ring finger while bony mallet injuries affected predominantly the middle finger. Both bony and tendinous mallets tend to be more frequent in male. The extensor lag on initial was the same (median −18.5° vs −20°). As for the outcome, we found both groups to have excellent outcome in regard of the extension lag (median 0° vs 0° p = 0.538) and Crawford Criteria Assessment (p = 0.570). Discussion: Mallet injuries, either tendinous or bony, are not common in children. They are often studied together and typically treated in the same way with extension splintage. Yet, the evidence in adults clearly shows there are different injuries, which present in the same way. This study reinforces these findings in children regarding demographic findings but not for the treatment outcome. 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 outcomes of radial shortening osteotomy for Kienböck disease: Minimum 20-year follow-up study. Suzuki, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Kienböck - surgical intervention This retrospective study assessed the long term effect of radial shortening osteotomy as a widely used surgical intervention for Kienböck disease. A total of 6 patients were followed up for more than 20 years following radial shortening osteotomy. The results showed that wrist range of movement and grip strength improved compared to before surgery, and QuickDASH scores remained unchanged. There was evidence of wrist osteoarthritis at follow up, however, the lunate collapse did not appear to have worsened. Keep in mind that there was no control group, hence, such improvements/lack of change could have been due to natural history of the condition. FIGURE 1: Radiographs of a 17-year-old man with Lichtman stage 3B Kienböck disease. A Before surgery. B At the 10-year follow-up 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 options, such as radial shortening osteotomy, may be reasonable approaches for Kienböck disease management. We can provide some hope to patients by letting them know that long term follow ups seem to show improvements in range of movement and grip strength despite ongoing functional limitations. If you are interested in Kienböck disease, have a look at the this synopsis on potential genetic aetiology of the condition . URL : https://doi.org/10.1016/j.jhsa.2025.04.018 Abstract Purpose: We have been performing radial shortening osteotomies for patients with negative ulnar variance and Lichtman stage 2 or higher Kienböck disease. Although we previously reported the results of this procedure 10 years after surgery, reports on follow-up beyond 10 years remain scarce. This study aimed to investigate the results of radial shortening osteotomy for Kienböck disease based on long-term clinical and radiographic outcomes for a minimum of 20 years after surgery. Methods: The cohort comprised seven patients with eight wrists treated between 1991 and 2002, whose average age at the time of surgery was 25.9 years (range: 17–44 years). The preoperative Lichtman classification was stage 3A in one wrist, 3B in five, and stage 4 in one; the mean preoperative ulnar variance was −2.2 mm (range: −1.0 to −3.5 mm). Changes in pain, range of motion, grip strength, modified Mayo Wrist Score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and radiographs were evaluated from 10 years after surgery to the last follow-up at least 20 years after surgery. Results: Pain remained reduced in all patients at 20 years after surgery. Improvements in wrist extension and flexion observed 10 years after surgery were maintained at the last follow-up. Grip strength at 10 years after surgery was maintained at the last follow-up. The mean modified Mayo wrist score and the mean DASH score were maintained from 10 years after surgery to the last follow-up. Radiography showed no progression of lunate collapse in any case, although one case showed progression of degeneration in the radiocarpal joint and the distal radioulnar joint. Conclusions: Good clinical results observed in patients 10 years after radial shortening osteotomy are likely to remain stable at 20 years after 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

Restless arm syndrome: A rare disease? Moser, et al. (2021) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic : Restless arm syndrome - Diagnosis and management This case report describes a challenging case of restless arm syndrome (RAS) in a middle-aged patient with a long-standing history of symptoms despite multiple specialist visits. The patient experienced significant sleep disturbances and daytime fatigue due to RAS. Luckily for the patient, they encountered a physician who prescribed them with 100 mg L-dopa +25 mg benserazide (medicines commonly used for Parkinson's disease), which resolved the symptoms. Below you can find the diagnostic criteria for RAS, which are the same as restless legs syndrome but applied to the arms. 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, Restless Arm Syndrome (RAS) presents as an urge to move the upper limb due to uncomfortable sensations, often disrupting sleep and leading to significant daytime fatigue. If one of your patients presents with these symptoms, do not dismiss them. Compare their presentation to the diagnostic characteristics above and refer them back to the GP or specialist suggesting whether a trial of dopaminergic drugs could be considered. URL : https://doi.org/10.1136/bcr-2021-244890 Abstract Restless legs syndrome (RLS) is a common neurological disorder characterised by an irresistible urge to move the lower limbs, often accompanied by unpleasant sensations in the legs, typically occurring in the evening and at night and improving with movement. Restless arms syndrome (RAS) predominantly affects the arms, while the legs are rarely affected. RAS appears to be very rare, with very few cases described to date, but the diagnosis of RAS is probably made too infrequently, especially for milder and transient forms. The patient reported here even had severe symptoms for years that could have indicated RAS. He observed an immediate improvement in all RAS-related symptoms after administration of 100 mg L-dopa +25 mg benserazide, which continues to this day. Clinicians should always be alert for RLS-like symptoms in one or both arms that worsen at rest and improve with movement, thinking of possible RAS. 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

Epidemiology of acute flexor tendon injury and an analysis of outcomes: A study of 91,239 patients in England and Wales. Mawhinney, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiological/Prognostic Topic : Flexor tendon - Incidence This retrospective study assessed trends and outcomes in flexor tendon injuries treated in England and Wales over eight years (2015–2023) using Hospital statistics. A large number of patients were included in the study (more than 90,000). The researchers focused on collecting patient's demographics, socioeconomic factors, and complications/reoperations rates. The results showed that the number of flexors injuries, were highest among patients from deprived areas. Sex differences were noted, with men more frequently affected. Peak flexors injuries occurred in patients between 20 and 30 years old. Re-ruptures occurred in less than 1% of patients, and the most common reoperation was tenolysis which occured in 3% of the patients. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : B ased on what we know today, flexor tendon injuries tend to occur in younger patients and those from deprived socio-economic areas suggesting physically demanding work or lack of access to safety equipment may be contributing factors. Once again, it appears that social determinants of health, such as economic status and access to resources, has an impact on flexor tendon injuries. This study provides additional evidence on how social deprivation can affect flexor tendon injury/recovery , as well as recovery from several other hand and upper limb injuries . URL : https://doi.org/10.1177/17531934251342419 Abstract The purpose of this study was to investigate the epidemiology of flexor tendon injuries and operative complications post-repair on a national scale. Using Hospital Episode Statistics data we identified a total of 91,239 patients in England who underwent a flexor tendon repair in the 20-year period between 1 April 1998 and 31 March 2018. Individuals were more likely to be male (74.6%) and of lower socioeconomic status. Median age was 31 years and patients had few medical comorbidities. After primary repair, 3.1% of patients required a revision repair within 90 days and 2.8% tenolysis within two years. Complications other than rupture, adhesions and wound site infection were rare. This study has shown that flexor tendon repair is primarily a procedure of working-age men, with rupture and adhesions the most common complication. The complication rate is less than previously reported in the literature. 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