Search Results

Is hand therapy associated with a delay in surgical treatment in thumb carpometacarpal arthritis? Portney, D. A., Stillson, Q. A., Strelzow, J. A. and Wolf, J. M. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Prognostic Topic : Thumb OA and hand therapy – Reduction in surgical rates This retrospective study examined the role of hand therapy in delaying surgical treatment for thumb carpometacarpal joint (cmcj) osteoarthritis. A total of 44,378 participants, from a national insurance claims database were included. Two groups of participants were compared: a hand therapy cohort comprising patients who received physical or occupational therapy after their thumb cmcj OA diagnosis and before surgery, and a non-therapy cohort selected by matching participants based on age, sex, and comorbidities. The results showed that hand therapy was associated with lower rates of subsequent surgery for thumb CMC osteoarthritis and longer times to surgery. Clinical Take Home Message : Based on what we know today, hand therapy is associated with lower rates of surgery and longer times to surgery for thumb carpometacarpal osteoarthritis. This may be useful for patients who are on a public wait-list for surgery or that are not so keen on undergoing surgery for their current levels of pain in the thumb. Similar findings have been shown for carpal tunnel syndrome . If you are interested in the available treatments for thumb OA, you should check the whole database . URL : https://doi.org/10.1016/j.jhsa.2023.05.019 Abstract Purpose: Thumb carpometacarpal (CMC) osteoarthritis (OA) causes functional disability and an increased health care burden in the aging population. The role of therapy in thumb CMC OA has been minimally analyzed in the literature. We hypothesized that patients treated with therapy for thumb CMC OA would demonstrate reduced rates of surgery for this diagnosis. Methods: We queried a national insurance dataset for all patients with an International Classification of Diseases, Ninth Revision, or International Statistical Classification of Diseases, Tenth Revision, code for thumb CMC OA, with a minimum of 2 years of follow-up. A 2:1 propensity-matched cohort of patients with CMC OA who did not receive therapy versus a therapy cohort was created, with a minimum of two sessions of hand therapy for inclusion. The primary outcome was the rate of thumb CMC OA surgery occurring within 2 years of diagnosis; time to surgery and use of thumb CMC injections were secondary outcomes. Multivariable logistic regression analysis was used to identify the risk factors for undergoing surgical treatment. Results: After matching, the therapy cohort comprised 14,548 patients, with a matched group of 28,930 patients who did not undergo therapy. In the overall sample, the rate of surgery within 2 years was 22.5%. Two-year surgical treatment rates were significantly higher for those who did not undergo therapy when compared with those who did (29.3% vs 13.1%). Patients treated with therapy had a significantly longer time to surgery, with no difference in the rate of surgery after one year. In multivariable regression of all included variables, lack of therapy intervention had the highest odds of surgery for thumb CMC OA (odds ratio 4.3). Conclusions: We present the findings of a large insurance database evaluating the association of therapy with rates of surgical treatment for thumb CMC arthritis. On average, those treated with therapy had longer times to surgery, and the 2-year surgery rates for patients diagnosed with thumb CMC arthritis were significantly higher in those who did not undergo therapy 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

Complications following volar locking plate fixation of distal radius fractures in adults: A systematic review of randomized control trials. Nwosu, C., et al. (2023) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Prognostic Topic : Distal radius fracture – Complications This systematic review assessed the incidence of postoperative complications following volar locking plate fixation of distal radius fractures (DRFs) in adults. A total of 1,419 participants out of 35 studies were included. The overall complication rate was 31%, with 12% being major complications. The most common complications were nerve-related injuries and additional surgery. The most common nerve affected was the median nerve at the carpal tunnel. 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, ORIF for DRFs is associated with a high rate of postoperative complications than what we would expect. In particular, 31% of participants appear to present with minor or major complications. This is in contrast with a previous paper (with a large sample), suggesting that complications occur in 12% of patients . Considering these findings combined, we can say that about 1 to 3 people out of 10 present with some form of complication post-ORIF for DRF. URL : https://doi.org/10.1016/j.jhsa.2023.04.022 Abstract Purpose: The purpose of this study was to assess the incidence of postoperative complications following volar locking plate (VLP) fixation of distal radius fractures (DRFs). Methods: A search using keywords and subject headings to represent the concepts of volar plating and radius fractures was generated. Databases such as MEDLINE (Ovid), Embase (Elsevier), Scopus (Elsevier), and SPORTDiscus (EBSCO) were searched from inception to November 24, 2021, for randomized controlled trials that reported complications following DRF treated with VLP. Inclusion criteria were studies with adult patients (aged ≥18 years) randomized to VLP fixation without other concomitant surgical interventions, with a minimum follow-up of 3 months. Study sample characteristics and post-surgical complications were extracted. The Cochrane Risk of Bias tool was used to evaluate quality of evidence. Results: Of the 4,059 articles identified using the search strategy, 1,778 titles/abstracts and 856 full-text articles were screened for inclusion, of which 35 articles were included for data extraction. Overall, 1,419 patients with a DRF were randomized to VLP fixation. The mean age was 60.3 years. The overall complication rate was 30.8% following VLP fixation, with 12.4% being major complications. The most common complications were median nerve-related (7.1%) and hardware removal (6.8%), secondary to other complications. Tenosynovitis was the most common tendon-related complication (3.4%). Other complications included complex regional pain syndrome (2.4%), malunion (1.3%), superficial wound infections (1.9%), and tendon rupture (1.3%). Conclusions: A meta-analysis of high-quality studies that discuss the complications after VLP fixation for DRF showed an overall complication rate of 30.8%. VLP may be related to more hardware-related complications than those previously reported. 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

Evaluating male patients: Understanding of osteoporosis evaluation and treatment following a distal radius fracture. Russo, M., et al. (2023) Level of Evidence : 4 Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : Bone mass density post forearm fractures - Shall we screen males This was a phenomenological study investigating the understanding of osteoporosis in male patients over 50 who had sustained a low-energy distal radius fracture (DRF). A total of 20 participants were selected amongst 80 male patients with low-energy DRF to get a representative sample. All twenty participants were interviewed. The results showed that participants had little knowledge of osteoporosis or its treatment, and many regarded it as a women's disease. Most participants had never discussed osteoporosis with their primary care physicians. Families, friends, or the internet served as the primary information source. Participants expressed a willingness to undergo a DEXA scan and treatment if necessary. Despite patients reporting that they felt their bones were strong, DEXA scan revealed osteopenia in a few (see table 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, male patients are often unaware of osteoporosis as a disease entity that could affect them. We should work alongside primary care physicians to raise awareness and improve the treatment of osteoporosis in male patients through a collaborative multi-disciplinary approach. This is especially true for those male patients presenting with a low-energy distal radius fracture. Remember that there are tools to screen your patients to determine whether they need further screening and these should be used. URL : https://doi.org/10.1016/j.jhsa.2023.07.006 Abstract Purpose: Current estimates suggest that 1–2 million men in the United States have osteoporosis, yet the majority of osteoporosis literature focuses on postmenopausal women. Our aim was to understand men’s awareness and knowledge of osteoporosis and its treatment. Methods: Semistructured interviews were conducted with 20 male patients >50 years old who sustained a low-energy distal radius fracture. The goal was to ascertain patients’ knowledge of osteoporosis, its management, and experience discussing osteoporosis with their primary care physicians (PCP). Results: Participants had little knowledge of osteoporosis or its treatment. Many participants regarded osteoporosis as a women’s disease. Most participants expressed concern regarding receiving a diagnosis of osteoporosis. Several patients stated that they believe osteoporosis may have contributed to their fracture. Families, friends, or mass media served as the primary information source for participants, but few had good self-reported understanding of the disease itself. The majority of participants reported never having discussed osteoporosis with their PCPs although almost half had received a dual x-ray absorptiometry scan. Participants expressed general interest in being tested/screened and generally were willing to undergo treatment despite the perception that medication has serious side effects. One patient expressed concern that treatment side effects could be worse than having osteoporosis. Conclusion: Critical knowledge gaps exist regarding osteoporosis diagnosis and treatment in at-risk male patients. Specifically, most patients were unaware they could be osteoporotic because of the perception of osteoporosis as a women’s disease. Most patients had never discussed osteoporosis with their PCP. Clinical relevance: Male patients remain relatively unaware of osteoporosis as a disease entity. Opportunity exists for prevention of future fragility fractures by improving communication between patients and physicians regarding osteoporosis screening in men following low-energy distal radius fractures. 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

Rehabilitation following flexor tendon injury in Zone 2: A randomized controlled study. Renberg, M., Turesson, C., Borén, L., Nyman, E. and Farnebo, S. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : Active vs passive mobilisation - Zone 2 flexor tendon repair This randomised trial examined the effects of active and passive motion therapy on the range of motion (ROM), grip strength, and key pinch of patients after flexor tendon repair. A total of 64 participants were randomised to either active mobilisation or passive mobilisation with place and hold. All participants were followed up for 12 months. Results showed no significant difference between the two groups in terms of ROM, grip strength, key pinch, rupture frequency, Disabilities of Arm, Shoulder and Hand (DASH) score and performance on the Purdue Pegboard test. 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 active and passive mobilisation regimens can lead to similar outcomes in terms of range of motion, grip strength, and key pinch strength at 3, 6, and 12 months following a zone 2 flexor tendon repair. However, active mobilization may lead to quicker recovery in terms of grip strength and patient-reported outcome measures. Overall, it appears that either approach can be utilised to accommodate patients' and clinicians' preferences. If you are interested in other approaches for flexor tendon rehab, have a look at this synopsis . URL : https://doi.org/10.1177/17531934231166336 Abstract The aim of this study was to compare an early active motion (EAM) regimen to a modified Kleinert passive motion therapy in Zone 2 flexor tendon injuries with regards to range of motion (ROM), grip strength and patient-reported outcome measures (PROMs). Seventy-two patients were included. At 3 months postoperatively, we found no difference in total active motion (TAM) between the EAM and the Kleinert groups (median 195.5°, range 115°–273° versus median 191.5°, range 113°–260°), but a significantly better grip strength (median 76%, range 44%–99% versus median 54%, range 19%–101%; p < 0.0005) in the EAM group. Disabilities of the Arm, Shoulder and Hand (DASH) score as well as patient-reported weakness, cold intolerance and problems in daily activities also favoured the EAM group. At 12 months postoperatively, there was no difference in TAM, grip strength or any of the PROMs used. We conclude that EAM leads to a quicker recovery in terms of grip strength and PROMs, but that both regimens lead to similar results at 12 months. 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

Exploring the role of a large language model on carpal tunnel syndrome management: An observation study of ChatGPT. Seth, I., et al. (2023) Level of Evidence : 5 Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : ChatGPT carpal tunnel syndrome – Information for patients This study assessed responses provided by ChatGPT when asked about carpal tunnel syndrome (CTS). Six questions were asked and the responses were evaluated for accuracy, coherence and comprehensiveness. Additionally, ChatGPT was asked to provide five evidence-based recommendations for CTS management. The results of the study showed that ChatGPT was able to provide clinically relevant information on CTS, although at a relatively superficial level. However, ChatGPT generated nonexistent and inaccurate references. Large language models can be used to support healthcare management of CTS, but they cannot replace the expertise of healthcare professionals. 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, large language models such as ChatGPT can be used to support healthcare management of carpal tunnel syndrome, but they don't have the same specialised knowledge as healthcare professionals. This is in line with previous evidence, which assessed ChatGPT's ability to provide patients with useful information for the management of scaphoid fractures . Remember that ChatGPT hallucinates when you ask them for scientific reference and it makes up studies. URL : https://doi.org/10.1016/j.jhsa.2023.07.003 Abstract Purpose: Recently, large language models, such as ChatGPT, have emerged as promising tools to facilitate scientific research and health care management. The present study aimed to explore the extent of knowledge possessed by ChatGPT concerning carpal tunnel syndrome (CTS), a compressive neuropathy that may lead to impaired hand function and that is frequently encountered in the field of hand surgery. Methods: Six questions pertaining to diagnosis and management of CTS were posed to ChatGPT. The responses were subsequently analyzed and evaluated based on their accuracy, coherence, and comprehensiveness. In addition, ChatGPT was requested to provide five high-level evidence references in support of its answers. A simulated doctor-patient consultation was also conducted to assess whether ChatGPT could offer safe medical advice. Results: ChatGPT supplied clinically relevant information regarding CTS, although at a relatively superficial level. In the context of doctor-patient interaction, ChatGPT suggested a diagnostic pathway that deviated from the widely accepted clinical consensus on CTS diagnosis. Nevertheless, it incorporated differential diagnoses and valuable management options for CTS. Although ChatGPT demonstrated the ability to retain and recall information from previous patient conversations, it infrequently produced pertinent references, many of which were either nonexistent or incorrect. Conclusions: ChatGPT displayed the capability to deliver validated medical information on CTS to nonmedical individuals. However, the generation of nonexistent and inaccurate references by ChatGPT presents a challenge to academic integrity. Clinical relevance: To increase their utility in medicine and academia, large language models must go through specialized reputable data set training and validation from experts. It is essential to note that at present, large language models cannot replace the expertise of health care professionals and may act as a supportive tool. 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

Management of distal biceps tendon ruptures: A survey of fellowship-trained subspecialist elbow surgeons. Rosenthal, R., Ting, R. S. and Sher, D. (2023) Level of Evidence : 5 Follow recommendation : 👍 👍 (2/4 thumb up) Type of study : Therapeutic Topic : Distal biceps repair - Is there a consensus? This was a survey study of 200 fellowship-trained elbow specialist orthopaedic surgeons to investigate their perceptions and management of distal biceps tendon ruptures. The results showed that one-incision (anterior) was preferred over two-incisions (anterior and posterior). Re-ruptures were the most common cause of reoperation, and the likelihood of encountering a re-rupture decreased with more conservative postoperative restriction. Overall there is limited consensus amongst elbow surgeons regarding the management of distal biceps tendon ruptures and the management approach is highly dependent on individual preferences. 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, distal biceps tendon ruptures are commonly managed by elbow surgeons, with the one-incision (anterior) approach being preferred. Complications from repair can be expected even amongst highly trained surgeons, and are associated with surgical approaches (see figure above) as well as the type of rehabilitation that patients undergo. More conservative postoperative rehabilitation may be associated with a lower risk of re-rupture. As a result, the additional cost associated with the involvement of hand therapists/physiotherapists in the rehab of these patients may be warranted. URL : https://doi.org/10.1016/j.jse.2023.05.034 Abstract Background: There are several approaches to the management of distal biceps tendon ruptures, with no consensus on what constitutes best practice. Methods: An online survey queried the perceptions and management of distal biceps tendon ruptures amongst fellowship-trained subspecialist elbow surgeons, which primarily comprised of members of the Shoulder and Elbow Society of Australia, the national subspecialist interest group of the Australian Orthopaedic Association and the Mayo Clinic Elbow Club (Rochester, MN). Results: One hundred surgeons responded. The median (IQR) experience as orthopedic surgeons amongst respondents was 17 (10–23) years. 78% of respondents saw >10 cases of distal biceps tendon ruptures annually. 95% of respondents would recommend surgery for symptomatic radiologically-confirmed partial tears, the most common indications being pain (83%), weakness (60%), and tear size (48%). 43% of respondents would have grafts available for tears older than 6 weeks. The one-incision approach (70%) was preferred over two-incisions (30%). 78% of one-incision users believed that their repair location was anatomic, compared to 100% of two-incision users. One-incision users were more likely to have encountered lateral antebrachial cutaneous nerve (78% vs 46%) and superficial radial nerve palsies (28% vs 11%). Two-incision users were more likely to have encountered posterior interosseus nerve palsy (21% v 15%), heterotopic ossification (54% vs 42%), and synostosis (14% vs 0%). Re-ruptures were the most common cause of reoperation. The more conservative a respondent’s postoperative immobilization was, the less likely they were to have ever encountered re-rupture (14% amongst cast users, 29% amongst splint/brace users, 49% amongst sling users, 100% amongst non-immobilizers). 30% of respondents who placed elbow strength restrictions for 6 months postoperatively encountered re-rupture, compared to 40% amongst those who restricted for 6–12 weeks postoperatively. Conclusions: The operation rate for repair of distal biceps tendon ruptures amongst subspecialist elbow surgeons is high, as seen in our cohort. However, there is a large variation in the approach toward its management. One-incision (anterior) was preferred over two-incisions (posterior). Complications from repair of distal biceps tendon ruptures can be expected even amongst subspecialists, and are associated with surgical approach. The responses imply that more conservative postoperative rehabilitation may be associated with a lower risk of re-rupture. 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

Recurrent and persistent carpal tunnel syndrome: Predicting clinical outcome of revision surgery. Sun, P. O., et al. (2019) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Carpal tunnel revision - who responds? This is a prospective study assessing the clinical outcome of revision surgery for carpal tunnel syndrome (CTS). A total of 114 participants who had a previous carpal tunnel release, who still presented with symptoms were included. The results showed that revision surgery significantly improved symptoms and function in the majority of patients. However, a longer total duration of symptoms, a higher Boston Carpal Tunnel Questionnaire (BCTQ) total score at intake, and diagnosis of complex regional pain syndrome (CRPS) along with CTS were associated with worse outcomes at 6 months post-operatively. The statistical analyses only explained 30% of the variance in outcome and other variables are likely to play a role in patients' 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, revision surgery for carpal tunnel syndrome (CTS) is an effective treatment for patients with recurrent and persistent symptoms. However, in patients with lower scores on the Boston Carpal Tunnel Questionnaire, longer duration of symptoms, and diagnosis of CRPS the likelihood of improvement with revision surgery is reduced. These results appear to support additional evidence on prognostic factors for responders to carpal tunnel release . URL : https://doi.org/10.3171/2018.11.JNS182598 Abstract OBJECTIVE: The aim of this study was to evaluate the self-reported outcome of revision surgery in patients with recurrent and persistent carpal tunnel syndrome (CTS) and to identify predictors of clinical outcome of revision surgery. METHODS: A total of 114 hands in 112 patients were surgically treated for recurrent and persistent CTS in one of 10 specialized hand clinics. As part of routine care, patients were asked to complete online questionnaires regarding demographic data, comorbidities, and clinical severity measures. The Boston Carpal Tunnel Questionnaire (BCTQ) was administered at intake and at 6 months postoperatively to evaluate clinical outcome. The BCTQ comprises the subscales Symptom Severity Scale (SSS) and Functional Status Scale (FSS), and the individual scores were also assessed. Using multivariable regression models, the authors identified factors predictive of the outcome as measured by the BCTQ FSS, SSS, and total score at 6 months. RESULTS: Revision surgery significantly improved symptoms and function. Longer total duration of symptoms, a higher BCTQ total score at intake, and diagnosis of complex regional pain syndrome (CRPS) along with CTS were associated with worse outcome after revision surgery at 6 months postoperatively. The multivariable prediction models could explain 33%, 23%, and 30% of the variance in outcome as measured by the FSS, SSS, and BCTQ total scores, respectively, at 6 months. Although patients with higher BCTQ scores at intake have worse outcomes, they generally have the most improvement in symptoms and function. CONCLUSIONS: This study identified total duration of symptoms, BCTQ total score at intake, and diagnosis of CRPS along with CTS as predictors of clinical outcome and confirmed that revision surgery significantly improves self-reported symptoms and function in patients with recurrent and persistent CTS. Patients with more severe CTS symptoms have greater improvement in symptoms at 6 months postoperatively than patients with less severe CTS, but 80% of patients still had residual symptoms 6 months postoperatively. These results can be used to inform both patient and surgeon to manage expectations on improvement of symptoms. 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

Scapholunate instability: Diagnosis and management - Anatomy, kinematics, and clinical assessment - Part I. Wessel, L. E. and Wolfe, S. W. (2023) Level of Evidence : 5 Follow recommendation : 👍 (1/4 Thumbs up) Type of study : Diagnostic, Therapeutic Topic : Scapholunate injury - Diagnosis and treatment This review provides an update on the anatomy of the scapholunate ligament and its stabilizing ligaments, such as the dorsal capsuloligamentous scapholunate septum, the deep scapholunate ligament, and the dorsal intercarpal ligament. Scapholunate instability is a term used to describe wrist dysfunction resulting from disruption of the scapholunate interosseous ligament. It is important to remember that the severity of scapholunate injuries sits on a spectrum rather than being a categorical presentation (yes/no instability). High-resolution MRI is the imaging modality of choice if available. If not available, clenched fist pencil view and Watson's test appear to be useful in making a diagnosis. 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, scapholunate instability is a complex condition that requires a thorough understanding of ligament anatomy and pathoanatomy, as well as normal and injured carpal kinematics. It is important to be aware of the imaging available (e.g. clenched fist pencil view, US imaging), which allows us to make a diagnosis of the condition. Once the diagnosis is made, early (within 6 weeks from injury) or delayed (within 12 weeks from injury) surgery provides similar outcomes . In terms of post-surgical rehabilitation, early mobilisation (after 2 weeks from surgery) or delayed mobilisation (5-6 post-surgery), provides similar outcomes . URL : https://doi.org/10.1016/j.jhsa.2023.05.013 Abstract Injuries to the scapholunate joint are the most frequent cause of carpal instability. The sequelae of these injuries account for considerable morbidity, and if left untreated, may lead to scapholunate advanced collapse and progressive deterioration of the carpus. Rupture of the scapholunate interosseous ligament and its critical stabilizers causes dyssynchronous motion between the scaphoid and lunate. Additional ligament injury or attenuation leads to rotary subluxation of the scaphoid and increased scapholunate gap. Intervention for scapholunate instability is aimed at halting the degenerative process by restoring ligament integrity and normalizing carpal kinematics. In the first section of this review, we discuss the anatomy, kinematics, and biomechanical properties of the scapholunate ligament as well as its critical ligament stabilizers. We provide a foundation for understanding the spectrum of scapholunate ligament instability and incorporate meaningful new anatomical insights that influence treatment considerations. The purpose is to provide an update regarding the anatomy of the scapholunate ligament complex, importance of the critical ligament stabilizers of the proximal carpal row, introduction of safe technique to surgically expose the scaphoid and lunate, as well as pathoanatomy as it pertains to the treatment of scapholunate dissociation. In the second section of this review, we propose a novel ligament-based treatment algorithm based on the stage of injury, degree and nature of ligament damage, and presence of arthritic changes. 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

Prognostic factors specific to work-related musculoskeletal disorders: An overview of recent systematic reviews. Tousignant-Laflamme, Y., et al. (2023) Level of Evidence : 2a Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Prognostic Topic : Modifiable factors - Personalise recovery This is a systematic review summarising the evidence on modifiable prognostic factors associated with recovery following work-related musculoskeletal injuries. A total of 20 studies were included. The best evidence suggested that modifiable factors include receiving rehabilitation, negative expectations for return to work, higher levels of pain catastrophising, participation of stakeholders in return to work, odd working positions, heavy loads at work, high body weight, and high pain intensity. Other factors shown in the figure below showed a correlation with recovery, however, they were supported by lower quality evidence. 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, focusing on the identification of modifiable prognostic factors may help personalise and improve rehabilitation in people with work-related musculoskeletal injuries. These factors may include barrier removal to participation in rehabilitation (e.g. reduction of fees), improve patients confidence in their ability to return to work, include the employers in return to work program, reduce pain catastrophising, provide ergonomic advice, and reduce pain intensity levels. By doing so, hand therapists can personalise treatment and improve patients' recovery. The results of this review are in line with previous evidence for recovery trajectories in musculoskeletal conditions . To read even more on factors affecting recovery in our upper limb patients, have a look at the database . URL : https://doi.org/10.1016/j.msksp.2023.102825 Abstract Purpose: Work-related injuries affect a considerable number of people each year and represent a significant burden for society. To reduce this burden, optimizing rehabilitation care by integrating prognostic factors (PF) into the clinical decision-making process is a promising way to improve clinical outcomes. The aim of this study was to identify PF specific to work-related musculoskeletal disorders. Methods: We performed an overview of systematic reviews reporting on PF that had the following outcomes of interest: Return to work, pain, disability, functional status, or poor outcomes. Each extracted PF was categorized according to its level of evidence (grade A or B) and whether it was modifiable or not. The risk of bias of each study was assessed with the ROBIS tool. Results: We retrieved 757 citations from 3 databases. After removing 307 duplicates, 450 records were screened, and 20 studies were retained. We extracted a total of 20 PF with a Grade A recommendation, where 7 were deemed modifiable, 11 non-modifiable and 2 were index test. For example, return to work expectations, previous sick leave, delay in referral and pain intensity were found to be predictors of return-to-work outcomes. We also identified 17 PF with a Grade B recommendation, where 11 were deemed modifiable. For example, poor general health, negative recovery expectations, coping and fear-avoidance beliefs, pain severity, and particularly physical work were found to predict return to work outcomes. Conclusion: We found numerous modifiable PFs that can help clinicians personalize their treatment plan beyond diagnostic-related information for work-related musculoskeletal disorders. 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

Comparison of total elbow arthroplasty complications between various surgical indications at 90-day and 1-year follow-up in 1600 elbows. Romero, B., et al. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Prognostic Topic : Total elbow arthroplasty - Complications This retrospective study assessed complications following total elbow arthroplasty (TEA) for rheumatoid arthritis (RA), elbow osteoarthritis (OA), and fracture (FX) in 1,600 elbows. The results showed that there were no significant differences in systemic complications and surgical complications between the three groups at 90 days post-operatively. However, at 1 year post-operatively, patients who had a TEA for an elbow fracture were more likely to have elbow stiffness (compared to TEA for elbow OA) and RA patients were more likely to have wound disruption and deep infection. For a full list of complications post-TEA, have a look at the table 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, TEA is an effective solution with moderate complication rates for patients with elbow fractures, osteoarthritis, and rheumatoid arthritis. However, patients undergoing TEA following an elbow fracture are more likely to have elbow stiffness (compared to TEA for elbow OA) due to heterotopic ossification at one-year post-surgery. Have a look at what other causes may lead to elbow stiffness . This is an important issue as greater elbow stiffness is associated with greater levels of depression . URL : https://doi.org/10.1016/j.jse.2023.02.008 Abstract Background: Total elbow arthroplasty (TEA) was traditionally a mainstay of treatment for patients with severe inflammatory arthritis. Recently, the indications for TEA have expanded, and TEA has grown into a versatile procedure that can be used to treat several pathologies of the elbow. The objective of this study was to compare complication rates between TEAs performed for rheumatoid arthritis (RA), fracture (FX), or osteoarthritis (degenerative joint disease [DJD]). Methods: A retrospective analysis of the MUExtr data set of the PearlDiver national database was performed. International Classification of Diseases, Tenth Revision codes were used to identify patients who underwent TEA from 2010-2020 and to separate them into RA, FX, and DJD cohorts. Demographic characteristics, comorbidities, and hospital data were identified and compared using analysis of variance. Systemic complications at 90 days and surgical complications at both 90 days and 1 year were compared using multivariable logistic regression. Surgical complications included wound dehiscence, hematoma, deep infection, periprosthetic FX, stiffness, instability, triceps injury, nerve injury, and need for revision. Results: We identified 1600 patients (DJD, 38.9%; FX, 48.8%; and RA, 12.3%). The majority of patients in all 3 cohorts were female patients, with the RA group having a significantly higher percentage of female patients than the FX and DJD groups (87.3% vs. 81.4% and 76.9%, respectively; P = .003). No significant differences in systemic complications and surgical complications were noted between all 3 groups at 90 days postoperatively. After controlling for patient factors, FX patients were more likely to have elbow stiffness (odds ratio, 1.53; P = .006) and less likely to have a triceps injury (odds ratio, 0.26; P < .001) at 1 year than were RA or DJD patients. Conclusion: The indications for TEA have expanded over the past 10 years, with nearly half of all cases being performed for FX. At 1 year postoperatively, TEAs performed for FX have a significantly lower rate of triceps injury and higher rate of elbow stiffness than TEAs performed for other indications. This finding is important to consider when preoperatively planning, as well as when discussing expected outcomes with patients prior to surgery, especially with the expanded incidence of TEA for FX being performed over the past decade. 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

Predicting the need for collateral ligament repair in transolecranon fractures of the elbow: A traffic light model. Stringfellow, T. D., Matheron, G., Subramanian, P. and Domos, P. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Diagnostic Topic : Transolecranon fractures x-ray – LCL rupture This retrospective study assessed the need for lateral collateral ligament (LCL) repair in transolecranon fractures of the elbow. A total of 19 consecutive participants with transolecranon fracture dislocations were included. The indirect measure utilised to determine the need for LCL repair was the distance between the centre of the radial head and the center of the capitellum obtained on lateral x-rays. Results showed that when the radial head was displaced more than 1 cm, there was a high likelihood of LCL rupture and the need for repair. A traffic light model was developed to triage the likelihood of needing a collateral ligament reconstruction. Further work is needed to validate this model and assess its value 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, transolecranon fractures of the elbow can be difficult to classify and manage. If the distance between the centre of the radial head and capitellum is more than 1 cm, an LCL repair is likely required. Keep in mind that this threshold has not been validated in a different population other than the sample studied. Assessment of LCL injury in less severe elbow injuries may be performed through the postero-lateral rotatory drawer test of the elbow , which appears to have high sensitivity and specificity. URL : https://doi.org/10.1016/j.jse.2023.06.006 Abstract Background: Biomechanical studies have shown translation of the proximal radius relative to the capitellum in the sagittal plane can predict integrity of the collateral ligaments in a transolecranon fracture model; no studies have examined this in clinical practice. Methods & Materials: Nineteen consecutive transolecranon fracture dislocations were retrospectively reviewed. Data collection included: patient demographics, fracture classifications, surgical management and failure with instability. Distance between the center of the radial head and the center of the capitellum was measured on initial radiographs by two independent raters on three separate occasions. Statistical analysis was used to compare the median displacement between patients who required collateral ligament repair for stability and those who did not. Results: Sixteen cases with a mean age of 57 years (32-85) were analyzed with an inter-rater Pearson coefficient of 0.89 for displacement measurement. Median displacement where collateral ligament repair was needed and performed was 17.13mm (IQR=10.43-23.88) compared with 4.63mm (IQR=2.68-6.58) where collateral ligament repair was not performed and not required; p=0.002. In 4 cases, ligament repair was not performed initially but deemed necessary based on clinical outcome, postoperative and intra-operative images. Of these, the median displacement was 15.59mm (IQR=10.09-21.20) and 2 of these required revision fixation. Discussion: Where displacement on initial radiographs exceeded 10mm, LUCL repair was required in all cases (red group). If less than 5mm, ligament repair was not required in any case (green group). Between 5-10mm, following fracture fixation, the elbow must be screened carefully to assess for any instability and a low threshold set for LUCL repair to prevent posterolateral rotatory instability (amber group). Using these findings, we propose a traffic light model to predict the need for collateral ligament repair in transolecranon fractures and dislocation. 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

Anatomic relationship of hand intrinsic tendons at the metacarpal head as it relates to the diagnosis of saddle syndrome: A cadaveric study. Campbell, B. R., et al. (2023) Level of Evidence : 5 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Diagnostic This cadaveric study explored the anatomy of the deep transverse metacarpal ligament (TML) and the intrinsic muscle of the hand in an attempt to clarify diagnosis and treatment of saddle deformity. This condition is caused by adhesions between the lumbrical and interosseous tendons plus/minus TML. Measurements between the TML and the joined tendon of lumbricals and interossei was assessed in both the neutral and intrinsic plus positions. Results showed that the distance between the tendons and TML decreased towards the ulnar digits and when assuming an intrinsic plus compared to neutral position. It was concluded that if inflamed/injured, the joining between lumbrical and interossei may cause impingement when getting into the intrinsic plus position or when stretching the intrinsic muscles of the hand. Corticosteroid injections, physical therapy, and in the most complex cases surgical release are successful (87%) in providing good to excellent 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, saddle deformity is an underrecognized and underreported pathology following traumatic events of the hand. Symptoms can be reproduced during either stretching of the intrinsic muscles of the hand or during active intrinsic plus movement. The results of the study highlight the importance of getting the hand moving as soon as possible following trauma. In addition, it highlights that immobilising the hand in POSI may contribute to the development of saddle deformity as in this position the tendon joining the intrinsic and lumbrical muscles is in close proximity to the deep transverse carpal ligament. If you would like to see a clinical example of saddle deformity, have a look at this case study . URL : https://doi.org/10.1016/j.jhsa.2023.06.005 Abstract Purpose: The purpose of this cadaveric study was to investigate the intrinsic anatomy surrounding the metacarpal head and the relationship between the interosseous-lumbrical junction (ILJ) and transverse metacarpal ligament (TML) as it pertains to saddle deformity—posttraumatic adhesions at the ILJ that cause impingement during intrinsic activation. Methods: Ten fresh frozen cadaveric arms underwent dissections, identifying the intrinsic musculature within the second through fourth webspaces. The TML and ILJ, or “true tendon,” were identified. A separate area of nontendinous fibrous tissue identified proximal to the ILJ was referred to as “pseudotendon.” Measurements were made within each webspace to identify distances between these structures in full finger extension and intrinsic plus position to assess for changes during simulated motion. Results: The true tendon to TML distance progressively decreased toward the ulnar digits. In the intrinsic plus position, the pseudotendon to TML distance was 0 mm at all webspaces for each specimen. When moving from neutral to intrinsic plus, the true tendon to TML distance decreased the most in the third and fourth webspaces compared with the second, consistent with the trend toward a smaller ILJ to TML gap in the ulnar digits. Conclusions: There is a fibrous pseudotendinous region proximal to the ILJ that abuts the TML in the intrinsic plus position, which may cause impingement when inflamed in the setting of saddle syndrome. Furthermore, a decreased ILJ to TML gap in the ulnar digits may be related to an increased predilection for saddle deformity in those areas. Clinical relevance: These results suggest that there is a fibrous region present proximal to the ILJ that may be implicated in the pathology of saddle deformity. Furthermore, decreased distances found between the ILJ and TML in vivo may be an explanation for increased occurrence of saddle syndrome in the third and fourth webspaces 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