Orthotic interventions for restoring proximal interphalangeal joint motion for patients with hand injuries or conditions: A systematic review and meta-analysis. Yates, S. E., Glinsky, J. V., Hirth, M. J. and Fuller, J. T. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic : Splinting for pipj - Traumatic vs Dupuytren's flexion deformities This systematic review and meta-analysis assessed the effectiveness of splinting interventions in restoring pipj motion for patients with hand injuries or conditions, focusing on Dupuytren's contracture and fixed flexion deformities following traumatic injury/surgery. Twelve RCTs were included, with findings suggesting that splinting interventions do not offer additional benefits for pipj extension compared to hand therapy alone in postoperative Dupuytren's contracture. In contrast, for pipj flexion deformities, splinting significantly improved extension more than hand therapy alone. No studies assessed splinting interventions aimed at improving pipj flexion. 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, splinting for pipj injuries has a clinically important benefit in reducing fixed flexion deformities. However, splinting options to improve pipj impairments following Dupuytren's surgery do not appear to have an important effect. These findings appear to be in line with previous evidence showing that prolonged low level tension on healing tissues may help improving flexibility and that chronic presentations are less likely to benefit from splinting interventions . URL : https://doi.org/10.1016/j.jht.2023.12.018 Abstract Background: Limitations to proximal interphalangeal joint (PIPJ) motion can result in significant functional impairment for people with hand injuries and conditions. The role of orthotic intervention to improve PIPJ motion has been studied; however, high-quality systematic reviews and meta-analyses are lacking. Purpose: This study aimed to determine the effectiveness of orthotic intervention for restoring PIPJ extension/flexion following hand injuries or conditions. Study design: Systematic review. Methods: A comprehensive literature search was completed in MEDLINE, CINAHL, Embase, Cochrane Central, and PEDro using terms related to orthoses, finger PIPJ range of motion, and randomized controlled trial design. Methodological quality was assessed using the PEDro score, study outcomes were pooled wherever possible using random effects meta-analysis, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation. Results: Twelve trials were included (PEDro score: 4-7/10). The addition of orthotic intervention was not more effective than hand therapy alone following Dupuytren’s release for improving total active extension (mean difference [MD] −2.8°, 95% confidence interval [CI]: −9.6° to 4.0°, p = 0.84), total active flexion (MD −5.8°, 95% CI: −12.7° to 1.2°, p = 0.70), Disability of the Arm, Shoulder and Hand scores (MD 0.4, 95% CI: −2.7 to 3.6, p = 0.79), or patient satisfaction (standardized MD 0.20, 95% CI: −0.49 to 0.09, p = 0.17). Orthotic intervention was more effective than hand therapy alone for improving PIPJ extension for fixed flexion deformities following traumatic finger injury or surgery (MD −16.7°, 95% CI: −20.1° to −13.3°, p < 0.001). No studies evaluated orthotic intervention to improve PIPJ flexion. Conclusion: The addition of an extension orthosis following procedures to manage Dupuytren’s contracture is no better than hand therapy alone for improving PIPJ extension. In contrast, the addition of a PIPJ extension orthosis in the presence of traumatic PIPJ fixed flexion deformities is more effective for improving PIPJ extension than hand therapy alone. Future studies are needed to evaluate the role of orthotic intervention for improving PIPJ flexion. 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 randomized controlled trial on the effectiveness of mirror therapy in improving strength, range of movement and muscle activity, in people with carpal tunnel syndrome. Muñoz-Gómez, E., et al. (2024). Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Carpal tunnel syndrome - Conservative treatment This randomised controlled trial, compared the efficacy of mirror therapy (MT) versus traditional therapeutic exercises (TE) performed on the unaffected side only in patients with unilateral Carpal Tunnel Syndrome (CTS). A total of 39 participants were included in the present study, and they were randomised to MT or TE groups. The MT group performed exercises with the unaffected hand, which was reflected in a mirror, while the TE group executed the same exercises without a mirror and the CTS hand hidden below the table. The results that MT significantly improved wrist flexion-extension range of motion (ROM) and handgrip strength compared to the TE group. Both groups reported decreased pain, however, only the MT showed a clinically significant improvement (see graph below). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, mirror therapy for carpal tunnel syndrome appears to provide better outcomes compared to exercises on the unaffected hand with the affected side out of sight. It is possible that part of the effectiveness of mirror therapy is due to increase attention towards the affected limb compared to an invitation to disregard the affected side when performing the exercises on the healthy hand. If you are interested in carpal tunnel syndrome assessment and management, have a look at the whole database . URL : https://doi.org/10.1016/j.jht.2024.02.007 Abstract Background: There is little information on the potential effects of mirror therapy (MT) on motor recovery in individuals with Carpal Tunnel Syndrome (CTS). Purpose: To compare the effectiveness of a MT protocol versus a therapeutic exercise (TE) protocol, in improving strength, range of motion (ROM), muscle activity, pain, and functionality in patients with CTS. Study design: Randomized clinical trial. Methods: Thirty-nine participants with unilateral CTS were divided into two groups: (i) MT group (n = 20) that followed an exercise protocol applied to the unaffected hand reflected in a mirror, and (ii) TE group (n = 19) that followed the same exercise protocol using the unaffected hand but without a mirror. Strength, wrist ROM, muscle activity, pain and functionality, were assessed at baseline (T0), after treatment (T1) and one month after treatment (T2). Results: At T1, the MT group showed significantly higher wrist flexion-extension ROM compared to TE (p = 0.04, d = 0.8), maintained at T2 (p = 0.02, d = 0.8). No significant changes were observed in ulnar-radius deviation, pronosupination, or fatigue following either MT or TE (p > 0.05). MT exhibited enhanced handgrip strength at T1 (p = 0.001, d = 0.7), as well as an increase in the extensor carpi radialis (ECR) and flexor carpi radialis (FCR) maximum muscle activity (p = 0.04, d = 1.0; p = 0.03, d = 0.4). At T1, both groups decreased pain (p = 0.002, d = 1.1; p = 0.02, d = 0.7), and improved functionality (p < 0.001, d = 0.8; p = 0.01, d = 0.5) (MT and TE respectively). Discussion: MT led to enhancements in wrist flexion-extension movement, handgrip strength and functionality unlike TE. MT notably increased muscle activity, particularly in the ECR and FCR muscles. Conclusions: MT is a favorable strategy to improve wrist flexion-extension ROM, handgrip strength, ECR and FCR muscle activity, and functionality in people with unilateral 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

A review of the New Zealand National Joint Registry to evaluate the survivorship and revision rates of Nexel and Coonrad-Morrey total elbow arthroplasty. Wengle, L., Frampton, C. and Poon, P. C. (2024) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Total elbow replacement - Revision rate This retrospective study assessed the survivorship and revision rates of the Nexel and Coonrad-Morrey total elbow arthroplasty implants in New Zealand, using data from the National Joint Registry. Prior research criticised the Nexel TEA for high failure rates. The results showed a 7% revision rate for Nexel at five years compared to 5% for the Coonrad-Morrey, with average times to revision being 3 years for Nexel and 5 years for Coonrad-Morrey. Component loosening was a primary reason for revisions in both groups. There was a trend for the Nexel implant having worse outcomes, however, the incidence of revision/complication was lower compared to what has been previously reported in the literature (34% to 60% of revisions and complications respectively). 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, in New Zealand, the survivorship of both the Nexel and Coonrad-Morrey total elbow arthroplasty implants appear to be acceptable. Total elbow replacement is therefore a viable option for people with osteoarthritis who have not responded to conservative treatment . URL : https://doi.org/10.1016/j.jse.2024.03.029 Abstract Background: Total elbow arthroplasty (TEA) is an appropriate surgical treatment option for a variety of conditions ranging from inflammatory arthritis to trauma. Due to a high complication profile, implant companies have attempted to improve patient outcomes with evolving design mechanics and philosophy. However, the Nexel TEA prosthesis has been criticized for its unacceptably high revision rate by other research groups in the literature. The purpose of this study was to evaluate the survivorship and revision rates of the Nexel and Coonrad-Morrey total elbow arthroplasty implant systems in New Zealand. Methods: Prospectively collected national joint registry data was used to compare the survival rates of these prostheses. Underlying diagnoses, reasons for revision, and patient demographics were all recorded. Statistical analysis included survival analysis using Kaplan-Meier curves and comparison between groups using independent t-tests. Results: Over the 23-year study interval, the Nexel and Coonrad-Morrey prostheses showed similar survivorship and revision rates. The revision rates at 5 years were 7.3% for ZN and 4.5% for the Coonrad-Morrey cohorts. The average time to revision for those who are revised was 3.13 ± 1.74 years in the Nexel group and 4.93 ± 4.13 years in the Coonrad-Morrey population. Conclusion: Our study confirms a lower revision rate of the Nexel TEA compared to other studies in the literature. Additionally, the Nexel TEA implant performs comparably to its predecessor, the Coonrad-Morrey prosthesis in New Zealand. While it is difficult to explain the discrepancy in results with the study by Morrey et. al, future studies should focus on investigating postoperative radiographs and a deep analysis of the specific surgical technique used for this implant. 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

Self-reported improvement after carpal tunnel release in patients with motor axonal loss. Livingston, N., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Carpal tunnel surgery - positive vs negative NCS This retrospective study assessed the effect of sensory and motor axonal loss (AL) on outcomes after carpal tunnel release (CTR). Sensory and motor AL were assessed through electrodiagnostic studies in the whole sample of 175 patients. Patient-reported outcomes were analysed before and three months after surgery. There was no difference in postoperative improvement between patients with and without sensory AL. However, those with motor AL experienced greater improvements in pain and QuickDASH outcomes. These findings suggest that despite severe CTS, surgery can significantly improve 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, patients with motor axonal loss due to carpal tunnel syndrome may experience greater postoperative improvements in function and pain relief compared to those without motor loss. In line with previous research, surgical intervention is therefore recommended for people with severe carpal tunnel syndrome. For those patients with mild to moderate symptoms, monitoring sensory and motor presentation and treating them with a night wrist splint appear to be an effective treatment approach. In particular, a splint blocking mcpj flexion appears to be more effective than a normal wrist splint . URL : https://doi.org/10.1016/j.jhsa.2024.10.010 Abstract Purpose: Electrodiagnostic studies can identify evidence of sensory and motor axonal loss (AL) in carpal tunnel syndrome (CTS) patients. However, the impact of sensory and motor AL on outcomes following carpal tunnel release (CTR) remains unclear. We hypothesize that patients with no evidence of sensory and motor AL will experience greater improvement following CTR compared to those with evidence of AL. Methods: Patients undergoing open and endoscopic CTR by four fellowship-trained orthopedic hand surgeons were identified. Sensory and motor AL were identified using preoperative electromyography and nerve conduction studies. Patients completed the following before surgery and 3-month postoperative patient-reported outcomes: Patient-Reported Outcomes Measurement Information System Upper Extremity (UE) and Pain Interference (PI) as well as Disabilities of the Arm, Shoulder, and Hand (QuickDASH [QD]). Preoperative and postoperative scores, changes in scores, and rates of achieving the minimally clinically important difference (MCID) were compared between patients with and without sensory and motor AL. Results: One hundred and seventy-five patients were included. Of these, 91 exhibited sensory AL and 98 exhibited motor AL. Demographic matched analysis of patients with and without sensory AL showed no differences in before surgery, after surgery, difference, or proportion meeting MCID for UE, PI, or QD. Matched analysis revealed no difference in preoperative PROMs between patients with and without motor AL. Patients with motor AL had increased postoperative UE (better function), decreased postoperative PI (less PI) and QD (less disability), increased changes in PI and QD, as well as a greater proportion meeting MCID for QD compared to those without motor AL. Conclusions: There was no difference in post-CTR improvement between patients with and without sensory AL. However, contrary to our hypothesis, motor AL patients experienced greater postoperative improvement according to QD. These findings suggest surgery should be recommended for severe CTS patients with evidence of AL. These results can better inform physicians and patients as they discuss expectations of CTR 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

Investigating the effect of triamcinolone local injection on clinical outcomes of patients with radial tunnel syndrome: A placebo-controlled clinical trial. Estaji, F., Daliri, M., Hashemi, S. and Moradi, A. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Radial tunnel syndrome - Cortisone vs placebo injections This randomised double-blind control trial compared the efficacy of cortisone vs saline injections for radial tunnel syndrome (RTS). A total of 42 participants characterised by pain exacerbated by activity, maximal tenderness 3 to 5 cm distal from lateral epicondyle, irradiation of pain to the dorsal aspect of the forearm, and pain with middle finger extension were included. The placebo/experimental injection was provided by a senior hand surgeon, without ultrasound guidance. Confirmation of the injection being delivered to the radial tunnel was provided by a short term duration (15-30 minutes) of wrist drop. Participants were assessed using the QuickDASH, VAS for pain, and the Oxford Elbow Score at baseline, two weeks, and three months post-injection. The results revealed no significant differences between the treatment and placebo groups regarding improvement across all measures. However, both groups showed clinically significant improvements over time. These results highlight the potential non-specific therapeutic effects of the injection process. 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, corticosteroid injections do not appear to be superior to saline injection (placebo) in radial tunnel syndrome. However, both injections provide clinically relevant improvements in pain and function over time. These findings are similar to previous research assessing the effectiveness of PRP and placebo injections for lateral epicondylalgia . URL : https://doi.org/10.1016/j.jhsa.2024.09.023 Abstract Purpose: The role of corticosteroid injection for radial tunnel syndrome (RTS) has not been studied in a placebo-controlled clinical trial. The present clinical trial aimed to evaluate the effect of local triamcinolone injection on pain intensity, upper-extremity disability, and elbow function of patients with RTS. Methods: Forty-nine patients clinically diagnosed with RTS were randomized into the intervention and placebo groups. The diagnosis of RTS was made based on the following criteria: activity-related pain, maximal tenderness 3 to 5 cm distal to the lateral epicondyle, pain that worsens with forearm supination, pain radiating to the dorsoradial aspect of the forearm, and a positive Lister test. To confirm RTS, patients needed to exhibit at least four of these five criteria, with the requirement that one of the criteria be the tenderness located 3–5 cm distal to the lateral epicondyle. Patients in the intervention group received local injection of a single dose of corticosteroid (0.25 mL lidocaine 1% and 1 mL triamcinolone 40 mg/mL), and the placebo group received injection of single dose of normal saline (0.25 mL lidocaine 1% and 1 mL normal saline). The clinical outcomes, including Quick DASH (Disabilities of the Arm, Shoulder, and Hand), visual analog scale for pain, and Oxford Elbow Score, were evaluated before treatment, as well as 2 weeks and 3 months after the injection. Results: Visual analog scale pain score, Quick DASH score, and Oxford Elbow Scores were similar between the intervention and placebo groups at 2 weeks and 3 months of follow-up. However, reduction in visual analog scale pain, Quick DASH score, and Oxford Elbow Scores were statistically significant over time among both groups. Conclusions: Triamcinolone injection does not have any superior effect on the clinical outcomes of patients with RTS, compared with placebo. 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

Arthrodesis versus ligament reconstruction and tendon interposition for thumb carpometacarpal joint arthritis: A systematic review and meta-analysis. Kim, C.-H., Lee, D.-H., Lee, J.-S. and Jung, H.-S. (2024) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Suspension plasty vs arthrodesis - 1st cmcj OA This systematic review and meta-analysis compared arthrodesis and ligament reconstruction with tendon interposition (LRTI) for 1st cmcj OA. Data from six studies involving 285 thumbs showed no significant differences between the two procedures regarding pain levels (visual analog scale), functional outcomes (QuickDASH), and grip strength. However, arthrodesis patients exhibited higher key pinch strength. Despite this advantage, arthrodesis was linked to increased reoperation and postoperative complication rates compared to LRTI. These findings suggest that LRTI may be a less risky choice, particularly for older patients or those at higher risk of complications, while arthrodesis might be reserved for younger or more active patients. Below you can find the forest plot of re-operation rate (A) and post-surgical complications (B) for the two approaches. 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, both arthrodesis and ligament reconstruction with tendon interposition (LRTI) for 1st cmcj OAmay be useful interventions. While arthrodesis enhances key pinch strength, it also associated with a higher risk of reoperation and postoperative complications compared to LRTI. Currently, the safest surgical approach for 1st cmcj OA appears to be trapeziectomy. URL : https://doi.org/10.1016/j.jhsa.2024.10.018 Abstract Purpose: Arthrodesis and ligament reconstruction and tendon interposition (LRTI) are commonly performed procedures for treatment of thumb carpometacarpal (CMC) osteoarthritis. Although LRTI is the most common surgical treatment, CMC arthrodesis has been performed because of its reported advantages. This systematic review and meta-analysis compared the differences between CMC arthrodesis and LRTI to better inform surgeons and patients when they are making treatment decisions. Methods: We searched MEDLINE, Embase, and the Cochrane Library for studies published up to 27 August 2023 that directly compared arthrodesis with LRTI for thumb CMC joint arthritis. The pooled analysis compared the visual analog scale; Quick Disabilities of the Arm, Shoulder, and Hand scores; grip strength; key pinch strength; reoperation rates; and postoperative complication rates. Results: Six studies describing 285 thumbs, including 141 and 155 thumbs that underwent arthrodesis and LRTI, respectively, were included. Visual analog scale (standard mean difference [SMD], −0.05; 95% CI, −0.40 to 0.30; P = .78), Quick Disabilities of the Arm, Shoulder, and Hand score (SMD, 0.53; 95% CI, −1.12 to 2.17; P = .53), and grip strength (SMD, −0.67; 95% CI, −1.85 to 0.51; P = .27) showed no difference between the two groups. The arthrodesis group showed significantly higher key pinch strength (SMD, 0.61; 95% CI, 0.32–0.90), reoperation rate (odds ratio, 8.02; 95% CI, 2.00–32.16), and postoperative complication rate (odds ratio, 2.08; 95% CI, 1.11–3.91; I2 = 0%) compared with the LRTI group. Conclusions: Carpometacarpal arthrodesis is associated with a better key pinch strength than LRTI. Nevertheless, no significant differences were observed in functional scores and grip strength. Patients who undergo arthrodesis have higher reoperation rates and incidence of postoperative complications than those who undergo LRTI. Thus, although arthrodesis may be a better operation for patients who require high pinch strength, surgeons should also consider the higher complication compared with LRTI. 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

Response to conservative treatment for thumb carpometacarpal osteoarthritis is associated with conversion to surgery: A prospective cohort study. Tsehaie, J., et al. (2019) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Thumb OA conservative treatment - Rates of surgery This prospective cohort study assessed the effectiveness of conservative treatment in patients with thumb carpometacarpal joint (cmcj) osteoarthritis (OA) and its association with subsequent surgical intervention. The study was conducted at the Xpert Clinic in the Netherlands, and 701 patients who underwent hand therapy and splint treatment for three months were included. Pain and function were assessed using the Michigan Hand Questionnaire (MHQ) at the outset, mid-treatment, and post-treatment. The results showed that reductions in pain during conservative treatment significantly correlated with decreased likelihood of elective surgery, whereas changes in functional scores did not show such an association. Notably, only 15% of patients transitioned to surgery after conservative treatment. 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, carefully monitoring pain responses during conservative treatments is important to determine whether escalation to surgery is required. Thus, reductions in pain are strongly linked to a decreased necessity for surgical intervention in people with thumb OA. These findings are in line with previous research showing that conservative treatment for thumb OA can reduce the need for surgical interventions . Interestingly, changes in functional outcomes alone do not predict surgical conversion, highlighting pain relief as a pivotal target for conservative management. URL : https://doi.org/10.1093/ptj/pzz009 Abstract Background: The current guidelines for treatment of carpometacarpal osteoarthritis recommend starting with conservative treatment before a surgical procedure is considered. Objective: The objective was to investigate how response to conservative treatment, in terms of pain and hand function, influences the hazard that patients convert to surgical treatment. Design: This was a multicenter, prospective cohort study. Methods: Participants comprised 701 patients who received 3 months of hand therapy and an orthosis. Pain and function were measured with the Michigan Hand Questionnaire (MHQ) at baseline and at 6 weeks and 3 months follow-up. Conversion to surgical treatment was recorded from clinical records. Joint modeling (a statistical method of combining prediction models) was used to perform the analysis and to calculate hazard ratios (HRs). Results: The joint analytical model showed that both MHQ pain score at a certain point (HR = 0.93; 95% confidence interval [CI] = 0.92–0.94) and change in MHQ pain score (HR = 1.07; 95% CI = 1.06–1.09) during conservative treatment was significantly associated with conversion to surgical treatment. The joint analytical model between functional outcome and conversion to surgical treatment showed only a significant association between MHQ function at a certain point (HR = 0.97; 95% CI = 0.95–0.99), and no significant association between the change in MHQ score for function (HR = 1.0; 95% CI = 1.0–1.0) and conversion to surgical treatment. Limitations: Missing data might have resulted in biased estimates. Conclusions: Self-reported pain and function, as well as change in self-reported pain during treatment, were associated with the hazard of conversion to surgical treatment, whereas change in self-reported functioning was not associated with conversion. Because a reduction in pain during conservative treatment appears to decrease the rate of conversion to surgical treatment, it is advised to structurally monitor pain levels during treatment. 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

Buddy taping after reduction of displaced extra-articular phalangeal finger fractures in children: a randomized controlled trial. Weber, D. M., et al. (2024) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic : Phalanx fracture - Taping This randomized controlled assessed the outcomes of taping or forearm and hand casting for children with displaced extra-articular phalangeal finger fractures. After reduction, a total of 81 children were randomised to either taping of the fingers or casting of the forearm/hand (see picture below). The primary outcome was the rate of fracture displacements, while secondary outcomes included patient comfort, analgesic use, and range of motion six months after injury. The results showed that five fracture displacements occurred in the casting group, compared to three in the taping group. As a result taping was deemed non inferior compared to casting. Patient comfort and the other secondary outcomes were comparable between groups. 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, buddy taping provides a non-inferior alternative to casting of forearm and hand in displaced extra-articular phalangeal finger fractures in children. Buddy splinting appears also to be more comfortable, less expensive, and would take less time compared to casting. Other fractures that only require buddy taping in adults are neck of the 5th metacarpal fractures . URL : https://doi.org/10.1177/17531934241293338 Abstract In this randomized controlled trial, we assessed the non-inferiority of buddy taping to splinting after reduction of displaced extra-articular proximal and middle phalangeal finger fractures in children. The primary outcome was the rate of secondary fracture displacements; the secondary outcomes were patient comfort, analgesic efficacy and total range of active motion 6 months after injury. Eighty-one patients participated: 43 with taping and 38 with splinting. Secondary displacement occurred in eight patients: five in the splinting group and three in the taping group. Risk difference was below the predefined non-inferiority of 10%. Patient comfort was significantly higher in the taping group, with no group differences for other parameters. Our previous study recommended taping for undisplaced finger fractures in children. With the current data, we recommend taping these finger fractures irrespective of displacement or need for reduction. We are encouraged to propose taping as an alternative to splinting for increased patient comfort, lower cost, and shorter application time. 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

Too much is too little: Estimating the optimal physical activity level for a healthy mental state. Shimura, A., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (/4 Thumbs up) Type of study: Aetiologic / Prognostic Topic : Physical activity - Mental health This cross-sectional study assessed the relationship between physical activity and mental health, hypothesising a U-shaped dose-response curve, suggesting that both too little and too much physical activity can negatively impact mental health. A total of 526 Japanese adult participants who completed self-administered questionnaires on physical activity and mental health factors like depression, anxiety, resilience, and insomnia. The results that no significant linear relationships between physical activity and mental health measures existed. As expected by the authors, a significant U-shaped relationship was instead observed. Optimal physical activity levels were identified as 6,953 MET-minutes for depression and 9,152 MET-minutes for insomnia. These numbers equate to 17 to 30 hours of moderate or vigorous physical activity per week. Further large-scale and intervention studies are required to assess the causality between these variables. 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, engaging in physical activities within the recommended range of 5.3 to 9.2 k METs-minutes per week, or 21 to 31 hours per week, is associated with improved mental health for depression, anxiety, and insomnia, along with enhanced resilience. This range is much higher than the WHO guidelines for physical activity, which suggest 75 minutes/week of vigorous or 150 minutes/week of moderate exercise . It is possible that the WHO wanted to indicate levels that appear to be achievable by people rather than the optimal amount of physical activity. It is also important to remember that association is not causation and experimental studies randomising patients to different levels of physical activity are needed to clarify any causative effect. URL : https://doi.org/10.3389/fpsyg.2022.1044988 Abstract Introduction: Although physical activity and exercise are generally thought to have favorable effects on mental health, excessive physical activity may have unfavorable effects. In this study, the associations between physical activity and the states of mental health with U-shaped dose–response curves were hypothesized, and the ranges of physical activity resulting in optimal effects on mental health were investigated. Methods: A cross-sectional survey was conducted on 1,237 adult volunteers in 2017 and 2018. Of these volunteers, 526 participants validly answered the self-administered questionnaires asking about physical activity, depression, anxiety, resilience, insomnia vulnerability, and life events. A comparison of mental health measures by physical activity levels and quadratic equation model regressions were performed. Results: No significant linear associations between physical activity levels and mental health measurements were observed; however, the U-shaped, quadratic equation models indicated a significance. The following levels of physical activity per week optimized the mental health measurements values of the participants: 6,953 MET-minutes and 25.70 h for depression, 5,277 MET-minutes and 21.60 h for state anxiety, 5,678 MET-minutes and 22.58 h for trait anxiety, 25.41 h for resilience, and 9,152 MET-minutes and 31.17 h for insomnia vulnerability. Conclusion: Physical activities in the optimal range were associated with more favorable mental health measurements. Physical activities that were too much or too long and outside of the optimal range were associated with less favorable mental health measurements. 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

Pain and instability ascribed to the distal radioulnar ligaments and central disc as part of the triangular fibrocartilage complex: a round table discussion. Teunis, T., Burnier, M., Chin, A. Y. H. and Ring, D. (2024) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : DRUJ & TFCC - Is surgery required? This expert opinion assessed the complexities surrounding pain and instability attributed to the triangular fibrocartilage complex (TFCC), focusing on the distal radioulnar joint (DRUJ) and the central disc. Four surgeons, were asked their opinions and answers from all were reported. What the article highlighted was the inconsistent interpretations of MRI findings (incidental vs symptoms related) among surgeons, leading to potential over or under-treatment. The discussion led by Teun Teunis, featuring experts Drs. Chin, Ring, and Burnier, uncovered varied opinions on diagnosing and treating ulnar wrist pain. While some experts argue for the reliability of surgical interventions following clinical tests like the ballottement test, others caution against overdiagnosis, noting the prevalence of age-related changes in the DRUJ and central disc. The article underscores the need for objective validation of surgical benefits over natural recovery and placebo effects, advocating for evidence-based approaches to manage ulnar sided wrist pathologies. 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, identifying the line between normal variations and symptomatic pathologies in TFCC and DRUJ is challenging and continues to evolve. Clinicians should be cautious in attributing pain and instability solely to these structures without comprehensive diagnostic corroboration. As current debates indicate, the correlation between MRI findings or arthroscopic observations and symptomatic presentations remains less than reliable. The uncertainty appears to be substantiated by multiple research papers suggesting that there is poor agreement between objective/imaging findings and symptoms reported by patients . URL : https://doi.org/10.1177/17531934241254705 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

Hand grip strength in senior athletes: Normative data and community-dwelling comparisons. Jordre, B. and Schweinle, W. (2020) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic, Prognostic Topic : Grip strength - Senior athletes This cross-sectional study assessed hand grip strength in senior athletes and compared it to community-dwelling older adults. Previously published normative data for hand grip strength have been collected from largely inactive participants. The novelty of this paper is that, senior athletes participating in the National Senior Games from 2011 to 2017, for a total of 2,333 participants, were included in this study. Male senior athletes demonstrated 9 to 11 kg greater dominant hand grip strength, while females showed an increase of 6 to 9 kg compared to their sedentary counterparts. These differences were statistically significant with large effect sizes. Notably, the hand grip strength levels of senior athletes ages 80-85 aligned more closely with younger community-dwelling adults aged 60-64. The findings underscore the need for specific normative values to accurately assess the health and capabilities of this physically active older population, challenging assumptions of age-related decline seen in the general older population. 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, regular participation in athletic activities significantly enhances hand grip strength among older adults, aligning their physical capacity with much younger community-dwelling adults. This insight suggests that senior athletes and similarly active older individuals can maintain a functional ability that defies conventional age-related declines. In line with previous findings, engaging in resistance training and other targeted exercises not only improves overall muscle strength but also acts as a protective measure against age-related conditions. Have a look at the WHO guidelines for physical activity and remind your patients of staying as active as possible! URL : https://doi.org/10.26603/ijspt20200519 Abstract Hand grip strength is supported as a valid physical capacity measure in older adults. Normative values for community-dwelling older adult hand grip strength were recently updated. With the majority of community-dwelling older adults identified as sedentary, it is likely that current norms represent a group that is relatively inactive. A sub-population of senior athletes who actively engage in exercise and competitive sport have consistently demonstrated superior performance on measures of physical capacity when compared to the general population. Normative values for hand grip strength have not been established for this unique group of aging athletes. The purpose of this study was to establish hand grip strength norms for senior athletes and to compare these outcomes to available normative data in community-dwelling older adults.  Measures of hand grip strength were taken on 2,333 senior athletes registered to compete in the National Senior Games between 2011 and 2017. Findings were divided into age and gender categories consistent with community-dwelling norms. Student t tests were used to compare senior athlete means to community-dwelling norms. Cohen’s d was calculated to estimate the effect size of each comparison. Normative values for senior athlete hand grip strength are reported in kilograms by age, gender and hand dominance. For each age and gender category tested, senior athletes demonstrate dominant hand grip strength that ranges from 8.6-11.1 kg higher for males and 5.5 to 8.9 kg higher for females (p values<.0001) than published community-dwelling norms. Non-dominant grip strengths were also significantly higher (p values<.0001). Effect sizes were medium to large (Cohen’s ds = 0.44-1.5). Senior athletes demonstrate hand grip strength that is significantly higher than their community-dwelling peers and more similar to a younger community-dwelling population. The population-specific norms presented here will assist health care providers in more accurately assessing this high-functioning subset of aging 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

What are the barriers to upper limb splint adherence, and how is adherence measured? A systematic review. Bamford, E., et al. (2024) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Splint wearing - Adherence and barriers This systematic review assessed the barriers to splint wearing and methods of measuring adherence to upper limb splint usage after traumatic injuries. A total of 16 articles were included in the present study. The results showed that methods used for assessing adherence varied, lacking a standardised approach. Patients' or therapists' reports were the most commonly utilised aproaches to measure adherence, with electronic sensors being utilised less frequently. Barriers to splint adherence identified by patients included the limitations caused by splinting in daily function (e.g. hygiene, caring for baby), patients' perception of clinical improvement. In contrast, increase adherence was associated with patients' perception that the splint was aiding their 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, non-adherence to upper limb splint regimens following traumatic injuries can adversely affect recovery outcomes and increase healthcare costs. Common barriers to splint adherence include limitations in function and perception of low injury severity by the patient. Another factor that appears to negatively impact splinting adherence is depression , which may be explained by lower levels of patients' perception of improvement with splint wearing. URL : https://doi.org/10.1177/17589983241268069 Abstract Introduction: Non-adherence to splint wearing following an upper limb traumatic injury is a significant medical issue. Optimal outcome following such injuries relies on people adhering to the prescribed splint, and a failure to do so can negatively impact outcome and increase healthcare burden and costs. This systematic review aims to compare and synthesise the evidence related to measuring adherence to wear recommendations and the barriers to splint wearing following upper limb trauma in adults. Methods: Databases (EBSCO, PubMed, EMBASE and Science Direct) were systematically searched for articles that met the pre-agreed eligibility criteria between February and May 2023. Data on study characteristics and reported outcomes relating to measuring and quantifying splint adherence and barriers to adherence were extracted. Results: A total of 16 articles were included for final review. Several methods were used to measure adherence, with no single tool used predominantly. These included patient or therapist reported data, preexisting classification systems and an electronic device. Methods used to quantify adherence was also heterogenous in nature, and a range of investigator and patient reported barriers to splint wearing were reported. Conclusion: This review demonstrates heterogeneity in both classifying and measuring splint adherence, as well as in the barriers to splint wearing reported. Moving forward, using agreed measurement and reporting practices for splint adherence will enable researchers to complete high quality trials to determine splinting outcomes, and may ultimately enable health care professionals to improve adherence and, subsequently, outcomes in clinical 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