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Association of weight loss and weight gain with structural defects and pain in hand osteoarthritis: Data from the osteoarthritis initiative. Salis, Z., Driban, J. B., McAlindon, T. E., Eaton, C. B. and Sainsbury, A. (2024) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic, Prognostic Topic : Weight loss/gain - Hand osteoarthritis The prospective study assessed the association between weight change and the incidence, progression, development, and resolution of hand osteoarthritis (OA) using data from the Osteoarthritis Initiative. A cohort of 4,598 participants was analysed, excluding those with cancer, rheumatoid arthritis, or a body mass index below 18.5 kg/m². The research utilised multivariable logistic regression to assess the impact of weight change over a 4-year period on radiographic hand OA and mixed-effects logistic regression to examine pain outcomes over an 8-year span. The study revealed no statistically significant correlations between weight change and the incidence or progression of radiographic hand OA or the development or resolution of hand pain. The findings support current guidelines that do not recommend weight management as a treatment for hand OA. The study suggests that the biomechanical impacts of weight change are not applicable to non-weight-bearing joints like those in the hand. 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, weight change (either loss or gain) over 4 to 8 years does not significantly influence the incidence or progression of radiographic hand osteoarthritis (OA) or the development or resolution of hand pain. Therefore, weight management should not be prioritised exclusively as a treatment strategy for hand OA. Despite these findings suggesting that weight changes are not associated with pain or OA progression, it appears that being overweight, in addition to several other factors, may contribute to the risk of developing hand OA . URL : https://doi.org/10.1002/acr.25284 Abstract Objective: Our aim was to define the association of weight change (weight loss or weight gain) with the incidence and progression of hand osteoarthritis (OA), assessed either by radiography or by pain, using data from the Osteoarthritis Initiative. Methods: Among the 4,796 participants, we selected 4,598 participants, excluding those with cancer or rheumatoid arthritis or a body mass index under 18.5 kg/m2. We investigated the association of weight change with incidence and progression of radiographic hand OA and the development and resolution of hand pain. Using multivariable logistic regression, we investigated the association of weight change from baseline to the 4-year follow-up with the incidence and progression of radiographic hand OA at the 4-year follow-up. Additionally, multivariable repeated-measure mixed-effects logistic regression analyzed the association of weight change with the development and resolution of hand pain across 2-year, 4-year, 6-year, and 8-year follow-ups. Results: No statistically significant associations were observed between weight change and the investigated outcomes. Specifically, for each 5% weight loss, the odds ratios for the incidence and progression of radiographic hand OA were 0.90 (95% confidence interval [95% CI] 0.67–1.23) and 0.92 (95% CI 0.84–1.00), respectively. Similarly, for each 5% weight loss, the odds ratios for the development and resolution of hand pain at the 8-year follow-up were 1.00 (95% CI 0.92–1.09) and 1.07 (95% CI 0.91–1.25), respectively. Conclusion: Our study found no evidence of an association between weight change and the odds of incidence or progression of radiographic hand OA over 4 years, nor the development or resolution of hand pain over 8 years. 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

Carpal tunnel syndrome: Rapid evidence review. Wipperman, J. and Penny, M. L. (2024) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic : Carpal tunnel syndrome - Diagnostic flowchart This narrative review aimed to summarise the most recent updates on carpal tunnel syndrome (CTS). Diagnoses rely on classic symptoms, physical examination tests like the Phalen test and Tinel ones, and may be supported by electrodiagnostic studies, especially in atypical cases. While provocative maneuvers have varying accuracy, thenar atrophy is a highly specific sign for CTS. Mild to moderate CTS often responds to nonsurgical treatments such as wrist splinting and corticosteroid injections. Night-only splinting is effective, and neutral wrist splints may be more beneficial than extension splints. In cases with recent onset, corticosteroid injections can offer short-term relief, with similar six-month outcomes compared to splinting. Severe cases, or those with objective weakness or sensory deficits, often require surgical decompression, with both endoscopic and open release techniques proving equally effective. Below you can find the diagnostic flowchart that the authors propose. 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 : Base on what we know today, Carpal Tunnel Syndrome (CTS), is one of the most prevalent entrapment neuropathy of the upper limb. Diagnosis is primarily clinical, supported by symptoms such as pain and paresthesia in the first three digits and radial half of the fourth digit, often exacerbated at night. Provocative tests like Phalen and Tinel may be used but have variable predictive power. For patients with mild to moderate symptoms, initial management should include night-time splints as it appears that corticosteroid injections have a similar efficacy and lead to a greater number of surgeries at two years . Keep in mind that other diagnoses (e.g. space occupying lesion , persistent median artery ) could cause symptoms of CTS and these should be investigated if conservative treatment is not effective. URL : https://pubmed.ncbi.nlm.nih.gov/39028782/ Abstract Carpal tunnel syndrome (CTS) is caused by compression of the median nerve as it travels through the carpal tunnel. Patients commonly experience pain, paresthesia, and, less often, weakness in the distribution of the median nerve. Provocative maneuvers, such as the Phalen test and Tinel sign, have varying sensitivity and specificity for the diagnosis of CTS. Thenar atrophy is a late finding and highly specific for CTS. Although patients with a classic presentation of CTS do not need additional testing for diagnosis, electrodiagnostic studies can confirm the diagnosis in atypical cases, exclude other causes, and gauge severity for surgical prognosis. An abnormal nerve conduction study is useful for ruling in CTS, but a normal test does not necessarily exclude it. Over-the-counter analgesics, such as nonsteroidal anti-inflammatory drugs and acetaminophen, have not shown benefit for CTS. Patients with mild to moderate CTS initially may be offered nonsurgical treatments, such as splinting or local corticosteroid injections. Night-only splinting is as effective as continuous wear. A neutral wrist splint may be more effective than an extension splint. In patients with recent onset of CTS, corticosteroid injections provide slightly greater improvement of symptoms compared with splinting at 6 weeks, with similar outcomes at 6 months. Patients with severe CTS, including objective weakness or sensory deficits, should be offered surgical decompression. Endoscopic and open carpal tunnel release techniques are equally effective. 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 effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomized trial. Burton, C., et al. (2022) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic : Carpal tunnel syndrome - CSI or splinting This randomised controlled trial assessed the long-term effectiveness of corticosteroid injection (CSI) compared to night splinting (NS) for managing mild-to-moderate carpal tunnel syndrome (CTS) over 24 months. A total of 239 participants were either randomised to a single CSI injection or night splinting for six weeks. The effectiveness of the intervention was assessed through the Boston Carpal Tunnel Questionnaire. The data was collected at baseline, six weeks, six months, one year, and two years. The results showed that both treatments improved symptoms, with no significant overall difference in clinical effectiveness between the groups at 12 and 24 months. At six weeks, the CSI group had greater relief. More participants in the CSI group sought and underwent surgery (22%) compared to the NS group (16%). CSI was determined to be less cost-effective than NS over the long term. 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, corticosteroid injection (CSI) and night splinting (NS) for the management of mild-to-moderate carpal tunnel syndrome NS are safe and effective options. However, initial treatment with NS may be more cost-effective in the long term. Patients can be encouraged to make a choice between CSI or NS based on their personal preferences and circumstances, keeping in mind that while both treatments are clinically effective, NS may lead to fewer surgeries and lower healthcare costs over time. If you want more information about CTS, have a look at the whole database . URL : https://doi.org/10.1093/rheumatology/keac219 Abstract Objectives: This follow-up study of the INSTinCTS (INjection vs SplinTing in Carpal Tunnel Syndrome) trial compared the effects of corticosteroid injection (CSI) and night splinting (NS) for the initial management of mild-to-moderate CTS on symptoms, resource use and carpal tunnel surgery, over 24 months. Methods: Adults with mild-to-moderate CTS were randomized 1:1 to a local corticosteroid injection or a night splint worn for 6 weeks. Outcomes at 12 and 24 months included the Boston Carpal Tunnel Questionnaire (BCTQ), hand/wrist pain intensity numeric rating scale (NRS), the number of patients referred for and undergoing CTS surgery, and healthcare utilization. A cost–utility analysis was conducted. Results: One hundred and sixteen participants received a CSI and 118 a NS. The response rate at 24 months was 73% in the CSI arm and 71% in the NS arm. By 24 months, a greater proportion of the CSI group had been referred for (28% vs 20%) and undergone (22% vs 16%) CTS surgery compared with the NS group. There were no statistically significant between-group differences in BCTQ score or pain NRS at 12 or 24 months. CSI was more costly [mean difference £68.59 (95% CI: −120.84, 291.24)] with fewer quality-adjusted life-years than NS over 24 months [mean difference −0.022 (95% CI: −0.093, 0.045)]. Conclusion: Over 24 months, surgical intervention rates were low in both groups, but less frequent in the NS group. While there were no differences in the clinical effectiveness of CSI and NS, initial treatment with CSI may not be cost-effective in the long-term compared with NS. 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

Locking of the metacarpo-phalangeal joint from a loose body: Report of a case. Honner, R. (1969) Level of Evidence: 4 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic, Therapeutic Topic : Mcpj locking - Loose body A 55-year-old woman had a twisting injury of their right index finger which had not resolved with four months of conservative management. At their first appointment, they reported pain and stiffness of the mcpj. In particular, they had full mcpj extension, but flexion was limited to 35 degrees. There was tenderness on palpation and swelling at the affected mcpj, however, there was no ligament laxity. Radiographs revealed a loose body within the joint (see picture below), which was surgically removed. Post-surgery, the patient regained nearly full range of motion. The authors highlight the rarity of this condition and compare it to other known causes of joint locking such as osteophytes, irregularities on the articular surface, or issues with the capsule or ligaments. 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, locking of the metacarpo-phalangeal joint due to a loose intra-articular body is an uncommon, but noteworthy phenomenon. Patients typically present with a history of joint trauma, which leads to locking, pain, and limited range of motion. Imaging techniques such as x-rays are useful in identifying these loose bodies. Conservative treatment often does not yield significant improvement, and surgical removal of the loose body tends to provide the best outcomes. URL : https://doi.org/10.1302/0301-620X.51B3.479 Abstract 1. Locking of the metacarpo-phalangeal joint from articular derangements is rare. 2. A case due to an intra-articular loose body is described. 3. The literature is reviewed. The commonest cause is catching of the volar capsule or collateral ligaments on osteophytes about the metacarpal head, but intra-articular bands, incongruities of the articular surface and entrapment of the sesamoid have also been described. 4. An analysis of the reported cases suggests the likely cause in the individual patient. 5. Operation is usually required to restore joint motion. 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

Loose body in the wrist: Diagnosis and treatment. Koh, S., et al. (2003) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic, Therapeutic Topic : Wrist loose bodies - Symptoms This retrospective study investigated the clinical presentation and management of loose bodies in the wrist joints. The diagnosis was made through arthroscopy. The participants included had been assessed and managed between 1986 and 2000. A total of 707 patients' files were reviewed and of these, 10 presented with loose bodies in the wrist joints. These 10 participants were mostly males with an average age of 28. They primarily reported wrist pain, with locking being uncommon. Preoperative diagnosis was challenging except in three cases with osseous components. Arthroscopy diagnosed and facilitated the removal of loose bodies in five cases involving the radiocarpal joint (RCJ), while arthrotomy (open surgery) was required for those in the distal radioulnar joint (DRUJ). Post-surgery, all patients experienced pain relief without complications. 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, loose bodies in the wrist joint should be considered in the differential diagnosis when evaluating patients with chronic wrist pain, especially when the pain is not explained by standard imaging techniques. Loose bodies in the wrist do not commonly present with locking and if there is no bony component to the loose body (e.g. cartilaginous), advanced imaging/surgery is required to make the diagnosis. If you are interested in joint locking of the upper limb, have a look at this case study about mcpj locking of the index finger . URL : https://doi.org/10.1016/S0749-8063(03)00738-2 Abstract Purpose: The purpose of this study was to report on 10 cases of symptomatic loose bodies in the wrist joints diagnosed using arthroscopy. Type of Study: Retrospective review. Methods: From1986 to 2000, we performed wrist arthroscopy for 707 patients, 10 of whom had loose bodies in the wrist joints. The clinical records were reviewed retrospectively. The patients included 8 men and 2 women, and the average age was 28 years (range, 16 to 67 years). The chief complaint was wrist pain in all patients, but locking was uncommon. Preoperative diagnosis was difficult in all but 3 cases; in those cases, an osseous component was found within the loose bodies. The remaining cases were diagnosed by wrist arthroscopy. Results: The loose bodies existed in the radiocarpal joint in 5 cases, and all could be removed arthroscopically. In the other 5 cases, the loose bodies were in the distal radioulnar joint, and arthrotomy was needed to remove them. After removal of the loose bodies, the pain was relieved in all cases without any surgical complications. Conclusions: Loose bodies in the wrist joint should be included in the differential diagnosis for chronic wrist pain. Wrist arthroscopy is of value because the preoperative diagnosis is usually difficult. 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 De Quervain disease in infant caregivers and its association with risk factors. Manzoor, A., et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Symptoms prevalence study, Prognostic Topic : De Quervain - Risk factors This cross-sectional study assessed the prevalence of De Quervain’s disease among infant caregivers and its association with various risk factors. Among the 190 participants, comprising mothers and other caregivers, the prevalence rate was found to be 30%. The diagnosis of De Quervain was made if the participants were positive on Finkelstein’s test. Significant risk factors included the infant’s age (highest risk between 4 and 6 months), the frequency of lifting (subjectively reported as often or always), and being right handed. Factors that did not appear to be significant were caregiver's age, history of wrist pain, infant weight, and relationship to the infant (e.g. mother or other) were not significant. 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, De Quervain disease shows a high prevalence among caregivers of infants, with 30% of participants in this study being affected. The findings highlight that infant's age, lifting frequency, and hand dominance are significant risk factors. It is possible that training caregivers to lifting weight prior to having to lift babies may help reduce the incidence of such presentation. If you are interested in more information about De Quervain assessment and management, have a look at the whole database . URL : https://doi.org/10.47391/JPMA.4916 Abstract De Quervain’s disease (DQD) is commonly reported in mothers during pregnancy up to delayed postpartum period. A cross-sectional study was conducted to assess infant caregivers who visited the paediatric outpatient department or vaccination centre in two hospitals of Lahore, during the months of May and June, 2021. A total of 190 subjects were interviewed directly and assessed by applying Finkelstein’s test on both hands. Data was collected using Numeric Pain Rating Scale (NPRS) and Patient Rated Wrist Evaluation (PRWE) from positive subjects. They were asked to report their pain and difficulty level of the affected hand with worsened symptoms. The results exhibited 26.8% prevalence of DQD in a sample size of 190. Infant’s age, lifting frequency and hand dominance were proved significant risk factors. However, caregiver’s age, history of wrist pain, infant weight and relationship with infant were proved insignificant. Mean PRWE pain and functional scores were 23.14 ± 7.72 and 18.53 ± 6.09, respectively. 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

Management of the spastic elbow deformity in adult patients with upper motor neuron syndrome. Israel, J., Fahrenkopf, M. and Rhee, P. C. (2024) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic : Post surgical splinting - Elbow spasticity This is an expert opinion on the management of spastic elbow deformities in people with upper motor neuron lesions. These central nervous system lesions can lead to elbow deformities associated with muscle spasticity, myostatic contracture, or joint contracture. In these instances, the elbow typically resting in a flexed position. Surgical interventions are often discussed with patients as an option. Surgical approaches include selective nerve resection, tendon lengthening, muscle origin release, myotomy, tenotomy, and/or periarticular soft tissue release if the deformity has been present for a long period of time. Postoperative management involves splinting and therapy. For splinting, these are usually worn full time except for hygiene for the first six weeks. Following this period of time, splints are worn at night only for another six weeks. The picture above is from another study covered in a previous synopsis . 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, splinting is utilised in the post-surgical management of patients presenting with elbow spasticity. This usually involves a full time splint for six weeks followed by a night splint only for another six weeks. Treatment will likely need to be individualised based on the surgical intervention utilised as the tissues released may need protection for a period of time (e.g. tendon lengthening) or not less so if periarticular structures were the main limiters (e.g. capsular release). If you are interested in the use of splinting to correct other upper limb deformities (e.g. pipj), have a look at the database . URL : https://doi.org/10.1016/j.jhsa.2023.09.015 Abstract Spastic elbow deformity in patients with upper motor neuron injuries results from an imbalance of flexor and extensor forces across the ulnohumeral joint. Although not all deformities reflect the same underlying imbalances, the elbow most commonly rests in a flexed position. Patients may present with a combination of muscle spasticity, myostatic contracture, and/or joint contracture. A focused history and physical examination are essential for developing individualized surgical plans that account for variations in deformity severity and patient goals. Patients may present with or without volitional control; goals and treatment options differ depending on the degree of control present. Techniques include hyperselective neurectomy, tendon lengthening, muscle origin release, myotomy, tenotomy, periarticular soft tissue release, and skin rearrangement. This article presents a comprehensive review of the surgical approach to the volitional and nonvolitional spastic elbow deformities. 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

When the diagnosis is in the patient’s hand and in the neurologist’s eye. Bertini, A., et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Focal hand dystonia - Mimickers This narrative review described common movement disorders of the hand that could mimic focal hand dystonias. The authors report that careful observation of hand patterns can differentiate between neurological and non-neurological conditions, central and peripheral etiologies, and organic versus functional disorders. Important differential diagnoses for movement disorders of the hand include Amyotrophic Lateral Sclerosis (ALS), strokes, and various syndromes like Alien Hand and Striatal Hand. Making sure that we refer people on when we are not sure whether their presentation is due to a focal benign hand dystonia is paramount. 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, careful observation of hand postures can be a useful diagnostic tool for clinicians. An important presentations that may show early to our clinic presenting as an entrapment neuropathy includes ALS . We should therefore maintain a high index of suspicion when patients present with unfamiliar movement disorders of the hand. URL : https://doi.org/10.1007/s10072-024-07626-1 Abstract The objective of this study was to encompass current knowledge about pathophysiological mechanisms of those specific hand postures or deformities caused by central nervous system disorders. In the era of high-resolution neuroimaging and molecular biology, clinicians are progressively losing confidence with neurological examination. Careful hand observation is of key importance in order to differentiate neurological from non-neurological conditions, central from peripheral aetiologies, and organic from functional disorders. Localizing the potential anatomical site is essential to properly conduct subsequent exams. We provided a practical guide for clinicians to recognize hand patterns caused by central nervous system disorders, avoiding mimicking conditions, thus optimizing and prompting the diagnostic pathway. 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: 4 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic, Therapeutic A 55-year-old woman had a twisting injury of their right index finger which had not resolved with four months of conservative management. At their first appointment, they reported pain and stiffness of the mcpj. In particular, they had full mcpj extension, but flexion was limited to 35 degrees. There was tenderness on palpation and swelling at the affected mcpj, however, there was no ligament laxity. What is it?

Treatment of wrist stiffness through posture orthosis and active exercise: A case report. Boccolari, P., et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Static progressive splint - Wrist ROM This is a case study reporting on the use of static progressive splinting and exercise to treat wrist stiffness following a distal radius fracture in a 64-year-old woman. The patient was initially treated with ORIF. Post-surgery, the wrist was immobilised for twenty days. The subsequent rehabilitative strategy included a combination of custom splinting and active exercises for both wrist flexion and extension. Range of movement in both extension and flexion doubled over the course of 12 weeks, starting from 20deg and 30deg at baseline for flexion and extension respectively. It therefore appears that for this specific patient such approach had some benefit. 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, progressive static splints and exercises may be useful in the management of stiffness following ORIF for distal radius fractures. However, to prevent the onset of stiffness, it would be useful to avoid immobilising distal radius fracture ORIFs beyond a reasonable amount of time. Thus, mobilisation within two weeks from surgery appears to provide better outcomes, including wrist ROM . An additional factor that appears to contribute to stiffness includes pain catastrophising . If you are interested in reading more about distal radius fractures ORIF, have a look at the whole database . URL : https://doi.org/10.1016/j.tcr.2024.101068 Abstract Introduction: Wrist fractures, particularly the distal radius, can result in significant stiffness and hand dysfunction if not mobilized early. The variable immobilization period post-fracture depends on fracture type, location, stability, and surgical intervention. Inadequate early mobilization typically leads to structured stiffness, influenced by patient health, injury mechanism, joint surface involvement, associated tissue injuries, and patient motivation. Case presentation: A 64-year-old female in good health suffered a distal radius fracture, treated with open reduction and internal fixation. A modified treatment plan, including custom orthosis and active wrist exercises, was initiated after the standard immobilization phase to enhance the range of motion while accommodating the patient's daily activities. Clinical discussion: The patient underwent 15 evaluations of active range of motion (AROM) using a goniometer, guided by the American Society of Hand Therapists. A Tissue Composition Analysis (TCA) was performed to guide the orthosis-treatment choice. Despite consistent improvement shown in AROM, it was inconclusive whether the modified treatment contributed significantly beyond the standard approach. Conclusions: While the patient's AROM improved, the treatment's effect on this single case cannot definitively confirm the efficacy of the modified approach. A more extensive study is necessary to evaluate the conservative treatment strategy's validity for such fractures in high-demand patients, considering the biomechanical complexity of the injury and the patient's professional needs. 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

Effect of cervical contralateral lateral flexion on the median nerve and fascia at the wrist – Cadaveric study. Pérez-Bellmunt, A., et al. (2024) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Cervical movement - Median nerve movement This study investigates the effect of cervical contralateral lateral flexion (CCLF) on the median nerve versus fascia at the wrist during the median nerve neurodynamic test. A total of five cadavers were included in the study. The main goal was to assess whether CCLF could mechanically differentiate nerve movement from fascial tissues. Measurements of excursion and strain were recorded using the KINOVEA software. The results showed a significant proximal excursion in the median nerve without significant changes in strain, while neither superficial nor deep fascia exhibited any significant excursion or strain alterations. These findings suggest that CCLF can effectively differentiate median nerve movement from local tissues at the wrist, potentially aiding in the diagnosis of wrist pain. 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, cervical contralateral lateral flexion (CCLF) as a structural differentiation maneuver during median nerve neurodynamic testing induces movement of the median nerve at the wrist. In contrast, the superficial and deep fascia in the wrist did not move. This study is a nice addition to growing evidence showing the effect of neurodynamic interventions/diagnostic procedure on the peripheral nervous system . URL : https://doi.org/10.1016/j.msksp.2024.103146 Abstract Background: Neurodynamic tests are an essential aspect of the physical examination of the patient when suspicion of neural involvement exists. A manoeuvre that is hypothesised to move nerves differentially relative to other structures (structural differentiation) has been proposed as a necessary part of neurodynamic testing for differential diagnosis. However, although the specificity of structural differentiation for peripheral nerve over muscle has been demonstrated in some body regions, no study has tested specificity of nerve movement relative to fascia. Objectives: The aim of this study was to measure the effect of the cervical contralateral lateral flexion (CCLF) as an structural differentiation manoeuvre for the median nerve compared to fascia (superficial and deep) at the wrist during the upper limb neurodynamic test 1 (ULNT1). Design: A cross-sectional study was performed in 5 fresh frozen cadavers. Methods: Excursion and strain in the fascia (superficial and deep) and the median nerve were measured at the wrist with structural differentiation during the ULNT1. KINOVEA software was used to measure kinematic parameters. Results: CCLF resulted in significant proximal excursion in the median nerve (p < 0.001*) but not in the strain. CCLF neither produced changes in strain nor excursion in the superficial and deep fascia (p > 0.05). Conclusion: This study showed that CCLF produced significant differential excursion in the median nerve at the wrist compared to the local superficial and deep fascia during the ULNT1. The data support CCLF in mechanical differentiation between nerve and fascia in this area in diagnosis of local sources of wrist pain. 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

Isolated post-traumatic osteoarthritis of the middle carpometacarpal joint: A report of two cases. Huang, H.-K., Wu, C.-H. and Wang, J.-P. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Symptoms prevalence Topic : Middle finger cmcj - Osteoarthritis This report describes two cases of isolated post-traumatic osteoarthritis of the middle finger carpometacarpal joint (cmcj). The first case involved a 34-year-old deliveryman who sustained a hand injury in a traffic accident, which presented with dorsal hand pain and swelling. He sought medical help 10 months post-injury due to worsening pain and hand weakness, which impaired their work performance. Radiographs and a CT scan showed middle finger cmcj OA, which was successfully managed with arthrodesis. The second case was a 53-year-old stock trader who injured their hand as a result of a FOOSH. Six months later, persistent symptoms led to the further investigations, which revealed a third cmcj OA, which was managed surgically with good results. Despite its rarity, isolated osteoarthritis in the third cmcj can cause significant functional impairment. 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, isolated post-traumatic osteoarthritis of the third cmcj can occur in absence of dislocation but as a result of high energy trauma. It is possible that such injuries may initially lead to cmcj instability , which then develop into post-traumatic osteoarthritis. URL : https://doi.org/10.1177/17531934241245830 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