How should we treat painful sensitivity in the hand? An international e-delphi study. Hebert, et al. (2024) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Alloynia - Management This Delphi study aimed to develop international consensus recommendations for treating allodynia, a condition characterised by hypersensitivity to touch, often seen in individuals with chronic pain conditions like complex regional pain syndrome (CRPS). The research involved surveying hand therapy experts to identify effective interventions and highlight gaps in evidence. Key findings include strong support for approaches that promote returning to meaningful activities, as well as direct tactile stimulation techniques such as desensitisation or sensory modulation. However, the study notes a lack of high-quality research on allodynia-specific treatments, with most studies showing low methodological quality. Experts emphasise the importance of tailoring interventions to individual factors, including functional and psychological status, when deciding whether to touch or avoid sensitive areas. 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, allodynia refers to a condition characterised by hypersensitivity to touch. This condition can be tackle with three approaches, which include desensitisation, sensory modulation, and anxiety/depression management. Desensitisation involves slowly exposing individuals to touch, similar to gradual exposure therapy for phobias. Sensory modulation refers to adjusting sensory input to make it more manageable, potentially through methods like gentle pressure or vibrations. Clinically, we might start with gentle, non-threatening techniques like light pressure or vibrations, gradually increasing intensity. Addressing psychological aspects such as anxiety and depression, which often accompany pain, is also essential for overall improvement. If you are interested in allodynia, have a look at the database on the topic . URL : https://doi.org/10.1016/j.jht.2023.08.003 Abstract Background: Evidence synthesis suggests allodynia resulting from neuropathic pain has few interventions with clear effectiveness. As research continues to build this needed evidence base, expert consensus recommendations can address the conflicting approaches within current hand therapy practice. Purpose: This study aimed to develop consensus recommendations for the clinical management of allodynia from an international panel of hand therapists. Study Design: This was an international e-Delphi survey study. Methods: We recruited international hand rehabilitation experts to participate in an e-Delphi survey. Consensus was defined as 75% or more of participants agreeing with a recommendation, and at least 3 rounds of consensus building were anticipated. Experts were identified from 21 countries, and clinical vignettes describing a spectrum of patients with painful sensitivity in the hand were provided to elicit treatment recommendations. Initial recommendations were summarized, and consensus sought for clinical practice recommendations. Results: Sixty-eight participants were invited, with 44 more added through peer nominations. Fifty-four participants from 19 countries completed the initial survey and were invited to participate in all subsequent rounds. Over 900 treatment suggestions were provided from the initial vignettes across domains, including sensory, physical, and functional interventions, education, and cortical representation techniques: 46 ultimately reached consensus. However, important discrepancies in justification (eg, why allodynia should be covered) and implementation of techniques (eg, desensitization, sensory reeducation) were identified as the consensus exercise progressed. Conclusions: Experts recommend individually tailored programs to treat allodynia using a variety of physical/movement, sensory-based, and “top-down” approaches; this is highly aligned with contemporary theories, such as the Neuromatrix Model of Pain. However, consensus was not reached on the justification and implementation of some of these approaches, reflecting the lack of a taxonomy and supporting evidence for tactile stimulation approaches in the current literature. Trials directly comparing the effectiveness of these approaches are needed. 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

Cost-effectiveness of a preoperative 12-week smoking cessation program prior to arthroscopic rotator cuff repair. Lugo, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Economic Study Topic : Smoking cessation - Clinical and cost effectiveness This retrospective study evaluates the cost-effectiveness of a preoperative 12-week smoking cessation program for adult smokers undergoing arthroscopic rotator cuff repair (ARCR). Using decision tree analysis and Monte Carlo simulations, researchers modeled the economic and clinical benefits of implementing such a program. The results demonstrated favorable outcomes, with the smoking cessation strategy being both more effective and less costly compared to no intervention. Key findings include reduced surgical complications, improved success rates, and lower overall healthcare costs associated with the program. The study also highlights the potential alignment of such interventions with value-based healthcare goals, which prioritise improving patient outcomes while minimising costs. 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 preoperative smoking cessation program can reduce complications following upper limb surgery (clinically effective), and also be cost-effective compared to no intervention. Smoking is a well-documented risk factor for poorer surgical outcomes, including bone non-union , increased infection rates , additional upper limb surgery , post-traumatic elbow stiffness , and reduced success rates of procedures like rotator cuff repair. It is therefore extremely important to offer your smoking clients additional advice/help . URL : https://doi.org/10.1016/j.jse.2025.04.006 Abstract Purpose: This study aims to evaluate the cost-utility of Preoperative 12-week Smoking Cessation Program (SCP) in adults undergoing arthroscopic rotator cuff repair. Methods: A decision-analysis model was developed for a hypothetical adult smoker undergoing arthroscopic rotator cuff repair. Literature review data identified event probabilities, costs, and health utilities. Health outcomes were measured in Quality-Adjusted Life Years (QALYs). Base-case analysis calculated incremental cost and effectiveness of a 12-week preoperative SCP. Probabilistic sensitivity analysis evaluated model uncertainty and calculated mean incremental costs, effectiveness, and net monetary benefits. One-way sensitivity analysis identified variables with the greatest model impact. Results: The preoperative 12-week SCP was the preferred strategy in 98.4% of iterations. It demonstrated greater benefits and lower costs, with an incremental cost-effectiveness ratio below the willingness-to-pay threshold of $50,000 per QALY. The use of preoperative 12-week SCP was associated with a mean incremental net monetary benefit (INMB) of $16,338 (95% CI 15,889-16,787). One-way sensitivity analyses identified QALYs associated with avoiding revision surgery due to re-tear as a key driver of the cost-utility outcomes. Conclusion: Use of a preoperative 12-week SCP is a cost-effective approach to reduce costs related to revision surgery and providing higher QALYs at 5 years. The use of smoking cessation programs should be strongly considered as part of patient management strategies. 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

Physical therapist identification of an undetected rotator cuff tear via a telehealth evaluation: A case report. Young, et al. (2021) Level of Evidence : 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic Topic : Rotator cuff tear - Not capsulitis A 66 years old sought a second opinion via telehealth for their shoulder injury. They reported left sided shoulder pain following a left FOOSH six weeks earlier. Some details about the patient characteristics and pain are reported in the table below. There was no obvious deformity or bruising on observation. Their active shoulder flexion, external rotation, and internal rotation were 80deg, 20deg, 50deg respectively (see pictures below). Passive range of movement of the shoulder was within normal range (see picture below). They also had a positive drop arm test. The patient was referred to an orthopaedic surgeon and after an MRI confirming a full thickness supraspinatus tear (see picture below), they underwent surgical repair. 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, it is important to screen for shoulder pathology following FOOSH trauma. These injuries can result not only in an upper limb fracture but also rotator cuff tears, shoulder dislocations, or even nerve lesions. For an interesting case of nerve lesion following FOOSH, have a look at this synopsis . URL : https://doi.org/10.2519/josptcases.2021.9990 Abstract Background: The COVID-19 pandemic has highlighted the need to explore alternative methods of health care delivery, including telehealth. Minimal evidence is available regarding telehealth as a diagnostic tool for suspected orthopaedic pathology. Case Presentation: A self-referred 66-year-old man presented with left shoulder pain that had been present for 6 weeks. Mechanism of injury included 2 falls 2 weeks apart. His physician diagnosed him with adhesive capsulitis and referred him to a physical therapist near his home. No imaging studies were performed. Initial management did not improve his status, so the patient requested a second opinion. A telehealth evaluation was chosen, as he resides 220 miles away. Live 2-way video conferencing was utilized throughout the evaluation. Visual motion observation noted marked active, but not passive, limitations. Pain in active external rotation was 8/10. Special testing noted positive drop arm test and impairments in external rotation. Outcome and Follow-Up: A rotator cuff tear was suspected and the patient was referred for a surgical consultation, with subsequent surgery completed for a full-thickness supraspinatus tear. During follow-up 3 months after surgery, the patient reported that the telehealth visits were very convenient and more effective than prior management. Discussion: A telehealth evaluation performed by a physical therapist was able to identify and manage, via referral, an undetected full-thickness rotator cuff tear. 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

Outcomes and performance following posteromedial elbow débridement in major league baseball players. Wollenman, et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic : Elbow debridement/osteophites resection - Surgical interventions This retrospective study assessed the outcomes of posteromedial elbow debridement or osteophyte resection in Major League Baseball (MLB) players, particularly focusing on return to play (RTP), performance (ball velocity - pitchers), and the need for further surgeries, such as ulnar collateral ligament (UCL) reconstruction. The study included 39 players who underwent the procedure between 2008 and 2021. The results showed a high RTP rate of 82% in MLB games, with pitchers specifically showing a 77% RTP rate. Pitching performance metrics were mostly unchanged in the short term, except for a significant decrease in fastball velocity over three years (1.5 km/hr, which may not be clinically significant). The rate of subsequent UCL reconstruction was 19% among pitchers, aligning with baseline rates for MLB pitchers. However, concerns remain over long-term outcomes, as 39% of pitchers returned to the injured list within three seasons post-surgery. 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, players in the Major League Baseball can expect an 80% return-to-play following elbow debridement or osteophytes removal. Following such surgery there is no higher risk of subsequent ulnar collateral ligament (UCL) reconstruction compared to other players not having undergone surgery. Nevertheless, amongst those pitchers who had surgery, 40% are classified as re-injured at three years post injury. This study is a nice addition to the already existing research on the management of athletes with hands and wrist injuries requiring surgery . URL : https://doi.org/10.1016/j.jse.2024.05.035 Abstract Background: Overhead athletes are particularly susceptible to elbow valgus extension overload syndrome and development of pathologic changes in the posteromedial elbow. Though arthroscopic débridement/osteophyte resection is frequently performed, few studies have analyzed the outcomes of this procedure and none have specifically addressed professional level athletes. Hypothesis: We hypothesized that following posteromedial elbow débridement, Major League Baseball (MLB) pitchers would exhibit a higher rate of ulnar collateral ligament (UCL) reconstruction than baseline incidence in the existing literature, along with a decline in pitching performance. Methods: Using publicly accessible websites, MLB athletes undergoing posteromedial elbow débridement from 2007 to 2022 were identified. Demographic information, procedure details, return to play (RTP) information, return to the disabled/injured list (DL/IL), subsequent UCL reconstruction, and pitching statistics were analyzed. Pitching performance metrics included earned runs average, walks plus hits per innings pitched, innings pitched, and fastball velocity. Results: A total of 39 MLB players, including 26 pitchers, were included. Within the first three seasons after surgery, 82.1% (n = 32) of players returned to play at the MLB level at a mean time of 176.1 ± 69 days. Pitchers exhibited a RTP rate of 76.9% (n = 20) at 175.8 ± 16 days. A total of 38.5% (n = 10) of pitchers returned to the DL/IL for elbow-related issues within three seasons. Subsequent UCL reconstruction was seen only in pitchers, with a frequency of 19.2% (n = 5). No statistically significant differences between single season preoperative/postoperative pitching metrics were identified. A small but significant (P < .05) decrease in fastball velocity (94.4 vs. 92.84; P = .02) was observed over a three-season comparison. Conclusion: Contrary to our hypothesis, this study demonstrates that posteromedial elbow débridement is a viable surgery in MLB athletes, with RTP rate of 82.1% and no increase in rate of UCL reconstruction. Furthermore, there was no significant difference in single season preoperative and postoperative statistical pitching performance. However, over three years postoperatively, there was a 38.5% rate of return to the DL/IL for ongoing elbow ailment and a significant decrease in pitch velocity, raising some concern over the longevity of postoperative improvements. 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 66 years old sought a second opinion via telehealth for their shoulder injury. They reported left sided shoulder pain following a left FOOSH six weeks earlier. Some details about the patient characteristics and pain are reported in the table below. There was no obvious deformity or bruising on observation. Their active shoulder flexion, external rotation, and internal rotation were 80deg, 20deg, 50deg respectively (see pictures below). Passive range of movement of the shoulder was within normal range (see picture below). They also had a positive drop arm test. What is it?

How to run a cost-effective subspecialty practice. Ring, et al. (2024) Level of Evidence : 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Economic Topic : Effective and ethical practice - Advice The text discusses the need for a more cost-effective approach in hand surgery/therapy and orthopedics. Three main points were highlighted: KISS principle: Keep it simple. Do not overuse expensive treatments for common conditions like tennis elbow and joint pain. They author emphasise that many interventions may not be necessary or could be replaced by simpler, less costly alternatives such as exercises or watchful waiting. Rely on evidence-based medicine: avoiding unnecessary diagnostic tests, and considering patient values and functional outcomes rather than defaulting to aggressive treatments. Avoid stress contagion: Anxious patients can make you anxious and push you to request additional imaging or expensive treatment. Keeping these points in mind, may help you optimising care whilst minimising costs. 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, simpler treatment alternatives, such as exercises or watchful waiting, the use of evidence based practice to guide treatment decisions rather than clinical habits, acknowledging that our stress might influence treatment decisions towards more aggressive approaches, are useful strategies to maintain an ethical and efficient practice. Evidence of how anxious patients can increase clinician's stress is already available and this paper is a good reminder. The suggestions of watchful waiting is also well suited for the treatment of a large proportion of musculoskeletal presentations (e.g. tennis elbow ). Watchful waiting should be considered as a management approach rather than a no intervention approach. URL : https://doi.org/10.1016/j.hcl.2024.05.004 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

Streptococcus pyogenes flexor tenosynovitis. Frith, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Diagnostic Topic : Bacterial flexor tenosynovitis - Systemic effects This paper describes a rare case of Group A Streptococcus (GAS) causing flexor tenosynovitis in an otherwise healthy individual, highlighting the need for vigilance due to increasing GAS outbreaks in developed countries. The 50-year-old patient presented with rapid progression of right index finger pain, swelling, and erythema over 12 hours, accompanied by systemic signs such as elevated white blood cell count, high C-reactive protein, and tachycardia. Imaging revealed a fluid collection in the flexor tendon sheath, confirmed on ultrasound, leading to urgent surgical intervention. The procedure revealed pus and inflamed synovium, with cultures positive for GAS. Despite antibiotic treatment (amoxicillin) and surgical drainage, the patient developed skin necrosis, eschar formation, and eventually osteomyelitis of the terminal phalanx. The case underscores the rapid and severe nature of GAS infections, which can progress to life-threatening complications like necrotising fasciitis or toxic shock syndrome. 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 timely treatment with antibiotics and surgery, severe complications such as skin necrosis, eschar formation, and osteomyelitis can develop following bacterial flexor tenosynovitis. These infections, can rapidly progress to life-threatening complications like necrotising fasciitis or toxic shock syndrome. Clinicians should remain vigilant for infection signs, especially systemic symptoms, consider imaging early, recognise the potential for severe complications despite timely treatment, and emphasise multidisciplinary care. Signs and symptoms that may help identify these presentations include fusiform swelling of finger/s, a flexed position, pain on palpation of the volar aspect of the finger/s from tip to A1 pulley, and pain with finger extension (Kanavel' signs). URL : https://doi.org/10.1177/17531934241286114 Abstract We describe a case of Group A streptococcal infection originally presenting as flexor tenosynovitis. Group A outbreaks have been recently described in developed countries, which constitutes an epidemiological shift that hand surgeons should be aware of. 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 terrible triad of the shoulder: Injury characteristics and outcomes of axillary nerve reconstruction. Wilson, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Axillary nerve injury - Upper limb trauma The patient I saw, had an upper limb injury, which resulted in anterior shoulder dislocation and a hand fracture. When I started seeing them, it appeared that they were unable to shoulder flex beyond 80deg and this was associated with significant scapular elevation. Their deltoid did not appear to be working, and upon MRI and nerve conduction studies, an axillary nerve injury was confirmed. This retrospective study assessed outcomes of axillary nerve injuries combined with shoulder injuries requiring surgical intervention. Surgical interventions like nerve grafting or transfer were implemented for 32 patients presenting with axillary nerve injury and supraspinatus tear/greater tuberosity fracture as a result of anterior shoulder dislocations. The results showed that shoulder flexion improved to 110° after surgery. Younger patients and those with a greater tuberosity fracture rather than supraspinatus tear experiences better outcomes. 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, axillary nerve injuries due to anterior shoulder dislocations, that are associated with either rotator cuff tears or greater tuberosity fractures, have poor functional outcomes. This is despite nerve grafting or nerve transfer. Keep this differential diagnosis in mind if your patients present with an upper limb injury which is also affecting their shoulder. If you want to know about other differential diagnoses for shoulder pathology associated with hand injuries as well as how shoulder injuries affect upper limb fracture recovery, have a look at the whole database on the topic . URL : https://doi.org/10.1177/17531934251333250 Abstract We aimed to describe outcomes, including shoulder motion, deltoid strength and Disabilities of Arm, Shoulder and Hand scores, in 19 patients with terrible triad shoulder injuries (anterior shoulder dislocation, rotator cuff tear or greater tuberosity fracture, and axillary nerve injury) who required axillary nerve reconstruction. The type of nerve surgery (grafting vs. nerve transfer), demographic factors and injury characteristics were not significantly associated with outcomes. The mean postoperative abduction and Disabilities of Arm, Shoulder and Hand score were 95° and 28, respectively. Patients with rotator cuff tears had a higher Disabilities of Arm, Shoulder and Hand score (more disability) than those with isolated greater tuberosity fractures. We conclude that spontaneous recovery of the axillary nerve may not occur in patients with a terrible triad injury. Functional outcomes after axillary nerve repair are poor with respect to motion, strength and patient-reported outcomes compared with reported results for axillary nerve reconstruction in the absence of rotator cuff 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

Are preoperative corticosteroid injections in large or intermediate joints associated with surgical site infection after soft tissue hand surgery? A retrospective database analysis. Zhuang, et al. (2025) Level of Evidence : 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Systemic effect of CSI - Infections after hand surgery This retrospective study assessed the effect of cortisone injections to large (e.g. shoulder) and intermediate size (e.g. elbow) joints on the risk of post surgical infections following hand surgery. A total of 1,338,077 participants were included. The results showed that independently of the time of delivery and size of the joint injected (e.g. shoulder/elbow), cortisone injections did not increase the risk of infection or complication following hand surgery. 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 injections of large joints (e.g. knee/hip) do not have a negative effect on risk of infections even if they are delivered in temporal proximity of hand surgery. However, keep in mind that cortisone or hyaluronic injections to joints (e.g. thumb) that are about to be operated on (trapeziectomy within the next three months) increase the risk of post surgical complications. This has been shown for trigger finger surgery (both in terms of number of injections and time-frames ) as well as trapeziectomy ( cortisone and hyaluronic acid ). Additional evidence is also available from other joints such as the hip, where CSI injections in close proximity of surgery increase the chance of infections ( https://pubmed.ncbi.nlm.nih.gov/36592824/ ). URL : https://doi.org/10.1016/j.jhsa.2025.03.020 Abstract Purpose: In this study, we asked the following question: Is intra-articular corticosteroid injection at a distant site prior to hand surgery associated with an increased risk of (1) surgical site infection, (2) reoperation for infection, or (3) wound dehiscence? Methods: Using a national administrative claims database, we identified adult patients undergoing carpal tunnel, trigger finger, or DeQuervain release. Patients were divided into four cohorts: intra-articular corticosteroid injection between 0 and 30, 31 and 60, or 61 and 90 days before surgery or no injection within 90 days prior to surgery. Large and intermediate joints were considered. We measured surgical site infection incidence, reoperation, and wound dehiscence within 90 days after surgery. We created multivariable logistic regression models to evaluate the association between preoperative corticosteroid injection and each outcome, adjusting for age, sex, region, insurance plan, Elixhauser comorbidities, and history of tobacco use. Results: Receiving a large-joint corticosteroid injection between 0 and 30, 31 and 60, or 61 and 90 days before surgery was not associated with surgical site infection or reoperation. Receiving a large-joint corticosteroid injection between 0 and 30 days before surgery was associated with a slightly higher incidence of wound dehiscence compared to no injection (0.5% vs 0.4%). Receiving an intermediate-joint corticosteroid injection between 0 and 30, 31 and 60, or 61 and 90 days before surgery was not associated with the incidence of surgical site infection, reoperation, or wound dehiscence. In patients with diabetes, receiving a corticosteroid injection within 90 days before surgery in a large or intermediate joint was not associated with an increased risk of surgical site infection, reoperation, or wound dehiscence. Conclusions: Corticosteroid injections into large- and intermediate-sized joints can be safely administered before hand surgery from a surgical site infection perspective, including in patients with diabetes. 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

Diagnostic accuracy of neurodynamic tests in upper-limb entrapment neuropathies: A systematic review and meta-analysis. Albert-Lucena, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic study Topic : Neurodynamic tests - Diagnostic accuracy Cx radiculopathy & CST This systematic review and meta-analysis assessed the diagnostic accuracy of Upper neurodynamic tests for upper-limb entrapment neuropathies, including carpal tunnel syndrome and cervical radiculopathy. A total of 12 studies, involving 957 participants, were included in the review. The overall evidence quality was very low due to study bias, imprecision, and heterogeneity. The results showed that neurodyanamic tests have moderate sensitivity but low to moderate specificity, with likelihood ratios varying based on diagnostic criteria, particularly when structural differentiation was applied. 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, neurodynamic tests should not be utilised as a standalone diagnostic tools for carpal tunnel syndrome or cervical radiculopathy. While neurodynamic tests can be part of an assessment, they are best used alongside patient history, physical exams, and imaging studies. In particular, for physical examination, several tests have been described as potentially useful when we suspect a carpal tunnel syndrome . Equally, if we suspect a cervical radiculopathy, the arm squeeze test as well as neurodynamic tests would be useful . Keep in mind, that cervical radiculopathies are associated with motor and sensory changes that need to be assessed and monitored. URL : https://doi.org/10.1016/j.msksp.2025.103317 Abstract Background: Upper-limb neurodynamic tests are commonly used to diagnose neuropathies in this area, including cervical radiculopathy and carpal tunnel syndrome, although their diagnostic accuracy remains uncertain across different conditions and criteria. Objective: To assess the diagnostic accuracy of upper-limb neurodynamic tests and their variations and criteria for upper-limb entrapment neuropathies. Methods: A systematic review with meta-analysis was conducted in different databases (for their inception in February 2025), including studies evaluating the diagnostic accuracy of these tests. Sensitivity, specificity, likelihood ratios (LR), diagnostic odds ratios, diagnostic accuracy and the area under the curve (AUC) were calculated using a bivariate and univariate meta-analysis. The quality of evidence was evaluated using the GRADE approach, and meta-regression was performed to examine the influence of diagnostic criteria. Results: Twelve studies were included. Likelihood ratios for neuropathic pain conditions were LR+:1.65 and LR-:0.57, for cervical radiculopathy were LR+:2 and LR-:0.47, and for carpal tunnel syndrome were LR+:1.45 and LR-:0.66. The upper-limb neurodynamic test 2A showed the highest diagnostic accuracy (AUC: 0.76), with LR+:2.59 and LR-:0.42 for cervical radiculopathy, while test 3 had the highest specificity (0.92; LR+:7, LR-:0.48). Diagnostic accuracy for carpal tunnel syndrome was lower (AUC: 0.62). Meta-regression showed significant diagnostic criteria interaction, favoring structural differentiation maneuvers (p = 0.002). Conclusion: Upper-limb neurodynamic tests show moderate sensitivity and low to moderate specificity for diagnosing upper-limb entrapment neuropathies, with diagnostic accuracy varying across conditions. The certainty of evidence ranges from very low to moderate, emphasizing the need for cautious clinical interpretation. Diagnostic reference criteria significantly influence test performance. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Does endoscopic carpal tunnel release during distal radial fracture fixation improve outcomes? A randomized controlled trial. Monteerarat, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Carpal tunnel release - Distal radius ORIF This randomised controlled study investigated the outcomes of prophylactic endoscopic carpal tunnel release (CTR) during distal radius fracture open reduction internal fixation (ORIF) compared to no CTR. A total of 60 participants were included and they were ransomised to CTR or not. The results showed that patient-reported functional outcomes, quality of life, and symptoms related to carpal tunnel syndrome (CTS) were comparable between the two groups. However, prophylactic CTR was associated with a reduced incidence of finger stiffness in patients with type C DRFs. Nevertheless, given the number of subgroup analyses, there is a 35% chance that the difference in finger stiffness between type of fracture is simply due to a random occurrence. 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, endoscopic carpal tunnel release during distal radius fracture ORIF offers no benefit in patient-reported functional outcomes, quality of life, or CTS symptoms compared to no release . This study is a nice addition to the randomised controlled trial comparing ulnar styloid repair or not during distal radius fracture ORIF . Overall, it appears that as long as the main fracture is repaired, additional interventions provide no added value. URL : https://doi.org/10.1177/17531934241288216 Abstract This study investigated the functional outcome of prophylactic carpal tunnel release during distal radial fracture fixation. A total of 60 patients undergoing anterior locking plate fixation for a distal radial fracture were randomized into two groups: one having prophylactic endoscopic carpal tunnel release and the other serving as a control. Functional outcomes were assessed using the Patient-Reported Wrist Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, EuroQol 5-Dimension 5-Level questionnaire, Boston Carpal Tunnel Questionnaire, Pain Numerical Rating Scale, grip strength and finger-to-palm distance over a 12-month period. The study found no significant differences in overall functional outcomes or complications between the groups. 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

Neglected posterior interosseous nerve injury. Lee, et al. (2024) Level of Evidence : 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Diagnostic Topic : Laceration - PIN lesion A 49 years old person underwent emergency surgery as they had a penetrating injury of the volar and dorsal forearm caused by a kitchen knife. Objectively, they had limited ability to flex the thumb as well as extend the thumb and the other fingers. There were no sensory deficits in the hand. Surgical exploration revealed lesions of the ECRL, ECRL, EDC, EDM, APL, EPL, and EPB. All of these were repaired. The patient was discharge one week later without evidence of complications. They were then reviewed at two months after surgery, which identified a 20° to 30° extension lag of the thumb, index, and little finger. Extension of the wrist, middle and ring finger was possible. These findings raised the suspect of a posterior interosseous nerve (PIN) palsy resulting from delayed diagnosis following trauma. During exploration surgery, a transected PIN with a neuroma was identified, leaving a 2.5 cm nerve gap between the two edges. After resection of the neuroma, a delayed nerve repair was performed using a harvested posterior antebrachial cutaneous nerve as a cable graft. The patient was lost at follow up and we therefore do not know whether thumb, index, and little finger active extension was recovered. 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, penetrating injuries of the forearm require a full neurovascular assessment before and after surgery. Early recognition of PIN injuries is vital to prevent long term neurological deficits. Thus it appears that l onger duration before repair and larger defects have lower probability of recovery. Furthermore, it seems that younger patients (under 45 yrs old) are more likely to obtain full functional recovery following nerve repair. URL : https://doi.org/10.1016/j.tcr.2024.100994 Abstract Posterior interosseous nerve (PIN) injury is uncommon due to its anatomically deep location. We report a neglected, rare case of PIN injury presenting the loss of extension of thumb, index, and small fingers with weakness of thumb abduction in a 49-year-old male patient. The patient sustained a penetrating injury to his right forearm caused by a kitchen knife that was repaired primarily through an emergency surgery under general anesthesia. During the regular follow-up on the 52nd postoperative day, the patient presented 20° of extension lags in the right thumb and index finger and 30° in the small finger. Wrist extension was intact, and there was no sensory deficit. We explored the wound and traced the PIN completely, identifying a club-shaped neuroma formation at the proximal cut end of the PIN. Delayed nerve repair was performed with a double-strip cable graft. Hand surgeons should be aware of the probable PIN injury in certain situations of forearm-penetrating injury and perform proper preoperative physical examination to rule out neurovascular deficits. Careful exploration and immediate repair of severe PIN are mandatory, even in emergency situations. 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