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Association of ultrasound and electrodiagnostic studies in patients evaluated for ulnar neuropathy. Sheen, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Cubital tunnel syndrome - Ultrasound imaging for diagnosis This retrospective study investigated the correlation between nerve conduction studies (NCS) severity and ultrasound measurements of ulnar nerve cross-sectional area (CSA). A total of 1,043 participants were included in the study of which 403 presented with cubital tunnel syndrome as per NCS. The ulnar nerve cross sectional area was measured via ultrasound 2 cm distal from the medial epicondyle, at the medial epicondyle, and 2 cm proximal to the medial epicondyle. The results showed that there was a moderate positive correlation between the ulnar nerve cross-sectional area and the severity of cubital tunnel neuropathy on NCS (see graph below). 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, ultrasound measurements of ulnar nerve cross-sectional area (CSA) are moderately correlated with cubital tunnel severity as indicated by NCS. This is in line with previous research showing that CSA measurement of the ulnar nerve can be utilised to diagnose cubital tunnel syndrom and that severity of the presentation can be inferred by CSA . Remember that US imaging can be utilised to diagnose not only cubital tunnel syndrome but also carpal tunnel syndrome . URL : https://doi.org/10.1016/j.jhsa.2024.12.004 Abstract Purpose: Our goal was to determine the association between the severity of electrodiagnostic (EDX) studies with the cross-sectional area (CSA) of the ulnar nerve at the cubital tunnel using diagnostic ultrasound. Based on our clinical experience, we hypothesized there would not be a positive correlation between the severity of EDX and ulnar nerve CSA. Methods: This was a retrospective analysis of patients 18 years or older evaluated from May 1, 2020, to June 31, 2021, referred for an upper limb EDX and neuromuscular ultrasound to evaluate for an upper limb neuropathy. History, physical examination, ultrasound imaging (ulnar nerve at elbow), and EDX were reviewed. Patients were excluded for age under 18 years or concomitant upper limb radiculopathy. Baseline sample characteristics were analyzed, including age, race, sex, ethnicity, body mass index (normal, overweight, obese, or morbid obesity), and smoking status. Results: Of 1,043 patients, there were more females than males (634 vs 409) with an average age (SD) of 54.0 (15.5). Most of the patients were White (863) compared to Black (113) and other races (67). The average CSA of the ulnar nerve at the elbow increased with increased severity based on EDX results. There was a significant association between increasing severity on EDX and the increased nerve CSA at the elbow. Conclusions: We found a positive association between the EDX severity and the CSA of the ulnar nerve on diagnostic ultrasound at the cubital tunnel. As the severity of ulnar neuropathy at the elbow increases, the CSA of the ulnar nerve correspondingly increases at the 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

The effect of area-level deprivation on the severity of cubital tunnel syndrome on presentation to a hand surgeon. Mwamba, et al. (2025) Level of Evidence: 4 factors Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Economic/Diagnostic Topic : Socioeconomic determinants of health - Cubital tunnel syndrome This retrospective study assessed whether socioeconomic factors influenced the presentation severity and management of cubital tunnel syndrome. A total of 406 participants with cubital tunnel syndrome were included in the present study. The area deprivation index was available for each patient. McGowan cubital tunnel grading was utilised to assess the medical notes review. Grade I was characterised by tingling in the ulnar nerve distribution at the hand, grade II as persistent tingling with no or mild atrophy, grade III as persistent tingling with severe atrophy of the ulnar innervate hand muscles. The results showed that patients from socioeconomically disadvantaged areas presented with more severe symptoms of cubital tunnel syndrome (see graph below). This is likely due to barriers such as limited access to healthcare services or financial constraints, leading individuals to delay seeking medical care until their symptoms become more pronounced. Despite these challenges, individuals from disadvantaged backgrounds are more likely to undergo diagnostic testing once they do seek care. The severity of their symptoms may prompt healthcare providers to order more comprehensive evaluations. Notably, there is no significant difference in surgical rates or treatment delays between disadvantaged and less deprived individuals. Nerve conduction studies were more often completed in people from areas of higher deprivation. The stage of cubital tunnel syndrome also tended to be worse in people with publich insurance. Ethnicity, race, or deprivation index were not associated with the delivery of surgery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, people from lower socio-economic areas present with more severe cubital tunnel syndrome to health professionals. Fortunately, once they are in the system, there are no disparities in the way that they are treated with greater care (e.g. higher number of nerve conduction studies) provided to people in greater need. These findings appear to be in line with previous research showing that insurance type matters in terms of presentation severity of cubital tunnel syndrome . It is our role as health professionals to increase the awareness of these presentations and try and make sure that even those people who are from less well off areas understand the importance of getting their symptoms attended to by a health professional . Remember that several tests are available to aid in the diagnosis of cubital tunnel, including small finger forced abduction test . URL : https://doi.org/10.1016/j.jhsa.2024.11.007 Abstract Purpose: Cubital tunnel syndrome (CuTS) is the second most common upper-extremity neuropathy and can cause debilitating symptoms. Patients presenting to care with severe CuTS can be left with permanent weakness and numbness despite treatment. The aim of this study was to examine the relationship between area-level deprivation and the severity of CuTS on presentation to a hand surgeon. Methods: We retrospectively identified 369 patients who were diagnosed with CuTS at a new patient visit between January 2017 and December 2021. We queried the electronic health record to assess the severity of CuTS using the McGowan grade. We used patient addresses to determine the national percentile of area-level deprivation for each patient. Bivariate analyses were used to determine if sociodemographic factors were associated with CuTS severity on presentation or rates of surgical intervention. Results: In bivariate analysis, patients with higher levels of area-level deprivation had more severe CuTS. Those who were older, were men, and had public insurance were also found to have more severe CuTS. Secondary analysis revealed that patients with higher levels of deprivation were more likely to receive nerve conduction testing. No sociodemographic factors were associated with whether patients received surgical intervention or in time from presentation to surgery. Conclusions: Patients from marginalized backgrounds present to hand surgeons with more severe CuTS disease. Clinical relevance: Delayed presentation can lead to worse outcomes in CuTS. Understanding barriers to earlier presentation in more deprived locations and certain patient populations can help develop solutions to address these disparities. 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

Acromial stress fractures and reactions after reverse total shoulder arthroplasty: A case-control study. Wiemer, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study : Diagnostic/Prognostic Topic : Stress fracture - Upper limb This retrospective study assessed the incidence and risk factors for acromial stress fractures following reverse total shoulder arthroplasty. A total of 220 participants who had undergone reverse shoulder replacement were included. X-rays, CT scans, and SPECT-CT scans were utilised to assess the presence of an acromial stress fracture. The results showed that around 10% of participants developed an acromial stress fractures. Risk factors for the presence of a stress fracture included oral corticosteroid use (for systemic disease e.g. rheumatoid arthritis), and a history of previous shoulder surgery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know, acromial stress fractures occur in 1 patient out of 10 following reverse shoulder replacement usually 5 months after surgery (range 1 month to 10 years after surgery). Those people who are more likely to develop this complication are those on oral cortisone for systemic condition or people who have had a previous shoulder surgery on the same side. Imaging for diagnosis would require a shoulder x-ray +/- CT or SPECT-CT scan. Management of these people is conservative and includes the use of a shoulder sling for 4-6 weeks. These findings appear to be in line with previous research in shoulder replacements suggesting that higher metabolic disease (e.g. obesity ) increase the risk of complications following upper limb surgeries . URL : https://doi.org/10.1016/j.jse.2024.11.035 Abstract Background: Acromial stress fractures can occur after reverse total shoulder arthroplasty (rTSA). We performed this study to assess the incidence, risk factors, characteristics, and outcome of acromial stress fractures and reactions after rTSA. Methods: We determined the incidence of acromial stress fractures and reactions in a cohort of patients who underwent rTSA, and assessed risk factors using a case-control design. Each patient who developed an acromial stress fracture or reaction after rTSA (case) was matched by date of rTSA with 2 patients who did not develop acromial stress fractures/reactions after rTSA (control subjects); univariate and multivariable analyses were performed to identify risk factors. Characteristics of acromial stress fractures/reactions are described. Outcomes were compared between cases and control subjects. Results: The incidence of acromial stress fracture/reaction after rTSA was 11% (24/220 rTSAs). Acromial stress fractures/reactions occurred at a median time of 5.5 months after rTSA (range: 20 days-118 months) and most were fractures (18/24, 75%). Using a multivariable analysis, we found 2 factors to be independently associated with the occurrence of an acromial stress fracture/reaction after rTSA: corticosteroids use (adjusted OR: 9.6, 95% confidence interval: 1.1-86.1, P = .04) and previous shoulder surgery (adjusted OR: 7.2, 95% confidence interval: 1.4-36.6, P = .02). In this cohort, in which the management was exclusively conservative, the occurrence of post-rTSA acromial stress fracture/reaction was associated with a significantly worse functional outcome at last follow-up visit, as compared with control subjects. This was illustrated by significantly lower American Shoulder and Elbow Surgeons Shoulder score, higher Shoulder Pain and Disability Index and Disabilities of the Arm, Shoulder and Hand scores, and worse forward elevation and internal rotation as compared with control patients who did not develop acromial stress fracture/reaction after rTSA. Conclusions: In our Australian cohort, acromial stress fractures/reactions were relatively common after rTSA, and independently associated with corticosteroids use and previous shoulder surgery. The occurrence of acromial stress fracture/reaction was associated with a significantly worse functional outcome, as compared with patients who do not develop this complication after rTSA. 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

Anatomy of the distal tendinous structure of the triceps brachii: Implications for the role of the triceps brachii to resist valgus elbow forces during baseball pitching. Yamamoto, et al. (2025) Level of Evidence : 5 Follow recommendation: 👍 👍 (3/4 Thumbs up) Type of study : Anatomical Topic : Triceps tendon - Elbow stability This cadaver study investigated the morphological features of the triceps brachii insertion at the elbow, focusing on the distal tendinous portion. A total of 21 cadavers were included in the study. The researchers found that the common tendon is divided into two distinct parts: the intramuscular tendon and the superficial aponeurosis. The intramuscular tendon, primarily attached to the long and medial heads of the triceps, has curved fibers that run medially to laterally, allowing it to generate tension across both the proximal and lateral facets of the olecranon via fibrocartilage. In contrast, the superficial aponeurosis, which merges with the anconeus fascia, runs parallel to the humerus and is thinner. These findings suggest that the intramuscular tendon plays a critical role in stabilising the elbow by counteracting valgus/varus stress. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the triceps tendon is divided into an intramuscular tendon (attached to the long and medial heads) and a superficial aponeurosis (connected to the anconeus fascia). These structures can contribute to elbow stability alongside force transfer. This anatomical study elucidates well why with a distal triceps tear/ olecranon fracture, patients may still be able to do overhead extension of the elbow, albeit with lower force output . URL : https://doi.org/10.1016/j.jse.2024.11.023 Abstract Background: Biomechanical studies suggest that the triceps brachii muscle generates resistive force against valgus stress on the elbow during baseball pitching. However, given the parallel fiber orientation in the distal tendinous structure of the triceps brachii, the mechanism behind this anti-valgus force remains unclear. In the present study, we aimed to examine the anatomy of the distal tendinous structure of the triceps brachii using bony morphological, macroscopic, and histologic methods. Methods: We analyzed 25 elbow specimens from 18 cadavers, all of Japanese ethnicity, using micro-computed tomography. Four specimens were excluded due to severe osteophytes, leaving 21 specimens randomly allocated to 3 groups: 13, 4, and 4 specimens to the macroscopic examination group, the histologic examination group, and the chemically débrided bone examination group, respectively. In 6 of the 13 specimens analyzed macroscopically, we quantitatively measured the local thickness of the triceps tendon using micro-computed tomography. Results: The distal tendinous portion of the triceps brachii was comprised of an intramuscular tendon and a superficial aponeurosis. The intramuscular tendon, located between the long and medial heads of the triceps, curved medially to laterally and inserted broadly onto the proximal and lateral facets via fibrocartilage. The superficial aponeurosis, attached to the lateral and medial heads, had fibers that ran straight and merged distally with the aponeurosis of the anconeus. The intramuscular tendon (2.2 ± 0.4 mm) was significantly thicker than the superficial aponeurosis (0.9 ± 0.2 mm, P < .001). Conclusion: The current study revealed a nonuniform distal tendinous structure of the triceps brachii, with a thick intramuscular tendon and a thin superficial aponeurosis. In particular, the intramuscular tendon was curved from the medial-to-lateral direction and had a firm insertion. These findings suggest that the intramuscular tendon can contribute force to prevent valgus stress on the elbow as a dynamic stabilizer during the pitching 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

Evaluating the effectiveness of patient-tailored treatment for patients with non-specific (sub)acute neck pain. Chys, et al. (2025) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic : Specific vs non-specific treatments - Outcome This study assessed the effect of patient-tailored treatment (PTT) versus non-patient-tailored treatment (NPTT) for acute and sub-acute non-specific neck pain (NSNP). A total of 61 participants were randomised to either a control group, PTT or NPTT. The control group received no intervention. The PTT underwent and extensive subjective and objective assessment with a combination of hands on and hands off approaches, which were tailored to the participant's presentation. The NPTT managed participants with a hands off approach, general exercise, range of movement, and strengthening exercises. Both intervention groups underwent 9 treatment sessions over the course of three months. The results showed that both treatments effectively reduced pain and disability, with no evidence of PTT superiority. Spontaneous recovery played a significant role, with the control group achieving similar outcomes. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, acute and sub-acute non-specific-neck-pain can be managed through a wait and see approach or via physiotherapy over the course of a few sessions with the aim of empowering the patient. Thus, it does not seem that personalisation is important. This seems to be supported by several other studies including a trial on specific vs non specific segment treatment and a meta-analysis comparing cervical vs thoracic manipulations for people with neck pain. URL : https://doi.org/10.1016/j.msksp.2024.103235 Abstract Background: An important issue in the debate about best practice management of non-specific neck pain (NSNP) is the effectiveness of tailored versus generalized interventions. Methods: Participants with (sub)acute NSNP were randomly allocated to a patient-tailored treatment (PTT), non-patient-tailored treatment (NPTT) or control group (no intervention). The outcome measures were pain (NPRS), disability (NDI), global perceived effect and satisfaction (GPES), productivity costs, and medical consumption. Patients were assessed at baseline, post-intervention, and at 3-, 6-, and 12-months post-intervention. Evolution of the complaints, treatment adherence, and medication intake was registered during the intervention period. Linear mixed models were used to examine interaction effects as well as between- and within-group differences. Results: Sixty-one participants were included. There was no “Group x Time”-interaction effect for all outcome measures. Nevertheless, all groups showed significant and clinically relevant within-group differences at all time points for pain and disability (p < 0.001). At 6 months follow-up, NPTT was superior to PTT for reductions in pain but not for disability. At 1 year, the number of responders in the NPTT group remained higher (75%) compared to the PTT group (40%). Conclusion: This study found a significant and clinically relevant reduction of pain and disability within all groups. Patient-tailored treatment as well as NPTT can be considered an effective method when aiming for a reduction in pain and disability at short-term (12 weeks). However, NPTT seemed to be more effective at 1-year follow-up and therapists should consider spontaneous recovery. The results should be interpreted with caution and further research 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

The forced small finger abduction test for assessing the strength of intrinsic muscles innervated by the ulnar nerve. Kittipongphat, et al. (2025) Level of Evidence : 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Diagnostic Topic : Objective test - Cubital tunnel syndrome This cross-sectional study assessed the forced small finger abduction test as a diagnostic tool for assessing intrinsic muscle strength. The forced small finger abduction test is shown below and would be positive if the little finger mcpj hyperextends whilst the examiner resists finger abduction. A total of 104 participants were included in the study. Of these, 24 participants had confirmed ulnar neuropathy (4 Guyon's canal syndrome, 20 cubital tunnel syndrome), whilst 80 were asymptomatic individuals. The forced small finger abduction test was compared to traditional tests, including Tinel’s, Wartenberg’s, and Froment’s signs. Two assessors underwent participants testing and they were blind to nerve conduction study results. The results showed that this new test demonstrated higher sensitivity (96%) and specificity (93%), outperforming Tinel’s (58% sensitivity, 99% specificity), and Wartenberg’s (54% sensitivity, 100% specificity), while being comparable to Froment’s sign (79% sensitivity, 100% specificity). The test exhibited moderate inter-observer (between the clinicians) reliability (Cohen’s κ = 0.51) and acceptable intra-observer (within clinician) reliability. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the forced small finger abduction test appears to be a promising diagnostic tool for ulnar neuropathy, offering higher sensitivity (96%) and specificity (93%) compared to traditional tests like Tinel’s and Wartenberg’s. Froment’s sign (79% sensitivity, 100% specificity) remains another good test to assess ulnar neuropathy. If patients present with these positive tests, and you believe they present have cubital tunnel syndrome, i t may be worth considering surgery as delaying it appears to be associated with worse sensory and strength outcomes . If you would like to see what could be a mimicker of cubital tunnel syndrome, have a look at this synopsis on degenerative cervical myelopathy . URL : https://doi.org/10.1177/17531934241310728 Abstract The study evaluates the forced small finger abduction test for assessing the strength of intrinsic muscles innervated by the ulnar nerve. The test was performed on healthy and ulnar neuropathy patients. Results demonstrate its ability to detect intrinsic weakness, which may enhance diagnosis of ulnar neuropathy. 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

Seasonal impact on surgical site infections and wound healing disturbance in carpal tunnel surgery: A retrospective cohort study. Froschauer, et al. (2021) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic : Weather - Wound healing The retrospective cohort study assessed whether weather and seasonal temperature changes influenced the rates of surgical site infections and wound healing disturbances after open carpal tunnel release. A total of 1,385 participants were included from a single Austrian centre. The average number of infections was 2.4%. The number of infections increased by 1% during the warm season (3.3%) although this was not statistically significant. The number of wound healing disorders was highest during the warm season (10%) and lowest during the cold season (6%), which was also statistically significant. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, surgical site infection rates do not vary with season, however, wound healing disturbances rise during warmer months (10 % vs 6 %). Given these findings, it may be worth keeping a closer look on wounds in summer including providing more prompt wound debridement . Other factors that may be beneficial for wound healing include the use of oral vitamins and light aerobic exercise . URL : https://doi.org/10.1111/iwj.13573 Abstract Carpal tunnel syndrome is the most common entrapment syndrome of a peripheral nerve. The gold standard treatment is open carpal tunnel release which has a high success rate, a low complication rate, and predictable postoperative results. However, it has not been analysed yet if there is a seasonal influence on complications for carpal tunnel release, a highly elective procedure. In this retrospective study, we determine whether there is a seasonal impact on surgical site infections (SSI) and wound healing disorders (WHD) in primary carpal tunnel syndrome surgery. Between 2014 and 2018, we have assessed 1385 patients (65% female, 35% male) at a mean age of 61.9 (SD 15.3) years, which underwent open carpal tunnel release because of primary carpal tunnel syndrome. The seasonal data such as the warm season (defined as the period from 1st of June until 15th of September), the average daily and monthly temperature, and the average relative humidity were analysed. Patient demographics were examined including body mass index, alcohol and nicotine abuse, the use of anticoagulants and antiplatelet drugs as well as comorbidities. These data were correlated regarding their influence to the rate of surgical site infections and wound healing disorders in our study collective. A postoperative SSI rate of 2.4% and a WHD rate of 7% were detected. Our data confirms the warm season, the average monthly temperature, and male sex as risk factors for increasing rates of WHDs. Serious SSIs with subsequent revision surgery could be correlated with higher age and higher relative humidity. However there is no seasonal impact on SSIs. We therefore advise considering the timing of this elective surgery with scheduling older male patients preferably during the cold season to prevent postoperative WHDs. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The use of cannabinoids in the treatment of peripheral neuropathy and neuropathic pain: A systematic review. Choi, et al. (2024) Level of Evidence : 1a Follow recommendation : 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic : Cannabinoid - Neuropathic pain This systematic review and meta-analysis assessed the effect of cannabinoids compared to placebo in treating chronic neuropathic pain. Fourteen randomised controlled trials for a total of 632 participants were included in the present review. Participants presented with conditions such as diabetic neuropathy, HIV-associated sensory neuropathy, and chemotherapy-induced neuropathy. Cannabinoids were delivered heterogeneously across study and some of these included oral spray, pills, or topical formats. The results showed statistically significant but clinically not significant reductions in pain intensity with cannabinoid. Thus, the mean reduction in pain was 0.7 out of 10 points. 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, cannabinoids provide some relief compared to placebo for neuropathic pain, however, their clinical relevance is minimal . The results from this meta-analysis appear to be in line with a previous randomised controlled study assessing the effect of topical cannabinoids in hand OA . Overall it appears that these medications are statistically significant compared to placebo, however, their clinical significance is debatable. URL : https://doi.org/10.1016/j.jhsa.2024.09.015 Abstract Purpose: Peripheral neuropathies are commonly occurring conditions that are chronic and debilitating for patients. Established nonsurgical treatments have yielded mixed and patient-dependent results. Although cannabinoids have demonstrated efficacy as a treatment for central neuropathic pain, the therapeutic potential of cannabis-based medications for the management of peripheral neuropathic pain caused by nerve injury, trauma, and other noncompressive etiologies has yet to be definitively established. This study aims to determine whether cannabinoids are a potentially effective treatment for pain and symptoms associated with peripheral neuropathy. Methods: A systematic search was conducted by two independent reviewers across PubMed, Cochrane, Ovid Medline, and CINAHL to identify studies in accordance with the predetermined inclusion/exclusion criteria. Information regarding study design, medication, dosage, effect on neuropathic pain, and other related outcomes was extracted. Meta-analysis of pain scores was performed for seven studies, and descriptive statistics were used to summarize other study findings as appropriate. Results: Of the 927 studies identified, 14 randomized controlled trials were included. Thirteen of 14 studies (79%) observed a statistically significant decrease in neuropathic pain score following treatment with a cannabinoid. Meta-analysis yielded a mean difference of −0.67 [−0.89, −0.45]) on a 0−10 scale compared with placebo. Improvements in secondary outcomes such as sleep, sensory symptoms, and quality of life were observed. Conclusions: Our analysis of the literature shows that cannabis-based medicines may be effective in treating the pain and symptoms of peripheral neuropathy. These findings suggest the applicability of cannabis-based medicines for peripheral neuropathy. 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

Examining outcomes and complications for operative versus nonoperative treatment of pediatric type II supracondylar humerus fractures: A systematic review of comparative studies. Baumann, et al. (2025) Level of Evidence : 2a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Supracondylar type II fractures - Surgical vs conservative management This systematic review and meta-analysis compared operative and nonoperative management of pediatric supracondylar humeral fractures. A total of seven studies were included in the review. Several measures including carrying angle, function, and satisfaction were included. Additional surgery and residual deformity on x-ray lateral view (sagital plane) were also analysed. The results showed that nonoperative treatments exhibited a higher failure rate, up to 20%, particularly in cases involving rotational deformities or varus/valgus malalignment. Deformity on sagital plane was also higher. Carrying angle, function, and satisfaction were equal between conservative and surgical management. 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, minimally dysplaced supracondylar fractures (type II - posterior condilar tilt with intact posterior cortex) can be managed conservatively and achieve similar function and carrying angle compared to surgically managed one. However, the number of complications tends to be higher when these are managed conservatively compared to surgically. Careful evaluation of rotational deformities, and varus/valgus malalignment seem to be important. In addition, ongoing monitoring of fracture alignment within the first few weeks is fundamental in the management triaging . URL : https://doi.org/10.1097/BPO.0000000000002789 Abstract Objective: The optimal management of pediatric type II supracondylar humerus fractures (SCHFs) is debated. We conducted a systematic review comparing outcomes and complications of nonoperative versus operative management to aid decision-making and inform future research. Methods: We searched PubMed, Web of Science, MEDLINE, and CINAHL from their inception until February 7, 2024, including studies on pediatric patients (<18 y) with any type II SCHF, provided they compared operative to nonoperative care and were in English. The quality of articles was evaluated using the Methodological Index for Non-Randomized Studies Scale. Results: Out of 417 studies reviewed, 7 met the inclusion criteria. These studies involved 1446 patients (mean age: 4.9 y; mean follow-up: 5.0 mo), comparing operative (n = 427) and nonoperative (n = 1019) treatments. Functional outcomes such as carrying angle, Baumann angle, elbow range-of-motion, and patient satisfaction were similar across treatment groups. Nonoperative management showed a higher incidence of residual sagittal deformity (14.1% vs 0.0%; P < 0.0001) and a treatment failure rate of 8.9% to 20.6%, necessitating surgical intervention. Factors prompting operative care included rotational deformity, varus/valgus misalignment, and a shaft-condylar angle below 30 degrees. Conclusion: Nonoperative treatment of type II SCHF is linked with higher rates of residual sagittal deformity and a notable failure rate requiring subsequent surgery. Both treatment strategies showed similar functional outcomes and patient satisfaction. Further research should focus on identifying anatomic criteria predictive of nonoperative treatment failure. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The effect of exercise training on blood lipids: A systematic review and meta-analysis. Smart, et al. (2025) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : Lipids - Resistance training This systematic review and meta-analysis assessed the effects of exercise training on lipid profiles in individuals with dyslipidemia. A total of 148 randomised controlled trials for more than 8,000 participants were assessed. Exercise was divided into resistance training, aerobic conditioning, and a combination of the two. The results showed that combined aerobic and resistance training was optimal for improving lipid outcomes, while resistance training alone showing limited effectiveness (see figure below). The combined effect reduced low density lipoprotein (LDL) by 7 mg/dL with 95% confidence intervals being between 9 and 5 mg/dL. 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 combination of aerobic and resistance training exercise appears to improve "bad" cholesterol by a significant albeit small level. It is important to remember that the improvements obtained with statins tend to be much higher (17 mg/dL to 68 mg/dL) , hence, if patients decide that they want to "self manage" with exercise it may be beneficial to point this out. Remember that in your patients utilising statins, the risk of developing tendinopathies appears to be higher in the first year of use . URL : https://doi.org/10.1007/s40279-024-02115-z Abstract Background: Dyslipidemia is a primary risk factor for cardiovascular disease (CVD). Exercise training (EXTr) improves some lipid markers but not others; the literature is dated and analyses may be underpowered. Objectives: To clarify which lipid markers are altered with ExTr and establish if information size had yet reached futility. Methods: We conducted a systematic review/meta-analysis, with meta-regression, to establish expected effect size in lipid profile with aerobic (AT), resistance (RT) and combined (CT = AT + RT) ExTr. We conducted trial sequence analysis (TSA) to control for type I and II error and establish if information size had reached futility. Results: We included 148 relevant randomized controlled trials (RCTs) of ExTr, with 227 intervention groups, total 8673 participants; exercise 5273, sedentary control 3400. Total cholesterol (TC) MD – 5.90 mg/dL (95% confidence interval (CI) – 8.14, – 3.65), high-density lipoprotein cholesterol (HDL) 2.11 (95% CI 1.43, 2.79), low-density lipoprotein cholesterol (LDL) – 7.22 (95% CI – 9.08, – 5.35), triglycerides – 8.01 (95% CI – 10.45, – 5.58) and very low-density lipoprotein cholesterol (VLDL) – 3.85 (95% CI – 5.49, – 2.22) all showed significant but modest 3.5–11.7%, improvements following ExTr. TSA indicated all analyses exceeded minimum information size to reach futility. CT was optimal for dyslipidemia management. Meta-regression showed every extra weekly aerobic session reduced TC – 7.68 mg/dL and for every extra week of training by – 0.5 mg/dL. Each minute of session time produced an additional 2.11 mg/dL HDL increase. Conclusion: TSA analysis revealed sufficient data exist to confirm ExTr will improve all five lipid outcomes. CT is optimal for lipid management. The modest effect observed may moderate dyslipidemia medication for primary prevention. Prediction intervals suggest TC, HDL, LDL and TGD are only improved in one-quarter of studies. 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

Stabilization of the distal radioulnar joint with or without triangular fibrocartilage complex tear by an external wrist band brace: A cadaveric study. Shin, et al. (2022) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic : DRUJ brace - Stability effect This study assessed the effect of an wrist band brace on distal radioulnar joint (DRUJ) stability in cadavers, both with and without a triangular-fibrocartilage TFCC lesion. A total of seven cadavers were included in this study. A circumferential brace that could be tightened with a dial was utilised and tightened to achieve a torque that appeared reasonable in clinical practice (1 kg x cm - I have tried it and it felt like a gentle squeeze). Radius translation on a fixed ulna was assessed through motion capture. The trial was completed with and without the brace as well as under the same conditions with a TFCC excised from the ulnar styloid. The results showed that the brace significantly reduced DRUJ translation under all conditions except for full pronaiton. With the brace, near-normal stability in TFCC-detached wrists was achieved. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the brace significantly reduced DRUJ translation in both intact and TFCC excised wrists . It is possible that these biomechanical findings may translate to clinical practice. Currently, it appears that wrist extension loading in people with ulnar side wrist pain may benefit from these sorts of braces . It is also possible that these braces may benefit a subgroup of people undergoing ulnar shortening osteotomies. However, symptoms response to this braces wearing should not be utilised for diagnostic purposes as it does not appear to be useful for that scope . URL : https://doi.org/10.3390/healthcare10050828 Abstract The purpose of this study was to investigate whether a watch-shaped external wrist band brace improves distal radioulnar joint (DRUJ) stability. Seven fresh cadaveric arms were used. Using a customized testing system, volar and dorsal translation forces were applied to the radius externally while the ulna was fixed. The test was performed with the forearm in neutral, 60° pronated, and 60° supinated positions, once without the brace and once with the brace applied. In each condition, the amount of translation was measured. Then, the triangular fibrocartilage complex (TFCC) was detached from the ulnar styloid process and the fovea ulnaris, and the same tests were performed again. Detachment of the TFCC significantly increased volar and dorsal translations in all forearm rotations compared to the intact condition (p < 0.05), except for the pronated dorsal translation of the radius (p = 0.091). Brace application significantly reduced volar and dorsal translations in all forearm rotations both in intact specimens and in TFCC-detached specimens (p < 0.05), except for pronated volar and dorsal translations in TFCC-detached specimens (p = 0.101 and p = 0.131, respectively). With the brace applied, the TFCC-detached specimens showed no significant difference in volar or dorsal translation in all forearm rotations compared to the intact specimens (p > 0.05). The external wrist band brace improved DRUJ stability in both normal and TFCC-torn wrists and reduced the DRUJ instability caused by TFCC tear to a near-normal level. 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

Revision rates between obese and non-obese total shoulder arthroplasty patients: An australian registry data study. Onggo, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Revision rate - Reverse shoulder replacement for fractures This retrospective study assessed the cumulative percent revision rates of shoulder replacement surgeries across different levels of Body Mass Index (BMI). More than 25,000 people were included in the study. People wither underwent anatomical or reverse shoulder replacements depending on the nature of their presentation. Long term complications were collected for all patients. The results showed that revision rates for anatomical replacements remained consistently low across all BMI groups, with no significant differences between normal weight, overweight, or obese patients. For reverse shoulder replacements, the results differed based on primary diagnosis and BMI category. In cases of rotator cuff arthropathy, revisions were initially similar across BMI categories but increase slightly over time among obese patients. When the primary diagnosis was a fracture, only severe obesity (BMI ≥40) significantly elevates revision risk. 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, all causes revisions following reverse shoulder replacement for fractures are higher in people with a BMI greater than 40 compared to people with a lower BMI. This rule does not appear to hold when the shoulder replacement is completed for osteoarthritis or cuff atrhopathy. It is possible that obese people undergoing shoulder replacement for fractures, may present with a more complex surgery due to higher levels of comminution due to greater trauma impact and potentially a lower rotator cuff quality. If your polytrauma patient has had a reverse shoulder replacement for a humeral fracture, keep a closer eye on them. URL : https://doi.org/10.1016/j.jse.2025.05.036 Abstract Background: Obesity is an epidemic more apparent in many developed countries, like Australia. The effect on total shoulder replacement (TSA) is not clear, with different studies reporting varying conclusions. This registry-based study offers a large-scale analysis of the effects of obesity on the risk of revision in anatomic TSA (aTSA) and reverse TSA (rTSA) for various indications. Methods: This is an observational cohort analysis of data from a national arthroplasty registry. Primary aTSA for osteoarthritis and primary rTSA for cuff arthropathy or fracture performed between January 2015 and December 2022 in Australia were included. Procedures were stratified by body mass index (BMI) groups and the cumulative percentage of revision was compared between groups. The analyses were undertaken using Kaplan-Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazards models. Results: There were 9,549 primary aTSAs for osteoarthritis, 13,920 primary rTSAs for cuff arthropathy, and 4,685 primary rTSAs for fractures. In rTSA indicated for fracture, obese class III had an increased all-cause revision risk compared with normal-BMI patients (HR 1.87, 95% CI 1.13-3.10, P = .014) throughout the entire follow-up period. In contrast, all-cause revision rates for aTSA for osteoarthritis and rTSA for rotator cuff arthropathy across BMI categories were not significantly different. There was an increased risk of revision for instability or dislocation in BMI class III compared with normal-BMI patients after rTSA for fracture (HR 2.84, 95% CI 1.43-5.63, P = .002). Obese class 1 and obese class 2 patients receiving aTSA for osteoarthritis had a higher rate of revision for cuff insufficiency compared with normal-BMI patients (entire period HR 2.30, 95% CI 1.17-4.55, P = .016, and entire period HR 2.10, 95% CI 1.00-4.40, P = .049, respectively). Conclusion: Obesity has an increased risk of all-cause revisions and revision for instability or dislocation in patients receiving rTSA indicated for fractures. BMI was not associated with an increased risk of revision in primary aTSA indicated for osteoarthritis, nor for primary rTSA indicated for rotator cuff arthropathy. We recommend BMI class III patients undergoing rTSA for fracture to be counseled on their complication risks during the informed consenting process. 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