Extensor mechanism dysfunction and hand deformities caused by dupuytren’s disease: Surgical and rehabilitation perspectives. Brutus, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Splinting - Post-surgical Dupuytren's This is an expert opinion on Dupuytren's disease surgical and post-surgical management. Traditionally associated with palmar flexion contractures due to palmar aponeurosis involvement, Dupuytren's disease also impacts the hand's extensor mechanism, potentially leading to deformities such as boutonniere and swan-neck deformities. This condition can severely impair hand function, necessitating surgical and therapeutic interventions. Surgical treatments may include addressing forces causing volar migration of the lateral bands and tendon repairs for specific deformities. Post-surgical rehabilitation emphasises static and dynamic splinting, pain management, and maintaining soft tissue flexibility through various strategies, including vibration therapy and elastic therapeutic taping. Understanding these surgical and rehabilitation modalities can improve patient outcomes, restoring hand functionality and reducing deformities caused by Dupuytren's. 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 : Base on what we know today, common extensor mechanism imbalances, such as boutonniere and swan-neck deformities are common following surgery for Dupuytren. Incorporating personalised therapy and splinting pre- and post-surgery may enhance recovery. However, if no surgery is done to release structures (e.g. pipj) that present with a fixed deformity, it is unlikely that splinting would have a very large therapeutic effect. Thus, it appears that splinting is most effective in correcting joint deformities following an acute injury/tissue lesion . If you would like further information on splinting effect for fixed deformities, have a look at the whole database . URL : https://doi.org/10.1016/j.jht.2024.12.017 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

Customized 3-dimensional-printed finger splints for mallet finger. Hou, et al. (2025) Level of Evidence: 4 Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Mallet Finger - 3D splinting The study assessed the effectiveness of customised 3D-printed finger splints compared to traditional ones in managing mallet finger injuries. Twenty-one patients were retrospectively analysed and divided into two groups: those treated with traditional splints (aluminium and foam bracing) and those with 3D-printed splints. While no significant difference in treatment success rates was observed, customised splints provided a superior fit, comfort, and increased treatment compliance. Notably, 3D splints minimised the incidence of skin complications and discomfort, enhancing patient satisfaction. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : B ased on what we know today, customised 3D-printed finger splints provide a more comfortable and tailored treatment option for mallet finger compared to an aluminium and foam splint. Their effectiveness is equal to more traditional splinting. Nevertheless, the thermoplastic splints that we currently utilise, are faster to create and can equally adapt to the patient's finger as a 3D printed one. URL : https://doi.org/10.1097/SAP.0000000000004190 Abstract We aimed to evaluate the feasibility and effectiveness of customized 3-dimensional (3D)-printed finger splints in the treatment of mallet fingers. We categorized 21 patients into those who received the traditional finger splint (group A) and those treated with a customized 3D-printed finger splint (group B). We retrospectively analyzed the functional outcomes and patient satisfaction in the 2 groups. During the follow-up period, 3 patients in group A failed treatment, of which 2 underwent extended immobilization and one 1 transferred to surgery. All 3 patents in group B who failed treatment received extended immobilization and did not require transfer to surgery. In patient satisfaction assessments, group B patients scored better in dimension and comfort than did group A patients. Customized 3D-printed finger splints provided a more comfortable and fitting treatment option for mallet finger. Although they did not result in a significant difference in treatment success rate, these splints significantly improved patient compliance with treatment and wearing. 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

Os Styloideum and third metacarpal partial coalition nonunion after traumatic fracture: A report of three cases. Azócar, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Os Styloideum - Fracture The paper discussed three cases presenting with dorsal wrist pain alongside swelling and tenderness on palpation following some form of wrist trauma. Conservative treatment including immobilisation did not resolve symptoms. Given the persistent pain presentation, advanced imaging was completed (see images below) and these identified an Os Styloideum, an accessory carpal bone located on the wrist's dorsal aspect. This is commonly asymptomatic until a traumatic event triggers symptoms. The study highlights how in certain cases the Os Styloideum presents with a partial coalition with the third metacarpal bone, which in case of a fracture non-union it can lead to persistent pain. Two patients underwent successful surgical excision under local anesthesia, leading to complete recovery, while conservative treatment with platelet-rich plasma injection and shock wave therapy was less effective in another case. 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 Os Styloideum (OS) is a rare anatomical variation that can lead to chronic pain in the dorsal aspect of the hand and wrist, especially after trauma. If non-surgical treatments, such as immobilisation and injections, fail to alleviate symptoms, surgical excision can lead to complete and rapid recovery. If you would like to challenge your diagnostic skills with another dorsal aspect pain presentation, you can have a look at this synopsis or the whole database . URL : https://doi.org/10.1177/15589447251317232 Abstract The Os Styloideum (OS) is an accessory carpal bone located in the dorsal aspect of the wrist between the base of the second and third metacarpal bones and the trapezoid and the capitate. It is frequently partially coalited with the metacarpal bones and is usually asymptomatic. It may become symptomatic after a traumatic fracture, developing swelling, edema, and pain. We report 3 cases with a fracture of an OS partial coalition with the third metacarpal bone with signs of delayed consolidation. They all complain of persistent pain at the dorsal aspect of the hand that increased with activity. One patient rejected surgery, had a platelet-rich plasma injection, shock wave therapy, and afterward did physiotherapy rehabilitation without complete solution; the other two patients underwent surgical excision with local anesthesia and had a complete recovery after 2 months of follow-up. The OS is an infrequent entity yet must be correctly diagnosed as a possible cause of dorsal pain in the hand and wrist. If symptoms are refractory to medical treatment, surgical excision should be considered. Open excision under local anesthesia is a simple, reproducible procedure with excellent 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

Malignant melanoma in the hand: Current evidence and recommendations. Blessley-Redgrave, et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Skin melanoma - Hand lesions This expert opinion article addresses challenges surrounding the diagnosis and management of malignant melanoma, especially in the hand. Despite advancements like sentinel lymph node biopsy and targeted therapies, worldwide death rates from melanoma have escalated. Melanomas on the hand, particularly subungual melanomas, are often diagnosed late, leading to poor prognoses. The paper emphasises that clinicians should approach pigmented hand lesions with vigilance. The article elaborates on melanoma's presentation and investigation processes, highlighting the significance of early diagnosis for effective treatment options, including surgery and systemic therapies. The ABCD (Asymmetry, Irregular Border, variable Colour, Diameter >7mm, Evolution over time) objective changes should be utilised to increase or reduce our index of suspicion. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, it is crucial that clinicians maintain a high level of suspicion when evaluating pigmented lesions on the hand, especially considering the potential for malignant melanoma. Early diagnosis and intervention are key to improving outcomes. If you would like to refresh your memory on malignant tumors of the hand , have a look at this synopsis. As clinians we should remember the basic ABCD: Asymmetry Irregular Border variable Colour Diameter >7mm Evolution over time URL : https://doi.org/10.1177/17531934241245028 Abstract Malignant melanoma is the leading cause of death from skin cancer. In spite of significant advances in the management of melanoma with the advent of sentinel lymph node biopsy (SLNB) and adjuvant oncological therapies, the death rate continues to increase worldwide. Melanoma in the hand poses additional diagnostic and management challenges. Consequently, these tend to present at a later stage and are associated with a poorer prognosis. It is imperative that hand surgeons treat any pigmented hand lesion with suspicion to ensure rapid diagnosis and treatment. This article outlines the presentation of melanoma, and how to investigate suspicious pigmented lesions of the hand and digits. It guides hand surgeons in their approach to melanoma of the hand, outlining the multidisciplinary team approach as well as current standard surgical and reconstructive options to optimize outcomes. 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

Literature review of postoperative distal radius fracture immobilization recommendations. Cevetello, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Distal radius fracture - Immobilisation This literature review assessed postoperative immobilisation recommendations for distal radius fractures (DRFs) ORIF. It highlights the lack of consensus on the ideal postoperative care, including whether immobilisation is necessary and the optimal method and duration for it. The review analyses various immobilisation techniques such as splints, removable wrist braces, and soft dressings, and their effects on functional outcomes like range of motion and patient quality of life. Some findings suggest that early mobilisation and the use of removable braces or soft dressings may promote faster recovery of strength and motion, although these benefits can level out over time when compared to prolonged immobilisation. However, the type of immobilisation often depends on patient-specific factors and surgeon preference rather than standardised guidelines. 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, following a distal radius fracture ORIF, a short period of immobilisation has been shown to provide quicker functional recovery and improved grip strength without a significant increase in complications. Evidence suggests that immobilisation should be limited to no more than three weeks. This is consistent with previous evidence that you can find on the topic . Additionally, engaging in daily activities and personal occupations can significantly aid in the recovery process by promoting wrist movement and providing psychological benefits . URL : https://doi.org/10.7759/cureus.78349 Abstract Distal radius fractures (DRFs) are a commonly treated injury in orthopedics. DRFs have a high incidence across patient demographics, including pediatrics, young patients in high-energy trauma, and geriatric patients in low-energy trauma. While DRFs occur across a large range of age groups, they are especially consequential in geriatric patients with osteoporosis. Management of DRFs has extensive variability, ranging from conservative casting to surgical interventions, such as open reduction and internal fixation surgical procedures. The diversity of treatment options for DRFs is due to a consideration of factors, such as fracture characteristics, time to presentation with an orthopedic surgeon, age of the patient, and medical comorbidities of the patient. Despite being a common fracture type, there remain discrepancies in the nonpediatric literature regarding postoperative recommendations, such as the timing and methods of immobilization. There is also debate regarding whether postoperative immobilization in adult DRFs has clinical benefit. Some of this variability depends on the type of fixation utilized, such as a volar locking plate, dorsal locking plate, and dorsal wrist-spanning fixation. This literature review examines recommendations and outcomes of postoperative splinting (supination, pronation, or neutral rotation of the forearm) versus removable wrist brace versus soft dressings only for DRFs with both intra-articular and extra-articular fracture patterns with operative fixation. Postoperative care is imperative to study as it carries long-term effects on patients’ quality of life, as their range of motion and strength can be dictated by the methodology of this care. Studies have been conducted comparing the outcomes of early mobilization versus prolonged immobilization after surgical intervention. This literature review analyzes these studies to understand which methods carry better outcomes with respect to the range of motion and quality of life of patients for operatively treated DRFs in non-pediatric patients. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Diagnostic accuracy of point-of-care ultrasound of the posterior fatpad in elbow fractures. Haak, et al. (2025) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Diagnostic Topic : Ultrasound - Elbow fracture detection This diagnostic study evaluates the diagnostic accuracy of point-of-care ultrasound (POCUS) for detecting elbow fractures in adults by examining the posterior fatpad. Conducted across four emergency departments, the multicentre prospective study involved 215 patients with elbow injuries who required X-rays. Emergency physicians, trained in POCUS, performed the ultrasounds, which showed a sensitivity of 91% and a specificity of 93% for identifying fractures, with improvements seen upon expert review. The study's findings suggest that POCUS, in conjunction with physical examination, could reduce the need for X-ray imaging by efficiently ruling out fractures, particularly when the fatpad is not elevated. While POCUS demonstrated high reliability, its diagnostic performance improves with the operator's experience and further training, indicating its potential as a critical adjunct in managing elbow injuries by minimising radiation exposure and healthcare costs. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, ultrasound imaging of the posterior fatpad is a valuable tool in triaging adult patients with elbow injuries. Thus, US imaging completed in clininc with a portable probe alongside physical tests , can increase or decrease our suspicion of an elbow fracture. Ultrasound imaging is becoming more and more relevant in upper limb diagnosis as shown by other studies on cubital tunnel syndrome , distal biceps tendinopathy/tears , and carpal tunnel syndrome . URL : https://doi.org/10.1136/emermed-2024-214448 Abstract Background: Point-of-care ultrasound (POCUS) can potentially be used in the triage of patients with elbow injuries. However, the diagnostic accuracy of POCUS performed by non-radiologists for the exclusion of elbow fractures is yet unknown. This study aimed to investigate the diagnostic potential of POCUS of the posterior fatpad performed by non-radiologists in the workup of adult patients presenting with elbow injuries. Methods: A multicentre, prospective cohort study was conducted between January 2021 and August 2022 in four EDs to determine the diagnostic accuracy of an elevated posterior fatpad on POCUS to demonstrate or exclude an elbow fracture in patients presenting with elbow injuries to the ED. The study population consisted of a convenience sample. In patients ≥16 years of age with an elbow injury for which an X-ray was ordered, POCUS was performed by emergency physicians trained in ultrasound. POCUS (index test) results were compared with X-ray outcomes (reference standard) to determine the diagnostic accuracy of POCUS. Results: A total of 215 patients were included, 143 (67%) of whom had a fracture confirmed on X-ray. POCUS was positive based on a visualised elevated posterior fatpad in 127 (59%) patients. An elevated posterior fatpad on POCUS had a sensitivity of 91% (95% CIs 85% to 95%), a specificity of 93% (95% CI 85% to 98%), a negative likelihood ratio of 0.10 (95% CI 0.06 to 0.16) and a positive likelihood ratio of 13.09 (95% CI 5.61 to 30.54) for the presence of an elbow fracture. Post hoc review of the images by expert sonographers improved sensitivity to 96% (95% CI 91% to 99%). Conclusion: POCUS of the posterior fatpad is a promising adjunct to physical examination to determine the need for further diagnostic studies in the triage of patients with elbow injuries. Sensitivity after a limited training is high, but not perfect, and can likely further be improved with additional training. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic The paper discussed three cases presenting with dorsal wrist pain alongside swelling and tenderness on palpation following some form of wrist trauma. Conservative treatment including immobilisation did not resolve symptoms. Given the persistent pain presentation, advanced imaging was completed (see images below). What do you think we have going on here?

Return to play and outcomes of surgically treated upper limb nerve entrapment in athletes: A systematic review. Lawand, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Surgery for nerve entrapment - Return to sport This systematic review assessed return-to-play (RTP) rates following surgical treatment of upper limb nerve entrapment in athletes. Upper limb nerve entrapment often results from repetitive stress, trauma, and sport-specific biomechanics. Surgical intervention is considered when conservative treatments fail, aiming to restore nerve function and enable athletes to return to their previous performance levels. The review followed the PRISMA guidelines and analysed 31 studies involving 1,297 athletes across 23 sports. Ulnar, brachial plexus, and suprascapular nerves were most commonly affected. Surgical techniques varied, including ulnar nerve decompression, first rib resection for thoracic outlet syndrome (TOS), and suprascapular nerve decompression. Return to sport rates averaged 87%, with suprascapular nerve decompression showing the highest success (100%). TOS outcomes showed greater variability (63–97%). The overall complication rate was low, though TOS had higher reoperation rates. The study highlights surgery's effectiveness in facilitating return to sport and functional recovery for athletes with nerve entrapment. 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, surgically treating upper limb nerve entrapment in athletes consistently leads to high return-to-play rates and functional recovery. Surgical interventions, particularly for the ulnar and suprascapular nerves, have shown reliable success. However, thoracic outlet syndrome surgeries exhibit more variability in outcomes. Thus, careful patient selection and individualised surgical approaches are crucial for optimising results in nerve decompression surgeries. URL : https://doi.org/10.1007/s00264-025-06473-9 Abstract Purpose: Athletes face a higher risk of upper limb nerve entrapment due to repetitive stress, trauma, and biomechanics. Diagnosis is challenging, and delayed treatment can impair performance. When conservative care fails, surgery may be needed to restore function and enable return to play (RTP). Methods: This systematic review adhered to PRISMA guidelines and evaluated surgical outcomes, RTP rates, and complications in athletes with upper limb nerve entrapment. A comprehensive search was conducted using MeSH terms and keywords for surgical interventions, nerve entrapment syndromes, and sports. Eligible studies included case series, cohort studies, and comparative studies that reported postoperative outcomes in athletes. Data extraction included nerve involvement, surgical techniques, clinical outcomes, and RTP rates. Results: Thirty-one studies, comprising 1,297 athletes across 23 sports, were included. The most common nerve entrapments involved the ulnar nerve (50.1%), brachial plexus (39.2%), and suprascapular nerve (9.5%). Surgical interventions included ulnar nerve decompression/transposition, first rib resection with scalenectomy for thoracic outlet syndrome (TOS), and suprascapular nerve decompression. RTP rates ranged from 62 to 100%, with an average of 87%. Suprascapular nerve decompression had the highest RTP success (100%), while TOS demonstrated greater variability (62.5–97%). Functional improvements included pain reduction, increased grip strength, and enhanced patient-reported outcomes. The overall complication rate was low, but TOS procedures had the highest reoperation rates (3.8–27%). Conclusion: Surgical treatment of upper limb nerve entrapment in athletes yields high RTP rates and functional recovery. Ulnar and suprascapular nerve decompressions show consistent success, while TOS surgery outcomes vary. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Clinical effectiveness of an orthosis after collagenase clostridium histolyticum injection for dupuytren contracture. Dent, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Splinting - Collagenase Clostridium Histolyticum for Dupuytren This randomised controlled study evaluates the effectiveness of a nighttime splint following Collagenase Clostridium Histolyticum (CCH) treatment for Dupuytren contracture. A total of 79 patients were split into two groups: one using a splint and the other not. The splint aimed at improving mcpj or pipj contracture, however, there is limited information about the type of splint. After 4 months, the splint group showed significantly lower contracture, specifically at the proximal interphalangeal (PIP) joints, compared to those without. However, there was no difference between groups when the mcpj was assessed. Reportedly, compliance decreased over time, with 52% adhering to orthosis use most nights by the fourth month. 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, post-treatment with Collagenase Clostridium Histolyticum (CCH) for Dupuytren's contracture, a night splint for proximal interphalangeal joint contractures worn over four months, may help improving range of movement. However, considering the lack of change in mcpj flexion deformity, the limited time patients were wearing the splint, and previous meta-analysis on the topic , it is unlikely that the splint would have a large effect size. Have a look at the whole database on the topic . URL : https://doi.org/10.1016/j.jhsa.2025.01.023 Abstract Purpose: Dupuytren contracture is a fibroproliferative disorder forming fascial cords in the hand. Collagenase clostridium histolyticum (CCH) is an alternative treatment to surgery. Current recommendations include nighttime extension orthosis after CCH for 4 months. Our purpose was to evaluate the effectiveness of night orthosis following CCH treatment. Methods: The study was a prospective, randomized, controlled trial at a single institution. Patients with Dupuytren contracture of one or more digits treated with CCH from May 2021 to 2023 were screened. Eighty patients were enrolled and randomized between groups (a nighttime orthosis or no nighttime orthosis). The orthosis group was instructed to wear an extension orthosis nightly until 4 months. Baseline, postmanipulation, and 1-month, and 4-month flexion contractures were collected. QuickDASH (Disabilities of the Arm, Shoulder, and Hand) and splint compliance surveys were collected at 1 and 4 months. Skin tears and adverse events were recorded. Results: There were 39 orthosis patients, and 40 nonorthosis patients who received CCH treatment. A total of 119 joints were treated, including 66 metacarpophalangeal (MCP) and 53 proximal interphalangeal (PIP) joints. Seventy-six and 69 patients completed 1- and 4-month follow-up. Baseline characteristics were similar between two groups. Mean baseline flexion contracture for all joints was 48° and 55° for the orthosis and nonorthosis groups, respectively. The orthosis group had significantly lower residual contracture at 4 months (11° vs 20°). No difference was found at any time for MCP joints. PIP joints in the orthosis group had significantly lower contracture at 1 and 4 months (13° vs 28°; 19° vs 36°). Reported compliance with orthosis was 79% at least “Most of the Time” at 1 month and 52% at least “Half of the Time” at 4 months. Conclusions: Our study suggests greater benefit of night orthosis for PIP joint contractures. We recommend night orthosis after CCH treatment of PIP joint contractures and optional use for MCP contractures. 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 arm curl score is the best indicator of reduced upper extremity exercise capacity in women with fibromyalgia: A cross-sectional study. Durdu, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic / Prognostic Topic : Upper limb strength - Fibromyalgia This cross sectional study assessed upper extremity exercise capacity in women with fibromyalgia (FM), comparing it with age-matched healthy controls. A total of 94 women were included in the study. Of these, 48 had FM and 48 were healthy controls. Using the Six Minute Pegboard and Ring Test (6PBRT) along with various muscle strength and flexibility assessments, the results showed that women with FM had significantly reduced upper extremity exercise capacity, muscle strength, and flexibility. The multivariate analysis indicated that upper extremity exercise capacity were best predicted by a model including the arm curl score, hand grip strength, disability scores, and overall disease impact, with arm curl scores being the most significant predictor. 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 arm curl score is a robust predictor of upper extremity exercise capacity in women with fibromyalgia. Given the significant relationship between upper extremity muscle strength and daily activity performance, it is possible that incorporating specific strengthening exercises for the upper limb may effectively enhance upper extremity exercise capacity in women with fibromyalgia. The goals of such exercises would not be to reduce pain , but increase patients' function. URL : https://doi.org/10.1016/j.jht.2024.12.012 Abstract Background: Unsupported upper extremity exercise capacity (UUEEC) is crucial for sustaining everyday functions; whether it is compromised in the fibromyalgia (FM) population is unknown. Purpose: The study aimed to assess UUEEC in women with FM and to determine associated factors. Study Design: This is a cross-sectional study. Methods: This study was conducted with 48 women with FM and 48 healthy women between the ages of 18–65. UUEEC, muscle strength, flexibility and disability of upper extremity, disease severity, pain catastrophizing, and quality of life assessed with the Six Minute Pegboard and Ring Test (6PBRT), arm curl test, hand grip strength test, back-scratch test, Disability of Arm, Shoulder, and Hand (DASH), Fibromyalgia Impact Questionnaire (FIQ) and Pain Catastrophizing Scale and Short-form 36 questionnaires, respectively. Results: The 6PBRT score was significantly decreased in the women with FM compared to healthy women (p < 0.001, Cohen d: 1.28). The multivariate linear regression analysis revealed that the model incorporating the arm curl score, hand grip strength, DASH, and FIQ scores was explained 68% of the variance in 6PBRT score (R2 = 0.672, p < 0.001). The results indicated that all variables in the model were independent predictors of 6PBRT score, with the arm curl score was the strongest predictor (β = 6.36, p = 0.015). Conclusions: This study suggests that UUEEC measured by 6PBRT is reduced in women with FM, and the upper extremity muscle strength is closely related to the 6PBRT score. Accordingly, strengthening the biceps brachii muscle in women with FM, whose muscle weakness is common, may be effective in improving UUEEC, which is directly associated to daily activities. 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

Evaluation of hand function using relative motion extension concept (with or without night wrist orthosis) or dynamic extension orthosis for extensor tendon injuries in zones 4–6: A randomized controlled trial. Bojnec, et al. (2025) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : RME only - Extensors zone 5 and 6 This ransomised controlled study assessed the effect of three different rehabilitation protocols on extensors zones 4–6 repair. In particular, a Dynamic Extension Orthosis (DEO), a Relative Motion Extension (RME) alone, and RME with a night wrist splint were compared. Fifty participants were randomised into these three groups. The outcomes measured included hand functionality via the Jebsen–Taylor hand function test (JTHFT), grip strength, range of motion (TAM), QuickDASH, and Patient Evaluation Measure (PEM). The study found that both RME protocols resulted in better early recovery of hand function, mobility, and strength than the DEO group. No significant differences were noted between RME-only and RME-plus groups, suggesting the RME-only approach is safe and effective. No tendon ruptures were reported, indicating all protocols were safe for rehabilitation. 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 Relative Motion Extension (RME) protocol for rehabilitation after extensor tendon injuries in extensors zones 4–6 is superior to a Dynamic Extension Orthosis (DEO) protocol. Thus people appear to regain hand function, range of motion, and grip strength more quickly. These results appear to be in contrast with another recent study showing that RME and DEO approaches had similar outcomes . When the current study assessed RME-only vs RME-plus a wrist splint they appeared to be equally effective, suggesting that the simpler RME-only protocol may be a safe and efficient choice for single extensor tendon injuries. URL : https://doi.org/10.3390/life15020249 Abstract This study aimed to compare outcomes of early active motion (EAM) using the relative motion extension (RME) approach to outcomes of early passive motion (EPM) with a dynamic extension orthosis (DEO) and to evaluate whether the RME-only approach is equivalent to the RME-plus approach. Fifty adults were randomized into one of the three intervention groups receiving the DEO, RME only, or RME plus orthosis. The score of the Jebsen–Taylor hand function test (JTHFT) without writing and QuickDASH at T1, all measures of mobility at T1 and T2, and grip strength were better in the RME-only and RME-plus group compared to the DEO group, whereas the values of Patient Evaluation Measure (PEM) at T1 and T2, as well as QuickDASH score at T2, orthosis adherence, and the patient’s comfort while wearing the orthoses did not statistically significantly differ among the three groups. The RME concept after extensor tendon injuries in zones 4–6 is superior to the DEO protocol in terms of earlier regain of hand function. The DEO and RME protocols were equivalent regarding patients’ adherence and satisfaction with the orthosis. We found no differences in the RME-plus and RME-only protocols, indicating the safe use of the RME-only protocol in single extensor tendon injuries in zones 4–6. 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

Use of a remote assessment pathway for diagnosis of carpal tunnel syndrome. Macdonald, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Economic Topic : Carpal tunnel screening - Remote pathway The retrospective study investigated a remote assessment pathway for diagnosing carpal tunnel syndrome (CTS), implemented during the COVID-19 pandemic, by using the Kamath and Stothard carpal tunnel questionnaire in a nurse-led telephone clinic. Patients with scores of 3 or higher were referred for nerve conduction studies or reviewed by a consultant hand surgeon. The study assessed the cost-effectiveness and diagnostic efficacy of this remote pathway compared to the previous in-person system. Results showed that a score of 3 or above predicted CTS in 83% of cases, resulting in cost savings of approximately £24,436. While effective in reducing in-person consultations, the remote pathway may have shortcomings in management, such as over-reliance on nerve conduction studies without sufficient clinical evaluation, possibly leading to unnecessary surgeries. Recommendations include refining assessment criteria and utilising more effective diagnostic tools to enhance the pathway's accuracy and efficiency. 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, utilising a remote assessment pathway for carpal tunnel syndrome has demonstrated promising cost-effectiveness compared to traditional in-person consultations. The remote use of the Kamath and Stothard questionnaire (see above), supported by nerve conduction studies if required, accurately predicts CTS in most cases, effectively streamlining the diagnostic process. This approach not only reduces direct healthcare costs but also offers an adaptable model for future telemedicine implementations. If you woul like to have a look a the whole database on CTS, have a look at the whole database on the topic . URL : https://doi.org/10.1177/17531934241270347 Abstract We undertook a retrospective cohort study of a remote carpal tunnel syndrome assessment pathway created in response to limitations caused by the COVID-19 pandemic. Between July 2020 and September 2021, 702 patients referred from primary care (general practice) were assessed in a nurse-led telephone clinic using the carpal tunnel questionnaire of Kamath and Stothard (2003) . Depending on their questionnaire score, patients were referred either for nerve conduction studies or a consultant hand surgeon review for diagnosis and treatment planning. Questionnaire scores of 3 and above accurately predicted a likely diagnosis of carpal tunnel syndrome in 83% of patients, and a diagnosis was unlikely in 90% of those with a score below 3. The pathway resulted in an estimated cost savings of £24,436 (€28,862, US$30,945) in comparison with the pre-pandemic service. However, some limitations in the pathway may have impacted effective patient management and we suggest possible improvements. Level of evidence: III 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