Preoperative malnutrition is associated with increased risk of 90-day major medical complications and increased 2-year revision rates following total shoulder arthroplasty. Lawand, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Malnutrition - Post-surgical recovery This retrospective study assessed the impact of preoperative malnutrition on postoperative complications in patients undergoing Total Shoulder Arthroplasty (TSA). By analysing data from a multi-institutional database, researchers identified malnutrition using surrogate markers such as low serum albumin, transferrin, and total leukocyte count. The findings revealed that patients with preoperative malnutrition experienced significantly higher rates of myocardial infarction, sepsis, and readmissions within 90 days post-surgery. Additionally, these individuals demonstrated increased risks of periprosthetic joint infections and the need for revision shoulder arthroplasty within two years postoperatively. The study underscores the importance of routine preoperative nutritional screening and optimisation to mitigate complications and improve surgical outcomes in TSA patients. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, preoperative nutritional status is a strong contributor of post-surgical outcomes following upper limb surgery. The identification of malnutrition through surrogate markers such as low serum albumin, transferrin, and total leukocyte count is a practical approach that can be easily incorporated into pre-operative screening. This study reinforces the importance of routine preoperative nutritional screening and optimisation in patients undergoing TSA. Malnutrition should be addressed as part of a comprehensive prehabilitation strategy to improve surgical outcomes and reduce postoperative risks. These issues could be flagged during our pre-surgical appointment, which is also useful in setting surgical expectations . URL : https://doi.org/10.1016/j.jse.2025.03.005 Abstract Introduction: Preoperative malnutrition is a known risk factor for poor short-term outcomes after Total Shoulder Arthroplasty (TSA), but the relationship between preoperative malnutrition and implant complications remains unclear. This study aims to evaluate the association between preoperative malnutrition lab markers with the risk of 90-day postoperative complications and 2-year revision rates in TSA patients. Methods: This retrospective cohort study used the TriNetX database to assess TSA patients with and without preoperative malnutrition markers (albumin <3.5g/dL, transferrin <204mg/dL, total leukocyte count <1,500 cells/mm3) from 2004 to 2022, with a minimum of two years of follow-up. Propensity matching (1:1) balanced malnourished and non-malnourished groups by demographics (age, race, ethnicity) and comorbidities (diabetes, hypertension, liver disease, tobacco use, chronic kidney disease, obesity, and osteoporosis). Ninety-day outcomes included infection, blood transfusion, sepsis, pulmonary embolism, myocardial infarction, stroke, readmission, pneumonia, and renal failure. Two-year outcomes assessed revision arthroplasty, periprosthetic joint infection (PJI), mechanical loosening, and prosthetic dislocation. Associations were measured with relative risks (RR), confidence intervals (CI), and p-values. Results: A total of 1,936 patients per group were analyzed after matching. Malnourished patients had significantly higher risks of 90-day major complications, including sepsis (RR 2.400, p = 0.016), myocardial infarction (RR 3.4, p < 0.001), readmission (RR 1.6, p = 0.003), pneumonia (RR 1.667, p = 0.018), renal failure (RR 1.806, p = 0.003), and blood transfusion (RR 5.1, p < 0.001). Within two years postoperatively, these patients were at increased risk of PJI (RR 2.0, p = 0.009), and revision TSA (RR 1.8, p = 0.001). No significant differences in pulmonary embolism, stroke, and mechanical loosening were reported. Conclusion: Preoperative malnutrition is associated with a higher rate of 90-day complications, including sepsis and myocardial infarction following shoulder replacement and a higher two-year risk of PJI and revision TSA. 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

Trapeziometacarpal osteoarthritis: Do not forget other disorders. Druel, et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Hidden disorders - 1st cmcj OA A retrospective study was conducted on patients with 1st cmcj OA to evaluate the prevalence of other hand disorders. The study involved 193 patients over a decade; 49% had additional hand disorders, and 35% underwent concurrent surgery. The most prevalent associated conditions were scaphotrapezotrapezoid (STT) osteoarthritis, median nerve compression, and tenosynovitis. Metacarpophalangeal hyperextension of the thumb, often linked to 1st cmcj OA, was found in 18% of cases. This research emphasises the necessity of a comprehensive hand examination before surgery, as associated disorders could impact surgical outcomes. Differences in prevalence rates of associated conditions and concurrent surgeries were noted compared to previous studies, possibly due to variations in diagnostic criteria. 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, 1st cmcj OA is frequently associated with STT osteoarthritis, carpal tunnel syndrome, and FCR tenosynovitis. This study appears to be in line with a previous meta-analysis showing that carpal tunnel syndrome is two times more likely in people with hand OA . Additionally, biopsychosocial factors play a role in exacerbating symptoms of osteoarthritis , and employing a multidisciplinary approach could be beneficial. URL : https://doi.org/10.1177/17531934231220644 Abstract A retrospective study of patients with symptomatic trapeziometacarpal osteoarthritis was conducted to assess the prevalence of other disorders of the hand. Another disorder of the hand was associated in 49% of cases. A systematic clinical examination of the whole hand must be performed preoperatively. 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

Ruhigstellungstechniken der oberen extremität bei kindern. Kaiser, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Children's fractures - Conservative treatment This expert opinion discusses conservative treatment methods for stable fractures in the upper extremities of children, emphasising non-operative techniques as the gold standard. Indications for these methods include undisplaced and displaced fractures which underwent reduction of the hand, forearm, and elbow. The use of forearm and long arm splints or casts, along with intrinsic plus splints for certain finger and metacarpal injuries, is highlighted. Immobilisation aims primarily at pain relief, with suggested durations varying based on the patient's age and fracture stability. Clinical and radiographic monitoring is recommended, especially for reduced or spontaneously corrected fractures. The article underscores that while these methods are cost-effective and devoid of surgery-related risks, there are potential complications like secondary displacement, pressure sores, and compartment 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, conservative treatment remains the gold standard for managing stable fractures of the upper extremity in children. Correct application of immobilisation techniques, such as forearm and long-arm casting, can effectively stabilise fractures and promote healing with a good cost-benefit ratio. Fracture stability should be reassessed following 1 week, especially in those fractures that have been reduced. A repeat x-ray in one week is supported by other research showing that within the first week there is the highest probability of displacement . The results of this study are supported by additional research in torus fractures (see guidelines ), and osteochondritis dissecans . URL : https://doi.org/10.1007/s00064-025-00896-8 Abstract Objective: Conservative treatment of stable fractures of the upper extremity in children. Indications: Undisplaced and age-tolerable displaced fractures of the hand, forearm, and elbow. Contraindications: Open fractures. Treatment options: Forearm splint/forearm cast for stable injuries to the radius or ulna. Long arm splint/long arm cast for injuries to the radius and ulna and after reduction of the forearm, as well as for stable, undisplaced injuries to the elbow. Intrinsic plus splint for injuries to the four fingers (excluding the thumb) and metacarpus. Further treatment: For stable injuries, immobilization for analgesia for 3-4 weeks. Clinical check after treatment. In the case of repositioned fractures or fractures displaced within the spontaneous correction limits, clinical-radiological control (if necessary, with cast wedging) after 1 week. Immobilization for 4 weeks (prepubertal children) or 5 weeks (pubertal children). Results: Conservative treatment of fractures of the upper extremity is still the gold standard today. In pediatric patients in particular, but also in adult patients, correct healing of the fracture with good analgesia can be achieved with manageable effort and a good cost-benefit ratio through correct cast immobilization. A measurable parameter for monitoring a good cast is the cast index. 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

A prospective, randomized, blinded study on the efficacy of using corticosteroids in hydrodilatation as a treatment for adhesive capsulitis of the shoulder. Gebellí-Jové, et al. (2024) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Hydrodilatation - Frozen shoulder This randomised controlled study investigated the efficacy of hydrodilatation with or without corticosteroids in treating shoulder adhesive capsulitis. A total of 82 participants, the study assessed pain relief and functionality using various metrics over a year. The hydrodilatation group receiving corticosteroids (HDC) demonstrated significantly better outcomes in pain reduction and shoulder function compared to the group without corticosteroids (HDA). Assessments including the Visual Analog Scale, Shoulder Pain and Disability Index, Simple Shoulder Test, and Subjective Shoulder Value were used to gauge effectiveness. Differences in these metrics were evident as early as 48 hours post-treatment and persisted through the one-year follow-up. It is unclear whether these differences were clinically relevant. 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, hydrodilatation with corticosteroids is effective, however, the addition cortisone may provide marginal improvements in pain and function. The effectiveness of hydrodilatation for frozen shoulder seems to be in line with previous evidence showing that this intervention provides improvements in pain and range of movement . URL : https://doi.org/10.1177/17585732241239030 Abstract Background: This study aimed to compare hydrodilatation with or without corticosteroid administration on the outcomes of patients with shoulder adhesive capsulitis. Methods: This was a prospective, randomized, blinded study of 82 patients with adhesive capsulitis treated with hydrodilatation with corticosteroids (HDC) or without corticosteroids (HDA). Assessments were performed at 48 h and 1, 3, 6, and 12 months. Results: Pain in HDC patients was significantly lower after 48 h of treatment than that of HDA, and the functional scales were better after the first month. These differences were maintained after 1 year. (visual analog scale: 0.8 vs. 1.6, p = 0.018; shoulder pain and disability index: 4.8 vs. 9.8, p = 0.003; simple shoulder test: 11.4 vs. 8.7, p = 0.008; subjective shoulder value: 96.6 vs. 90.1, p = 0.024). Conclusion: We found that hydrodilatation with corticosteroids improved pain levels, shoulder function, and subjective perception of shoulder status compared to hydrodilatation without corticosteroids. 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

High radial nerve entrapment neuropathy: An anatomical cadaver study and case report. Tada, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Aetiologic Topic : Radial nerve - High entrapment This paper explores the pathophysiology of high radial nerve entrapment neuropathy through an anatomical study of 22 cadaveric limbs and a case report. The radial nerve, which passes through the fibrous tunnel formed by the lateral head of the triceps brachii and the lateral intermuscular septum, is susceptible to entrapment neuropathy due to the complex structure. This study highlights the critical role played by the lateral head of the triceps brachii-lateral intermuscular septum complex in nerve compression. It also emphasises the rarity yet significant impact of such neuropathy on patients. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, high radial nerve entrapment neuropathy arises from fibrous tunnels formed by the structures at the lateral head of the triceps brachii and the lateral intermuscular septum. This condition can lead to significant nerve compression. It is possible that radial tunnel syndrome unresponsive to localised treatment may be due to a more proximal compression site. Have a look at these synopses if you are interested in how common radial tunnel syndrome is or how effective injections are . URL : https://doi.org/10.1016/j.jse.2025.02.060 Abstract Background: The pathogenetic mechanism of high radial nerve entrapment neuropathy involves the fibrous arch of the lateral head of the triceps brachii and lateral intermuscular septum. However, the details of these anatomical structures remain unknown. We described the anatomical course of the radial nerve in the upper arm and its relationship with the lateral head of the triceps brachii and lateral intermuscular septum. Methods: Eleven freshly frozen cadavers (22 limbs, 7 females, and mean age: 87.3 years) were used. The elbow joint was placed at 90° flexion, and a lateral incision was made. Specifically, the tendons of the lateral head of the triceps brachii, deep fascia, and lateral intermuscular septum are continuous at the attachment and form a complex. The radial nerve runs obliquely through the fibrous tunnel formed by this complex, and the entry and exit portions form fibrous arches. Additionally, the distance from the lateral humeral epicondyle to the entrance (X1) and exit (X2) of the fibrous tunnel and fibrous tunnel length were measured. The tunnel was incised, and the radial nerve was exposed. Specifically, the radial nerve was observed from the lateral aspect of the humerus. R1, R2, and R3 were defined as the points where the radial nerve crosses the posterior aspect, lateral center, and anterior aspect of the humeral shaft, respectively. Their distances from the lateral humeral epicondyle were also measured. Results: The distance from the lateral humeral epicondyle to X1 and X2 was 145±15 (121–185) and 91±14 (72–122) mm, respectively, while the fibrous tunnel length was 55±12 (28–83) mm. Additionally, the distances from the lateral epicondyle to R1, R2, and R3 were 143±18 (103–177), 107±13 (75–142), and 79±14 (59–105) mm, respectively. No significant correlation was found between the humeral and tunnel lengths. Conclusion: The lateral head of the triceps brachii and lateral intermuscular septum form a complex that creates a fibrous tunnel. Additionally, the radial nerve traverses obliquely within this fibrous tunnel on the humerus, forming fibrous arches at both its entrance and exit. The lateral head of the triceps brachii-lateral intermuscular septum complex can be a source of compression in cases of high radial nerve entrapment neuropathy. Such neuropathy may result from a plane of compression. Therefore, we advocate for surgery in high radial nerve entrapment neuropathy cases that are resistant to conservative treatment. Dissecting the entire length of the fibrous tunnel is also important during surgery. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Surgical treatment of lateral epicondylitis: A prospective, randomized, double-blinded, placebo-controlled clinical trial. Kroslak, et al. (2018) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Tennis elbow - surgery vs sham The study conducted by Martin Kroslak and George A.C. Murrell compared the effectiveness of surgical excision versus placebo surgery for treating chronic tennis elbow, or lateral epicondylitis. The trial, conducted at St George Hospital in Sydney, Australia, involved 26 patients divided into two groups: one undergoing surgery to remove degenerative tissue from the extensor carpi radialis brevis (ECRB), and the other receiving a placebo involving a skin incision without tissue removal. Results showed significant improvements in pain and function in both groups over 6 months to 2.5 years, with no significant differences between surgical and placebo groups. Despite patient improvements, the study concluded that ECRB excision offered no additional benefits over placebo surgery. Limited by small sample size, a post hoc analysis suggested over 6,500 participants per group would be required to demonstrate significant differences. The study highlights the challenges in demonstrating the efficacy of surgical interventions for chronic tennis elbow. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, surgical excision of the CEO offers no additional benefit over placebo surgery. The findings emphasise that tennis elbow is often a self-limiting condition, where both surgical and sham interventions can lead to significant improvement without being significantly different from each other in outcome. These findings are supported by additional research comparing surgery to PRP and PRP to saline injections . URL : https://doi.org/10.1177/0363546517753385 Abstract Background: A number of surgical techniques for managing tennis elbow have been described. One of the most frequently performed involves excising the affected portion of the extensor carpi radialis brevis (ECRB). The results of this technique, as well as most other described surgical techniques for this condition, have been reported as excellent, yet none have been compared with placebo surgery. Hypothesis: The surgical excision of the degenerative portion of the ECRB offers no additional benefit over and above placebo surgery for the management of chronic tennis elbow. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: This study investigated surgical excision of the macroscopically degenerated portion of the ECRB (surgery; n = 13) as compared with skin incision and exposure of the ECRB alone (sham; n = 13) to treat patients who had tennis elbow for >6 months and had failed at least 2 nonsurgical modalities. The primary outcome measure was defined as patient-rated frequency of elbow pain with activity at 6 months after surgery. Secondary outcome measures included patient-rated pain and functional outcomes, range of motion, epicondyle tenderness, and strength at 6 months and 2.5 years. All outcome measures up to and including the 6-month follow-up were measured in person; the longer-term questionnaire was conducted in person or over the phone. Results: The 2 groups, surgery and sham, were similar for age, sex, hand dominance, and duration of symptoms. Both procedures improved patient-rated pain frequency and severity, elbow stiffness, difficulty with picking up objects, difficulty with twisting motions, and overall elbow rating >6 months and at 2.5 years ( P < .01). Both procedures also improved epicondyle tenderness, pronation-supination range, grip strength, and modified Orthopaedic Research Institute–Tennis Elbow Testing System at 6 months ( P < .05). No significant difference was observed between the groups in any parameter at any stage. No side effects or complications were reported. The study was stopped before the calculated number of patients were enrolled (40 per group); yet, a post hoc futility analysis was conducted that showed, based on the magnitude of the differences between the groups, >6500 patients would need to be recruited per group to see a significant difference between the groups at 26 weeks in the primary outcome (patient-rated frequency of elbow pain with activity). Conclusion: With the number of available participants, this study failed to show additional benefit of the surgical excision of the degenerative portion of the ECRB over placebo surgery for the management of chronic tennis elbow. 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

Dynamic position of the thumb metacarpophalangeal joint in patients with secondary passive hyperextension from base of thumb arthritis. Acott, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic Topic : The study investigated the relationship between passive mcpj hyperextension and dynamic mcpj positioning during functional activities in patients with 1st cmcj osteoarthritis. The research aimed to determine whether passive hyperextension serves as an indicator for the necessity of mcpj stabilisation. It was found that despite the presence of passive mcpj hyperextension, most patients dynamically positioned their mcpj in a flexed position during activities such as pinch and grasp. The study revealed poor correlation between passive mcpj hyperextension and dynamic mcpj position or pinch strength, suggesting that passive hyperextension may not be a reliable parameter for deciding on whether mcpj stabilisation is required. 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, passive hyperextension of the thumb mcpj does not correlate with dynamic mcpj positions during functional activities in people with thumb OA. If you would like to know mind blowing facts about thumb OA and exercise, have a look at the whole database . URL : https://doi.org/10.1177/17531934251330984 Abstract This study seeks to understand passive metacarpophalangeal hyperextension, dynamic position and pinch strength in patients with trapeziometacarpal joint arthritis. Our finding of poor correlation suggests passive metacarpophalangeal hyperextension in patients with trapeziometacarpal arthritis may not reliably indicate a need for thumb metacarpophalangeal stabilization. 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

Incidence and predictors of subsequent triggering requiring treatment after trigger finger release. Pohl, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Aetiologic / Prognostic Topic : Trigger finger - Additional interventions This retrospective study investigated the incidence and predictors of subsequent treatment following an initial trigger finger release. Conducted on 1,715 patients between 2015 and 2017, the results showed that 40% of people required additional treatment with either steroid injection or further surgical release for the same finger or other fingers. Notably, smoking and high comorbidity burden were linked to increased subsequent treatment. Moreover, patients with higher body mass index (BMI) and comorbidity burden had heightened chances of needing additional surgery. See graph below for an estimate of time in relation to the need for additional 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, whilst trigger finger release is effective, additional treatment is required in a significant proportion of patients, especially those with higher body mass index or comorbidities. It is essential to inform patients that 40% of people may require additional procedures, such as steroid injections or further surgeries for the same or different finger. Current smokers appear to be at higher risk for needing subsequent interventions, reinforcing the importance of discussing lifestyle modifications with patients as part of their treatment plan. For additional research on trigger finger, have a look at the whole dataset . URL : https://doi.org/10.1016/j.jhsa.2025.02.009 Abstract Purpose: To assess the incidence of subsequent treatment of trigger finger in the same or additional digits after the initial trigger finger release, as well as identify patient characteristics associated with the need for subsequent treatment. Methods: This study retrospectively analyzed 1,715 patients with a trigger finger who underwent surgical release from 2015 to 2017. Bivariate analysis was performed to determine the percentage of patients requiring further trigger finger treatment by either steroid injection or operative release. Patient factors were then compared in those who did and did not undergo subsequent treatment. Cox proportional hazards models and survival analysis were performed to identify patient characteristics associated with requiring subsequent treatment, injection, and surgery. Results: Overall, 690 (40.2%) patients required subsequent treatment with either steroid injection or surgical release in either the same or an additional finger. Four hundred sixty patients (26.8%) underwent at least one subsequent injection, with 36 (2.1%) of these on the same finger. Additionally, 230 (13.4%) patients received at least one subsequent first annular pulley release, with 14 (0.8%) on the same finger as the initial release. Cox proportional hazards models showed patients with a higher comorbidly burden and current smoking status were more likely to receive subsequent treatment. Higher body mass index and greater comorbidity burden were also associated with requiring subsequent surgery. Additionally, current smokers or patients with a greater comorbidity burden had a higher risk of requiring subsequent treatment in an additional digit not initially released. Conclusions: Subsequent release or injection in the same or another digit was common following an initial trigger finger release. Patient characteristics such as higher body mass index and greater comorbidity burden were associated with requiring subsequent surgery, and smoking status as well as comorbidity burden were associated with subsequent treatment in an additional digit not initially released. 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

Can surgeons or patients predict the likelihood of improvement with nonoperative treatment of chronic tennis elbow? Karjalainen, et al. (2025) Level of Evidence : 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Surgeon - Tennis elbow recovery prediction This longitudinal study investigated whether surgeons or patients can effectively predict improvement in individuals with chronic tennis elbow. Out of 97 patients recruited, 89% initially agreed to persist with nonoperative care. Over a two-year period, only 9% of these patients required surgical intervention. Initial mean scores on the Oxford Elbow Score improved significantly without surgery, challenging the presumption that persistent tennis elbow symptoms necessitate surgical resolution. Surgeons’ predictions did not align with actual patient outcomes, suggesting a limited ability to predict who might recover without surgery. Notably, patients with more optimistic views of their recovery had slightly better outcomes. Interestingly, prior or planned injection therapy increased patients' optimism despite limited evidence supporting its effectiveness. The study implies that patient-centric predictions might offer some prognostic value, but the default approach should remain nonoperative, given the generally favorable natural course of the condition. 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, persistent tennis elbow symptoms often resolve without surgical intervention, challenging the notion that surgery is necessary when nonoperative treatments 'fail.' Most patients demonstrate considerable recovery over time with continued nonoperative care. Surgical intervention should therefore not be driven by the duration of symptoms or perceived failures of conservative management. As shown by previous research, tennis elbow resolves in 90% of people within 12 months and longer symptoms duration is not associated with worse outcomes . URL : https://doi.org/10.1097/CORR.0000000000003425 Abstract Background: Persisting symptoms after an attempt of nonoperative treatment represents one of the most common indications for surgery in many musculoskeletal conditions, such as tennis elbow. The rationale behind the practice of resorting to surgery in individuals with long-standing symptoms is that resolution of symptoms is believed to be unlikely without surgery after a certain period, and surgeons can identify a subgroup to benefit from surgery. For this approach to be sound, surgeons must be able to reliably distinguish between patients unlikely to improve without surgery and those who are likely to benefit from it. Questions/purposes: (1) Do patients with persistent tennis elbow symptoms (lasting > 10 months) who are referred to a surgeon improve without surgery over a 24-month follow-up period? (2) Are surgeons’ or patients’ predictions about improvement associated with actual improvement? (3) What patient characteristics, if any, are associated with predictions of improvement made by either surgeons or patients? Methods: Between 2016 and 2018, we prospectively recruited 97 patients with persistent tennis elbow symptoms (> 10 months) who were dissatisfied with nonsurgical treatment and referred for surgical consultation at five secondary or tertiary public hospitals. Of these, 89% (86 of 97) agreed to continued nonoperative treatment and were included in this observational cohort study. To evaluate the outcomes of continued nonoperative treatment, we measured the Oxford Elbow Score (OES) and global improvement at 6 weeks and at 3, 6, 12, and 24 months. To assess whether either the surgeons or the patients could predict the likelihood of symptom improvement, we asked both parties at baseline to predict whether each patient would be satisfied with their symptom state without surgery within the next 6 months. We then evaluated the prognostic value of these predictions by comparing the OES and global improvement scores between (1) patients who believed that they would improve versus patients who did not and (2) patients whom the surgeons predicted would improve versus those whom the surgeons predicted would not. To explore factors that might explain the predictions, we assessed the correlation between the predictions and baseline characteristics, including age, sex, affected side, smoking status, duration of symptoms, disability (OES score), Pain Catastrophizing Scale score, prior corticosteroid injections, and any planned injection treatments. Data from patients who underwent surgery during the follow-up period were included only up to the time of surgery. The mean ± SD age of the patients was 49 ± 5.4 years, and prior to the initial consultation, they had had symptoms for a mean ± SD of 20 ± 12 months. One-half of the patients were female. Results: Nine percent (8 of 86) of patients eventually underwent operation during the 2-year follow-up period. The mean total OES of the cohort (range 0 to 100, with higher scores indicating better outcomes) increased from approximately 50 points at baseline to 80 points at the final 24-month follow-up visit. Surgeons’ predictions about likelihood of improvement were not associated with the observed improvement, while patients who were more pessimistic about their likelihood of recovery at baseline had slightly inferior outcomes compared with patients who were more optimistic about their likelihood of recovery. As for factors associated with patients’ predictions of recovery, both patients who had previously received corticosteroid injections (relative risk [RR] 1.4 [95% confidence interval (CI) 1.1 to 1.7]; p = 0.03) and those scheduled to receive botulinum toxin or platelet-rich plasma injections (RR 3.8 [95% CI 2.0 to 7.3]; p < 0.001) were more likely to predict improvement compared with those who opted to wait and see. Surgeons’ predictions about the recovery were not associated with any of the measured patient characteristics, indicating that the predictions were based on heuristics, that is, mental shortcuts or rules of thumb that clinicians commonly use in clinical decision-making. Conclusion: Our findings suggest that persistent tennis elbow symptoms are a poor indication for surgery, as the majority of patients experience symptom resolution without it, and surgeons are unable to reliably predict who will or will not improve with nonoperative treatment. Therefore, treatment decisions should not be based on the clinician’s perception of the disease course. Patients’ predictions, especially more pessimistic views, were found to more accurately reflect the likely recovery trajectory. Finally, despite evidence demonstrating the ineffectiveness of injections, they elevated patients’ expectations for improvement. 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

Incidence of carpal tunnel syndrome requiring surgery may increase in patients treated with trigger finger release: A retrospective cohort study. Hsieh, et al. (2022) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic / Prognostic Topic : Trigger finger - Incidence of CT release This retrospective study explores the potential increase in carpal tunnel syndrome (CTS) requiring surgery following trigger finger (TF) release surgery. Utilising a retrospective cohort dataset from Taiwan’s National Health Insurance Research Database, a comparative analysis of patients who underwent TF surgery against those who did not was completed. Findings showed that post-surgical TF patients had a higher adjusted hazard ratio of 1.51 for developing severe CTS. Despite this difference between groups, the risk is unlikely to be clinically relevant. Risk factors identified include being female, aged over 65, having diabetes mellitus, or suffering from chronic renal failure. The research underscores the importance of considering CTS risk in post-TF release management, especially in identified high-risk groups. Limitations noted involve lack of detailed clinical symptom data and specific work condition assessments. 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, patients undergoing surgical release of trigger finger (TF) may face an increased risk of subsequent carpal tunnel syndrome (CTS) necessitating surgery. Despite them presenting a higher risk the increase in probability appears to be less than 0.5%, which is unlikely to be relevant. This small risk increase is higher in females and individuals over the age of 65. Furthermore, chronic conditions such as diabetes mellitus and chronic renal failure further exacerbate the risk of developing severe CTS after TF surgery. It is possible that this small subgroup of people requiring both TF release and CTS may be presenting with a connective tissue disease called amyloidosis . URL : https://doi.org/10.2147/CLEP.S383397 Abstract Purpose: The correlation between carpal tunnel syndrome (CTS) surgery and trigger finger (TF) surgery is unclear; we conducted this nationwide population-based study to assess the development of severe CTS requiring surgery after TF surgery. Patients and Methods: This retrospective cohort study used the data of patients diagnosed as having TF between January 1, 2001, and December 31, 2017, and they were divided into two comparative groups. Patients who underwent surgical release within 1 year of diagnosis were included in the TF-OP group, and those who did not undergo TF release during the same period were included in the TF-NOP group. The primary outcome was the new incidence of CTS release (CTR), and data on the related risk factors were collected for analysis. Results: A total of 8232 patients each were enrolled into the TF-OP and TF-NOP groups and were 1:1 propensity score matched (mean patient age, 54.7 ± 10.1 years; mean follow-up duration, 6.58 years). The incidence rate of CTR was 1.1 per 1000 person-years in the TF-OP group and 0.7 per 1000 person-years in the TF-NOP group. The adjusted hazard ratio of TF surgery was 1.51. The factors significantly correlated with an increased incidence of CTR were age, female sex, diabetes mellitus, and chronic renal failure. In subgroup analysis, patients aged > 65 years and female patients in the TF-OP group were still at significantly higher risks of CTR than were their counterparts in the TF-NOP subgroups. The cumulative incidence of CTR after TF surgery linearly increased with time in both groups. Conclusion: Patients undergoing TF release may have a higher incidence of CTR 1 year later, especially women and patients aged > 65 years. Diabetes mellitus and chronic renal failure may be risk factors. 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

Testosterone replacement therapy and associated rates of trigger finger, de quervain tenosynovitis, and their subsequent management. Barhouse, et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic Topic : Anabolic steroids - Upper limb tendinopathies This retrospective cohort study examined the association between testosterone replacement therapy (TRT) and the development of hand conditions like trigger finger and de Quervain tenosynovitis. Using a large insurance claims database from 2010 to 2019, researchers compared patients who had filled TRT prescriptions for at least three months to those who had not, controlling for various factors such as age, sex, and comorbidities. The findings indicated that TRT patients had a higher likelihood of developing these hand conditions and were more likely to undergo steroid injections or surgical procedures for treatment (see graph below). The study highlights concerns regarding TRT's impact on tendon health, aligning with prior research linking high-dose steroids to tendon injuries. Limitations include the lack of stratification by physical activity levels, which may contribute to the results reported. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, there is a significant association between testosterone replacement therapy (TRT) and the increased likelihood of developing tenosynovitis in the hand, including conditions like trigger finger and de Quervain tenosynovitis. Patients undergoing TRT are not only more prone to these conditions but also demonstrate a higher probability of requiring steroid injections or surgical interventions. These findings are in line with previous studies, which have shown a correlation between TRT use and distal biceps ruptures . Other risk factors for the onset of hand and elbow tendinopathies include the use of statins for cholesterol control. URL : https://doi.org/10.1016/j.jhsa.2024.01.018 Abstract Purpose: Anabolic steroid therapy has been associated with tendon injury, but there is a paucity of evidence associating physiologic testosterone replacement therapy (TRT) with tenosynovitis of the hand, specifically trigger finger and de Quervain tenosynovitis. The purpose of this study was to evaluate the relationship between TRT and tenosynovitis of the hand. Methods: This was a one-to-one exact matched retrospective cohort study using a large nationwide claims database. Records were queried between 2010 and 2019 for adult patients who filled a prescription for TRT for 3 consecutive months. Rates of new onset trigger finger and de Quervain tenosynovitis and subsequent steroid injection or surgery were identified using ICD-9, ICD-10, and Current Procedural Terminology billing codes. Single-variable chi-square analyses and multivariable logistic regression were used to compare rates in the TRT and control cohorts while controlling for potential confounding variables. Both unadjusted and adjusted odds ratios (OR) are reported for each comparison. Results: In the adjusted analysis, patients undergoing TRT were more than twice as likely to develop trigger finger compared to their matched controls. TRT was also associated with an increased likelihood of experiencing de Quervain tenosynovitis. Of the patients diagnosed with either trigger finger or de Quervain tenosynovitis over the 2-year period, patients with prior TRT were roughly twice as likely to undergo steroid injections or surgical release for both trigger finger and de Quervain tenosynovitis compared to the controls. Conclusions: TRT is associated with an increased likelihood of both trigger finger and de Quervain tenosynovitis, and an increased likelihood of requiring surgical release for both conditions. 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

Imaging on the painful and compressed nerve: Upper extremity. Bordalo, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Entrapment neuropathies - Upper limb This is an expert opinion on compressive neuropathies in the upper extremities. As we are aware, these pathologies can lead to pain, weakness, and reduced functionality due to the entrapment of peripheral nerves in osteofibrous tunnels and muscular pathways. Traditional diagnostic techniques like clinical assessments and electrophysiological studies are important but have limitations in pinpointing lesion locations. Recent advances in ultrasonography (US) and magnetic resonance imaging (MRI) have enhanced nerve visualisation, improving diagnostic accuracy and treatment planning. These imaging methods are critical in managing neuropathies affecting various nerves such as the brachial plexus, axillary, median, ulnar, suprascapular, and radial nerves (see pictures below). They help identify key features like nerve thickening and muscle changes (e.g. fat atrophy), aiding in both diagnosis and surgical strategies. 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, integration of advanced imaging techniques such as ultrasonography and MRI, including MR neurography is pivotal in the management of upper extremity compressive neuropathies. By providing high-definition visualisation of nerve anatomy and pathological manifestations like thickening and signal abnormalities, these techniques enhance diagnostic precision and therapeutic effectiveness. Ultrasound imaging is truly a useful imaging technique and there are plenty of examples on how you could use it to aid your practice . URL : https://doi.org/10.1007/s00264-025-06436-0 Abstract Compressive neuropathies of the upper extremity are a common cause of pain, weakness, and functional impairment, often resulting from chronic mechanical compression or entrapment of peripheral nerves in anatomical regions such as osteofibrous tunnels, fibrous bands, or muscular pathways. While traditional diagnostic methods, including clinical evaluation and electrophysiological studies, are essential, they are limited in localizing lesions and identifying underlying causes. Advances in ultrasonography (US) and magnetic resonance imaging (MRI), particularly MR neurography and high-resolution 3D volumetric imaging, have significantly improved the evaluation of peripheral nerves by enabling detailed visualization of nerve anatomy, adjacent structures, and muscle denervation patterns. This article reviews the role of these imaging techniques in diagnosing and managing compressive neuropathies affecting the brachial plexus, suprascapular, axillary, median, ulnar, and radial nerves, highlighting key imaging findings such as nerve thickening, signal abnormalities, and muscle changes. The integration of advanced imaging modalities into clinical practice enhances diagnostic accuracy, facilitates surgical planning, and improves treatment outcomes for patients with peripheral nerve compression. 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