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

Shear wave elastography ultrasound assessment of the ulnar collateral ligament in the elbow of college baseball players. Lee, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Elbow UCL - stiffness This study explores the use of shear wave velocity (SWV) to assess the ulnar collateral ligament (UCL) elasticity in college baseball players, particularly focusing on its correlation with valgus laxity of the elbow joint. Thirty healthy male athletes, free from elbow pain and previous UCL injuries, were evaluated using SWE under both resting and valgus stress conditions. Results indicated a significant increase in the ulnohumeral gap, especially in throwing arms, under valgus stress conditions. Notably, a reduced shear wave velocity (SWV), indicating decreased tissue elasticity, was observed in arms showing increased joint gaps. These ligaments were not only less stiff but also thicker. Relying solely on ligament thickness may not be sufficient to determine its biomechanical effect. 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, repetitive throwing motions in baseball players can lead to increased joint laxity, which is associated with increase flexibility and thickness of the UCL. It seems that such changes are due to repeated loading of the UCL as it seems that a single session of pitching by itself is not sufficient to change the biomechanical properties of the ligament . URL : https://doi.org/10.1016/j.jse.2025.01.027 Abstract Background: The ulnar collateral ligament (UCL) stabilizes the elbow during overhead throwing activities. Repetitive throwing can cause valgus laxity even without injury. Shear-wave ultrasound elastography (SWE) is a novel imaging technique that assesses tissue elasticity. This study aimed to assess UCL elasticity in college baseball players using SWE under resting and valgus stress conditions. Methods: The study included 30 healthy male college baseball players (mean age 20.48 ± 1.34 years). The dominant and non-dominant arms of participants were examined, excluding those with a history of UCL injury. UCL thickness was measured using conventional ultrasound, and elastography was conducted at the same sites. Measurements were repeated under valgus stress, and the ulnohumeral joint gap was recorded. Participants were categorized into throwing and non-throwing arm groups. A subgroup analysis of the throwing arm was conducted based on joint laxity, defined as an increase of >1 mm in the ulnohumeral joint gap under valgus stress, which is associated with UCL injury and joint laxity. Correlations between UCL evaluation parameters and changes in ulnohumeral gap were analyzed. Results: Out of 54 elbows, 26 were classified as throwing and 28 as non-throwing. The throwing group had a significant increase in the ulnohumeral gap compared to the non-throwing group. The ulnohumeral gap under valgus stress increased from 0.59 to 0.72 cm (p=0.01). There was no significant difference in shear-wave velocity (SWV) between the two groups. Within the throwing group, 13 elbows were classified as lax arms and 15 as non-lax arms. The SWV of the lax arms (6.71 ± 4.59 m/s) was significantly lower than that of the non-lax arms (8.54 ± 5.17 m/s) (p=0.045). Multiple regression analysis showed that UCL thickness and SWV were independently correlated with the rate of change in the ulnohumeral gap (ß=0.335, p=0.018 and ß=-0.319, p=0.013, respectively). Conclusion: Valgus laxity of the elbow joint can be evaluated based on the elasticity of the UCL measured above the joint line using SWE at rest. Thickened UCL may exhibit a decrease in function; therefore, physicians should not evaluate the joint status solely on the basis of the structural properties on conventional ultrasound. 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

Patient-centered care in the conservative management of an unstable proximal phalanx fracture: A case report. Cole, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic : Unstable proximal phalanx fracture - Conservative or surgical management? This case report explores the management of a challenging unstable proximal phalanx fracture in a 56-year-old male, with a focus on patient-centered care. After a football injury (see x-ray below), the patient underwent two local anesthetic and manipulation procedures (LAMP). Following reduction, the patient was placed in hand based splint. Despite the advice, the patient went to the gym, utilised their hand and took place into all their activities whilst wearing the splint. Due to objective evidence of ulnar deviation of the little finger upon splint removal, an additional x-ray was completed and showed loss of reduction (see figure below). An additional LAMP instead of surgical intervention was performed as per patient's preference. Following this procedure, the patient resumed wearing the hand based splint. By 12 weeks following the second LAMP, the patient had regained full range of motion reporting no pain. They were able to return to all daily activities, including manual labor, and gym workouts. As you can see from the latest x-ray image, alignment was better than what they had started with. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, conservative management, even in cases of initially unstable proximal phalanx fractures, can result in acceptable patient outcomes. This approach underscores the value of a tailored, patient-focused strategy where surgical intervention can be reserved for cases where nonsurgical methods do not achieve the desired outcomes. If you would like additional evidence on the possibility of conservative treatment for phalangeal fractures have a look at this synopsis . Several other hand fractures, like metacarpal ones, can be managed conservatively despite past believes that they had to be treated surgically . URL : https://doi.org/10.1016/j.jht.2024.12.008 Abstract Background: Proximal phalangeal fractures are common yet challenging due to their inherent instability. Purpose: This study presents a case for patient-centered care and a nonsurgical management pathway. Study Design: Case report. Methods: M, a 56-year-old male, sustained a comminuted oblique proximal phalanx fracture to his left nondominant small finger while playing football. Five days post injury, the fracture was reduced with local anesthetic and manipulation (LAMP). The injury was managed conservatively with a full-time hand-based orthosis with metacarpophalangeal joint flexion, and buddy taping. One week later, the fracture had lost reduction and significantly displaced. Instead of converting to surgery, a further LAMP (LAMP2) was performed, and conservative management continued. Outcomes were collected at baseline, 6, 12, and 15 weeks, and 10 months following LAMP2. Results: By 12 weeks, M had a full range of motion, minimal pain, no difficulty with personal daily activities, and resumed full manual labor work duties and gym workouts. Quality of life was reported as high from 6 weeks. M was extremely satisfied. Conclusions: Conservative management of an initially unstable proximal phalanx reduced by LAMP, with a second LAMP one week later, demonstrated excellent outcomes and could be a possible management pathway for similar 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

Kinematics of trapeziometacarpal joint during first dorsal interosseous maneuver in osteoarthritic patients: An imaging study using real-time magnetic resonance imaging and ultrasonography. Ooishi, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : First dorsal interosseous - Thumb OA This study explored the effectiveness of the First Dorsal Interosseous (FDI) exercise in patients with trapeziometacarpal osteoarthritis (cmcj OA) using real-time MRI and ultrasound. The study assessed ten patients with cmcj OA and ten healthy individuals. Results indicated that in cmcj OA patients, the FDI maneuver resulted in greater radial translation and ulnar/dorsal tilt of the first metacarpal, as well as reduced FDI muscle volume compared to healthy thumbs. Patients showed increased dorsal subluxation during the maneuver. Following a month of therapy including splint wear and FDI exercises, pain and pinch strength improved, although kinematic changes did not correlate with these improvements. The study concluded that FDI exercises might not be beneficial and could worsen subluxation in cmcj OA patients due to muscle imbalances, suggesting that such exercises should be avoided for these patients. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, patients with cmcj OA exhibit greater dorsal subluxation during first dorsal interosseous (FDI) exercises. Hence, the theory that FDI activation can reduce such biomechanical behavior does nor appear to be real. Interestingly, patients' pain improved over a period of conservative treatment, however, this was not associated with cmcj biomechanical changes. If you want to know more about thumb OA, have a look at the whole database . URL : https://doi.org/10.1016/j.jhsa.2024.12.018 Abstract Purpose: First dorsal interosseous (FDI) exercise is a dynamic stability exercise recommended for patients with trapeziometacarpal osteoarthritis (TMC-OA), although its biomechanical efficacy has only been examined in healthy subjects. This study used real-time magnetic resonance imaging (MRI) and ultrasonography to elucidate the kinematic effects of the FDI maneuver used for the treatment of TMC-OA. Methods: Using a real-time MRI protocol developed for continuous imaging of TMC movements, TMC joints were examined in 10 end-stage patients with TMC-OA and 10 thumbs of five healthy volunteers while performing FDI maneuvers. Changes in translation and tilt of the first metacarpal (MC1) were evaluated using sagittal and coronal images, and FDI volume was analyzed. Based on TMC joint kinematics determined according to dynamic ultrasound observations, the subjects were classified into three groups. Patients with TMC-OA received hand therapy with orthosis and FDI exercise for a period of 1 month. Results: Magnetic Resonance Imaging analyses of the TMC-OA patients demonstrated that radial translation and ulnar/dorsal tilt of the MC1 were significantly greater, whereas FDI volume was significantly lower than healthy thumbs. Results of ultrasound analyses showed increased dorsal subluxation of the TMC joint in six patients with TMC-OA. These values were decreased in six healthy thumbs and unchanged in the remaining thumbs. All of the patients with TMC-OA demonstrated significantly improved pain intensity and pinch strength following implementation of the therapy program, although no direct correlations with MC1 kinematic alterations of were noted. Conclusions: Thumbs in patients with TMC-OA and healthy thumbs have different kinematics during FDI maneuvers. An atrophic FDI may not be an efficient dynamic stabilizer for TMC-OA. In patients with a subluxated TMC-OA, the FDI maneuver was ineffective or caused exacerbation, contradicting previous findings. For a goal of improving dynamic stability in patients with TMC-OA, FDI exercise should be avoided. 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 comparison between two intervals of daily total end range time for treatment of proximal interphalangeal joint flexion contracture using an elastic tension digital neoprene orthosis. Punsola-Izard, et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : TERT - Range of movement This randomised controlled study assessed the effect of daily Total End Range Time (TERT) on treating proximal interphalangeal joint flexion contractures using a neoprene splint. Fifty patients (57 fingers) were divided into two groups: Group A wore the orthosis between 20 to 22 hours daily, while Group B adhered to a 10-14 hours daily schedule. Both groups participated in identical exercise programs to maintain finger flexion. The results showed that Group A experienced a significantly greater improvement in passive range of motion (PROM), with an average improvement of 30° compared to Group B's 20° over three weeks. Unfortunately, they combined both chronic and subacute presentations without reporting on the number in each group, which could be a confounding factor in the range of movement recovery. 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 higher dose of daily Total End Range Time (TERT) may improve passive range of motion (PROM) in proximal interphalangeal joint flexion contractures. However, there is other evidence suggesting that beyond 11 hrs per day, the benefit of TERT may reduce . If you would like to know more about splinting for pipj, have a look at the whole database on the topic . URL : https://doi.org/10.3390/jcm12051987 Abstract Focusing on fingers with proximal interphalangeal joint flexion contractures, this study seeks to determine whether significant differences exist between the joint passive range of motion PROM improvement when receiving higher doses of daily total end range time (TERT) compared to those that receive lower doses. The study randomized a parallel group of fifty-seven fingers in fifty patients with concealed allocation and assessor blinding. Divided into two groups receiving different doses of daily total end range time with an elastic tension digital neoprene orthosis, they also participated in an identical exercise program. Patients reported orthosis wear time, and the researchers performed goniometric measurements at every session during the three-week period. The primary outcome related the time patients wore the orthosis to the degrees of improvement in PROM extension. Compared to group B (daily TERT of twelve hours), group A (TERT, twenty+ hours) showed a statistically significant greater improvement in PROM after three weeks of treatment. Group A improved by a mean of 29° compared to group B’s mean of 19° improvement. This study provides evidence that a higher dose of daily TERT can generate better results in the treatment of the proximal interphalangeal joint flexion 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

Routine 6-weeks outpatient visit in patients treated surgically for upper extremity fractures: Is it truly necessary? Bosch, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Economic Topic : Upper limb fractures - Routine 6 weeks follow up This retrospective cohort study questioned the necessity of routine 6-week outpatient visits and radiographs for patients who have undergone surgical treatment for common upper extremity fractures, such as those of the clavicle, proximal humerus, humeral shaft, olecranon, radial shaft, and distal radius. Conducted at a Level 1 trauma center in Switzerland, the retrospective cohort study included 267 patients treated between 2019 and 2022. Findings revealed that abnormalities were detected in only 4% of radiographs, with clinical implications for just 2% of cases. Only 3% of patients required a deviation from the standard postoperative care, often exhibiting symptoms suggesting complications. The study suggests reconsidering these routine check-ups, proposing selective follow-ups based on patient demand or clinical necessity. Emphasis is placed on educating patients about potential complications, suggesting that e-health applications could support postoperative care, thereby reducing the burden on healthcare systems without compromising patient 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, routine 6-week outpatient visits and radiographs for patients who have undergone surgical treatment for common upper extremity fractures may not be necessary. The low incidence of clinically impactful deviations at these visits suggests that healthcare systems could explore more efficient alternatives, such as selective follow-ups for symptomatic patients or those with higher complication risks. This shift could reduce the burden on healthcare resources without compromising patient care. It is likely that patients requiring further care include those with high levels of catastrophising , lower socioeconomic status , and/or those who present with significant comorbidities . URL : https://doi.org/10.1016/j.jse.2024.04.025 Abstract Background: Due to the increasing burden on the heatlhcare system the usefulness of the routinely planned 6-week outpatient visit and radiograph in patients treated surgically for the most common upper extremity fractures, including clavicle, proximal humerus, humeral shaft, olecranon, radial shaft, and distal radius, should be investigated. Method: This was a retrospective cohort study of all patients treated surgically for the most common upper extremity fractures between 2019 and 2022 in a level 1 trauma center. The first outcome of interest was the incidence of abnormalities found on the radiograph taken at the 6-week outpatient visit. Abnormalities were defined as all differences between the intraoperative (or direct postoperative) and 6-week radiograph. In case an abnormality was detected, the hospital records were screened to determine its clinical consequence. The clinical consequences were categorized into requiring either additional diagnostics, additional interventions, change of standard postoperative immobilization, weightbearing, or allowed range of motion (ROM). The second outcome of interest was the incidence of deviations from the local standard postoperative treatment and follow-up protocol based on the 6-week outpatient visit as a whole. Deviations were also categorized into either requiring additional diagnostics, additional interventions, change of standard postoperative immobilization, weightbearing, or allowed ROM. Results: A total of 267 patients were included. Abnormalities on radiograph at 6 weeks postoperatively were found in only 10 (3.7%) patients, of which only 4 (1.5%) had clinical implications (in 3 patients extra imaging was required and in 1 patient it was necessary to deviate from standard weightbearing/ROM limitation regimen). The clinical/radiologic findings during the 6-week outpatient visit led to a deviation from standard in only 8 (3.0%) patients. Notably, the majority of these patients experienced symptoms suggestive of complications. Conclusion: The routine 6-week outpatient visit and radiograph, after surgery for common upper extremity fractures, rarely has clinical consequences. It should be questioned whether these routine visits are necessary and whether a more selective approach should be considered. 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: 5 Type of study: Therapeutic This case report explores the management of a challenging unstable proximal phalanx fracture in a 56-year-old male, with a focus on patient-centered care. After a football injury (see x-ray below), the patient underwent two local anesthetic and manipulation procedures (LAMP). Following reduction, the patient was placed in hand based splint. Despite the advice, the patient went to the gym, utilised their hand and took place into all their activities whilst wearing the splint. Due to objective evidence of ulnar deviation of the little finger at follow up, an additional x-ray was completed and showed loss of reduction (see figure below). What would you do?

Impact of collagen peptide supplementation in combination with long-term physical training on strength, musculotendinous remodeling, functional recovery, and body composition in healthy adults: A systematic review with meta-analysis. Bischof, et al. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Collagen peptides - Effect on tendon This systematic review and meta-analysis assessed the impact of long-term collagen peptide (CP) supplementation on musculoskeletal health in healthy adults undergoing physical training. A total of 9 studies with 768 participants, assessed the effects on strength, musculotendinous remodeling, functional recovery, and body composition. Evidence suggests that CP intake significantly enhances fat-free mass, tendon morphology, muscle architecture, and maximal and reactive strength following exercise. Though findings show low to moderate certainty, they highlight CP’s potential as an effective supplement for improving musculoskeletal performance. Optimal results seem to require at least an 8-week daily intake of 15 grams of CP. 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, collagen peptide supplementation, when combined with regular physical training, shows potential in enhancing tendon health. This regimen appears to improve fat-free mass, tendon morphology, and muscle architecture, while also aiding in maximal strength and recovery following exercise-induced muscle damage. However, it is also possible that taking enough daily protein provides similar effects to what is provided by taking collagen peptides . URL : https://doi.org/10.1007/s40279-024-02079-0 Abstract Introduction: Over the past decade, collagen peptide (CP) supplements have received considerable attention in sports nutrition research. These supplements have shown promising results in improving personal health, enhancing athletic performance, and preventing injuries in some but not all studies. Objective: A systematic review and meta-analysis of randomized controlled trials (RCTs) has been conducted to investigate the effects of long-term daily collagen peptide (CP) supplementation on strength, musculotendinous adaptation, functional recovery, and body composition in healthy adults, both with and without concurrent exercise interventions over several weeks. Methods: The PRISMA with PERSiST guidelines were followed for this systematic literature review, which was conducted in December 2023 using PubMed, Scopus, CINAHL, and SPORTDiscus databases. Eligible studies included healthy, normal to overweight adults over 17 years of age who engaged in exercise and daily collagen peptide (CP) supplementation for a minimum of 8 weeks (except one 3-week trial only included for maximal strength). Studies examining recovery-related outcomes were also eligible if they included a 1-week supplementation period without exercise. Methodological study quality was assessed using the PEDro scale. A random-effects model with standardized mean differences (SMD) of change scores was chosen to calculate overall effect sizes. Results: Nineteen studies comprising 768 participants were included in both the systematic review and meta-analysis. Results indicate statistically significant effects in favor of long-term CP intake regarding fat-free mass (FFM) (SMD 0.48, p < 0.01), tendon morphology (SMD 0.67, p < 0.01), muscle architecture (SMD 0.39, p < 0.01), maximal strength (SMD 0.19, p < 0.01), and 48 h recovery in reactive strength following exercise-induced muscle damage (SMD 0.43, p = 0.045). The GRADE approach revealed a moderate certainty of evidence for body composition, a very low certainty for tendon morphology and mechanical properties, and a low certainty for the remaining. Conclusion: This systematic review and meta-analysis represents the first comprehensive investigation into the effects of long-term CP supplementation combined with regular physical training on various aspects of musculoskeletal health in adults. The findings indicate significant, though of low to moderate certainty, evidence of improvements in fat-free mass (FFM), tendon morphology, muscle mass, maximal strength, and recovery in reactive strength following exercise-induced muscle damage. However, further research is required to fully understand the mechanisms underlying these effects, particularly regarding tendon mechanical properties and short-term adaptations to collagen peptide (CP) intake without exercise, as observed in recovery outcomes. Overall, CP supplementation appears promising as a beneficial adjunct to physical training for enhancing musculoskeletal performance in adults. 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

Kinesiophobia, catastrophizing, and the duration of immobilization: A prospective study on factors associated with shoulder disability following wrist-hand injuries. Cantero-Téllez, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic Topic : Wrist immobilisation - Shoulder disability This prospective study assessed factors contributing to shoulder disability following wrist-hand injuries, focusing on the role of immobilisation duration, kinesiophobia (fear of movement), and pain catastrophizing. A total of107 participants with wrist fractures requiring immobilisation were included. The results showed that longer immobilisation time was significantly associated with increased shoulder pain and disability. Additionally, higher levels of kinesiophobia were linked to greater shoulder impairment. Wrist immobilisation duration appeared to have the most substantial impact on shoulder pain and disability, with a marked 10.2 points increase in disability index for each week of immobilization. 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, prolonged immobilisation after a wrist-hand injury can significantly contribute to shoulder pain and disability. A proactive approach involving early rehabilitation and addressing psychological factors like kinesiophobia and pain catastrophising could improve outcomes. Considering that immobilisation often is prolonged unnecessarily (e.g. scaphoid fractures ), it's worth thinking twice when extending splint/cast usage. URL : https://doi.org/10.1016/j.jht.2024.08.004 Abstract Background: Shoulder pain is a major musculoskeletal problem after wrist-hand immobilization. There is limited evidence regarding the relationship of kinesiophobia or pain catastrophizing with shoulder pain and disability after wrist-hand injury. Purpose: To explore associations between kinesiophobia and pain catastrophizing with ipsilateral persistent shoulder disability in patients with wrist-hand injury after 6 months. Study Design: Prospective study. Methods: Participants aged ≥18 years referred to hand therapy after wrist-hand injury requiring wrist-hand immobilization were recruited and completed the Numeric Pain Scale, Shoulder Pain and Disability Index, Pain Catastrophizing Scale (PCS), and Tampa scale for kinesiophobia (TSK) at baseline, after an immobilization period, and after 6 months. Results: A total of 107 patients were included in the study. Scaphoid fractures were found in 49 (45.8%) of patients, and 58 (54.2%) had distal radius fractures. For each week of increased time spent in immobilization, the Shoulder Pain and Disability Index score increased by 10.2 points, 95% confidence interval (CI) [6.76, 13.57], with higher levels of immobilization being associated with increased shoulder pain and disability. The baseline TSK score was 17.4 and 11.2 at follow-up. The PCS score was initially 14.8 and decreased to 9.3 at follow-up. The addition of TSK and PCS to the predictive model led to a statistically significant increase in R2 of 0.163, F(2,100) = 47.471, p < 0.001. Conclusions: The duration of wrist immobilization following an injury may play a crucial role in the level of shoulder disability experienced at the 6-month mark post-injury. This shoulder disability may be influenced by factors such as fear of movement. 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

Is kinesio taping an alternative to static wrist orthosis in patients with carpal tunnel syndrome? A randomized clinical trial. İnceboy, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Carpal tunnels syndrome - Kinesiotape vs splint This randomised trial compared the effectiveness of kinesiotaping (KT) to static wrist splints for managing idiopathic carpal tunnel syndrome (CTS). Sixty patients with mild to moderate CTS were divided into two groups: one received static wrist splint, while the other received KT, both supplemented with tendon and median nerve gliding exercises. The results showed that both KT and splinting were effective for alleviating pain, enhancing grip, and pinch strength, improving symptom severity, and functional status. Of note, there were statistically significant but not clinically relevant difference on the Visual Analog Scale (VAS), Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) function, and SF-36 mental health scores. 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, kinesiotaping is as effective as static wrist splints for patients with mild to moderate carpal tunnel syndrome . Currently, this therapeutic option is not in the guidelines, however, you could try it if patients cannot cope with a rigid night splint. You may also want to consider utilising a soft wrist splint as these appear to be as effective as rigid ones . If you want to read more about carpal tunnel syndrome, have a look at the whole database . URL : https://doi.org/10.1016/j.jht.2024.08.002 Abstract Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. Conservative treatments are effective for treating mild and moderate CTS. There is still a need for studies to investigate the superiority of conservative treatments over each other. Purpose: The aim of our study was to compare the efficacy of orthosis treatment and Kinesio taping (KT) treatment on pain, functional status, and grip strength in patients with idiopathic CTS. Study Design: Randomized clinical trial. Methods: Sixty patients (90% women) who were diagnosed with mild or moderate CTS by electroneuromyography were included in this study. Patients were randomized into two groups: the orthosis and KT groups. Hand grip, and three-point pinch strength measuring with a dynamometer and a pinch meter, Visual Analog Scale (VAS), Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS), and Short Form-36 Health Survey Questionnaire (SF-36) were used in clinical assessment. Clinical evaluations were made baseline and at the end of 4 weeks of treatment. Results: Both KT and static wrist orthosis were found to be effective on SF-36 pain, VAS rest, VAS activity, LANSS, grip strength, three-point pinch strength, BCTQ symptom, and functional scores. The changes in VAS activity (between-group mean difference [MD] = −0.93; CI = −1.83:−0.03; p < 0.05; d = 1.74), BCTQ function scores (MD = −2.60; CI = −5.39:0.19; p < 0.05, d = 5.40), and SF-36 mental health scores (MD = 5.87; CI = 1.15:10.59; p < 0.05; d = 9.13) were significantly higher in the KT group compared to the orthosis group. Conclusions: KT, which is a straightforward and safe treatment that does not restrict daily activities, may offer a beneficial alternative to restrictive and uncomfortable orthosis therapy for treating mild to moderate CTS in those leading active daily lives. 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

Combined home and clinic-based therapy versus home-based exercise programme after distal radial fracture: A randomized controlled study. Sakurai, et al. (2024) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Distal radius fracture - Treatment frequency This randomised study assessed the effectiveness of combining home-based and clinic-based hand therapy after ORIF for distal radial fractures. A total of 102 participants were randomised into three groups: home-based exercises alone, exercises with low-frequency clinic sessions, and exercises with high-frequency clinic sessions. At 6 weeks, the group undergoing more clinic sessions showed better Patient-Rated Wrist Evaluation (PRWE) scores and grip strength compared to those with home exercises alone, although this advantage was not sustained at 12 weeks. The findings suggest that combined clinic and home-based therapy facilitates earlier functional recovery, particularly in grip strength. Despite enhanced outcomes in the short term, the long-term benefits of increased clinic-based therapy frequency remain inconclusive, with no significant differences observed at 12 weeks. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, combining home-based exercise programs with clinic-based hand therapy sessions can enhance early functional recovery in patients following distal radial fractures. Specifically, high-frequency clinic-based therapy appears to be more effective in improving wrist function and grip strength within the first six weeks post-surgery. However, at three months, a higher frequency in person approach is not superior to a home exercise program. It may be worth reducing early hand therapy appointments and spread them over a year to reduce the possibility of grip strength impairment . URL : https://doi.org/10.1177/17531934241231709 Abstract We investigated outcomes of clinic-based hand therapy combined with a home-based exercise programme after anterior plating for distal radial fractures. A total of 102 patients were randomly assigned to one of three groups: a home-based exercise programme alone; a home-based exercise programme combined with four hand therapy sessions in the clinic; and a home-based exercise programme with seven sessions in the clinic. Mean Patient-Rated Wrist Evaluation scores at 6 weeks were significantly better for the group of patients with seven sessions in the clinic than in those with only home exercises (12 vs. 30), but the difference was no longer significant at 12 weeks. Grip strength was significantly better at 6 and 12 weeks. Combined home- and clinic-based hand therapy may facilitate an earlier return of function after anterior plating for distal radius fractures. Level of evidence: II 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

Does lidocaine reduce pain intensity during corticosteroid injection? A double-blind randomized controlled equivalence trial. Teunis, et al. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Anaesthetic - CSI injection pain This randomised study assessed the effects of using lidocaine alongside corticosteroid injections to alleviate pain in hand and wrist conditions. A total of 39 participants with De Quervain, 1st cmcj OA, and trigger finger, were randomised to receive 0.5 mL triamcinolone (cortisone) with or without 0.5 mL lidocaine. Results indicated that co-injection with lidocaine led to a median reduction of 2.4 points in pain intensity on a 0–10 scale with a 95% probability of at least a 1-point decrease. While lidocaine lowered immediate pain intensity effectively, its benefits on pain reduction at 5 minutes and 4 hours post-injection were less pronounced, not meeting the pre-set 95% probability threshold. Despite some limitations like potential unblinding of surgeons (higher injection volume in the lidocaine group), findings challenge previous studies suggesting higher pain with lidocaine. 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, lidocaine significantly reduces pain intensity when used alongside corticosteroid injections for hand and wrist conditions. In particular, there is a 95% probability that lidocaine reduces pain by 1 point out of 10 or more during injection, providing a clear advantage in terms of patient comfort compared to corticosteroids alone. Have a look at these links if you are interested in the effectiveness of injection for radial tunnel syndrome , 1st cmcj OA , or tennis elbow . URL : https://doi.org/10.1177/17531934241245036 Abstract Of the strategies considered to limit the discomfort of corticosteroid injection, one is to inject without lidocaine to reduce the total volume and avoid acidity. In a Bayesian trial, adults receiving corticosteroid injections were randomized to receive 0.5 mL of triamcinolone with or without 0.5 mL of lidocaine. Serial analysis was performed until a 95% probability of presence or absence of a 1.0-point difference in pain intensity on the 0–10 Numerical Rating Scale was reached. Injections with lidocaine were associated with a median of 2.4-point lower pain intensity during injection with a 95% probability of at least a 1-point reduction. The 95% probability was confirmed in 90% of the repeated analysis (36/40). Lidocaine is associated with lower immediate pain intensity during corticosteroid injection for hand and wrist conditions. Level of evidence: I 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