Climbing while healing: An orthotic intervention for rock climbers with a low- grade A2 pulley injury, a case series. Hartnett, E., Bondoc, S. and Feretti, A. M. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : A2 pulley injury - Splint This case series investigated whether the use of a pulley ring orthosis (PRO) among rock climbers with low-grade A2 pulley injuries, allowed people to continue climbing. Four patients with grade I to III A2 pulley injuries followed a 12-week protocol involving consistent use of a custom-fitted PRO during climbing. They trained at least 3 times per week for 2-3 hrs each time. Weekly evaluations measured strength, pain, and functional outcomes. Results indicated enhanced that strength increased and pain reduced over time, without increasing edema. By the end of the study, all participants showed full healing and maintained their climbing activities. Of note, the splint was weakened on the dorsal aspect to avoid degloving of the finger in the event it got caught whilst climbing. 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, for rock climbers with A2 pulley injuries, using a Pulley Ring Orthosis (PRO) may help continuing rock climbing whilst the injury heals. Based on previous biomechanical studies, it is however unlikely that this splint would reduce loading through the A2 pulley . If you are interested in the classification of A2 pulley injuries, have a look at this other synopsis . URL : https://doi.org/10.1016/j.jht.2023.08.005 Abstract Background: Pulley injuries are common among rock climbers, which is a growing population. Hand therapists need a therapeutic intervention which promotes healing and enables participation. Purpose: The purpose of this case series is to detail the functional outcomes of a 12-week protocol using a pulley ring orthosis (PRO) among rock climbers with a grade I, II, or III pulley injury. Study Design: A prospective repeated measures case series followed the healing timeline of four participants who rock climbed while wearing the invervention device, the PRO, with weekly measurements to monitor healing. Methods: Participants with a grade I, II, or III A2 pulley injury were custom fitted for a PRO, which they wore while rock climbing a minimum of 3 times per week for 12 weeks. Weekly check-ins were scheduled for subjective and objective measurements. Results: All participants demonstrated indicators of full healing, which, in this study, is defined as progressive improvement in strength, function, and pain, without interruption of their typical rock climbing schedules. Conclusions: Providers should consider the use of a PRO as a protective orthosis for rock climbing patients with a low-grade A2 pulley injury who want to continue rock climbing while they are healing. 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

Stress fracture of capitate bone—A case report of an unusual fracture. da Silva, M. O., Duarte, M. L., Passarelli, F. A. F. and Gobbo, D. K. P. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Capitate - Stress fractures A 23-year-old mechanic, experienced pain and swelling in the left wrist for two months, without relief with over the counter anti inflammatories. The pain initiated after changing work place and having to repeatedly perform specific mechanical repairs (e.g. using pneumatic wrench). Objectively, they presented with mild edema on the dorsal aspect of the affected wrist and there was tenderness on palpation of the central-dorsal aspect of the wrist. Radiographs were impeccable. Additional imaging was completed and magnetic resonance imaging (MRI) showed a stress fracture of the capitate. Conservative treatment, include immobilisation of the wrist for eight weeks, analgesics, and subsequent physical therapy. This course of action led to symptoms resolution and the patient's ability to return to work, albeit in a new role. 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, stress fractures of the capitate bone are uncommon and therefore often missed. While stress fractures elsewhere are commonly linked to weight-bearing and high-impact activities, capitate fractures usually arise from repetitive wrist movements, often going unrecognised initially. Radiographs are often inconclusive. Magnetic Resonance Imaging (MRI) is the preferred modality due to its superior sensitivity in detecting stress fractures and associated bone marrow edema. Conservative treatment involving immobilisation and rest for around six weeks to three months is generally effective. If you are interested in another case of hand bones stress fracture, have a look at this synopsis . URL : https://doi.org/10.1016/j.jht.2023.09.006 Abstract Introduction: The capitate is the largest, most central bone and the first to ossify in the wrist. It has a well-protected anatomic location, making traumatic or stress fractures extremely rare in clinical practice. Isolated fractures of the capitate bone are very uncommon and often without displacement due to the great stability provided by the intracarpal ligaments. Purpose of the study: This study aimed to report a case of isolated stress fracture of the capitate related to the work activity of a mechanic. Case report: We report the case of a 23-year-old patient complaining of pain and swelling in the left wrist for 2 months without improvement after using analgesics. On physical examination, he presented pain on palpation in the central region of the wrist, pain when performing flexion and extension movements of the wrist, and frustrated edema. Magnetic resonance imaging diagnosed a stress fracture of the capitate bone. Conservative treatment with forearm-palmar immobilization for 2 months, analgesic medication, and physical therapy rehabilitation after immobilization were performed. After the complete resolution of the symptoms, the patient started to work in a new role. Discussion: There are five case reports of stress fractures in the capitate—two in teenagers and three in adults, but none of them was a mechanic. Clinical suspicion can be formulated when repetitive activity is associated with the wrist in extension and specific location of pain and swelling. Individuals with an immature skeleton are more susceptible. The development of occupational disease should be considered in similar cases of insidious and persistent pain in the palm of people with high work demands. Conclusion: Stress fractures of the capitate bone are a disease that must be suspected in insidious and persistent pain in the palm of the hand. Magnetic resonance imaging is the best image test to diagnose this disorder, and conservative treatment is indicated. 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

Relevance of the scaphoid shift test for the investigation of scapholunate ligament injuries. Schmauss, D., et al. (2022) Level of Evidence: 3b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Scaphoid shift test - Diagnostic accuracy This retrospective study assessed the diagnostic value of the scaphoid shift test (SST - Watson test) for scapholunate ligament (SLL) injuries. A total of 447 patients who underwent wrist arthroscopy were included. Of this group, 153 patients had evidence of injury during artroscophy. The SST showed low sensitivity (0.50) and moderate specificity (0.78). In patients specifically referred for suspected SLL injury, sensitivity increased to 0.61, but specificity dropped to 0.62. The SST was more sensitive (0.66) for severe SLL lesions. Despite these findings, the SST alone is insufficient for a definitive diagnosis, especially for lower-grade lesions. 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 scaphoid shift test (Watson test) should be considered alongside history and other objective findings when making a diagnosis of scapholunate ligament (SLL) injury. Its sensitivity and specificity are limited, particularly for lower-grade lesions. Nevertheless, the test can be useful for an initial assessment, but a negative test result should not exclude the need for further diagnostic evaluations. If you are interested in what imaging would be useful for this condition, have a look at this synopsis . URL : https://doi.org/10.3390/jcm11216322 Abstract Background: Although it is part of the common clinical examination of scapholunate ligament pathologies, there are only little data on the diagnostic value of the scaphoid shift test. The aim of this study was to evaluate the scaphoid shift test in a large cohort of patients. Materials and Methods: We retrospectively analysed 447 patients who underwent the scaphoid shift test and wrist arthroscopy because of various suspected injuries of the wrist, correlating the results of clinical examination with data obtained during the wrist arthroscopy. Sensitivity, specificity, and positive and negative predictive values were calculated and evaluated. Results: The sensitivity of the scaphoid shift test was low (0.50) when examining the whole cohort. In a subgroup of patients specifically referred for suspected scapholunate ligament injury, the sensitivity was higher (0.61), but the specificity was low (0.62). In detecting more serious lesions (Geissler 3 + 4), the scaphoid shift test demonstrated higher sensitivity (0.66). Conclusions: An isolated scaphoid shift test may only be of limited value in the diagnosis of scapholunate ligament lesions and should, therefore, be viewed as a useful tool for a preliminary assessment, but a negative test should not prevent the surgeon from indicating a more extensive diagnostic workup. 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 A 23-year-old mechanic, experienced pain and swelling in the left wrist for two months, without relief with over the counter anti inflammatories. The pain initiated after changing work place and having to repeatedly perform specific mechanical repairs (e.g. using pneumatic wrench). Objectively, they presented with mild edema on the dorsal aspect of the affected wrist and there was tenderness on palpation of the central-dorsal aspect of the wrist. Radiographs were impeccable. What is it?

Soft bandage, splint or cast as the treatment of distal forearm torus fracture in children: A systematic review and meta-analysis. Pakarinen, O., et al. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Torus fractures - Splinting vs casting This systematic review and meta-analysis compared the effectiveness of soft bandage, splint, and cast for treating distal forearm torus fractures in children. Seven randomised controlled trials involving, 1550 participants, were included. The comparisons that the meta-analysis focused on were splinting vs casting and bandage vs rigid immobilisation (splinting/casting). The primary outcomes measured were pain, clinical healing (based on absence of pain on palpation), and return to activities. Secondary outcomes included adverse events and patient/parental satisfaction. The results suggested higher pain scores with splint in the early stages but faster return to activities when compared to casting. All fractures healed clinically within 3-4 weeks. In addition, when bandaging was compared to rigid immobilisation, participants had higher pain on the first day, however, no study comparing these interventions reported on clinical healing or return to activities. 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 appears to be as effective as casting for distal forearm torus fractures in children. Unfortunately, we don't have much information regarding clinical healing and return to activities with bandaging, hence splinting is the safest option at this stage. In specific instances where splinting may be presenting with low compliance, a shared decision-making process involving the patient's parents can be beneficial in offering bandaging instead of splinting. URL : https://doi.org/10.1038/s41598-024-71970-7 Abstract A meta-analysis including all relevant randomized controlled trials was conducted to compare soft bandage, splint and cast as the treatment of torus fracture. PubMed, Scopus, and Web of Science databases were searched in January 2023. Two comparisons were made: (1) splint versus cast, and (2) bandage versus rigid immobilization (i.e. splint or cast). Main outcomes were pain, clinical healing of the fracture and return to activities. Secondary outcomes were adverse events (skin issues, problems with cast/splint/bandage) and patient/parental satisfaction. Seven studies with 1550 patients were included. Splint was associated with higher pain scores at 3 days compared to cast (Mean difference [MD] 1.00, CI 0.06–1.94) and at 1 week (MD 1.46, CI 0.84–2.08, moderate-certainty evidence), but faster return to activities (at 3 weeks RR 1.77, CI 1.09–2.88, at 4 weeks RR 1.44, CI 1.11–1.82, moderate-certainty evidence). All torus fractures heal clinically within 3–4 weeks (low-certainty evidence). Bandage may lead to slightly higher pain score (MD 0.35, CI 0.04–0.66, moderate-certainty evidence) at first day after treatment compared to rigid immobilization, but no evidence of a difference was found in later time points. In conclusion, soft bandage or removable wrist splint seem to be optimal first-line treatment of distal forearm torus 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

Efficacy of hydrodilatation in frozen shoulder: A systematic review and meta-analysis. Poku, D., Hassan, R., Migliorini, F. and Maffulli, N. (2023) Level of Evidence: 1a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Frozen shoulder - hydrodilatation This systematic review and meta-analysis assessed the efficacy of hydrodilatation in treating frozen shoulder compared with other conservative management options (e.g. cortisone injections). The review includes data from 39 studies involving 2623 participants. Outcomes measured included pain, upper limb function, range of movement (e.g. shoulder flexion, external rotation, internal rotation). The results showed that hydrodilatation provides transient improvements in shoulder disability and passive external rotation compared to intra-articular corticosteroid injections, although no long-term superiority in pain relief was observed. Significant improvements in passive external rotation were noted at both early and late follow-ups. The procedure did not show significant differences when compared with other treatments like manipulation under anesthesia (MUA) and arthroscopic capsular release (ACR), but it remains a less invasive and more cost-effective alternative. Keep in mind that around 18 comparisons were made and only three were statistically significant, suggesting that there is 30% chance of these findings being significant due to chance. 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, hydrodilatation is a promising conservative treatment for patients suffering from frozen shoulder. It leads to short-term pain relief and significant improvements in shoulder disability and passive external rotation compared to intra-articular corticosteroid injections. The confidence in these findings is however limited due to the multiple statistical comparisons made. If you are interested in additional information on shoulder assessment and management, have a look at the whole database . URL : https://doi.org/10.1093/bmb/ldad018 Abstract Introduction: It is unclear whether hydrodilatation is beneficial in the management of frozen shoulder compared with other common conservative management modalities. This systematic review evaluates the efficacy of hydrodilatation for the management of frozen shoulder. Sources of data: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An extensive search of PubMed, Embase, Scopus, Cochrane Central, Web of Science and CINAHL databases using multiple keyword combinations of ‘shoulder’, ‘rotator’, ‘adhesive capsulitis’, ‘hydrodilatat*’, ‘distension’ since inception of the databases to June 2023 was implemented. Areas of agreement: Hydrodilatation leads to at least transient more marked improvements in shoulder disability and passive external rotation compared with intra-articular corticosteroid injections. Areas of controversy: Hydrodilatation improves passive external rotation in the longer term. Moreover, hydrodilatation may be a preferable option over manipulation under anaesthesia, given its lower cost and better patient convenience. Growing points: Intensive mobilization after hydrodilatation is a promising adjuvant treatment option for patients suffering from a frozen shoulder. Areas timely for developing research: Although current evidence suggests that hydrodilatation provides a transient improvement in disability in patients with frozen shoulder, its clinical relevance remains unclear. Further research is necessary to establish its role in the management of the condition. 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

Association of weight loss and weight gain with structural defects and pain in hand osteoarthritis: Data from the osteoarthritis initiative. Salis, Z., Driban, J. B., McAlindon, T. E., Eaton, C. B. and Sainsbury, A. (2024) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic, Prognostic Topic : Weight loss/gain - Hand osteoarthritis The prospective study assessed the association between weight change and the incidence, progression, development, and resolution of hand osteoarthritis (OA) using data from the Osteoarthritis Initiative. A cohort of 4,598 participants was analysed, excluding those with cancer, rheumatoid arthritis, or a body mass index below 18.5 kg/m². The research utilised multivariable logistic regression to assess the impact of weight change over a 4-year period on radiographic hand OA and mixed-effects logistic regression to examine pain outcomes over an 8-year span. The study revealed no statistically significant correlations between weight change and the incidence or progression of radiographic hand OA or the development or resolution of hand pain. The findings support current guidelines that do not recommend weight management as a treatment for hand OA. The study suggests that the biomechanical impacts of weight change are not applicable to non-weight-bearing joints like those in the hand. 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, weight change (either loss or gain) over 4 to 8 years does not significantly influence the incidence or progression of radiographic hand osteoarthritis (OA) or the development or resolution of hand pain. Therefore, weight management should not be prioritised exclusively as a treatment strategy for hand OA. Despite these findings suggesting that weight changes are not associated with pain or OA progression, it appears that being overweight, in addition to several other factors, may contribute to the risk of developing hand OA . URL : https://doi.org/10.1002/acr.25284 Abstract Objective: Our aim was to define the association of weight change (weight loss or weight gain) with the incidence and progression of hand osteoarthritis (OA), assessed either by radiography or by pain, using data from the Osteoarthritis Initiative. Methods: Among the 4,796 participants, we selected 4,598 participants, excluding those with cancer or rheumatoid arthritis or a body mass index under 18.5 kg/m2. We investigated the association of weight change with incidence and progression of radiographic hand OA and the development and resolution of hand pain. Using multivariable logistic regression, we investigated the association of weight change from baseline to the 4-year follow-up with the incidence and progression of radiographic hand OA at the 4-year follow-up. Additionally, multivariable repeated-measure mixed-effects logistic regression analyzed the association of weight change with the development and resolution of hand pain across 2-year, 4-year, 6-year, and 8-year follow-ups. Results: No statistically significant associations were observed between weight change and the investigated outcomes. Specifically, for each 5% weight loss, the odds ratios for the incidence and progression of radiographic hand OA were 0.90 (95% confidence interval [95% CI] 0.67–1.23) and 0.92 (95% CI 0.84–1.00), respectively. Similarly, for each 5% weight loss, the odds ratios for the development and resolution of hand pain at the 8-year follow-up were 1.00 (95% CI 0.92–1.09) and 1.07 (95% CI 0.91–1.25), respectively. Conclusion: Our study found no evidence of an association between weight change and the odds of incidence or progression of radiographic hand OA over 4 years, nor the development or resolution of hand pain over 8 years. 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

Carpal tunnel syndrome: Rapid evidence review. Wipperman, J. and Penny, M. L. (2024) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic : Carpal tunnel syndrome - Diagnostic flowchart This narrative review aimed to summarise the most recent updates on carpal tunnel syndrome (CTS). Diagnoses rely on classic symptoms, physical examination tests like the Phalen test and Tinel ones, and may be supported by electrodiagnostic studies, especially in atypical cases. While provocative maneuvers have varying accuracy, thenar atrophy is a highly specific sign for CTS. Mild to moderate CTS often responds to nonsurgical treatments such as wrist splinting and corticosteroid injections. Night-only splinting is effective, and neutral wrist splints may be more beneficial than extension splints. In cases with recent onset, corticosteroid injections can offer short-term relief, with similar six-month outcomes compared to splinting. Severe cases, or those with objective weakness or sensory deficits, often require surgical decompression, with both endoscopic and open release techniques proving equally effective. Below you can find the diagnostic flowchart that the authors propose. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Base on what we know today, Carpal Tunnel Syndrome (CTS), is one of the most prevalent entrapment neuropathy of the upper limb. Diagnosis is primarily clinical, supported by symptoms such as pain and paresthesia in the first three digits and radial half of the fourth digit, often exacerbated at night. Provocative tests like Phalen and Tinel may be used but have variable predictive power. For patients with mild to moderate symptoms, initial management should include night-time splints as it appears that corticosteroid injections have a similar efficacy and lead to a greater number of surgeries at two years . Keep in mind that other diagnoses (e.g. space occupying lesion , persistent median artery ) could cause symptoms of CTS and these should be investigated if conservative treatment is not effective. URL : https://pubmed.ncbi.nlm.nih.gov/39028782/ Abstract Carpal tunnel syndrome (CTS) is caused by compression of the median nerve as it travels through the carpal tunnel. Patients commonly experience pain, paresthesia, and, less often, weakness in the distribution of the median nerve. Provocative maneuvers, such as the Phalen test and Tinel sign, have varying sensitivity and specificity for the diagnosis of CTS. Thenar atrophy is a late finding and highly specific for CTS. Although patients with a classic presentation of CTS do not need additional testing for diagnosis, electrodiagnostic studies can confirm the diagnosis in atypical cases, exclude other causes, and gauge severity for surgical prognosis. An abnormal nerve conduction study is useful for ruling in CTS, but a normal test does not necessarily exclude it. Over-the-counter analgesics, such as nonsteroidal anti-inflammatory drugs and acetaminophen, have not shown benefit for CTS. Patients with mild to moderate CTS initially may be offered nonsurgical treatments, such as splinting or local corticosteroid injections. Night-only splinting is as effective as continuous wear. A neutral wrist splint may be more effective than an extension splint. In patients with recent onset of CTS, corticosteroid injections provide slightly greater improvement of symptoms compared with splinting at 6 weeks, with similar outcomes at 6 months. Patients with severe CTS, including objective weakness or sensory deficits, should be offered surgical decompression. Endoscopic and open carpal tunnel release techniques are equally effective. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomized trial. Burton, C., et al. (2022) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic : Carpal tunnel syndrome - CSI or splinting This randomised controlled trial assessed the long-term effectiveness of corticosteroid injection (CSI) compared to night splinting (NS) for managing mild-to-moderate carpal tunnel syndrome (CTS) over 24 months. A total of 239 participants were either randomised to a single CSI injection or night splinting for six weeks. The effectiveness of the intervention was assessed through the Boston Carpal Tunnel Questionnaire. The data was collected at baseline, six weeks, six months, one year, and two years. The results showed that both treatments improved symptoms, with no significant overall difference in clinical effectiveness between the groups at 12 and 24 months. At six weeks, the CSI group had greater relief. More participants in the CSI group sought and underwent surgery (22%) compared to the NS group (16%). CSI was determined to be less cost-effective than NS over the long term. 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 injection (CSI) and night splinting (NS) for the management of mild-to-moderate carpal tunnel syndrome NS are safe and effective options. However, initial treatment with NS may be more cost-effective in the long term. Patients can be encouraged to make a choice between CSI or NS based on their personal preferences and circumstances, keeping in mind that while both treatments are clinically effective, NS may lead to fewer surgeries and lower healthcare costs over time. If you want more information about CTS, have a look at the whole database . URL : https://doi.org/10.1093/rheumatology/keac219 Abstract Objectives: This follow-up study of the INSTinCTS (INjection vs SplinTing in Carpal Tunnel Syndrome) trial compared the effects of corticosteroid injection (CSI) and night splinting (NS) for the initial management of mild-to-moderate CTS on symptoms, resource use and carpal tunnel surgery, over 24 months. Methods: Adults with mild-to-moderate CTS were randomized 1:1 to a local corticosteroid injection or a night splint worn for 6 weeks. Outcomes at 12 and 24 months included the Boston Carpal Tunnel Questionnaire (BCTQ), hand/wrist pain intensity numeric rating scale (NRS), the number of patients referred for and undergoing CTS surgery, and healthcare utilization. A cost–utility analysis was conducted. Results: One hundred and sixteen participants received a CSI and 118 a NS. The response rate at 24 months was 73% in the CSI arm and 71% in the NS arm. By 24 months, a greater proportion of the CSI group had been referred for (28% vs 20%) and undergone (22% vs 16%) CTS surgery compared with the NS group. There were no statistically significant between-group differences in BCTQ score or pain NRS at 12 or 24 months. CSI was more costly [mean difference £68.59 (95% CI: −120.84, 291.24)] with fewer quality-adjusted life-years than NS over 24 months [mean difference −0.022 (95% CI: −0.093, 0.045)]. Conclusion: Over 24 months, surgical intervention rates were low in both groups, but less frequent in the NS group. While there were no differences in the clinical effectiveness of CSI and NS, initial treatment with CSI may not be cost-effective in the long-term compared with NS. 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

Locking of the metacarpo-phalangeal joint from a loose body: Report of a case. Honner, R. (1969) Level of Evidence: 4 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic, Therapeutic Topic : Mcpj locking - Loose body A 55-year-old woman had a twisting injury of their right index finger which had not resolved with four months of conservative management. At their first appointment, they reported pain and stiffness of the mcpj. In particular, they had full mcpj extension, but flexion was limited to 35 degrees. There was tenderness on palpation and swelling at the affected mcpj, however, there was no ligament laxity. Radiographs revealed a loose body within the joint (see picture below), which was surgically removed. Post-surgery, the patient regained nearly full range of motion. The authors highlight the rarity of this condition and compare it to other known causes of joint locking such as osteophytes, irregularities on the articular surface, or issues with the capsule or ligaments. 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, locking of the metacarpo-phalangeal joint due to a loose intra-articular body is an uncommon, but noteworthy phenomenon. Patients typically present with a history of joint trauma, which leads to locking, pain, and limited range of motion. Imaging techniques such as x-rays are useful in identifying these loose bodies. Conservative treatment often does not yield significant improvement, and surgical removal of the loose body tends to provide the best outcomes. URL : https://doi.org/10.1302/0301-620X.51B3.479 Abstract 1. Locking of the metacarpo-phalangeal joint from articular derangements is rare. 2. A case due to an intra-articular loose body is described. 3. The literature is reviewed. The commonest cause is catching of the volar capsule or collateral ligaments on osteophytes about the metacarpal head, but intra-articular bands, incongruities of the articular surface and entrapment of the sesamoid have also been described. 4. An analysis of the reported cases suggests the likely cause in the individual patient. 5. Operation is usually required to restore joint motion. 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

Loose body in the wrist: Diagnosis and treatment. Koh, S., et al. (2003) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic, Therapeutic Topic : Wrist loose bodies - Symptoms This retrospective study investigated the clinical presentation and management of loose bodies in the wrist joints. The diagnosis was made through arthroscopy. The participants included had been assessed and managed between 1986 and 2000. A total of 707 patients' files were reviewed and of these, 10 presented with loose bodies in the wrist joints. These 10 participants were mostly males with an average age of 28. They primarily reported wrist pain, with locking being uncommon. Preoperative diagnosis was challenging except in three cases with osseous components. Arthroscopy diagnosed and facilitated the removal of loose bodies in five cases involving the radiocarpal joint (RCJ), while arthrotomy (open surgery) was required for those in the distal radioulnar joint (DRUJ). Post-surgery, all patients experienced pain relief without complications. 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, loose bodies in the wrist joint should be considered in the differential diagnosis when evaluating patients with chronic wrist pain, especially when the pain is not explained by standard imaging techniques. Loose bodies in the wrist do not commonly present with locking and if there is no bony component to the loose body (e.g. cartilaginous), advanced imaging/surgery is required to make the diagnosis. If you are interested in joint locking of the upper limb, have a look at this case study about mcpj locking of the index finger . URL : https://doi.org/10.1016/S0749-8063(03)00738-2 Abstract Purpose: The purpose of this study was to report on 10 cases of symptomatic loose bodies in the wrist joints diagnosed using arthroscopy. Type of Study: Retrospective review. Methods: From1986 to 2000, we performed wrist arthroscopy for 707 patients, 10 of whom had loose bodies in the wrist joints. The clinical records were reviewed retrospectively. The patients included 8 men and 2 women, and the average age was 28 years (range, 16 to 67 years). The chief complaint was wrist pain in all patients, but locking was uncommon. Preoperative diagnosis was difficult in all but 3 cases; in those cases, an osseous component was found within the loose bodies. The remaining cases were diagnosed by wrist arthroscopy. Results: The loose bodies existed in the radiocarpal joint in 5 cases, and all could be removed arthroscopically. In the other 5 cases, the loose bodies were in the distal radioulnar joint, and arthrotomy was needed to remove them. After removal of the loose bodies, the pain was relieved in all cases without any surgical complications. Conclusions: Loose bodies in the wrist joint should be included in the differential diagnosis for chronic wrist pain. Wrist arthroscopy is of value because the preoperative diagnosis is usually difficult. 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

Prevalence of De Quervain disease in infant caregivers and its association with risk factors. Manzoor, A., et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Symptoms prevalence study, Prognostic Topic : De Quervain - Risk factors This cross-sectional study assessed the prevalence of De Quervain’s disease among infant caregivers and its association with various risk factors. Among the 190 participants, comprising mothers and other caregivers, the prevalence rate was found to be 30%. The diagnosis of De Quervain was made if the participants were positive on Finkelstein’s test. Significant risk factors included the infant’s age (highest risk between 4 and 6 months), the frequency of lifting (subjectively reported as often or always), and being right handed. Factors that did not appear to be significant were caregiver's age, history of wrist pain, infant weight, and relationship to the infant (e.g. mother or other) were not significant. 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, De Quervain disease shows a high prevalence among caregivers of infants, with 30% of participants in this study being affected. The findings highlight that infant's age, lifting frequency, and hand dominance are significant risk factors. It is possible that training caregivers to lifting weight prior to having to lift babies may help reduce the incidence of such presentation. If you are interested in more information about De Quervain assessment and management, have a look at the whole database . URL : https://doi.org/10.47391/JPMA.4916 Abstract De Quervain’s disease (DQD) is commonly reported in mothers during pregnancy up to delayed postpartum period. A cross-sectional study was conducted to assess infant caregivers who visited the paediatric outpatient department or vaccination centre in two hospitals of Lahore, during the months of May and June, 2021. A total of 190 subjects were interviewed directly and assessed by applying Finkelstein’s test on both hands. Data was collected using Numeric Pain Rating Scale (NPRS) and Patient Rated Wrist Evaluation (PRWE) from positive subjects. They were asked to report their pain and difficulty level of the affected hand with worsened symptoms. The results exhibited 26.8% prevalence of DQD in a sample size of 190. Infant’s age, lifting frequency and hand dominance were proved significant risk factors. However, caregiver’s age, history of wrist pain, infant weight and relationship with infant were proved insignificant. Mean PRWE pain and functional scores were 23.14 ± 7.72 and 18.53 ± 6.09, respectively. 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