Management and outcomes of brachial plexus injuries after shoulder dislocation: A systematic review. Shekouhi et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Aetiologic/Prognostic Topic: Hand impairments - Shoulder dislocation This is a systematic review on the mechanisms, diagnostic approaches, and treatment outcomes of brachial plexus injuries following shoulder dislocations. A total of 9 studies for 255 participants were included in the review. The axillary, radial, and ulnar nerves, were the most commonly affected when the brachial plexus was involved. This is because the brachial plexus involvement was most commonly the posterior cord (radial and axillary nerve - 38%), medial cord (ulnar nerve - 38%), lateral cord (medial nerve - 13%). Diagnostic methods such as clinical evaluations and nerve conduction studies are crucial for assessing injury severity and prognosis. Treatment approaches vary based on the extent of injury, ranging from conservative management for mild cases to surgical intervention for severe injuries involving nerve avulsion or significant entrapment due to scarring around brachial plexus. Early surgical exploration is often recommended in severe cases to improve recovery outcomes. The study highlights the importance of timely diagnosis and treatment to prevent long-term complications such as muscle atrophy, contractures, and persistent neurological deficits. While most patients experience some degree of recovery, functional impairment can persist in a subset of individuals. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, despite brachial plexus injuries following shoulder dislocations are rare, the repercussions can be significant in those who experience this injury. Hand therapists are most likely going to see those people who have a posterior cord injury (e.g. radial nerve palsy) or intrinsic muscle of the hand weakness. Nerve conduction studies and potentially surgical intervention are useful in very severe cases. In people with a conservatively managed nerve injury, 12 to 18 months recovery seem to the average time required. Another nerve lesion that you may pick up after a shoulder dislocation is an axillary nerve lesion, which could present with significant shoulder movement impairments alongside reduced sensation in the deltoid region. URL: https://doi.org/10.1142/S2424835525500638 Abstract Background: Brachial plexus (BP) injuries are a known complication of shoulder dislocation, yet optimal management strategies remain unclear. This systematic review aims to evaluate the outcomes and treatment approaches for BP injuries following shoulder dislocation. Methods: A systematic review was conducted according to PRISMA guidelines across four databases: PubMed/MEDLINE, Embase, Scopus and Web of Science. Eligible studies included human subjects with BP injuries following shoulder dislocation. Data extraction and risk of bias (ROB) assessment were independently performed by two reviewers. Due to heterogeneity amongst the studies, a meta-analysis was not conducted. Results: Out of 2,060 initial studies, 9 met the inclusion criteria, encompassing a total of 255 patients (256 limbs) with a mean age of 55.9 ± 16.0 years. Of these, 193 (75.7%) had BP injuries post dislocation. Conservative management was the most common treatment (149 cases, 67.4%), followed by neurolysis ± nerve transfer (44 cases, 19.9%) and nerve repair (28 cases, 12.7%). Amongst 133 patients with reported BP injury patterns, the posterior cord was most frequently involved (38.3%). Sensory and motor recovery was observed in 51.6% and 45.2% of patients respectively, with 60.4% of patients achieving MRC grade ≥ 4 in studies that reported this metric. The mean follow-up period was 28.4 months. Conclusions: BP injuries following shoulder dislocation are uncommon but clinically significant. Conservative treatment remains the predominant approach, though surgical interventions may offer improved functional recovery in selected cases. 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

Radiographic outcomes decline linearly with increased time to surgery in distal radius fractures: A cohort analysis. Wadsten, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Distal radius fracture ORIF - Perils of delayed surgery This retrospective study assessed the effect of surgical timing on radiographic outcomes in patients with distal radius fractures (DRFs) who underwent open reduction internal fixation (ORIF). A total of 693 participants were managed with ORIF. The results showed that any delay increased the risk of malalignment and worse radiographic outcomes. A delay of up to 21 days was associated with a doubling of the risk of unacceptable alignment, as well as an average increase in dorsal tilt by 5° after two weeks. No functional outcomes were included, making the clinical implication effect harder to estimate. 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, early surgical intervention is important to optimise distal radius fracture alingment in those people undergoing ORIF. This is important to remember as significant volar/dorsal or positive ulnar variance tend to lead to worse outcomes following such fractures. If you would like to know more about the distal radius fractures recovery and management, have a look at the whole database. URL: https://doi.org/10.1177/17531934251379171 Abstract Introduction:The optimal timing for distal radial fracture fixation remains controversial. Most previous studies have dichotomized timing into early or delayed categories, potentially obscuring the true effect of delay. This study investigated surgical timing as a continuous variable to determine its influence on radiographic alignment. Methods: In a retrospective multicentre cohort study, we reviewed 691 surgically treated distal radial fractures across four Swedish hospitals. Radiographic parameters assessed included dorsal tilt (primary outcome), radial inclination, ulnar variance, intra-articular step, coronal shift and anterior apposition. Logistic regression was used to analyse overall acceptable alignment, while linear regression was used for dorsal tilt. Models were adjusted for age and sex. Interobserver reliability was evaluated with intraclass correlation coefficients. Results: The mean patient age was 61 years, and 80% of the cohort were female. Each additional day delay to surgery increased the risk of unacceptable alignment by 6%, corresponding to a twofold risk increase with a 2 week delay. Dorsal tilt worsened linearly by approximately 0.34° per day, accumulating to nearly 5° after 2 weeks. Male sex was associated with significantly greater dorsal tilt (mean difference >2°) and reduced correction compared with females. Interclass correlation coefficients demonstrated excellent reliability for dorsal tilt (0.952) and radial inclination (0.947), and moderate reliability for ulnar variance (0.748) and coronal shift (0.611). Conclusion: A linear relationship was identified between surgical delay and declining radiographic outcomes, highlighting that each day’s delay progressively compromises fracture alignment. These findings emphasize the importance of prompt surgical intervention for distal radial fractures to achieve optimal radiographic results. 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

Evidence of a genetic background predisposing to complex regional pain syndrome type 1. Shaikh, et al. (2024) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Aetiologic Topic: CRPS - Genetic predisposition This was a cohort study assessing genetic contributions to complex regional pain syndrome (CRPS) type 1. A whole exome (protein coding parts of the genome) sequencing of UK cohorts and a subset of alleles for people with CRPS type 1 (N = 84) was completed. The result showed that the individual or combined presence of four rare alleles were significantly more common in people with CRPS type 1 compared to healthy control and persistent pain populations. In particular these variants were were present in roughly 30% of people with CRPS type 1 compared to 15% in the general UK population (0% in the pain control group). These four specific variants appear to modulate the inflammatory body response and have therefore been proposed to contribute to the neuro‑immune dysfunction in people with CRPS type 1. 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, specific genes appear to increase the chance of developing CRPS type 1. In particular, it appears that these variants are present in 30% of people with CRPS type 1 compare to 15% in the UK general population. Currently, we have no way of identifying these people to reduce their risk, unless they have decided to get a DNA test. However, factors that we know increase the risk of CRPS type 2 and approaches that have been shown to be effective in reducing incidence have been previously published. URL: https://doi.org/10.1136/jmg-2023-109236 Abstract Background Complex regional pain syndrome type 1 (CRPS-1) is a rare, disabling and sometimes chronic disorder usually arising after a trauma. This exploratory study examined whether patients with chronic CRPS-1 have a different genetic profile compared with those who do not have the condition. Methods Exome sequencing was performed to seek altered non-synonymous SNP allele frequencies in a discovery cohort of well-characterised patients with chronic CRPS-1 (n=34) compared with population databases. Identified SNP alleles were confirmed by Sanger sequencing and sought in a replication cohort (n=50). Gene expression of peripheral blood macrophages was assessed. Results In the discovery cohort, the rare allele frequencies of four non-synonymous SNPs were statistically increased. The replication cohort confirmed this finding. In a chronic pain cohort, these alleles were not overexpressed. In total, 25 out of 84 (29.8%) patients with CRPS-1 expressed a rare allele. The SNPs were rs41289586 in ANO10, rs28360457 in P2RX7, rs1126930 in PRKAG1 and rs80308281 in SLC12A9. Males were more likely than females to have a rare SNP allele, 8 out of 14 (57.1%) vs 17 out of 70 (24.3%) (Fisher’s p=0.023). ANO10, P2RX7, PRKAG1 and SLC12A9 were all expressed in macrophages from healthy human controls. Conclusion A single SNP in each of the genes ANO10, P2RX7, PRKAG1 and SLC12A9 was associated with developing chronic CRPS-1, with more males than females expressing these rare alleles. Our work suggests the possibility that a permissive genetic background is an important factor in the development of CRPS-1. 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 comprehensive review of the neurological manifestations of celiac disease and its treatment. Gala, et al. (2022) Level of Evidence: 3a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: Upper limb peripheral neuropathies - Celiac disease This narrative review assessed the systemic effects of Celiac disease that could mimic musculoskeletal presentations. Non gastrointenstinal manifestations span from isolated but symmetrical peripheral neuropathies to central manifestations such as ataxia, migraine, epilepsy and cognitive decline. These extra‑intestinal presentations are underdiagnosed because patients may lack classic gastrointestinal symptoms. In these patients it may take up to 35 months for a diagnosis to be made. The pathophysiology for peripheral neuropathies is an autoimmune response initiated by gluten. Concurrent malabsorption can worsen this picture through deficiencies of B12, folate and trace elements. The gluten-free diet remains the cornerstone of therapy, but adherence is challenging. 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, bilateral peripheral neuropathies like cubital tunnel syndrome could be caused or exacerbated by Celiac disease. Early neuro assessment, sensory testing and muscle endurance, can detect subtle deficits indicative of bilateral nerve impairments. Other mimickers of upper limb entrapment neuropathies include amyotrophic lateral sclerosis and cervical myelopathy. URL: https://doi.org/10.3390/diseases10040111 Abstract Celiac disease (CD) is a common chronic inflammatory disorder occurring in genetically predisposed individuals secondary to gluten ingestion. CD usually presents with gastrointestinal symptoms such as pain, bloating, flatulence, and constipation or diarrhea. However, individuals can present in a nonclassical manner with only extraintestinal symptoms. The neurological manifestations of CD include ataxia, cognitive impairment, epilepsy, headache, and neuropathy. A lifelong gluten-free diet is the current recommended treatment for CD. This review discusses the relevant neurological manifestations associated with CD and the novel therapeutics. Further research is required to get a better understanding of the underlying pathophysiology of the neurological manifestations associated with CD. Clinicians should keep CD in the differential diagnosis in individuals presenting with neurological dysfunction of unknown cause. 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

Which is more common: Right or left distal radial fractures?. Giddins, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Symptoms prevalence study Topic: Incidence of distal radius fractures - Affected side This systematic review assessed the incidence of distal radial fractures based on side and hand dominance. A total of 10 studies were included, for more than 47,000 participants with distal radius fractures. The results showed that distal radius fractures occurred significantly more often on the left (55%) compared to the right (45%). These fractures occurred more often on the non-dominant side than the dominant side. This pattern was consistent across various age groups, including adults and the elderly. The reasons for this asymmetry remain unclear. 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, every second Exos/wrist brace order you should buy 6 left and 4 right items. This way you would end up with a stock of 55% left braces and 45% right braces, which will make you less likely to run out of braces unevenly. For other ways on how to optimise your clinic and provide efficient care for selected cases, have a look at this other synopsis. URL: https://doi.org/10.1177/17531934251375711 Abstract Introduction: The aim of this study was to review the published literature to assess whether adult distal radial fractures were more common on the left side than the right, and more common on the non-dominant or dominant side. Methods: A structured literature review was performed using a predefined search. There were 1726 papers possibly related to dominance and 1571 related to laterality. After screening of the abstracts, 41 papers relating to hand dominance and 144 to laterality were retrieved for full text analysis. Studies reporting adult patients, over 250 fractures and providing data on laterality or hand dominance were included. Results: There were 10 papers fulfilling the inclusion criteria. Three were from national databases providing 92% of the cases. Overall there were 47,959 distal radial fractures of which 26,534 (55.3%) occurred on the left and 21,425 (44.7%) occurred on the right (p < 0.0001). Of 1738 distal radial fractures where hand dominance was reported, 935 (53.8%) were on the side of the non-dominant hand and 803 (46.2%) on the side of the dominant hand (p < 0.0001). Conclusion: Distal radial fractures occur significantly more often on the left side and to the non-dominant hand. This is confirmed in the limited data on side of injury in studies of fracture fixation and with the data on implant purchasing patterns for institutions. Why there is this difference is unclear, but may relate to fall mechanics, protective reflexes or subtle differences in bone density. These results may help validate randomization in clinical trials. 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

Machine learning can aid in the differential diagnosis of neurogenic thoracic outlet syndrome and carpal tunnel syndrome. Ahmed, et al. (2025) Level of Evidence: 2b Follow recommendation:👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: Neurogenic vs CTS - Differential diagnosis This study explored the use of a machine learning models to differentiate neurogenic thoracic outlet syndrome (nTOS) from carpal tunnel syndrome (CTS). By integrating patient demographics and objective testing, the model achieved 85% accuracy in distinguishing between nTOS and CTS. Key factors influencing the model included BMI (greater in CTS), symptom duration (unclear direction although I suspect longer duration for nTOS), and Roos' tests. One of the limitations includes the small dataset, which limit generalisability of the findings. 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, neurogenic thoracic outlet syndrome (nTOS) is more likely in older people, who presents with lower BMI, and a positive Roos's test compared to carpal tunnel syndrome (CTS). In this specific study the number of nTOS and CTS was similar to make the modelling easier. However, in day to day clinical practice, the odds of nTOS are significantly lower compared to CTS. It is still important to retain nTOS as a differential diagnosis as it is one of the most close mimickers of CTS. If you want to learn more about nTOS to recognise it in your patients, have a look at what imaging can be done for it. URL: https://doi.org/10.1016/j.bjps.2025.09.004 Abstract Introduction: Symptoms related to neurogenic thoracic outlet syndrome (nTOS) and carpal tunnel syndrome (CTS) may overlap, leading to diagnostic uncertainty. In this study, we used a machine learning model to identify key predictors of nTOS by comparing it with CTS. Methods: We reviewed records of patients who underwent surgical intervention for nTOS (n = 68) or CTS (n = 65). The machine learning model was developed using the scikit-learn library in Python, and a binary logistic regression model incorporating patient history and physical exam findings was developed to differentiate nTOS from CTS. Positivity rates of Tinel’s sign and the scratch collapse test (SCT) were compared using Agresti-Coull confidence intervals, chi-squared goodness-of-fit, and binomial tests. Results: For diagnosis of nTOS, the baseline random forest model achieved 80.0% accuracy (F1-score: 0.76, area under the receiver operating characteristic curve: 0.91). After hyperparameter tuning, accuracy improved to 85.0% and precision reached 1.0, yielding a 7.7% gain in overall performance. Both Tinel’s sign and SCT in isolation were diagnostic of nTOS and CTS but could not differentiate between the 2 conditions. In both the baseline and optimized random forest model, the Roos/Elevated Arm Stress Test, body mass index, and duration of symptoms prior to surgery emerged as the most influential predictors of nTOS. Conclusions: The random forest model predicted nTOS with up to 85% accuracy. SCT and Tinel’s tests in isolation could not distinguish between nTOS and CTS. Combining multiple clinical and demographic variables within a machine learning model yielded superior diagnostic accuracy for distinguishing nTOS from CTS. 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

Preoperative vascular assessment of patients with a supracondylar humeral fracture and a perfused, pulseless limb. Holme (2023) Level of Evidence: 3a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: Vascular assessment - Pediatric elbow fractures This systematic review assessed the usefulness of objective tests in the assessment of vascular perfusion in children with a supracondylar humeral fracture presenting with a pulseless limb. Overall 25 studies were included in the review, for a total of 504 children. The results showed variability in clinical assessment methods, including color and capillary refill time (CRT), which may be limited in non-Caucasian patients. Ultrasound was considered useful for detailed vascular evaluation, but lacks standardised criteria for routine use. The authors recommend using CRT (with vascular compromise indicated by > 3 seconds refill) as a pragmatic cutoff, comparing it to the uninjured limb, and incorporating oxygen saturation measurements. 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 use of capillary refill time may be useful in the vascular assessment of children's with a supracondylar humeral fractures who do not present with a pulse. The refill time should be less than 3 seconds to provide some reassurance in terms of arterial supply. Alternatively, the use of temperature monitoring may be useful for non-Caucasion patients. If you are interested in supracondylar fractures have a look at the synopses on the topic. For another vascular presentation that we need to be aware of, this synopsis is on hypothenar hammer syndrome. URL: https://doi.org/10.1302/0301-620x.105b3.bjj-2022-0699.r2 Abstract Aims: The ‘pink, pulseless hand’ is often used to describe the clinical situation in which a child with a supracondylar fracture of the humerus has normal distal perfusion in the absence of a palpable peripheral pulse. The management guidelines are based on the assessment of perfusion, which is difficult to undertake and poorly evaluated objectively. The aim of this study was to review the available literature in order to explore the techniques available for the preoperative clinical assessment of perfusion in these patients and to evaluate the clinical implications. Methods: A systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered prospectively with the International Prospective Register of Systematic Reviews. Databases were explored in June 2022 with the search terms (pulseless OR dysvascular OR ischaemic OR perfused OR vascular injury) AND supracondylar AND (fracture OR fractures). Results: A total of 573 papers were identified as being suitable for further study, and 25 met the inclusion criteria for detailed analysis. These studies included a total of 504 patients with a perfused, pulseless limb associated with a supracondylar humeral fracture. Clinical examination included skin colour (23 studies (92%)), temperature (16 studies (64%)), and capillary refill time (13 studies (52%)). Other investigations included peripheral oxygen saturation (SaO2) (six studies (24%)), ultrasound (US) (14 (56%)), and CT angiogram (two studies (8.0%)). The parameters of ‘normal perfusion’ were often not objectively defined. The time to surgery ranged from 1.5 to 12 hours. A total of 412 patients (82%) were definitively treated with closed or open reduction and fixation, and 92 (18%) required vascular intervention, ranging from simple release of entrapped vessels to vascular grafts. Conclusion: The description of the vascular assessment of the patient with a supracondylar humeral fracture and a pulseless limb in the literature is variable, with few objective criteria being used to define perfusion. The evidence base for decision-making is limited, and further research is required. We were able, however, to make some recommendations about objective criteria for the assessment of these patients, and we suggest that these are performed frequently to allow the detection of any deterioration of perfusion. 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

Updating risk and protective factors for dementia in older adults. Rodriguez, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (2/4 Thumbs up) Type of study: Aetiologic Topic: Brain health - Protective factors This narrative review highlights emerging evidence on population-level and individual-level factors influencing the risk of age-related dementia. The authors identified post-traumatic stress disorder, bipolar disorder, psychotic disorders, anxiety, and ultra-processed food consumption as high-risk factors. Protective factors included fruit and vegetable intake, purpose in life, residential greenness, and musical instrument play. Both population-level strategies, such as policy changes and individual-level approaches were suggested. These include lifestyle modifications and the use of digital tools (e.g. cognitive training, mindfulness programs) for the prevention of this disease. The authors also suggest that these approaches need to be adapted across different communities for the development of effective interventions. 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, mental health appears to be an important factor in the prevention of dementia. Considering that people with upper limb conditions can become depressed and anxious due to their injury, we play an important role in reducing their long term risk by providing good care for them. Furthermore, helping them to stop smoking also reduces their overall risk. Furthermore, keeping them mentally active by encouraging them to play games, use computers rather than watching TV, are additional strategies that can reduce their dementia risk. I am also reminding us, that simple physical exercise can have a large impact. URL: https://doi.org/10.1038/s44159-025-00438-w Abstract Promoting good cognitive functioning and preventing dementia in late life are priority actions for many countries with rapidly ageing populations. Although epidemiological research has established some modifiable factors that influence the risk of cognitive impairment (such as low education level, hearing impairment, smoking, obesity, physical inactivity or social isolation), a growing literature suggests further risk and protective factors that might affect cognitive functioning and dementia. In this Review, we examine the potential effects of these less well-established factors, and discuss promotion and prevention strategies at the population and individual levels that might reduce dementia risk in the long term. Reducing financial struggles, neighbourhood deprivation and workplace strain and promoting leisure activities, emotional wellbeing and healthy nutritional styles have emerged as factors that might help to prevent dementia and could be included among priority actions for healthy cognitive ageing. 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 a1 pulley release: An analysis of risk factors using a national database. Weaver, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic: Trigger finger release - Revision risks This retrospective study assessed risk factors for revision surgery in people who underwent trigger finger release. More than 46,000 participants who underwent a single trigger finger release were included in the study. Revision surgery was assessed across all patients up to 5 years after surgery. The fingers with the highest probability or revision were the middle and ring finger, with the thumb being the least likely one. The overall revision surgery was 4%. Several variables (e.g. demographics, comorbidities) were included in models that controlled for confounding factors. The results showed that type 2 diabetes, cardiovascular conditions, older age, and the presence of carpal tunnel were all contributors to increased risk of revision 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, trigger finger revision is more likely in the middle and ring finger of people presenting with type 2 diabetes, who are older affected by carpal tunnel and cardiovascular conditions. The association between trigger finger and carpal tunnel syndrome is not new and this has been previously reported across several papers. In terms of most common trigger finger location, previous evidence has shed light on this condition being mostly prevalent in the middle finger, thumb, and ring finger. URL: https://doi.org/10.1016/j.jhsa.2024.09.016 Abstract Purpose: Trigger finger release (TFR) is a commonly performed procedure in hand surgery. Trigger finger release has a high success rate, but recurrence can occur. Data on revision TFR (rTFR) are sparse, with little known regarding factors associated with the need for revision surgery. Our purpose was to analyze risk factors associated with rTFR procedures. Methods: Using a national database (PearlDiver Research Program), patients who underwent TFR between 2015 and 2022 were identified using Current Procedural Terminology and International Classification of Diseases (ICD)-10 codes. Patients were included if they received an ICD-10 diagnosis of trigger finger on the same day as their release or within 2 weeks of their procedure. Patients who underwent rTFR were determined through identification of a secondary procedure completed in the same digit on the ipsilateral hand performed after the index procedure. Revision rates at 1, 3, and 5 years were recorded. Demographics and comorbidities were categorically examined via univariate and multivariable logistic regression analyses. Results: A total of 46,613 patients meeting inclusion criteria were identified after TFR with 1,793 (3.85%) undergoing revision release. Multivariable analysis demonstrated that diabetes, ischemic heart disease, and male sex were associated with statistically significantly increased odds of revision procedures at 1, 3, and 5 years from the initial operation. Age >65 years and hypertension were associated with an increased odds of revision surgery at 3 and 5 years, and carpal tunnel syndrome as a risk factor at 1 and 3 years only. Hypothyroidism was associated with a decreased revision rate at all time points and tobacco use at 5 years only. Conclusions: These data demonstrate that male sex, diabetes, and heart disease are risk factors for requiring revision TFR in the short and medium terms. This information can add to preoperative counseling with patients undergoing surgical treatment of trigger digits. 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

Proximal humeral fractures in patients over 60 years old: A randomized study of nonoperative versus operative treatment with locking plate. Gracitelli, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Proximal humerus fractures - Conservative vs surgical management This randomised controlled study assessed the effectiveness of open reduction internal fixation vs conservative management of displaced proximal humerus fractures in people over 60 years old. A total of 71 participants were included in the present study with 40 participants randomised to conservative management and 31 to surgical management. Outcomes of interest included shoulder function, complications rates, and overall perceived improvement and they were measured at 3, 6, 12, and 24 months. The results demonstrate showed that both groups had comparable outcomes in terms of function and overall perceive improvements. The surgical group experienced a higher complication rate (35.5% vs. 15.0%), however, this difference was not 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, for displaced proximal humerus fractures in patients over 60 years old, nonoperative management is equally effective as open reduction internal fixation. Function, overall improvement, and complication rates are similar, with neither approach being superior. Physiotherapy plays a crucial role in both approaches with the aim of monitor healing and improving shoulder flexibility. Most of our patients with humeral fractures also present with a hand/wrist fracture/injury; remember that the longer we immobilise these wrists, the worst their shoulder function tends to be. Get them moving if you can. Following such humeral fractures, it is also possible to develop a frozen shoulder and hydrodilatation +/- CSI seem to be helpful. If you want to know more of how to help your patients with shoulder conditions, have a look at the whole database. URL: https://doi.org/10.1016/j.jse.2024.12.036 Abstract Background: Proximal humerus fractures (PHFs) are common in the elderly, with a rising incidence. Despite advances in surgical techniques, the optimal treatment for displaced PHFs remains controversial, as high-quality studies show no significant differences in functional outcomes between surgical and nonsurgical treatments. This study aims to compare nonoperative with surgical treatment using a locking plate (LP) for displaced PHFs in patients over 60 year old. Methods: This prospective, randomized clinical trial compared nonoperative and operative treatments using LPs for displaced PHFs in patients over 60 year old. Patients were randomized 1:1 into 2 groups using a block randomization stratified by tuberosity involvement. The primary outcome was the Constant-Murley score at 24 months. Secondary outcomes included the Individual Relative Constant Score, American Shoulder and Elbow Surgeons (ASES) score, and Single Assessment Numeric Evaluation (SANE) score at 3, 6, 12, and 24 months. The incidence of complications and the need for reoperations were evaluated. Results: Eighty patients were randomized, with 71 completing 24 months of follow-up: 40 in the non-operative group and 31 in the operative group. At 24 months, the mean Constant-Murley scores were 68.7 ± 16.1 for the non-operative group and 66.5 ± 15.8 for the operative group (P = .433). The ASES score at 24 months was 77.0 ± 23.1 for the nonoperative group and 79.1 ± 20.0 for the operative group (P = .871). The SANE scores at 24 months were 83.8 ± 19.3 for the nonoperative group and 88.5 ± 17.2 for the operative group (P = .236). The Individual Relative Constant Score at 24 months was 79.5 ± 25.2% for the nonoperative group and 73.0 ± 29.2% for the operative group (P = .244). Seventeen patients experienced complications, with 6 (15.0%) in the nonoperative group and 11 (35.5%) in the operative group (P = .070). The rate of a new surgical indication was 12.5% in the nonoperative group and 22.6% in the operative group (P = .421). Rotator cuff tears were 20.0% in the nonoperative group vs. 25.8% in the operative group (P = .768). Conclusion: The operative treatment of displaced proximal humeral fractures with LP osteosynthesis in patients over 60 year old shows no evidence of differences in clinical outcomes compared to nonoperative treatment, as measured by the Constant-Murley Score, Individual Relative Constant Score, ASES, SANE, and complication rates. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Effect of time from injury to surgery on surgical technique and complication rate in distal biceps tendon repair. Morrison, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Distal biceps repair - Type of surgery This study retrospective study assessed the relationship between the time elapsed from injury to surgery and the surgical technique used for distal biceps tendon ruptures. A total of 373 patients were included. The results showed that three main types of surgery were completed and that these were associated with time from injury. In particular, direct repair was predominantly performed for acute injuries, occurring within 16 days of injury on average, while high flexion angle repair and allograft reconstruction were more commonly used in chronic cases with longer delays, averaging 82 and 274 days, respectively. The three types of surgeries were equally like to happen at 25-27 weeks post-injury. Complication rates were low overall (12%), with isolated sensory nerve injuries being the most frequent complication (either superficial branch of the radial nerve or posterior interosseous nerve). There were no significant differences in re-rupture or major complication rates between surgical techniques. Probability of surgical technique based on time from injury to surgery. DR = direct repair; HFA = high flexion angle repair; AR = allograft reconstruction. 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 type of surgery for a distal biceps repair is highly dependent on the time from injury. Direct Repair is used for acute injuries (within 16 days). High Flexion Angle Repair occurs when the repair is completed "under tension" as the surgeon is unable to repair the distal biceps unless the elbow is flexed to 60deg or 100deg. An alternative to this is completing and allograft repair, often with a palmaris longus. These two repairs are much more likely if injury occurred 7-8 months after injury. In the case of these last two repairs, a hinged ROM brace is likely required, especially for the high flexion angle approach, to avoid re-rupture. URL: https://doi.org/10.1016/j.jse.2025.07.027 Abstract Background: Surgical treatment options for distal biceps tendon ruptures vary based on time from injury to surgery. While direct repair (DR) is preferred for acute injuries, high flexion angle repair (HFA) and allograft reconstruction (AR) are alternatives for chronic cases. This study examines the relationship between time to surgery, surgical technique selection, and complication rates. Methods: A retrospective chart review was conducted on patients treated surgically for distal biceps tendon ruptures at a single center from January 2012 to June 2023. Cases were identified through electronic medical records and included patients ≥18 years with unilateral ruptures. Demographics, time to surgery, surgical techniques (DR, HFA, AR), and complications were recorded. Descriptive statistics and multinomial logistic regression were used to assess the association between time to surgery and surgical technique. Results: A total of 373 patients were included, with 90% undergoing DR (n=334), 6% HFA (n=22), and 5% AR (n=17). The mean (standard deviation) time from injury to surgery was 16 (±30) days for DR, 82 (±162) days for HFA, and 274 (±455) days for AR. Surgical technique selection was significantly associated with time to surgery (Kruskal Wallis p<0.001), with DR favored in acute cases and HFA/AR in chronic presentations. The inflection point for equal probabilities of DR, HFA, and AR occurred at 25-27 weeks post-injury. The overall complication rate was 12% (n=45), with nerve injuries being the most common (7%, n=25). Conclusion: Timing significantly impacts surgical technique selection in distal biceps tendon ruptures. DR remains the standard for acute injuries, while HFA and AR are viable options for chronic cases. The multinomial probability graphic (Figure 2) can be used to educate and council patients on surgical decision making for chronic distal biceps ruptures. 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

Supervised machine learning and clinical decision support. Bukowiec, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic: Machine learning - Human supervision The expert opinion provides an overview of supervised machine learning (ML) in clinical settings. It highlights its applications, challenges, and ethical considerations. Supervised ML involves training models using labeled data to predict outcomes or classify patterns, making it valuable for analysing electronic health records (EHRs), medical imaging, and treatment recommendations. Examples include predicting patient risks, diagnosing fractures, and automating radiographic positioning. However, challenges such as overfitting (models working great on dataset but not on new patients), underfitting (models not findings a pattern), have implications for broad implementation of models, which require human supervision. Furthermore, ethical concerns include bias in AI systems exacerbating disparities amongst social or ethnic groups. Additionally, issues like patient privacy, regulatory frameworks, and implementation barriers hinder widespread adoption. Overall, the authors state that human supervision will be paramount in the use of these tools across, reasearch, patient care, and evidence based medicine. 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, supervised machine learning offers significant advancements in clinical settings, including applications like risk prediction, diagnosis, and adoption of evidence based medicine. However, its implementation must address several key challenges: ensuring that models generalise well across diverse populations and new patients, control for bias to avoid widening of inequitable care, transparency for trust, and maintenance of patient privacy. Another key aspect for implementation of these tools includes the education of clinicians in their use for successful adoption. For your information, some of the currently available tools include a scaphoid fracture probability prediction and another one on the probability of patients with carpal tunnel syndrome to positively respond to surgery. If you want to learn more about the use of artificial intelligence for hand therapy, look at the whole database. URL: https://doi.org/10.1016/j.hcl.2025.08.001 No Abstract available publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings