Prevalence and practice characteristics of advanced practice providers in upper-extremity surgery. Das, R. K., Bittles, O., Thayer, W. P. and Drolet, B. C. (2024) Level of Evidence: 3b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Economic Topic : Advanced practice providers - Hand Therapy The study conducted a retrospective analysis from 2013 to 2021 to assess the prevalence and characteristics of advanced practice providers (APPs), such as nurse practitioners and physician assistants, in upper-extremity care, based on Medicare data. Findings revealed a 170.9% increase in APPs billing for upper-extremity services, with the number rising from 1,965 to 5,324 over the period. In contrast, the numbers for upper-extremity surgeons decreased by 5.2%. APPs, predominately women, were more likely to operate in rural areas compared to surgeons. The role of APPs in enhancing accessibility to care appears to be important, especially as surgeon numbers decline. This study highlights the growing reliance on APPs for future healthcare resilience. The graph below shows the number of surgeon vs APP in the past 10 years. 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, there is a rapidly growing reliance on Advanced Practice Providers, such as nurse practitioners and physician assistants, in the field of upper-extremity care. With the anticipated shortage of surgeons, especially in rural areas, APPs are key in ensuring accessible, efficient, and high-quality care. URL : https://doi.org/10.1016/j.jhsa.2024.08.015 Abstract Purpose: This study evaluated the prevalence, characteristics, and reimbursement of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to the diagnosis and treatment of diseases and conditions of the hand, wrist, and upper extremities in the United States from 2013 to 2021. Methods: Our analysis was a retrospective cohort study evaluating the diagnostic, procedural, and therapeutic services provided by advanced practice providers from 2013 to 2021 using the Medicare Provider Utilization and Payment Data Public Use Files from the Centers for Medicare and Medicare Services. The reported provider type and billing codes were used to identify health care professionals providing upper-extremity care such as ordering radiographs, applying casts and splints, and performing procedures on the hand, wrist, or other anatomic regions of the upper extremity. Trends over the study period and available data about services provided were analyzed. Results: From 2013 to 2021, providers of upper-extremity care included 19,525 (64.7%) doctor of medicine or doctor of osteopathic medicine upper-extremity surgeons, 7,612 (25.2%) physician assistants, and 3,042 (10.1%) nurse practitioners. The nonsurgeon providers were more likely to be women and provide care in micropolitan areas with less than 50,000 people compared with upper-extremity surgeons. Overall, the number of advanced practice providers who billed for upper-extremity care increased by 170.9% from 1,965 in 2013 to 5,324 in 2021. Based on these trends, the growth of APPs providing upper-extremity care is expected to continue. Conclusions: There is a growing prevalence of advanced practice providers in upper-extremity care, and this trend is expected to continue. Clinical relevance: With a growing need for upper-extremity care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation. 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

Provocative wrist tests and MRI are of limited diagnostic value for suspected wrist ligament injuries: A cross-sectional study. Prosser, R., et al. (2011) Level of Evidence: 3b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : MRI and special tests - Very useful? This cross sectional study assessed the diagnostic accuracy of provocative wrist tests and MRI in diagnosing wrist ligament injuries. A total of 105 participants with wrist pain (at least four weeks) were included. Seven provocative tests and MRI findings were compared against wrist arthroscopy (gold standard). The results reveal that most provocative tests and MRI findings have limited diagnostic value. Notably, the scaphoid shift test (SS), midcarpal test (MC), and distal radioulnar joint test (DRUJ) exhibited mild usefulness when diagnosing specific ligament injuries. MRI showed moderate utility for diagnosing injuries to the triangular fibrocartilage complex (TFCC), scapholunate ligament, and lunate cartilage damage. Combining MRI with provocative tests provided slight diagnostic improvement for TFCC injuries and lunate cartilage damage. 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 provocative wrist tests are commonly used in clinical settings, their diagnostic accuracy for wrist ligament injuries is limited. These results are in line with additional research suggesting that the Watson test or the fovea sign have got limited diagnostic utility. One test that seems to have reasonable reliability and validity for the wrist appears to be the DRUJ ballottement test . URL : https://doi.org/10.1016/S1836-9553(11)70055-8 Abstract Question: What is the diagnostic value of provocative wrist tests and magnetic resonance imaging (MRI) for suspected wrist ligament injuries? Design: Cross-sectional study. Participants: 105 people presenting to hand clinics with wrist pain and suspected wrist ligament injuries were evaluated prospectively. Outcome measures: The integrity of wrist ligaments was tested with seven provocative tests. The results were compared to the reference standard of arthroscopy. In a subgroup of 55 participants, MRI findings were also compared to arthroscopy. The provocative tests were the scaphoid shift test (SS test), lunotriquetral test (LT test), midcarpal test (MC test), distal radioulnar joint test (DRUJ test), triangular fibrocartilage complex (TFCC) stress test (TFCC test), TFCC stress test with compression (TFCC comp test), and the gripping rotatory impaction test (GRIT). Results: Most provocative tests and MRI findings were of little or no value for diagnosing wrist ligament injuries. Exceptions were the SS test (+ve LR 2.88 and –ve LR 0.28), MC test (+ve LR 2.67) and DRUJ test (–ve LR 0.30), all of which were of mild diagnostic usefulness. MRI was moderately useful for diagnosing TFCC injuries (+ve LR 5.56, –ve LR 0.15), and was mildly useful for diagnosing scapholunate (SL) ligament injuries (+ve LR 4.17, –ve LR 0.32) and lunate cartilage damage (+ve LR 3.67, –ve LR 0.33). Adding MRI to provocative tests improved the accuracy of diagnosis of TFCC injuries slightly (by 13%) and lunate cartilage damage (by 8%). Conclusion: Provocative wrist tests of SL ligament injuries and midcarpal ligament injuries are mildly useful for diagnosing wrist injuries. MRI diagnostic findings of SL ligament injuries, lunate cartilage damage, and TFCC are mildly to moderately useful. MRI slightly improves the diagnosis of TFCC injury and lunate cartilage damage compared to provocative tests alone. 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 meta-analysis of randomized clinical trials on the impact of oral vitamin C supplementation on first-year outcomes in orthopedic patients. Hung, K.-C., et al. (2021) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Vitamin C - CRPS post surgery The meta-analysis investigated the effects of oral vitamin C supplementation on orthopedic patients' recovery, particularly focusing on functional outcomes and complex regional pain syndrome type I (CRPS I). A total of seven randomised controlled trials comprising 1,361 participants, the study found that vitamin C supplementation did not significantly improve functional outcomes or reduce pain severity within the first year post-procedure. However, it notably diminished the risk of developing CRPS I, regardless of the dosage administered. The analysis also highlighted the biochemical properties of vitamin C, such as its role in collagen formation, bone development, and its antioxidant effects on reducing reactive oxygen species, which are implicated in inflammatory and neuropathic pain. Despite the observed benefits concerning CRPS I, the limited number of trials suggests the need for further clinical research to refute these findings. The forest plot below shows the risk of developing CRPS in people taking vitamin C compared to placebo. 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, oral vitamin C supplementation, at a dosage of 500mg to 1g daily for 40-50 days,could significantly reduce the risk of developing Complex Regional Pain Syndrome Type I (CRPS-I) in orthopedic settings. However, it does not appear to improve functional outcomes such as pain severity or range of motion. Keep in mind that we need large scale RCTs to better assess the effect of Vitamin C post-surgery. Considering the low cost and risk associated with this supplement, it may be worth suggesting to our patients. URL : https://doi.org/10.1038/s41598-021-88864-7 Abstract This meta-analysis aimed at investigating the impact of oral vitamin C supplementation on the post-procedural recovery of orthopedic patients, including functional outcomes and complex regional pain syndrome type I (CRPS I). Literature search using the Medline, Cochrane Library, and Embase databases from inception till March 2021 identified seven eligible randomized controlled trials with 1,361 participants. Forest plot revealed no significant difference in the functional outcomes at 6–12 months [standardized mean difference (SMD) = −0.00, 95% CI − 0.19 to 0.18, 467 patients], risk of overall complications (RR = 0.98, 95% CI 0.68 to 1.39, 426 patients), and pain severity at 3–6 months (SMD = − 0.18, 95% CI − 0.49 to 0.12, 486 patients) between patients with and without oral vitamin C supplementation. Pooled analysis showed that vitamin C treatment reduced the risk of CRPS I regardless of dosage (RR = 0.46, 95% CI 0.25 to 0.85, 1143 patients). In conclusion, the current meta-analysis demonstrated that oral vitamin C supplementation may reduce the risk of complex regional pain syndrome type I but did not improve the functional outcomes in orthopedic patients. Nevertheless, because of the small number of trials included in the present study, further large-scale clinical studies are warranted to support our findings. 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

Guideline on managing thumb ulnar collateral ligament injuries: The british society of surgery for the hand evidence for surgical treatment (BEST) findings and recommendations. Dean, B., et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : ULC injury - management This article discusses the development of guidelines for managing thumb ulnar collateral ligament (UCL) injuries. These guidelines were created by the British Society of Surgery for the Hand by synthesise evidence from systematic reviews on diagnostic and therapeutic approaches for these injuries. The guidelines created recommend that acute UCL injuries of the thumb should be initially assessed through history, physical examination, and radiographs. For patients with significant joint instability, a decision between non-surgical immobilisation and surgery should be made collaboratively within two weeks. The guideline development process involved multiple stakeholders, emphasising the need for future research to enhance the understanding of the natural history, diagnostics, and treatment effectiveness of UCL injuries. 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, clinical examination is crucial for initial assessment of thumb UCL injuries, particularly to identify significant joint laxity. Radiographs may be used to evaluate for any fractures or subluxations. In cases of significant laxity, a shared decision-making process should occur to decide between early surgical intervention or non-surgical immobilization. Despite this recommendation, it appears that early or delayed ucl repair provide similar long term outcomes . If you are interested in more research on thumb ucl, have a look at the whole database . URL : https://doi.org/10.1177/17531934241274612 Abstract The development of the ulnar collateral ligament (UCL) guideline was undertaken in accordance with the British Society for Surgery of the Hand Evidence for Surgical Treatment (BEST) Process Manual, which has been accredited by the National Institute for Health and Care Excellence, UK. This review article serves as a summary of the systematic reviews and the final guideline. The group included two patients, a radiologist, a commissioner, an emergency medicine doctor, hand therapists and hand surgeons. The group’s recommendations are that patients with acute UCL injuries should be assessed with a history, clinical examination and radiographs. Patients without significant joint laxity can be treated non-surgically. Patients with significant joint laxity on clinical examination may be treated with non-surgical joint immobilization or surgical repair and should reach a shared decision with their clinician about the definitive treatment within 2 weeks of presentation. 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 the ulnar fovea sign positive only in foveal tears of the triangular fibrocartilage complex? Choudhury, M. M., Ling, A. A. A. and Yap, R. T. J. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Ulnar sided wrist pain - Fovea sign This was a short report assessing the specificity of the ulnar fovea sign, which is traditionally associated with tears in the distal radioulnar ligaments of the triangular fibrocartilage complex (TFCC). A retrospective review of 73 patients with positive ulnar fovea signs revealed that only 21 had foveal tears upon arthroscopic examination. Instead, many displayed dorsal peripheral tears, suggesting that the ulnar fovea sign can indicate both foveal and dorsal tears. Keep in mind that the patient cohort mostly comprised of young, right-handed males, often affecting the dominant hand, which may not be applicable to all the patients we see in clinical practice. 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 positive ulnar fovea sign, which has been suggested to be associated with foveal tears of the TFCC, is also frequently observed in dorsal peripheral tears. Remember that the number of TFCC "abnormalities" increases with age, and that splinting of the wrist is not the only treatment approach available for this condition . URL : https://doi.org/10.1177/17531934241279921 Abstract A positive ulnar fovea sign is usually considered to be specific for foveal disruption of the distal radioulnar ligaments. A retrospective review was done of 73 patients with a positive ulnar fovea sign. Only 21 patients had a foveal tear on arthroscopic examination. 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

Ultrasonography of the median nerve before removal of anterior locking plates from the distal radius. Hosokawa, T., et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic, Therapeutic Topic : Median nerve morphology - distal radius fracture ORIF This retrospective study assessed the median nerve's positioning and morphology following distal radial fractures open reduction and internal fixation (ORIF). A total of 36 participants were included in the study. The median nerve morphology and position was assessed via ultrasound. The results showed that the median nerve was shifted more radially in the operated arm compared to the healthy arm, showing hypertrophy and flattening at the distal radius. It appears that such positional and morphological change was caused by adhesions and scar around the median nerve. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, following a distal radial fractures treated with anterior ORIF, the median nerve is likely to be positioned more radially and undergo morphological changes. It is possible that following such changes, traditional treatment approaches including cortisone injection / splinting may be less effective. URL : https://doi.org/10.1177/17531934241280184 Abstract Both forearms of 36 patients who had been treated with an anterior locking plate using the trans-flexor carpi radialis approach for unilateral distal radial fractures were investigated by ultrasonography from the distal end of the radius to 5 cm proximally before plate removal. After fixation of the anterior locking plate, the median nerve was significantly more radially located to the flexor carpi radialis tendon than on the healthy side and showed hypertrophy and flattening at the distal end of the radius. In six cases, the median nerve on the plate side lay radial to the flexor carpi radialis tendon. The median nerve after plate fixation may lie more radially than its original position. Confirming the radial deviation of the median nerve by ultrasonography before removal of the anterior locking plate is useful to prevent the complication of median nerve injury. 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

Ultrasound evaluation shows increase in laxity after partial common extensor origin detachment but not after additional lesion of the radial band of the lateral collateral ligament. Arrigoni, P., et al. (2021) Level of Evidence: 3b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : CEO - Varus stability This cadaver study investigated the impact of sequential lateral releases on lateral elbow stability using dynamic ultrasound. A total of nine cadavers were included. The common extensor origin (CEO) was the first to be released, followed by the radial band of the lateral collateral ligament (RCL). Upon releasing the CEO, a significant increase of 200% in lateral joint line widening was observed, indicating increased compartmental laxity. However, the additional release of the LCL did not significantly alter joint laxity. This suggests that the CEO has an important stability role in elbow varus stability. 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 CEO tendon has a central role in varus stability of the elbow. It is therefore likely that trauma to the CEO (partial/full avulsion) can lead to laxity of the elbow. Alternatively, traumatic tendinopathy could develop if CEO is subjected to varus traumatic events. URL : https://doi.org/10.1007/s00167-021-06711-8 Abstract Purpose: The lateral elbow musculature conveys a dynamic valgus moment to the elbow, increasing joint stability. Muscular or tendinous lesions to the anterior half of the common extensor origin (CEO) may provoke a deficiency in the elbow dynamic stabilizers, regardless of their traumatic, degenerative, or iatrogenic aetiology. Furthermore, a role for the radial band of the lateral collateral ligament (R-LCL) has been postulated in the aetiology of lateral elbow pain. This study aimed to evaluate the effects of sequential lateral releases with dynamic ultrasound, evaluating its capability to detect lesions of the CEO and of the R-LCL. Methods: Ultrasound investigation of the lateral compartment of the elbow was performed on nine cadaveric specimens with a 10 MHz linear probe in basal conditions, after the release of the anterior half of the CEO and after complete R-LCL release. The lateral joint line widening (λ) was the primary outcome parameter, measured as the linear distance between the humeral and radial articular surfaces. Results: The release of the anterior half of the CEO significantly increased λ by 200% compared to the starting position (p = 0.0008) and the previously loaded position (p = 0.0015). Conversely, further release of the R-LCL caused only a marginal, non-significant increase in λ. Conclusions: Ultrasound evaluation can detect changes related to tendon tears or muscular avulsions of the CEO and can depict lateral elbow compartmental patholaxity by assessing articular space widening while scanning under dynamic stress. However, it cannot reliably define if the R-LCL is injured. Iatrogenic damage to the CEO should be carefully avoided, since it causes a massive increase in compartmental laxity. 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

Who crashes their car following wrist fracture? Stinton, S. B., et al. (2024). Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic / Prognostic Topic : Distal radius fracture - car crash This retrospective study assessed the occurrence of car crashes in individuals with wrist fractures. A total of 37,107 participants with either a carpal, radius, or combined radius and carpal bone fracture were included in the present study. Results revealed a 3.3% decrease in car crashes within two years post-fracture compared to pre-fracture. Of note, individuals with severe wrist injuries exhibited a 79% higher crash likelihood in the first 3 months post-fracture. Employed individuals were also at greater risk. These findings underscore the need for targeted education for those with complex injuries to mitigate crash risk. Contrary to initial assumptions, no increased crashes were observed in the early post-fracture period, potentially due to reduced driving exposure or increased cautiousness. 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, whilst having had a wrist fracture (i.e. radius/carpal bones/both) is overall protective for car crashes, those patients with a severe injury patterns or who have to return to work earlier, are more likely to have a car crash. This is in line with previous evidence showing that within the first few weeks after a distal radius fracture, people tend to be less accurate in their driving skills . If you are interested in knowing how much range of movement is required for driving, have a look at this other synopsis . URL : https://doi.org/10.1016/j.jht.2023.09.002 Abstract Background: Wrist fractures are common injuries associated with high disability in the early recovery period. The impact of wrist fractures on safe return to drive is not understood. Purpose: (1) To compare the proportion of adults who were drivers in car crashes before and after wrist fracture; (2) To examine potential factors (demographic and/or clinical) associated with increased odds of being a driver in a car crash following wrist fracture. Study Design: Retrospective cohort study. Methods: Three state-wide government datasets (MainRoads Western Australia [WA], Hospital Morbidity Data Collection and the Emergency Department Data Collection) were used to obtain and link demographic, clinical and car crash information relating to adults with a wrist fracture sustained between 2008 and 2017. McNemar’s tests were used to compare the proportion of drivers in a car crash within the 2 years prior to and following the fracture date. Multivariable logistic regressions were used to identify if any variables were associated with increased odds of crashing in the post-fracture period. Results: Data relating to 37,107 adults revealed a 3.3% (95% CI 3.0%–3.6%, p < 0.05) decrease in the proportion of drivers in a car crash following wrist fracture, persisting for the entire 2 years post-fracture, when compared to the proportion who crashed before their fracture. Those with more severe wrist fracture injury patterns had 79%(95% CI 1.07–3.0, p = 0.03) higher odds of having a crash in the first 3 months following their injury, compared to those with isolated wrist fracture injuries. Conclusions: These results inform and update return to drive recommendations. The reduced proportion of drivers involved in crashes following wrist fracture persisted for 2 years; longer than the expected physical recovery timeframe. It is important that hand therapists actively educate the sub-group of adults with more severe wrist fracture injury patterns of the increased likelihood of car crash for the 3 months following their fracture. 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

Dorsal blocking orthoses for proximal interphalangeal joint volar plate injuries: A retrospective cohort study investigating the impact of joint angle on patient outcomes. Papatolicas, K. A., Clingin, J. E. and Nicks, R. J. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : pipj volar plate injuries - neutral vs flexes immobilisation This retrospective study investigated the impact of joint angle in the treatment of proximal interphalangeal joint (PIPJ) volar plate injuries using dorsal blocking orthoses. Clinically, we have used varying flexion angles, but the optimal remains unclear. A total of 110 patients were included and splinting in neutral vs 25-30° flexion was compared. The results showed that those with the splint in neutral required fewer hand therapy appointments, with no statistically significant differences in developing a fixed flexion deformity (FFD) or achieving full flexion at discharge compared to those positioned in flexion. One of the limitations of the study is that due to its retrospective nature, it is not possible to determine whether a lower number of sessions was due to the different injury severity or the actual 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, proximal interphalangeal joint volar plate injuries can be immobilised in either a neutral or flexed dorsal blocking splint. Hence, if the patient is comfortable being immobilised in pipj neutral, there is no reason to keep them flexed. If you are interested in pipj treatment of flexion deformity/stiffness, have a look at the whole database . URL : https://doi.org/10.1016/j.jht.2024.06.002 Abstract BACKGROUND: Injuries to the proximal interphalangeal joint (PIPJ) of the fingers are commonly treated in hand therapy departments. Conservative management for PIPJ volar plate injuries typically involves a dorsal blocking orthosis and flexion exercises. Historically hand therapists have placed the PIPJ in varying degrees of flexion but the optimal angle is unknown. PURPOSE: To compare the outcomes of two treatment groups who received dorsal blocking orthoses: Those who the orthosis was positioned in neutral compared to those in 25-30° of flexion. STUDY DESIGN: Retrospective cohort study. METHOD: Patients treated by the hand therapy service at a major metropolitan hospital network in Melbourne, Australia, for conservative management of a PIPJ volar plate injury over a three-year period were included in our study. Data regarding patient demographics, digits affected and injury type were collected. Outcomes included presence of a fixed flexion deformity (FFD), amount of hand therapy received and total active flexion at the PIPJ. RESULTS: One hundred and eleven participants were included in our study. The mean age was 26 and 59 (53%) were males. Seventy two (64%) participants received a dorsal blocking orthosis positioned in neutral and 39 (35%) were positioned in 25-30° flexion at the PIPJ. Participants whose orthosis was positioned at 25-30° had an average of 24 more minutes in hand therapy (which equates to approximately one appointment) compared to those whose PIPJ was positioned in neutral (p=0.006, d=0.5). Eight percent less participants developed a FFD (p = 0.24) and 13% more participants achieved full flexion (p = 0.06) in the group who received a dorsal blocking orthosis in neutral, however these results were not statistically significant. CONCLUSION: PIPJ volar plate injures treated in an orthosis positioned in neutral required fewer hand therapy appointments. There was no statistically significant difference between groups regarding development of a FFD or full 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

Range of motion following flexor tendon repair: Comparing active flexion and extension with passive flexion using rubber bands followed by active extension. Renberg, M., Svingen, J., Arner, M. and Farnebo, S. (2024). Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Flexor tendon repair - EAM vs passive flexion This retrospective study assessed the effects of early active motion (EAM) and passive flexion with rubber bands followed by active extension on finger/hand range of motion (ROM) following flexor tendon repair in fingers and thumbs. Utilising data from the Swedish HAKIR registry, the study analyzed 702 injured fingers and 126 thumbs at 3 and 12 months post-surgery with lacerations in Zone I and II. The results showed no significant difference in total ROM between the groups at 12 months. Both groups showed similar results in achieving good or excellent outcomes based on the Strickland classification. Despite potential limitations such as non-randomisation, the study presented with a large cohort size. 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, managing post-operative flexor tendon repair in zones I and II with either Early Active Motion (EAM) or passive motion regimens demonstrate similar long-term outcomes in terms of range of motion (ROM). However, EAM may offer advantages in quicker short-term recovery of grip strength and patient-reported outcomes. A joined decision which takes into account patient's and clinician's preferences is therefore appropriate. URL : https://doi.org/10.1016/j.jhsa.2024.08.003 Abstract Purpose: This study aimed to compare the outcome in terms of range of motion between early active flexion and extension (early active motion, [EAM]) and passive flexion using rubber bands followed by active extension (sometimes referred to as a Kleinert regimen) after flexor tendon repair in zones 1 and 2. Methods: Data were collected from the Swedish national health care registry for hand surgery (HAKIR). Rehabilitation regimens were decided by the preference of each caregiver. At 3 months, 828 digits (656 EAM and 172 passive flexion) and at 12 months, 448 digits (373 EAM and 75 passive flexion) were available for analysis. Thumbs were analyzed separately. Results: No notable difference in total active motion was found between the groups at 12 months of follow-up. Conclusions: This large registry study supports the hypothesis that EAM rehabilitation may not lead to better range of motion long-term than passive motion protocols. 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

Examining the flexural behavior of thermoformed 3d-printed wrist-hand orthoses: Role of material, infill density, and wear conditions. Vlăsceanu, D., Popescu, D., Baciu, F. and Stochioiu, C. (2024) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic : 3d printed splints - biomechanical properties This lab based study investigated the mechanical properties (flexibility) of 3D-printed wrist-hand splints made from polylactic acid (PLA) and polyethylene terephthalate glycol (PETG). In particular, the study focused on how the material type and density impacted the splint flexibility. Results indicated that both PLA and PETG splints maintain suitable rigidity, with PETG showing better elasticity and less degradation over time. PLA orthoses are easier to create, while PETG orthoses offer better stability. 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, 3D-printed wrist-hand splints made from PLA and PETG materials reveals promising results for daily use in orthopedic/hand therapy applications. Despite a reduction in mechanical properties over time, both materials maintain sufficient rigidity for wrist immobilisation, with PETG demonstrating superior resistance. 3D printed splints have already been shown as to be useful following distal radius fracture . However, at the moment, thermoplastic splint are still the easiest and fastest to create. URL : https://doi.org/10.3390/polym16162359 Abstract This paper examined the mechanical properties of wrist–hand orthoses made from polylactic acid (PLA) and polyethylene terephthalate glycol (PETG), produced through material extrusion with infill densities of 55% and 80%. These orthoses, commonly prescribed for wrist injuries, were 3D-printed flat and subsequently thermoformed to fit the user’s hand. Experimental and numerical analyses assessed their mechanical resistance to flexion after typical wear conditions, including moisture and long-term aging, as well as their moldability. Digital Imaging Correlation investigations were performed on PLA and PETG specimens for determining the characteristics required for running numerical analysis of the mechanical behavior of the orthoses. The results indicated that even the orthoses with the lower infill density maintained suitable rigidity for wrist immobilization, despite a decrease in their mechanical properties after over one year of shelf life. PLA orthoses with 55% infill density failed at a mean load of 336 N (before aging) and 215 N (after aging), while PETG orthoses did not break during tests. Interestingly, PLA and PETG orthoses with 55% infill density were less influenced by aging compared to their 80% density counterparts. Additionally, moisture and aging affected the PLA orthoses more, with thermoforming, ongoing curing, and stress relaxation as possible explanations related to PETG behavior. Both materials proved viable for daily use, with PETG offering better flexural resistance but posing greater thermoforming challenges. 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

Evening regular activity breaks extend subsequent free-living sleep time in healthy adults: A randomised crossover trial. Gale, J. T., Haszard, J. J., Wei, D. L., Taylor, R. W. and Peddie, M. C. (2024) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Evening exercise - sleep This randomised crossover study assessed the impact of evening regular physical activity vs sedentary behavior on sleep. In particular, participants engaged in regular three-minute resistance exercise breaks every 30 minutes over a four-hour evening session and were compared to a period of prolonged sitting. A total of 28 healthy participants were included in the study. The results demonstrated an increase in time to sleep and total sleep time by approximately 29 minutes and 28 minutes respectively for those performing the activity breaks, with no disruption to sleep quality. These findings suggest that regular evening resistance exercises, despite traditional recommendations against nighttime workouts, may enhance total sleep time without disrupting sleep quality or daily activity levels. 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, body weight exercises performed prior to sleep can extend sleep duration without affecting overall sleep quality. In contrast with previous evidence , it appears that resistance training has a positive effect on sleep. It is possible that exercise sessions closer to the evening period, may have an effect on sleep compared to earlier in the day resistance training sessions. If you are interested in other activities to improve your clients' sleep, have a look at the whole database . URL : https://doi.org/10.1136/bmjsem-2023-001774 Abstract Objective: To determine if performing regular 3-min bouts of resistance exercise spread over 4 hours in an evening will impact subsequent sleep quantity and quality, sedentary time and physical activity compared with prolonged uninterrupted sitting. Methods In this randomised crossover trial, participants each completed two 4-hour interventions commencing at approximately 17:00 hours: (1) prolonged sitting and (2) sitting interrupted with 3 min of bodyweight resistance exercise activity breaks every 30 min. On completion, participants returned to a free-living setting. This paper reports secondary outcomes relating to sleep quality and quantity, physical activity and sedentary time which were assessed using wrist-worn ActiGraph GT3+ accelerometers paired with a sleep and wear time diary. Results A total of 28 participants (women, n=20), age 25.6±5.6 years, body mass index 29.5±6.7 kg/m2 (mean±SD) provided data for this analysis. Compared with prolonged sitting, regular activity breaks increased mean sleep period time and time spent asleep by 29.3 min (95% CI: 1.3 to 57.2, p=0.040) and 27.7 min (95% CI: 2.3 to 52.4, p=0.033), respectively, on the night of the intervention. There was no significant effect on mean sleep efficiency (mean: 0.2%, 95% CI: −2.0 to 2.4, p=0.857), wake after sleep onset (1.0 min, 95% CI: −9.6 to 11.7, p=0.849) and number of awakenings (0.8, 95% CI: −1.8 to 3.3, p=0.550). Subsequent 24-hour and 48-hour physical activity patterns were not significantly different. Conclusions Performing bodyweight resistance exercise activity breaks in the evening has the potential to improve sleep period and total sleep time and does not disrupt other aspects of sleep quality or subsequent 24-hour physical activity. Future research should explore the longer-term impact of evening activity breaks on sleep. 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