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Platelet-rich plasma injection versus operative treatment for lateral elbow tendinosis: A systematic review and meta-analysis. Kim, C.-H., Y.-B. Park, J.-S. Lee and H.-S. Jung (2021) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍(4/4 Thumbs up) Type of study : Therapeutic Topic : Lateral epicondylalgia – surgery vs platelet-rich plasma injections This is a systematic review and meta-analysis assessing the effectiveness of platelet-rich plasma (PRP) vs surgery for lateral epicondylalgia. Two randomised controlled trials (RCT) and two retrospective studies were included for a total of 340 participants. All the studies were assessed through a critiquing tool suitable for experimental and non-experimental studies. Intervention efficacy was assessed through improvements in pain (visual analogue scale - VAS) and function (patient-related tennis elbow evaluation - PRTEE). To be included in the review, studies had to compare PRP injections to surgery. Surgery involved in all cases debridement with decortication. Follow-up periods ranged between 3 and 12 months. The results showed that there was no statistical or clinically significant difference between PRP and surgery in terms of pain or function at any time point. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, surgery for tennis elbow does not appear to be more effective than PRP injections. In addition, PRP injections do not appear to be more effective than placebo saline injections for tennis elbow . Surgery for tennis elbow is therefore unlikely to be more effective than placebo. Considering the high cost of surgery and PRP injections, we may be better of telling our clients to adopt other less expensive alternatives such as initial rest followed by graded resistance training . If you would like to get a more complete picture about lateral epicondylalgia, have a look at the whole collection . URL : https://www.sciencedirect.com/science/article/pii/S1058274621007242 Available through EBSCO Health Databases for PNZ members. Abstract Background Although surgical treatment is considered reliable for lateral elbow tendinosis, local injection therapy may be preferable, as it avoids surgery. Among a number of local injections, platelet-rich plasma has been used successfully to treat lateral elbow tendinosis. The purpose of this study was to compare the outcomes in patients treated with either platelet-rich plasma injections or surgery for lateral elbow tendinosis using a systematic literature review and meta-analysis. Methods MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 1, 2021, that compared platelet-rich plasma with operative treatment for lateral elbow tendinosis. The pooled analysis was designed to compare the visual analog scale scores and the Patient-Related Tennis Elbow Evaluation scores between the platelet-rich plasma and surgical treatment groups at serial time points. Results We included five studies involving 340 patients with lateral elbow tendinosis, comprising of 154 patients treated with platelet-rich plasma and 186 patients who underwent surgical treatment. The pooled analysis showed no statistically significant differences in the visual analog scale scores at any of the follow-up time points, namely post-intervention 2 months (mean difference = 1.11, 95% confidence interval: −2.51 to 4.74, P = 0.55, I2 = 94%), 6 months (mean difference = 0.80, 95% confidence interval: −2.83 to 4.42, P = 0.67, I2 = 92%), and 12 months (mean difference = −0.92, 95% confidence interval: −4.63 to 2.80, P = 0.63, I2 = 93%) and in the Patient-Related Tennis Elbow Evaluation scores at post-intervention 12 weeks (mean difference = −1.86, 95% confidence interval: −22.30 to 18.58, P = 0.86, I2 = 81%), 24 weeks (mean difference = −3.33, 95% confidence interval: −21.82 to 15.17, P = 0.72, I2 = 74%), and 52 weeks (mean difference = −3.64, 95% confidence interval: −19.65 to 12.37, P = 0.66, I2 = 69%). Conclusions Local platelet-rich plasma injections and surgical treatment produced equivalent pain scores and functional outcomes in patients with lateral elbow tendinosis. Thus, platelet-rich plasma injections may represent a reasonable alternative treatment for patients who are apprehensive to proceed with surgery or for poor surgical candidates. 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

Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: A systematic review and meta-analysis of randomized placebo-controlled clinical trials. Simental-Mendía, M., Vilchez-Cavazos, F., Álvarez-Villalobos, N., Blázquez-Saldaña, J., Peña-Martínez, V., Villarreal-Villarreal, G., & Acosta-Olivo, C. (2020) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍(4/4 Thumbs Up) Type of study : Therapeutic Topic : Lateral epicondylalgia – platelet-rich plasma injections This is a systematic review and meta-analysis assessing the effectiveness of platelet-rich plasma (PRP) vs placebo injections for lateral epicondylalgia. Five randomised placebo-controlled trials (RCT) were included for a total of 276 participants (PRP = 153; Placebo injection = 123). All the RCTs were assessed through the Risk of Bias criteria recommended by the Cochrane Review Group. Efficacy of intervention was assessed through improvements in pain (VAS) and function (patient-rated tennis elbow evaluation - PRTEE). To be included in the review, RCTs had to compare PRP injections to placebo injections (saline). Follow-up periods ranged between 2 to 6 months. The results showed that all the RCTs presented a low risk of bias. There was no difference between PRP or placebo injections on pain (Mean difference: -0.51; 95%CI: -1.32 to 0.3) or function (Standardised mean difference: -0.07; 95%CI: -0.46 to 0.33). Pain improved to a clinically significant level in both placebo and PRP injections groups (median reduction in pain of 5 points out of 10 in both groups). Neither the placebo nor the PRP injection group improved to a clinically significant level in the functional outcomes (1 point change on DASH). Clinical Take Home Message : PRP injections do not appear to show any additional benefit on pain or function when compared to placebo (saline) injections. Both interventions appeared to provide a clinically meaningful improvement in pain, which is most likely due to the contextual effect of the injection treatment. URL : https://link.springer.com/article/10.1007/s10067-020-05000-y

Discussing conflicting explanatory approaches in flexibility training under consideration of physiology: A narrative review. Warneke, K., et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Flexibility - Mechanisms This narrative review discussed the efficacy of common flexibility training techniques including stretching and foam rolling. All the techniques/approaches show similar improvements in range of movement due to increased muscle temperature and decreased stiffness. A point is made that a simple warm-up regime may obtain similar short-term flexibility improvements as static stretching/foam rolling. For long-term flexibility, both stretching and resistance training through full joint range of movement can induce comparable structural adaptations, likely attributable to mechanical tension at extended muscle lengths, which stimulates protein synthesis and potentially sarcomerogenesis. Despite limited direct evidence of sarcomerogenesis in humans, the proposed mechanisms align with known physiological responses from animal studies. 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, effective flexibility training does not rely solely on traditional stretching methods. In particular, other physical training routines, such as full range of motion resistance training or general warm-ups, can induce similar flexibility gains. These findings are in line with previously published research showing that resistance training through range alone , without the addition of stretching , can improve flexibility. Therefore, if you or your patients don't have much time, you can avoid stretching . URL : https://doi.org/10.1007/s40279-024-02043-y Abstract The mechanisms underlying range of motion enhancements via flexibility training discussed in the literature show high heterogeneity in research methodology and study findings. In addition, scientific conclusions are mostly based on functional observations while studies considering the underlying physiology are less common. However, understanding the underlying mechanisms that contribute to an improved range of motion through stretching is crucial for conducting comparable studies with sound designs, optimising training routines and accurately interpreting resulting outcomes. While there seems to be no evidence to attribute acute range of motion increases as well as changes in muscle and tendon stiffness and pain perception specifically to stretching or foam rolling, the role of general warm-up effects is discussed in this paper. Additionally, the role of mechanical tension applied to greater muscle lengths for range of motion improvement will be discussed. Thus, it is suggested that physical training stressors can be seen as external stimuli that control gene expression via the targeted stimulation of transcription factors, leading to structural adaptations due to enhanced protein synthesis. Hence, the possible role of serial sarcomerogenesis in altering pain perception, reducing muscle stiffness and passive torque, or changes in the optimal joint angle for force development is considered as well as alternative interventions with a potential impact on anabolic pathways. As there are limited possibilities to directly measure serial sarcomere number, longitudinal muscle hypertrophy remains without direct evidence. The available literature does not demonstrate the necessity of only using specific flexibility training routines such as stretching to enhance acute or chronic range of 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

Posterior interosseous nerve compression in the forearm, AKA radial tunnel syndrome: A clinical diagnosis. Patterson, J. M. M., Medina, M. A., Yang, A. and Mackinnon, S. E. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic, Therapeutic Topic : Radial tunnel syndrome - Assessment and treatment This retrospective study assessed the clinical characteristics of radial tunnel syndrome. A total of 182 patients who underwent posterior interosseous nerve decompression between 2000 and 2020 were screened. After exclusion of patients who presented with polyneuropathy, motor palsy, and common extensor origin tendinopathy, 14 patients were included in the study. Clinical presentation commonly involved dorsal forearm pain with a somewhat heterogeneous presentation of symptoms (see pain drawings below). Surgical decompression led to significant improvements in pain, quality of life, and DASH scores. Overall, the authors suggested that surgery should be used as a last resort for those patients not responding to conservative treatment. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, radial tunnel syndrome is predominantly a pain syndrome without motor paralysis of the posterior inteosseous nerve. Pain is often reported in the dorsal forearm and surgical intervention should be considered for patients resistant to conservative management. Radial tunnel syndrome is not an easy diagnosis to make as it appears to be common in people presenting with common extensor origin tendinopathy . The evidence for treatment is scarce , however, on a positive note, radial tunnel syndrome is easily differentiated from posterior interosseous nerve syndrome as radial tunnel syndrome does not present with motor impairments . URL : https://doi.org/10.1177/15589447221122822 Abstract Background: Posterior interosseous nerve (PIN) compression in the forearm without motor paralysis is a challenging clinical diagnosis. This retrospective study evaluated the clinical assessment, diagnostic studies, and outcomes following surgical decompression of the PIN in the forearm. Methods: This study reviewed 182 patients’ medical charts following PIN decompression between 2000 and 2020 by a single surgeon. After exclusion of combined nerve entrapments, polyneuropathy, motor palsy, or lateral epicondylitis, the study included 14 patients. Data collected included: clinical presentation and pain drawings, provocative testing, functional outcomes, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Results: There were 15 PIN decompressions (14 patients, mean follow-up = 11.9 months). Clinical presentation included pain (n = 14) (proximal dorsal forearm, n = 14; distal forearm over radial sensory nerve, n = 3) and positive clinical tests (sensory collapse test over the radial tunnel, n = 8; pain with forearm pronation and compression over the radial tunnel, n = 10; Tinel sign, n = 5). Postoperatively, there were significant improvements in Visual Analog Scale pain scores (6.7 to 3.3, P = .0006), quality-of-life scores (74.7 to 32.7, P = .0001), and DASH scores (46.3 to 33.6, P = .02). Conclusions: The PIN compression in the forearm without motor paralysis is a clinical diagnosis supported by pain drawings, pain quality, and provocative tests. Patients with persistent, therapy-resistant dorsal forearm pain should be evaluated for PIN compression. Surgical decompression provides statistically significant quantifiable improvement in pain and quality of life. 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 using wrist orthoses on forearm flexor and extensor muscle activation. Novais Van Petten, A. M. and Ávila, A. F. (2010) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Wrist splinting - Effect on muscle activity This study compared the effect of wrist immobilisation orthoses made from different materials on forearm flexor and extensor muscle activation during specific tasks. Twenty-six adults underwent the Jebsen-Taylor functional hand test and grip strength test under three conditions: no splint, wearing a composite sandwich orthosis (different materials layered one on top of the other), and wearing a thermoplastic orthosis (Ezeform). Surface electrodes recorded muscle activity, which was compared across conditions. The results indicated that any orthosis significantly changed muscle activation, with no significant difference between splint type. In particular, extensor muscle activity decreased, whilst flexor muscle activity increased with splint use during the gripping activity. 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, wrist splint may modify forearm muscle activation. Specifically, there may be a decrease in extensor muscles, which could be beneficial in the presence of a tendinopathy . The specific type of splint utilised does not appear to have an effect. Wrist splints can be utilised for several different conditions and these may include scaphoid fractures , tennis elbow, or distal radius fractures . Choose the most comfortable splint for your patients, as the splint type does not appear to matter. URL : https://doi.org/10.1016%2FS2255-4971(15)30220-2 Abstract The study aimed to evaluate the impact of wrist immobilization orthoses made from different materials on the activation of forearm flexor and extensor muscles during specific tasks. Twenty-six adults, with an average age of 26.2 years, participated in the Jebsen-Taylor functional hand test and the grip strength test (Jamar® dynamometer) under three conditions: free hand, wearing a composite orthosis, and wearing a thermoplastic orthosis. Surface electrodes recorded muscle electrical activity. The results showed significant differences in muscle activation between free hand use and any orthosis but no significant difference between the two orthoses types. Extensor muscle activity decreased during all tasks, while flexor muscle activity increased with orthosis use. These findings are important for determining whether an orthosis should be prescribed during the rehabilitation process for various disorders, such as tendinitis of wrist and finger flexors and extensors, and for predicting the duration of orthosis use. 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

Multifaceted exercise prescription in the management of an overhead athlete with suspected distal biceps tendinopathy: A case report. Holshouser, C. and Jayaseelan, D. J. (2020) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Distal biceps tendinopathy - Rehabilitation This paper presents the case of a 19-year-old collegiate baseball pitcher with suspected distal biceps brachii tendinopathy. The pain initiated following pitching tryouts, and symptoms were located in the antecubital area of the elbow. The key interventions included a multimodal exercise regime with a focus on eccentric, concentric, and plyometric exercises. You can see examples of that in the picture below. The patient showed significant improvements in pain, function, and strength over five physical therapy sessions within four weeks. 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, employing a combination of eccentric, concentric, and plyometric exercises can effectively reduce pain and restore function in athletes presenting with a distal biceps tendinopathy. Creating exercises that are specific for the patient's activity may help with their return to sport. Remember that there are quite a few assessment tests for distal biceps tendinopathy, which include the distal biceps loading test and palpation of its insertion . URL : https://doi.org/10.3390/jfmk5030056 Abstract Background and Purpose: Distal biceps brachii tendinopathy is an uncommon diagnosis. Various exercise prescriptions have demonstrated efficacy in the management of tendinopathy, although studies frequently focus on the effects of a specific type of muscular contraction (i.e., concentric, isometric, or eccentric). Currently, there is limited research guiding the conservative management of distal biceps tendinopathy, particularly with overhead athletes, and even less evidence reporting a multifaceted exercise prescription for individuals with tendinopathy. The purpose of this case report is to describe the integration of various modes of therapeutic exercise into a rehabilitation program for an overhead athlete with suspected distal biceps brachii tendinopathy. Case Description: A 19-year-old male collegiate baseball pitcher presented to an outpatient physical therapy clinic via direct access for left antecubital pain, which began 6 weeks prior to the evaluation while pitching during try-outs. Following physical examination, distal biceps tendinopathy was the likely clinical diagnosis. Interventions focused on early eccentric exercise eventually progressing to concentric and plyometric activity for return to sport. Outcomes: The patient was seen five times over the course of 4 weeks. He had significant improvements of pain, patient-reported functional outcomes, global rating of change, strength, tenderness, and provocation testing. The patient was able to return to an off-season pitching program. Discussion: An impairment-based and task-specific exercise prescription was effective for this patient with distal biceps tendinopathy. Understanding the biomechanical demands of an individual’s functional limitation, in this case baseball pitching, may assist the decision-making process and optimize outcomes. Additional research into the most effective exercise prescriptions for individuals with uncommon tendinopathies is warranted. 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

Exercise-based interventions are effective in the management of patients with thumb carpometacarpal osteoarthritis: A systematic review and meta-analysis of randomised controlled trials. Karanasios, S., Mertyri, D., Karydis, F. and Gioftsos, G. (2024) Level of Evidence: 1a Follow recommendation : 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic : Thumb osteoarthritis - Exercises This systematic review and meta-analysis examined the efficacy of exercise-based interventions compared to other conservative treatments in managing thumb cmcj osteoarthritis (OA). This review included 14 randomised controlled trials for a total of 1,280 participants. The results showed that exercise-based interventions provided statistically and clinically relevant improvements in pain intensity and disability at short-term follow-up compared to no treatment. There were no significant differences between exercise-based and standard treatments at mid- and long-term 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, exercise-based interventions significantly reduce pain and disability in patients with thumb cmcj OA in the short term. These findings reinforce the importance of incorporating exercise-based treatments into clinical practice for managing thumb cmcj OA. You can still get your patients to use a splint on an intermittent basis , however, this is not necessary . URL : https://doi.org/10.3390/healthcare12080823 Abstract Exercise-based interventions are a common management strategy in patients with thumb carpometacarpal joint osteoarthritis (CMCJ OA); however, their exact effect on or the use of an optimal training programme for reducing pain and disability remains unclear. Our purpose was to evaluate the effectiveness of exercise-based interventions compared with other conservative interventions in patients with CMCJ OA. We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fourteen randomised clinical trials with 1280 patients were finally included. Exercise-based interventions present statistically and clinically better outcomes in reducing pain intensity (mean difference [MD]: −21.91; 95% confidence interval [CI]: −36.59, −7.24; p = 0.003) and wrist disability (MD: −8.1, 95% CI: −4.6, −11.5; p = 0.02) compared with no treatment at short-term follow-up. Proprioceptive exercises have statistically and clinically better outcomes compared with standard care only in pain intensity at very short-term (standardised mean difference [SMD]: −0.76; 95% CI: −1.30, −0.21; p = 0.007) and short-term (SMD: −0.93; 95% CI: −1.86, −0.01; p = 0.049) follow-up and statistically better results in wrist disability at very short-term (SMD: −0.94; 95% CI: −1.68, −0.21; p = 0.01) follow-up. No differences were found between the comparators at mid- and long-term follow-up. Low to moderate certainty of evidence suggests that exercise-based interventions can provide clinically better outcomes compared with no treatment in patients with thumb CMCJ OA, at least in the short term. 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

Custom-made finger splint versus prefabricated finger splint: Finger flexion stabilization. Güven, E. and Suner-Keklik, S. (2022) Level of Evidence: 2b Follow recommendation: 👍 👍 👍  (3/4 thumbs up) Type of study: Therapeutic Topic : Custom vs off the shelf splints - Finger injuries This cross-sectional study assessed the effectiveness of custom-made splint compared to prefabricated finger splint in limiting joint motion in the pipj and dipj of the index finger. Forty healthy individuals (20 women, 20 men) were included in the present study and were asked to bend their index finger whilst wearing either the custom or prefabricated splint. Range of movement at the pipj and dipj was assessed. The results showed that the custom splint limited both pipj and dipj range to a large extent. In contrast, the prefabricated splint allowed dipj and pipj movement to about 24° and 17° respectively. 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 appears that custom-made splints limit finger's pipj and dipj to a greater extent compared to prefabricated finger splints. This may be especially useful to know for conservatively managed of finger's fracture or tendon/bony lesions such as mallet finger . URL : https://doi.org/10.1590%2F1806-9282.20220093 Abstract Finger splints are used as a treatment option in tendon, bone, and soft tissue injuries. For immobilization, custom-made splints and prefabricated finger splints are used. In splints made for immobilization, it is aimed to limit joint movement. The aim of our study is to reveal how much custom-made splints and prefabricated finger splints limit joint motion (flexion angle in proximal interphalangeal and distal interphalangeal joints). Custom-made splints and prefabricated finger splints were applied to the second fingers of the dominant side in a total of 40 individuals, 20 women and 20 men, not having any health problems. Individuals were asked to flex and joint motion was measured with the iPhone compass application. The mean distal interphalangeal joint angle values of the participants measured by prefabricated finger splints were found to be 24.27±8.29, and the mean distal interphalangeal joint angle values measured by custom-made splints was 0.52±1.50. There was a difference between the participants’ distal interphalangeal joint angle values measured by prefabricated finger splints and custom-made splints (p<0.001). Distal interphalangeal joint angle values measured with custom-made splints were significantly smaller than those measured with prefabricated finger splints. The mean of the participants’ proximal interphalangeal joint angle values measured by prefabricated finger splints was 16.55±7.90, and the proximal interphalangeal joint angle values measured by custom-made splints was “0” for all participants. There was a difference between the participants’ proximal interphalangeal joint angle values measured by prefabricated finger splints and custom-made splints (p<0.001). Distal interphalangeal joint angle values measured with custom-made splints were significantly smaller than those measured with prefabricated finger splints. According to our study, custom-made splints can significantly reduce the flexion of the finger interphalangeal joints compared to prefabricated finger splints. 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

An open-label feasibility trial of transdermal cannabidiol for hand osteoarthritis. Bawa, Z., et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Thumb osteoarthritis - Cannabidiol This feasibility study assessed the potential use of a novel 4% CBD transdermal gel on hand osteoarthritis (OA). A total of 15 participants took part in it. Over a four-week period, participants applied the gel three times daily to their most painful hand. Pain severity was assessed using the Numeric Pain Rating Scale (NPRS) and hand functionality via a grip dynamometer (connected via Bluetooth to a phone) and self-report questionnaires. Quality of life including sleep, anxiety, stiffness, and fatigue were also assessed. Significant reductions in current, average, and maximum pain were observed, alongside increases in grip strength. In addition, subjective stiffness, anxiety, and fatigue all improved. Urine tests confirmed the systemic absorption of CBD. Despite favorable pain and strength outcomes, these benefits returned to baseline post-treatment (around 7 days from treatment interruption). 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, topical cannabidiol (CBD) gels show promise as a treatment option for reducing pain and improving grip strength in patients with symptomatic hand osteoarthritis. In addition, there appeared to be improvements in quality-of-life, anxiety, stiffness, and fatigue. These findings appear to be in line with previous evidence , however, it is important to remember that we have currently limited evidence in support of this topical agent . URL : https://doi.org/10.1038/s41598-024-62428-x Abstract Hand osteoarthritis (OA) is an irreversible degenerative condition causing chronic pain and impaired functionality. Existing treatment options are often inadequate. Cannabidiol (CBD) has demonstrated analgesic and anti-inflammatory effects in preclinical models of arthritis. In this open-label feasibility trial, participants with symptomatically active hand OA applied a novel transdermal CBD gel (4% w/w) three times a day for four weeks to their most painful hand. Changes in daily self-reported pain scores were measured on a 0–10 Numeric Pain Rating Scale (NPRS). Hand functionality was determined via daily grip strength measures using a Bluetooth equipped squeeze ball and self-report questionnaire. Quality of life (QoL) ratings around sleep, anxiety, stiffness and fatigue were also measured. All self-report measures and grip strength data were gathered via smartphone application. Urinalysis was conducted at trial end to determine systemic absorption of CBD. Eighteen participants were consented and 15 completed the trial. Pain ratings were significantly reduced over time from pre-treatment baseline including current pain (− 1.91 ± 0.35, p < 0.0001), average pain (− 1.92 ± 0.35, p < 0.0001) and maximum pain (− 1.97 ± 0.34, p < 0.0001) (data represent mean reduction on a 0–10 NPRS scale ± standard error of the mean (SEM)). A significant increase in grip strength in the treated hand (p < 0.0001) was observed although self-reported functionality did not improve. There were significant (p < 0.005) improvements in three QoL measures: fatigue, stiffness and anxiety. CBD and its metabolites were detected at low concentrations in all urine samples. Measured reductions in pain and increases in grip strength seen during treatment reverted back towards baseline during the washout phase. In summary, pain, grip strength and QoL measures, using smartphone technology, was shown to improve over time following transdermal CBD application suggesting feasibility of this intervention in relieving osteoarthritic hand pain. Proof of efficacy, however, requires further confirmation in a placebo-controlled randomised trial. 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

Self-assisted finger stiffness splint (SFSS). Almigdad, A., Obeidat, N., Melhem, M. and Abu-Ashour, S. (2024) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Relative motion splints - Finger stiffness This technical report discussed the use of a dynamic splint facilitating active finger movement or protecting tendons from excessive loading post-surgically. The splint that you can see below can be classified as a relative motions splint, which could be used to perform self-administered stretching exercises or protect extensor tendon repair (e.g. relative motion extension splint). The authors report it particularly beneficial for pipj and mcpj stiffness, with some utility in multiple-digit stiffness. The authors also indicate that they have been using it following tenolysis of extensor tendons or after phalanx fractures to improve flexibility. 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, relative motions splints present as an option to mobilise stiff finger or protect healing tissues . These splints appear useful to mobilise or restrict movement at the pipj/dipj. If you are interested in the use of relative motion splints for hand therapy, have a look at the whole database as these splint have been utilised for all sorts of conditions including trigger finger . URL : https://doi.org/10.7759%2Fcureus.51921 Abstract Finger stiffness may arise from injuries, surgeries, or hand-related medical conditions, impacting hand function and overall well-being in daily life. Rehabilitation and hand therapy play a crucial role in restoring optimal range of motion, strength, and functionality. This article introduces the Self-Assisted Finger Stiffness Splint (SFSS), a dynamic splint designed for active finger movement applicable in post-trauma or postoperative rehabilitation. SFSS empowers patients to perform self-administered stretching exercises, expediting recovery and improving compliance. Its versatility extends to postoperative rehabilitation, covering cases like tenolysis of extensor tendons or rehabilitation after fracture healing. While particularly effective for proximal interphalangeal joint (PIPJ) and metacarpophalangeal joint (MCPJ) stiffness, SFSS remains valuable for managing isolated finger stiffness and proves beneficial in addressing multiple-digit stiffness. 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 neural mobilisation for the treatment of nerve-related cervicobrachial pain: A systematic review with subgroup meta-analysis. Lascurain-Aguirrebeña, I., et al. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Neurodynamic exercises - Cervicobrachial pain This ssystematic review and meta-analysis aimed to assess the effectiveness of neural mobilisations (NM) for treating nerve-related cervicobrachial pain. A total of 27 randomized controlled trials comparing NM to no treatment, cervical traction, and exercise for pain and disability outcomes were included in the present review. All the studies were scored through the Cochrane Risk of Bias tool and the overall quality of the evidence was scored through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The results showed that NM was more effective than no treatment, traction, and standard physiotherapy alone, specifically in patients fulfilling the Wainner cluster criteria (At least 3 out of 4 positive tests: median nerve tension test, reduced Cx rotation, Cx distraction test, and Spurling's test). However, the evidence was very low to moderate due to high risk of bias, small sample sizes, and significant heterogeneity among studies. There was limited evidence about NM's medium-term and long-term effects. The study concluded that NM might be particularly beneficial for specific subgroups of patients with nerve-related cervicobrachial 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, neural mobilisations (NM) exhibit variable effectiveness for treating nerve-related cervicobrachial pain, depending on specific subgroups of patients. Of note, patients classified under the Wainner cluster criteria appear to benefit the most from NM exercises, although previous evidence appears to be in contrast with these findings . Remember that if you are suspecting a radiculopathy, you should complete a full neurological assessment including myotome testing . URL : https://doi.org/10.1097/j.pain.0000000000003071 Abstract Neural mobilisations (NM) have been advocated for the treatment of nerve-related cervicobrachial pain; however, it is unclear what types of patients with nerve-related cervicobrachial pain (if any) may benefit. Medline, Web of Science, Scopus, PeDro, Cinahl, and Cochrane databases were searched from inception until December 2022. Randomised controlled trials were included if they assessed the effectiveness of NM in nerve-related cervicobrachial pain, and outcome measures were pain intensity and/or disability. Studies were classified according to their inclusion/exclusion criteria as radiculopathy, Wainner cluster, Hall, and Elvey cluster or other. Meta-analyses with subgroup analyses were performed. Risk of bias was assessed using Cochrane Rob2 tool. Twenty-seven studies were included. For pain and disability reduction, NM was found to be more effective than no treatment (pooled pain mean difference [MD] = −2.81, 95% confidence interval [CI] = −3.81 to −1.81; pooled disability standardized mean difference = −1.55, 95% CI = −2.72 to −0.37), increased the effectiveness of standard physiotherapy as an adjuvant when compared with standard physiotherapy alone (pooled pain MD = −1.44, 95% CI = −1.98 to −0.89; pooled disability MD = −11.07, 95% CI = −16.38 to −5.75) but was no more effective than cervical traction (pooled pain MD = −0.33, 95% CI = −1.35 to 0.68; pooled disability MD = −10.09, 95% CI = −21.89 to 1.81). For disability reduction, NM was found to be more effective than exercise (pooled MD = −18.27, 95% CI = −20.29 to −17.44). In most comparisons, there were significant differences in the effectiveness of NM between the subgroups. Neural mobilisations was consistently more effective than all alternative interventions (no treatment, traction, exercise, and standard physiotherapy alone) in 13 studies classified as Wainner cluster. 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

Efficacy of splinting the wrist and metacarpophalangeal joints for the treatment of Carpal tunnel syndrome: An assessor-blinded randomised controlled trial. Nadar, M. S., Alotaibi, N. and Manee, F. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : Carpal tunnel syndrome - Lumbricals splint This randomised controlled study, assessed the effectiveness of a normal wrist splint vs a lumbrical splint for people with carpal tunnel syndrome (CTS). A total of 59 participants with mild-to-moderate CTS, were randomly assigned to wear either a traditional wrist-only splint or a modified splint that also limited mcpj flexion for six weeks. Outcome measures included grip and pinch strength, sensory tests, and pain. The results showed that both splints improved CTS symptoms, but the lumbrical splint was more effective in improving tip and palmar pinch strength. 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 splint including the mcpj may be more effective than a simple splint in reducing symptoms for carpal tunnel syndrome. The rational for the use of such splint is that most lumbricals enter the carpal tunnel during finger flexion . If you would like to read more about lumbricals you can have a look at the full dataset . URL : https://doi.org/10.1136/bmjopen-2023-076961 Abstract Objectives: To compare the efficacy of a traditional cock-up splint, which supports the wrist only, with a modified splint that supports the wrist and the metacarpophalangeal (MCP) joints of the medial four digits in the treatment of carpal tunnel syndrome (CTS). Design: An assessor-blind randomised controlled trial.Setting Hospital-based hand therapy clinics. Participants: Fifty-nine adults with mild-to-moderate CTS were randomly assigned to wear a wrist splint (control group) or an MCP splint (intervention group) for 6 weeks. Outcome measures: The standardised outcome measures used included grip and pinch strength, the static two-point discrimination test, Phalen’s manoeuvre test, Tinel’s sign and the Boston CTS Questionnaire. Results: Both groups improved significantly from splint use in some clinical features. The wrist splint and the MCP splint groups had significant improvements in lateral pinch strength (p=0.032 and p=0.002, respectively), two-point discrimination of the thumb (p=0.003 and p=0.041, respectively), two-point discrimination of the index (p=0.035 and p=0.023, respectively) and the Phalen’s manoeuvre symptoms (p=0.025 and p=0.002, respectively). The MCP splint group had additional improvements over the wrist splint group in tip pinch (p=0.012) and Palmar pinch (p=0.011) strength. Conclusion: Splinting is a practical and effective intervention option for improving the symptoms of CTS. A wrist splint that incorporates the MCP joints is more effective than the traditional wrist-only splint, with long-lasting improvements that remained consistent after 6 months of the splint intervention. Using the more effective MCP splint may consequently reduce disability, facilitate return to work and lower the associated costs. 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