Evaluating the efficacy of hinged elbow braces in reducing passive valgus forces after ulnar collateral ligament injury: A biomechanical study. Hoffeld, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Elbow ROM splint - Ligament protection This biomechanical study assessed the efficacy of hinged elbow braces in reducing passive valgus forces after ulnar collateral ligament (UCL) injuries. Eight cadaveric elbow specimens were included and three scenarios were tested: intact ligaments, simulated UCL rupture, and the application of a hinged elbow brace following a UCL rupture. All the three conditions were assessed in 90deg of elbow flexion. Intraclass correlation (ICC) calculations validated the testing setup's reliability. The results showed that hinged elbow splints do not significantly reduce passive valgus forces when the ucl is ruptured. 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 hinged elbow orthosis does not significantly reduce passive valgus forces in the elbow following ulnar collateral ligament (UCL) injuries. However, what you could do with a hinge brace is limit the range of movement of the elbow in extension and flexion, which has the potential to limit stress on healing ligaments . URL : https://doi.org/10.1002/jeo2.70094 Abstract Purpose: This biomechanical study aimed to investigate the effectiveness of a hinged elbow orthosis in reducing passive valgus forces following medial ulnar collateral ligament (UCL) injuries of the elbow joint. The hypothesis tested was that a hinged elbow orthosis reduces these passive valgus forces. Methods: Eight fresh frozen cadaveric elbow specimens were prepared and tested under three scenarios: intact ligaments, simulated UCL rupture and application of a hinged elbow brace after simulated UCL rupture. Valgus instability was assessed using a custom testing set‐up and the Optotrak motion capture system. Statistical analysis was conducted to compare the results across scenarios. Results: Intraclass correlation (ICC) calculation showed that the testing set‐up was reliable in investigating valgus deflection across all levels of applied force. The hinged elbow brace reduced passive valgus forces after UCL rupture. The reduction in valgus instability was consistent with close approximation to the native state, although not reaching its level. Conclusion: The hypothesis—that a hinged elbow orthosis significantly reduces passive valgus forces in the elbow following UCL injuries—is not supported by the data and therefore has to be rejected. Nevertheless, the study demonstrates a tendency that a hinged elbow brace could mitigate these forces, at least in an experimental cadaveric model with static study conditions. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Serial range of motion and grip strength measurements, patient-reported outcomes, and radiographic thresholds associated with less satisfactory outcomes after low-energy distal radius fracture in women aged 50 years and older. Johnston, et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Distal radius fracture - Recovery This retrospective study aimed to assess the clinical recovery and patient-reported outcomes after distal radius fracture (DRF) in women aged 50 and older, treated either non-surgically or surgically. The analysis included 1,319 women, predominantly managed nonoperatively. The results showed that by 12 months, there was notable recovery in wrist motion, grip strength, and Patient-Rated Wrist Evaluation (PRWE). In addition, radiographic thresholds critical for favorable outcomes were volar/dorsal tilt, ulnar variance, and radial inclination. Outcomes were generally satisfactory when these parameters were within identified limits; exceeding these limits was associated with poorer recovery. This highlights the potential benefit of early surgical intervention in selected cases. 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 presenting with excessive dorsal tilt, increased ulnar variance, or reduced radial inclination, may benefit from early surgical intervention. Furthermore, following a low energy distal radius fracture, assessing bone density should be a priority to prevent future fragility fractures . It is also important to consider psychological factors and promote positive behavior changes as these can enhance clinical outcomes . URL : https://doi.org/10.1016/j.jhsa.2024.01.012 Abstract Purpose: To document the change of clinical (wrist motion and grip strength) measurements and Patient-Rated Wrist Evaluation (PRWE) scores at 9 weeks and 3, 6, and 12 months after distal radius fracture (DRF) in women 50 years and older with exclusively isolated, displaced, and low-energy DRFs treated by either closed and/or open reduction and to relate these outcomes to their radiographic results. Methods: In this retrospective single-institution cohort study, patients’ post-DRF clinical measurements and PRWE scores were prospectively collected from December 2007 through September 2018 and stratified according to their final radiographic values of volar/dorsal tilt, ulnar variance, and radial inclination. Results: Of the 1,319 women identified, 1,126 (85%) were treated nonsurgically, and 193 (15%) were treated operatively. At 12 months, patients averaged restoration (ratio of injured and uninjured sides’ values) of 96% pronation, 95% extension, 91% supination, 81% flexion, and 80% (77% nondominant, 85% dominant) grip strength. The mean PRWE score was 39.5 at week 9 and 14.4 at 12 months with 54% of patients scoring <10 and 13% scoring zero. The mean volar/dorsal tilt, ulnar variance, and radial inclination values in those treated nonsurgically were 1.4° dorsal, +3.9 mm, and 18.0°, respectively. Analogous values in patients treated surgically were 6° volar, +2.6 mm, and 22°, respectively. Volar tilt ≥25°, dorsal tilt >10°, ulnar variance >+7.5 mm, and radial inclination ≤13° were thresholds beyond which motion and grip strength were reduced and/or PRWE scores increased. In general, older patients experienced more residual deformity and were less likely to have undergone surgery. Conclusions: Generally, outcomes were satisfactory for patients with radiographic results within identified thresholds for acceptable fracture reduction. Outcomes were significantly less favorable for patients with radiographic results beyond these thresholds; for these patients, early surgical intervention should be considered. Low-energy DRFs should prompt bone density investigation. 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

Long-term leisure-time physical activity intensity and all-cause and cause-specific mortality: A prospective cohort of us adults. Lee, et al. (2022) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Physical activity - Mortality This prospective study assessed the long-term impact of leisure-time physical activity on mortality among US adults. The study classified physical activity as moderate (MPA) and vigorous (VPA) using data from the Nurses’ Health Study and Health Professionals Follow-up Study. A cohort of 116,221 participants was followed for 30 years, during which 47,596 deaths were recorded. Results showed that meeting the upper bound of the recommended 75-149 minutes per week of VPA or 150-299 minutes per week of MPA was associated with a 19% and 20% reduction in all-cause mortality, respectively. Surprisingly, higher levels of activity did not yield additional mortality benefits. Furthermore, individuals with lower MPA who engaged in VPA saw improved mortality outcomes, but additional VPA did not benefit those already achieving higher MPA levels. Based on this study, achieving a 150-300 minutes of VPA or 300-600 minutes of MPA weekly is optimal for mortality risk reduction. 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, engaging in long-term leisure-time physical activity at moderate or vigorous intensities significantly reduces all-cause, cardiovascular, and non-cardiovascular mortality. The maximum benefit can be obtained by achieving 150–300 minutes of vigorous or 300–600 minutes of moderate physical activity per week, or a combination of both. If you believe that physical activity only reduces mortality, think again. Higher levels of physical activity appear to be associated with lower levels of symptoms in people with carpal tunnel syndrome . URL : https://doi.org/10.1161/CIRCULATIONAHA.121.058162 Abstract Background: The 2018 physical activity guidelines for Americans recommend a minimum of 150 to 300 min/wk of moderate physical activity (MPA), 75 to 150 min/wk of vigorous physical activity (VPA), or an equivalent combination of both. However, it remains unclear whether higher levels of long-term VPA and MPA are, independently and jointly, associated with lower mortality. Methods: A total of 116 221 adults from 2 large prospective US cohorts (Nurses’ Health Study and Health Professionals Follow-up Study, 1988–2018) were analyzed. Detailed self-reported leisure-time physical activity was assessed with a validated questionnaire, repeated up to 15 times during the follow-up. Cox regression was used to estimate the hazard ratio and 95% CI of the association between long-term leisure-time physical activity intensity and all-cause and cause-specific mortality. Results: During 30 years of follow-up, we identified 47 596 deaths. In analyses mutually adjusted for MPA and VPA, hazard ratios comparing individuals meeting the long-term leisure-time VPA guideline (75–149 min/wk) versus no VPA were 0.81 (95% CI, 0.76–0.87) for all-cause mortality, 0.69 (95% CI, 0.60–0.78) for cardiovascular disease (CVD) mortality, and 0.85 (95% CI, 0.79–0.92) for non-CVD mortality. Meeting the long-term leisure-time MPA guideline (150–299 min/wk) was similarly associated with lower mortality: 19% to 25% lower risk of all-cause, CVD, and non-CVD mortality. Compared with those meeting the long-term leisure-time physical activity guidelines, participants who reported 2 to 4 times above the recommended minimum of long-term leisure-time VPA (150–299 min/wk) or MPA (300–599 min/wk) showed 2% to 4% and 3% to 13% lower mortality, respectively. Higher levels of either long-term leisure-time VPA (≥300 min/wk) or MPA (≥600 min/wk) did not clearly show further lower all-cause, CVD, and non-CVD mortality or harm. In joint analyses, for individuals who reported  ≥300 min/wk of long-term leisure-time MPA, additional leisure-time VPA was associated with lower mortality; however, among those who reported ≥300 min/wk of long-term leisure-time MPA, additional leisure-time VPA did not appear to be associated with lower mortality beyond MPA. Conclusions: The nearly maximum association with lower mortality was achieved by performing ≈150 to 300 min/wk of long-term leisure-time VPA, 300 to 600 min/wk of long-term leisure-time MPA, or an equivalent combination of both. 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 a distal radial fracture lead to osteoarthritis? Re-examining the evidence for early treatment. Warwick, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic : Distal radius fracture - Post traumatic osteoarthritis This narrative review assessed whether distal radial fractures lead to symptomatic osteoarthritis, examining current evidence and clinical experiences. It challenges the belief that distal radial fractures inherently cause osteoarthritis, asserting that both literature and clinical insights do not support this notion. Despite the common treatment aim to prevent osteoarthritis, the evidence indicates that the condition is often asymptomatic post-fracture. The review highlights that many fractures can be effectively managed non-operatively, especially in less active elderly patients, with surgery offering no significant long-term benefits. The paper also points out the issues of study biases and variations in outcome measures, urging for more comprehensive research. Consensus exists regarding better early outcomes in younger, functional demographics with surgical intervention. However, the article concludes that symptomatic osteoarthritis is uncommon following a distal radius fracture, advocating for an informed and cautious therapeutic approach without overstating surgical benefits. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, whilst osteoarthritis is commonly detected on x-rays after such fractures, it seldom correlates with clinical symptoms. Thus, it may not be justifiable to perform surgery solely to prevent osteoarthritis, especially given the lack of strong evidential support that untreated fractures significantly predispose to symptomatic osteoarthritis. Overall, surgical intervention may provide better outcomes only in those people presenting with severely displaced fractures, as shown by a recently published study . URL : https://doi.org/10.1177/17531934241265839 Abstract There are many good reasons to improve the anatomy of a distal radius fracture, such as early return to function and avoidance of sigmoid notch incongruity or ulnocarpal impaction. It is often feared by patients, and portrayed by some authors of scientific articles and medicolegal reports, that a fracture of the distal radius has a propensity to cause symptomatic osteoarthritis. This article examines some of the current evidence and shares the authors’ experience. Critical questions are asked to direct our observations and guide future research questions. We propose that both clinical experience and a literature analysis do not support the commonly held assumption that untreated distal radial fractures lead to symptomatic osteoarthritis. Level of evidence: V 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

Production time and practicability of 3d-printed wrist orthoses versus low temperature thermoplastic wrist orthoses. von Haller, et al. (2024) Level of Evidence: 2b. Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Economic Topic : 3D vs Thermoplastic splints - Production time This economic study assessed the production time and practicality of three-dimensional (3D) printed wrist splints with those made from low-temperature thermoplastic (LTTO). In particular, the production time of 17 splints was assessed (8 were 3D printed and 9 were LTTOs). The results showed that 3D-printed orthoses required significantly more time to produce (over 12 hours total, and 44 minutes of active production time) compared to LTTOs, which took approximately 14 minutes overall. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, whilst 3D-printed splints offer high levels of customisability and potential for patient-specific designs, their long production time limits their widespread clinical adoption. In addition, 3D-printed splints do not appear to have significantly better outcomes for hand related conditions . Therefore, low-temperature thermoplastic splints remain the best option for splinting at this stage. URL : https://doi.org/10.1177/17589983241287069 Abstract Introduction: In recent years, three-dimensional (3D) printing has emerged as a new manufacturing technique for orthoses, showing comparable stability and wearing comfort to traditional orthoses. However, the lengthy designing and printing process is assumed to take more time than the common practice of manufacturing low-temperature thermoplastic orthoses (LTTOs). The aim of this prospective cross-sectional study was to compare the production time of 3D-printed orthoses (3DPO) to LTTOs. Methods: The active and passive time needed to manufacture the orthoses was measured in a clinical setting. 17 orthoses (8 3DPOs and 9 LTTOs) were included in the data analysis. Results: The mean total production time of a 3DPO (12:14:50h total time; 0:44:35h active production time) was significantly longer than in LTTOs (0:14:14h; p < 0.001). Discussion: The longer production time might be a hurdle regarding the implementation of 3DPOs in hand therapy. Although 3D-printing might become more cost- and time-efficient due to future developments in technology and growing experience, some practical advantages of LTTOs prevail, such as the fast and efficient provision of orthoses and the adaptability of the material if subsequent changes are needed. A combination of both manufacturing techniques may be a feasible solution to provide patient-centred orthosis provision in future hand therapy practice. 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

Misinformation about upper extremity conditions in guidelines for clinicians. Tonnel, et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic : Guidelines - Are they up to date? This expert opinion assessed the presence of potential misinformation in clinician guidelines concerning upper extremity conditions. The analysis focuses on sections from the BMJ Best Practice Guidelines, Up-To-Date, and DynaMed. The results showed that approximately 53% of the statements could potentially reinforce unhelpful thinking or provide misleading information, with specific conditions like rotator cuff tendinopathy and elbow tendinopathy having particularly high percentages of potential misinformation. The types of incorrect information identified include statements that encourage kinesiophobia or catastrophic thinking, provide false hope, or misrepresent the natural history or necessity of treatments. The research suggests this misinformation feels intuitive due to its alignment with common misconceptions. To counteract this, a checklist for potential misinformation is proposed as a debiasing tool for authors and editors. The paper underscores the need for accurate and beneficial information to ensure better health outcomes and avoid promoting harmful misconceptions. 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, clinicians should be aware of the significant potential for reinforcement of unhelpful thinking patterns through guideline recommendations. The study identifies that over half the statements from prominent clinical resources for upper extremity conditions contain language potentially reinforcing kinesiophobia, false hope, or misconceptions about treatment necessity. For a large list of studies showing the effect of mental health on hand therapy related presentations, have a look at the database . URL : https://doi.org/10.1177/17531934241270348 Abstract The potential for reinforcement of unhelpful thinking and feelings of distress was present in half the sentences from the general description of the condition and management recommendation sections in three sources of information describing upper extremity conditions for clinicians. 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

Relationship between the elasticity of the forearm flexor-pronator muscles and elbow valgus torque in young baseball pitchers: A descriptive laboratory study. Saito, et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic / Prognostic Topic : Forearm flexors - Elbow valgus This cross sectional study assessed the relationship between the elasticity of forearm flexor-pronator muscles and elbow valgus torque in young baseball pitchers aged 9 to 12. The strain ratios of the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) was assessed utilising ultrasound elastography. The valgus angle during three pitching trials was then measured in the participants. The results showed that increased elasticity in the FCU and FDS correlated with greater elbow valgus torque during pitching. 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, higher elasticity of the forearm flexor muscles is correlated with increased elbow valgus torque during pitching in young baseball pitchers. This paper is an additional piece of evidence suggesting that the forearm flexors contribute to medial elbow joint stability . This concept appears to be true not only for the medial but also for the lateral elbow where the common extensor origin plays an important role in limiting elbow varus stress . URL : https://doi.org/10.1016/j.jse.2024.05.027 Abstract Background: The forearm flexor-pronator muscles act as a dynamic elbow stabilizer against elbow valgus load during baseball pitching. The elasticity of these muscles increases with pitching. However, it is unclear whether increased muscle elasticity is associated with greater elbow valgus torque during pitching. This study aimed to determine the relationship between the elasticity of the forearm flexor-pronator muscles and elbow valgus torque during pitching in young baseball pitchers. Methods: We recruited 124 young baseball pitchers aged 9 to 12 years. The exclusion criteria included current pain with pitching, history of surgery on the tested extremity, or injuries on the tested extremity within the past 12 months. Before the examination, participants completed a questionnaire about their age, height, weight, dominant arm, and practice time per week. The strain ratios of flexor carpi ulnaris (FCU), flexor digitorum superficialis (FDS), and pronator teres as the index of muscle elasticity were measured using ultrasound strain elastography. Participants pitched 3 fastballs at a distance of 16 m (52 ft 6 in) with maximum effort while wearing a sensor sleeve that recorded the elbow valgus torque. A multiple linear regression analysis was conducted to examine the association between muscle elasticity and elbow valgus torque, adjusting for age, height, weight, and practice time. Results: The final analysis included 107 pitchers. After adjusting for covariates, increased strain ratio of the FCU was significantly associated with greater elbow valgus torque (coefficients = 0.038, 95% confidence interval, 0.016–0.059, P < .001). Similarly, increased strain ratio of the FDS was significantly associated with greater elbow valgus torque (coefficients = 0.027, 95% confidence interval, 0.013–0.042, P < .001). Conclusion: The high elasticities of the FCU and FDS were associated with greater elbow valgus torque during pitching in young baseball pitchers. The high elasticity of these muscles is a protective response and may be necessary for young baseball pitchers with greater elbow valgus torque during pitching. Among young baseball pitchers with greater elbow valgus torque, those who are unable to produce the higher elasticities of these muscles could have greater elbow valgus load during pitching and be at a higher risk for elbow injuries. The measurement of the elasticities of the FCU and FDS may be useful for identifying young baseball pitchers at risk of sustaining elbow injuries. 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

Premature closure of the distal radial physis without evident history of trauma. Tomori, et al. (2020) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Distal radius growth plate - Premature closure This case study described the clinical presentation of a 14-year-old girl, who presented with wrist pain, deformity, and functional impairment since the age of 5. Subjectively, there was no history of trauma. They reported significant pain, which limited the patient's daily and sports activities. There were close to no range of movement limitations in the wrist compared to the unaffected side. On x-ray there was significant radioulnar length discrepancy, as you can see from the x-ray shown below. The orthopedic team diagnosed the presentation as idiopathic premature closure of the distal radial physis. The corrective surgical intervention involved an opening wedge osteotomy of the distal radius using an iliac bone graft and a subsequent shortening osteotomy of the ulna. Post-operatively, the patient achieved full painless wrist mobility. 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, premature closure of the distal radial physis can occur in rare instances without a trauma history. In this cases, corrective osteotomy combined with bone grafting and ulnar shortening may be a useful management options to reduce symptoms and correct the deformity. Despite this presentation being much more common as a result of trauma, it remains a rare injury. Thus, torus fractures are the most common presentations of distal radius fracture in children and teenagers . URL : http://dx.doi.org/10.1097/MD.0000000000021515 Abstract Rationale: The distal radius is the region of the body with the highest incidence of physeal injury. However, it is uncommon for the distal radius to undergo growth arrest without a history of trauma. We present a case of premature closure of the distal radial physis without evident history of trauma in a girl. Patient concerns: A 14-year-old girl presented with chronic progressive deformity and painful functional limitation of her right forearm. The right wrist pain had begun when the patient was 5 years old. There was no evident history of trauma. The deformity and persistent right wrist pain had prevented her from performing sports activities and activities of daily living. Diagnoses: Radiography and computed tomography showed a volarly angulated distal radius and dorsally protruding distal ulna with a length discrepancy between the distal radius and ulna due to premature physeal closure of the right distal radius. Interventions: To eliminate the deformity and achieve painless functional recovery of the wrist, an opening wedge osteotomy of the distal radius with an iliac bone graft was performed, followed by a shortening osteotomy of the distal ulna. Outcomes: Radiography at final follow-up 1 year and 9 months postoperatively showed good alignment of the distal radioulnar joint without length discrepancy between the two forearm bones. The range of motion of the left wrist had reached 100% of the contralateral wrist without any pain, and the right grasp strength was 18 kg, which was 82% compared with the dominant left wrist. Lessons: Premature closure of the distal radial physis impairs the growth potential of the physis and leads to wrist dysfunction due to deformities. In the present case, a satisfactory outcome was achieved via corrective osteotomy of the distal radius with an iliac bone graft combined with ulnar shortening osteotomy. 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

Effectiveness of manual therapy to the cervical spine on clinical outcomes and electrodiagnostic tests in people with carpal tunnel syndrome: A randomized controlled trial. Zarrin, et al. (2024) Level of Evidence: 1b- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Cervical intervention - Carpal tunnel syndrome This randomised controlled study investigated the effectiveness of incorporating cervical spine manual therapy (CMT) in conjunction with traditional physical therapy (PT) on patients with carpal tunnel syndrome (CTS). Forty-eight individuals with CTS were randomly assigned to receive either conventional PT alone or PT combined with CMT. Over ten sessions, the CMT group also received specific neck mobilisations. Clinical outcomes such as pain intensity, functional status, and nerve electrophysiology were evaluated before, immediately after, and six months post-treatment. Results indicated greater improvements in the CMT group across multiple measures, including pain reduction, functional ability, and nerve conduction metrics, both immediately post-intervention and in the longer term. It is important to remember that this was a small studies and larger RCTs would be required to exclude this being a false positive finding. 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, incorporating cervical spine manual therapy into the standard physical therapy regimen for carpal tunnel syndrome may provide benefits in reducing pain and improving functional status . It is more likely that such interventions would benefit people who have a neck contribution to their symptoms based on additional subjective and objective information that you can gather . Currently, the suggested interventions for an isolated carpal tunnel syndrome include night splinting and exercise for mild to moderate entrapment with cortisone and/or carpal tunnel release for severe median nerve neuropathies . URL : https://doi.org/10.1016/j.jbmt.2024.04.020 Abstract Objective: To determine if cervical spine manual therapy (CMT) plus conventional physical therapy (PT) optimizes clinical objective and self-reported outcomes, compared to PT alone, in people with carpal tunnel syndrome (CTS). Method: Forty-eight patients with the diagnosis of CTS were randomly divided into conventional PT (control group) and conventional PT plus cervical spine manual therapy (intervention group). All patients received 10 sessions of supervised conventional physical therapy (wrist splint, electrotherapy and wrist joint mobilization). Patients in the cervical spine manual therapy group also had manual therapies techniques given to their neck. Visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), the disabilities of the arm, shoulder, and hand (DASH) questionnaire, median nerve motor distal latency (mMDL), and median sensory nerve conduction velocity (mSNCV) were assessed at three points: baseline, post-intervention, and six months later. Results: The cervical spine manual therapy group showed significantly greater improvement in VAS, DASH score, mMDL, and mSNCV in post-intervention and follow-up compared to the conventional group. There was no significant difference in two subscales of BCTQ at post-intervention for two groups, whereas these two subscales showed a significant difference in favor of the cervical manual therapy group at follow-up. Conclusion: The analysis of results showed that conventional CMT combined with PT could be more effective in improving the clinical outcomes and electrodiagnostic findings of patients with CTS compared to conventional PT only in the long term. Therefore, it can be suggested as a proper therapeutic method in 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

Improving patient care and streamlining follow-up: Compliance with national institute for health and care excellence (NICE) guidelines for pediatric distal radius buckle fractures. Ali, F., et al. (2024) Level of Evidence: 3a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Torus fracture - Guidelines alignment This audit assessed the adherence to NICE guidelines for treating pediatric distal radius buckle fractures (Torus fractures) at Queen's Hospital (UK). Initially, 65 children were assessed, with 95% receiving full plaster casts rather than the recommended removable splints. Following the baseline assessment, which included hospital staff education and improved splint availability, a second audit of 87 patients showed notable progress. Thus, splint use increased from 5% to 53%, and first-visit discharge rose from 8% to 45%. 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, providing clinicians with education about torus fractures and having pediatric splints available for treatment has the potential to increase alignment with the NICE guidelines for the management of this condition. The use of splints instead of casting is not only in line with the NICE guidelines but also allows early return to function without increased risk of complications . Another distal radius pediatric injury that we need to be aware of is growth plate injury, which can stun bone growth . URL : https://doi.org/10.7759/cureus.73624 Abstract INTRODUCTION: Torus fractures, also known as buckle fractures, are among the most common types of fractures seen in children who present to the emergency department (ED). These injuries usually occur when a child falls onto an outstretched hand, resulting in the compression and buckling of the dorsal cortex of the radius while the volar cortex remains intact. These fractures generally have a good prognosis and heal well with simple immobilization with a low risk of complications. However, current treatment practices often involve using a rigid cast and scheduling multiple follow-up clinic visits, which increases the hospital's financial strain. MATERIALS AND METHODS: We conducted an initial audit that reviewed the practice in our unit between August and October 2017 at Queen's Hospital, Burton Upon Trent, United Kingdom. It included all children below the age of 16 who had radiograph images confirming distal radius buckle fractures and have been referred to the fracture clinic. Patient demographics, clinic visits, treating doctor grade/specialty, radiographs, initial and final treatment outcomes, and cast application were collected. After the initial audit, compliance with National Institute for Health and Care Excellence (NICE) guidelines was promoted through the education of healthcare providers. A second audit was performed within 12 months to reassess the compliance. RESULTS: This study looked at the management of pediatric distal radius buckle fractures in a cohort of 152 patients, of which 65 and 87 children were included in audit cycles I and II, respectively. In the ED, splint usage increased from 0% in the first cycle (all children initially treated in a back slab) to 20% following new recommendations. In the fracture clinic, there was a notable improvement in the use of splints over full plaster casts between the first and second cycles. Initially, in the first cycle, only 5% of patients were treated in a splint, with 95% receiving full plaster casts. Following recommendations, splint use increased significantly in the second cycle, rising to 53%, while cast use decreased to 47%. In the first audit, only 7.7% (five patients) were discharged at the first visit, compared to 44.8% (39 patients) in the second audit. In the first audit, 86.2% (56 patients) required a second visit, whereas in the second audit, this decreased to 55.2% (48 patients). Four individuals received a cast owing to splint size difficulties or patient preferences. CONCLUSION: Despite the improvement seen regarding compliance with NICE guidelines, work is still needed to further enhance compliance. Staff education and optimizing splint availability will be a priority to reduce the burden on fracture clinic resources by unnecessary follow-up appointments. 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 This case study described the clinical presentation of a 14-year-old girl, who presented with wrist pain, deformity, and functional impairment since the age of 5. Subjectively, there was no history of trauma. They reported significant pain, which limited the patient's daily and sports activities. There were close to no range of movement limitations in the wrist compared to the unaffected side. On x-ray there was significant radioulnar length discrepancy, as you can see from the x-ray shown below. What is it?

Prospective study on splinting for first carpometacarpal joint: A comparison of conventional and three-dimensional printed splint. Inaba, N., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Thumb OA - Splinting This study assess the effectiveness of three-dimensional (3D) printed splints (including or not the mcpj) compared to conventional splints for first carpometacarpal osteoarthritis (no mcpj involved - see picture below). A total of 12 hands from nine patients were splinted. The study assessed pain, function, use time, satisfaction, and discomfort over two-week periods for each type of splint: conventional, short-type 3D-printed, and long-type 3D-printed. The results showed that there was no difference across splinting types except that the 3D-printed versions resulted in significantly less discomfort whilst wearing them. 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 3D-printed splints for first carpometacarpal joint osteoarthritis offers comparable pain relief to conventional splints, with the added benefit of reduced discomfort. Despite this added benefit, it seems unlikely that the added cost of the machinery and time required currently outperform the traditional custom made thermoplastics. It is also important to remember that splinting for thumb OA may have limited effectiveness and hence a cheaper option (thermoplastic) may be sufficient if the patient would like to try it. URL : https://doi.org/10.3390/jcm13237043 Abstract Background: Patient compliance is a major concern of hand orthosis in first carpometacarpal osteoarthritis. To address this issue, we established a method for creating a custom-made three-dimensional printed splint based on computed tomography. This prospective study evaluates the usefulness of the three-dimensional printed splint compared with the conventional splint. Methods: A total of 12 hands in nine patients were included. The mean age of the patients was 69 years (range: 58–84). Conventional orthoses were made by prosthetists using molds. Three-dimensional printed orthoses (long and short types) were digitally designed from computed tomography data and created using Fused Deposition Modeling. Subjects were instructed to use three types of orthoses for 2 weeks each. They completed questionnaires that indicated pain, function, percentage of daytime spent using the orthosis, satisfaction score, and discomfort caused by wearing orthoses. Results: The pain on motion showed an improvement of approximately 20% for all orthoses. There was no significant difference in pain scale, function, percentages of daytime spent using each orthosis, and satisfaction score among the three types of orthoses. Discomfort caused by wearing orthosis was more frequent in conventional orthosis than in 3D-printed orthosis, and there was a significant difference between the conventional type and the long-type 3D-printed orthosis. Conclusions: This study suggests that 3D-printed splints provide comparable pain relief to conventional splints with reduced discomfort. However, limitations such as small sample size, short follow-up, and reliance on CT imaging highlight the need for further research. 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