Comparison of the effects of volar-assisted and elastic wrist splints on edema, pain, grip strength, and functionality in pregnant women with carpal tunnel syndrome. Mete Cavus, F., Maden, C. and Turhan, B. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Rigid vs elastic splint - Carpal tunnel syndrome This quasi-experiment study assessed the effects of a rigid vs an elastic wrist splints on edema, pain, grip strength, and upper extremity function in pregnant women with carpal tunnel syndrome (CTS). Forty-one women in their last trimester were assigned to either a rigid or elastic wrist splint. There was limited information about randomisation, hence, the classification of the study as a quasi-randomised study. Pain was assessed utilising the Visual Analog Scale (VAS), function utilising the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) and Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Grip strength was measured with a Jamar hand dynamometer, and edema with the water overflow method. The results showed that both splints reduced pain and edema whilst improving grip strength and function after four weeks. There were no between groups differences. 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, we may consider using either a rigid or elastic wrist splints for managing CTS symptoms in pregnant women. Both types of splints appeared to be effective in reducing pain and edema while increasing grip strength and improving upper-extremity function. If deemed suitable, splints limiting mcpj flexion appear to be superior to normal wrist splint and they could be utilised at night without impairing daily function. If you are interested to read more about CTS, have a look at the entire database . URL : https://doi.org/10.1177/15589447241257647 Abstract Background: Carpal tunnel syndrome (CTS) is a common musculoskeletal problem in pregnancy. The aim of this study is to compare the effects of rigid and elastic wrist splints on edema, pain levels, grip strength, and upper-extremity functionality in pregnant women with CTS. Methods: Forty-one pregnant women in the last trimester of pregnancy who were diagnosed with CTS were included in the study. The grip strength was evaluated with the Jamar hand dynamometer, functionality with the Quick Disabilities of the Arm, Shoulder, and Hand and Boston Carpal Tunnel Syndrome Questionnaire, pain with the Visual Analog Scale (VAS), and edema with the water overflow method. Results: The mean age of the participants was 31.71 ± 5.78 years, body mass index was 28.85 ± 3.63 kg/m2, duration of pain was 2.24 ± 0.79 months, and their pain intensity was 6.63 ± 1.69 according to the VAS. As a result of the study, reductions in pain (P = .001), increases in functionality values (P = .001), increases in grip strength (P = .001), and decreases in edema (P = .001) were observed in both groups after the treatment. However, there was no significant difference in pain, functionality, or grip strength values between the groups after the treatment (P > .05). Conclusion: In this study comparing the effects of a wrist splint to those of an elastic splint, both treatment methods for pregnant women with CTS decreased pain and edema, increased grip strength, and improved upper-extremity functionality. Considering individual needs, characteristics, and living conditions, both splints can be recommended for pregnant women with CTS. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Effect of lacertus fibrosus release on perineural pressure of the median nerve at the elbow: a cadaveric study Archambault, G., Boudier-Revéret, M., Hagert, E., Effatparvar, M. R. and Sobczak, S. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic, Therapeutic Topic : Lacertus fibrosus - Median nerve pressure This cadaver study assessed the impact of releasing the lacertus fibrosus (LF) on the perineural pressure of the median nerve at the elbow. Seven upper limbs were assessed in this anatomical study. The perineural pressure of the median nerve was measured before and after LF release during passive elbow flexion. The results showed a significant reduction in maximal pressure from before (average of 700 mmHg) to after the release (average 80 mmHg), which equates to an 80%-90% decrease. 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 simple surgical release of the lacertus fibrosus significantly reduces pressure at the median nerve by an average of 80% to 90% during elbow flexion. The reduction in pressure with lacertus fibrosus release appears to justify the use of surgery in recurrent carpal tunnel presentations . Furthermore, this study may provide some biomechanical basis explaining why some patients with carpal tunnel syndrome present with symptoms exacerbated by sustained elbow flexion. In these cases it is possible that the use of a night elbow extension splint may help in reducing symptoms . URL : https://doi.org/10.1007/s00264-023-05735-8 Abstract Purpose The lacertus fibrosus (or bicipital aponeurosis) is a potential site of proximal median neuropathy at the elbow. Lacertus syndrome with motor and/or sensory symptoms has been addressed with a minimally invasive surgical lacertus release. This study evaluates if a lacertus release alters the maximal perineural pressure (Pmax) of the median nerve at the level of the lacertus fibrosus during elbow flexion. Methods Seven upper limbs from four fresh cadavers were included. Perineural pressure of the median nerve at the level of the lacertus fibrosus was measured continuously during automated elbow flexions by the biceps brachii muscle. Results The mean Pmax before the lacertus release was significantly different than the mean Pmax after the lacertus release (669.15 mmHg vs 77.01 mmHg, p = 0.0180). The mean Pmax after the lacertus release decreased with an average 81.41%. Conclusion A simple surgical release of the lacertus fibrosus significantly decreases the maximal perineural pressure of the median nerve at the level of the lacertus fibrosus during elbow 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

The effectiveness of exercise-based rehabilitation in people with hand osteoarthritis: A systematic review with meta-analysis. Huang, L., et al. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Hand osteoarthritis - Exercise This systematic review and meta-analysis assessed the effectiveness of exercise compared to no intervention for hand osteoarthritis (OA). Fourteen randomised controlled trials for a total of 1,341 participants were included in the study. The results showed low-quality evidence of short-term improvement in pain, function, and grip strength, and moderate-certainty evidence in terms of stiffness reduction. There was also no evidence of long-term benefits for pain, function, and stiffness. Subgroup analyses suggested that exercise alone may be more effective than mixed interventions for immediate-term benefits, however, it is unlikely that the difference would be clinically relevant. 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, exercise interventions are effective in the short-term for people with hand OA to improve pain, function, stiffness, and grip strength. However, these benefits are not evident in the long term, suggesting that patients may need to keep exercising to maintain those improvements. These result appear to be in line with previous evidence on exercise for people with 1st cmcj OA . Despite the results from this study, it appears that multimodal interventions are useful and provide good improvements for our patients . If you are interested in reading more about hand OA, have a look at the entire database . URL : https://doi.org/10.2519/jospt.2024.12241 Abstract OBJECTIVE: To investigate the effectiveness of exercise-based rehabilitation programs compared with nonexercise intervention or no intervention for people with hand osteoarthritis (OA). DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched 5 databases on July 23, 2023. STUDY SELECTION CRITERIA: We included randomized controlled trials that compared the effectiveness of rehabilitation programs that included an exercise component, with nonexercise intervention or no intervention for people with hand OA. DATA SYNTHESIS: Standardized mean differences (SMDs) were pooled using a random-effects model. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. RESULTS: Fourteen trials were included in the meta-analysis (n = 1341 participants). In the immediate term (<24 weeks), there was low-certainty evidence of an effect of exercise-based rehabilitation on improving pain (13 trials; SMD = −0.65; 95% CI: −1.06, −0.25), function (11 trials; SMD = −0.35; 95% CI: −0.54, −0.15), and grip strength (14 trials; SMD = 0.21; 95% CI: 0.03, 0.38). There was moderate-certainty evidence of an effect on reducing stiffness (7 trials; SMD = −0.33; 95% CI: −0.51, −0.16). There was low-certainty evidence of no effect on improving pinch strength and quality of life. For the long term (≥24 weeks), there was low-certainty evidence that exercise-based rehabilitation had no additional effect on improving pain, function, and stiffness. CONCLUSION: Exercise-based rehabilitation improved pain, function, stiffness, and grip strength in people with hand OA in the immediate term; the benefits were not maintained in the long term. 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 association between social determinants of health and distal radius fracture outcomes. Truong, N. M., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Social determinants - Complications after distal radius fracture This retrospective study assessed the impact of adverse social determinants of health (SDOH) on complications following open reduction internal fixation (ORIF) of distal radius fractures. A total of 114,050 patients were split into two groups (SDOH and controls) and matched by age, sex, insurance type, and comorbidities. The results showed that patients presenting with adverse SDOH had significantly higher 90-day and 1-year postoperative complications (odds ratios from 1.1 to 3.2), including increased emergency department visits, infections, wound dehiscence, complex regional pain syndrome, malunion/nonunion, and hardware removal. Economic and social challenges were the variables with the strongest association to 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, adverse social determinants of health significantly elevate the risk of complications following ORIF of distal radius fractures. This includes a higher likelihood of emergency department visits, infections, and wound dehiscence within the first 90 days post-surgery, as well as long-term complications like complex regional pain syndrome and hardware removal within a year. The results of this study are in line with previous research showing that social deprivation has negative effects on outcomes following flexor tendon repair and rotator cuff surgery , as well as the burden of osteoarthritis . URL : https://doi.org/10.1016/j.jhsa.2024.04.009 Abstract Purpose The purpose of this study was to determine if adverse social determinants of health (SDOH) are associated with differential complication rates following surgical fixation of distal radius fractures and assess which SDOH domain (economic, educational, social, health care, or environmental) is most associated with postoperative complications. Methods Using a national administrative claims database, we conducted a retrospective cohort analysis of patients undergoing open treatment for an isolated distal radius fracture between 2010 and 2020. Patients were stratified based on the presence/absence of at least one SDOH code and propensity score matched to create two cohorts balanced by age, sex (male or female), insurance type, and comorbidities. Social determinants of health examined included economic, educational, social, health care, and environmental factors. Multivariable logistic regression analyses were performed to assess the isolated effect of SDOH on 90-day and 1-year complication rates. Results After propensity matching, 57,025 patients in the adverse SDOH cohort and 57,025 patients in the control cohort were included. Patients facing an adverse SDOH were significantly more likely to experience 90-day complications, including emergency department visits (Odds ratio (OR): 3.18 [95% confidence interval (CI): 3.07–3.29]), infection (OR: 2.37 [95% CI: 2.12–2.66]), wound dehiscence (OR: 2.06 [95% CI: 1.72–2.49]), and 1-year complications, including complex regional pain syndrome (OR: 1.35 [95% CI: 1.15–1.58]), malunion/nonunion (OR: 1.18 [95% CI: 1.08–1.29]), and hardware removal (OR: 1.13 [95% CI: 1.07–1.20]). Additionally, patients facing an adverse SDOH had a significantly increased risk of 90-day complications, regardless of fracture severity, and patients with economic and social challenges had the highest odds of both 90-day and 1-year postoperative complications. Conclusions Social determinants of health are associated with increased complications following distal radius fracture fixation, even when controlling for demographic and clinical factors. We recommend routine screening for adverse SDOH and inclusion of SDOH data into health records to not only inform quality improvement initiatives and risk adjustment for outcome-based quality measurements but also to allow providers to begin to discuss and address such barriers during the perioperative period. 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 interventions for lateral elbow tendinopathy: A systematic review and network meta-analysis for patient-rated tennis elbow evaluation pain outcome. Lowdon, H., et al. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Tennis elbow - Conservative interventions This systematic review and network meta-analysis assesses the effectiveness of various treatments for common extensor origin (CEO) tendinopathy. A total of 13 randomised controlled trials (RCTs) assessing 12 different treatments were included. In the short-term (up to six weeks), no treatment showed significant improvement over placebo. In the mid-term (up to six months), physiotherapy/exercise demonstrated a moderate benefit, whilst steroid injections, dry needling, and autologous blood injections also showed potential, the confidence intervals were large reducing the certainty of the findings. Overall, there was not one single treatment that lead to symptoms resolution faster compared to placebo or control interventions. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, patients with CEO tendinopathy should be made aware of the fact that there is no strong evidence supporting that any particular treatment produces faster improvement in pain symptoms over control/placebo in the short to mid-term. Overall, it appears that tennis elbow has a positive prognostic course and that people affected by the condition are highly likely to get better over 12 months independently of the treatment provided . Conservative treatments can be certainly provided to manage and support people in their recovery, however, one approach does not appear to be superior to another. URL : https://doi.org/10.1016/j.jhsa.2024.03.007 Abstract Purpose There is controversy regarding the optimal treatment for lateral elbow tendinopathy (LET), and not all available treatment options have been compared directly with placebo/control. A network meta-analysis was conducted to compare the effectiveness of different LET treatments directly and indirectly against control/placebo based on a validated outcome, the Patient-Rated Tennis Elbow Evaluation (PRTEE) pain score. Methods Randomized, controlled trials comparing different treatment methods for LET were included, provided they reported outcome data using the PRTEE pain score. A network meta-analysis with random effect was used to combine direct and indirect evidence between treatments compared with placebo in the short term (up to six weeks) and midterm (more than six weeks and up to six months) after intervention. Results Thirteen studies with 12 comparators including control/placebo were eligible. The results indicated no significant improvement in PRTEE pain score in the short term across all treatments compared with control/placebo. In the midterm, physiotherapy/exercise showed benefit against placebo (mean difference: −4.32, 95% confidence interval: −7.58 and −1.07). Although steroid injections, dry needling, and autologous blood also exhibited potential treatment effects, it is crucial for the clinician to consider certain pitfalls when considering these treatments. The limited number of small studies and paucity of data call for caution in interpreting the results and need for further evidence. Conclusions Patients should be informed that there is currently no strong evidence that any treatment produces more rapid improvement in pain symptoms when compared with control/placebo in the short and medium terms. 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

How do orthoses impact ease of donning, handwriting, typewriting, and transmission of manual torque? A study of three prefabricated wrist-hand orthoses. Ferrari, A. L. M., Medola, F. O. and Sandnes, F. E. (2021) Level of Evidence: 3b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Splint wearing - Daily life activities limitations This cross-sectional study investigated the impact of three prefabricated wrist splints on ease of applying the splint, completing manual tasks (typing and handwriting), and applying force through tools. A total of 30 healthy participants performed the tasks with and without the splints. The results showed that there were significant differences in task performance when wearing the splints. In particular, typing and handwriting were faster and perceived as easier without any splint. Not surprisingly, the most rigid splint showed the highest difficulty and lowest force transmission when measuring the ability to generate torque. The neoprene splints were the one providing the most amount of function, despite them still restricting upper limb function compared to no splint. 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, prefabricated wrist hand splints significantly impact the performance of manual tasks such as typing, handwriting, and manual torque transmission. The rigid splints are the one limiting movement and function the most. Despite rigid splints being the most effective in limiting hand movement, we also need to remember that it may reduce patients' likelihood of wearing them if they are unable to compete tasks. If you are interested in creating custom thermoplastic wrist splints, it appears that most of the times, there is no significant difference in movement limitations provided by a light weight (1.6 mm) vs a heavier (3.2 mm) splint . URL : https://doi.org/10.1097/JPO.0000000000000344 Abstract Introduction Many upper-limb injuries have work-related causes such as continued use of computers, typing activities, mouse manipulation, and repetitive movements performed for long periods. This study evaluated the performance of wrist-hand orthoses in manual tasks and in transmission of torque measurement during canned glass opening. Methods Thirty healthy participants performed donning, typing, and handwriting tasks and transmission of manual torque. The procedures were performed in four conditions: with three different orthoses and with no orthosis as a control. Results The results showed a significant difference in the time of manual writing (P < 0.001) and in the number of words per minute (P < 0.001) in the typing task with and without orthoses. The perceived difficulty in performing typing (P < 0.001) and manual writing (P < 0.001) was lower with no orthoses and higher for canvas orthosis and the two neoprene orthoses. Transmission of manual torque also decreased with the orthoses compared with using no orthosis (P < 0.001). Among the orthoses, the canvas fabric orthosis yielded a lower performance compared with the two different neoprene fabric orthoses for all the tasks. Conclusions There are effects of the materials used and the orthosis design when performing handwriting typing tasks and twisting tasks (transmission of manual torque), as well as the correctness of how users donned the orthosis. 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

Advances in the treatment of hand and wrist injuries in the elite athlete. Noble, D. M., Dacus, A. R. and Chhabra, A. B. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Return to sport - Hand and wrist injuries This narrative review focused on the treatment of hand and wrist injuries in elite athletes. Common injuries discussed included metacarpal fractures, thumb ulnar collateral ligament (UCL) tears, and scaphoid fractures. These injuries can negatively impact performance and career longevity. Effective treatment must balance accelerated rehabilitation alongside long-term outcomes. For metacarpal fractures, surgical reduction and fixation, including intramedullary screw techniques, facilitate quicker return-to-play with fewer complications than traditional methods. Thumb UCL injuries often necessitate surgical repair for stability with overall positive outcomes. Scaphoid fractures, require prompt, often surgical, intervention, with two-screw or plate fixation. Longer term outcomes of these expedite approaches are lacking and future research is likely going to clarify long term results of these management strategies. 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, recent advances in the surgical and perioperative treatment of metacarpal fractures, thumb ulnar collateral ligament (UCL) injuries, and scaphoid fractures offer promising outcomes for elite athletes. These options support accelerated rehabilitation and earlier return-to-play, which are crucial in the demanding environment of professional sports. Of note, previous research in the National Football League (NFL) has shown that stable metacarpal fractures can be managed conservatively with splinting and early return to competition. In contrast, scaphoid fractures in athletes tend to always be managed surgically unless the athlete can take time off. Thumb ucl injuries appear to have positive outcomes even if surgery is delayed , hence, a conservative trial of a few weeks may be justifiable without significant risks. URL : https://doi.org/10.1016/j.jhsa.2024.03.018 Abstract Caring for hand and wrist injuries in the elite athlete brings distinct challenges, with case-by-case decisions regarding surgical intervention and return-to-play. Metacarpal fractures, thumb ulnar collateral ligament tears, and scaphoid fractures are common upper-extremity injuries in the elite athlete that can be detrimental to playing time and future participation. Treatment should therefore endure the demand of accelerated rehabilitation and return-to-activity without compromising long-term outcomes. Fortunately, the literature has supported emerging management options that support goals specific to the athlete. This review examined the advances in surgical and perioperative treatment of metacarpal fractures, thumb ulnar collateral ligament injuries, and scaphoid fractures in the elite athlete. 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

Adherence of individuals with shoulder pain to home exercise booklets: Barriers, facilitators, and the impact of disability, self-efficacy, and treatment expectations. Francisco, I. M., Tozzo, M. C., Martins, J. and de Oliveira, A. S. (2024) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Shoulder exercises - Adherence factors This prospective study assessed barriers, facilitators, and the roles of disability, self-efficacy, and treatment expectations on adherence to exercise in people with persistent shoulder pain. A total of 47 participants were included in the present study and adherence was assessed utilising the Exercise Adherence Assessment Scale. The results showed that 50% of participants adhered to the exercise program. The primary barriers included pain and health issues, time constraints, and other commitments, while facilitators were pain improvement and enjoyment of exercises. Statistical analysis revealed that disability, self-efficacy, and treatment expectations did not significantly predict adherence. 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, half of our patients with upper limb pain adhere to home exercise programs. The main barriers for non-adherence include pain and time constraints, while improvement in symptoms and enjoyment of exercises were facilitators to adherence. Another way to improve exercise adherence may be to limit the number of exercises to two or a maximum of three . In addition, social support and task appreciation appear to be useful in boosting exercise adherence . URL : https://doi.org/10.1016/j.msksp.2024.102956 Abstract Background home exercise booklets offer several benefits to individuals with shoulder pain. However, it is necessary to investigate the factors that determine adherence to home exercises. Objectives 1) To investigate the level of adherence of individuals with chronic shoulder pain to a home exercise booklet conducted without the mediation of a healthcare professional, 2) To describe the barriers and facilitators to adherence, and 3) to determine if shoulder disability, self-efficacy, and treatment expectations are predictors of the level of adherence. Design prospective longitudinal study. Methods A total of 47 individuals with chronic shoulder pain were recruited. The Numeric Pain Rating Scale (NPRS) was used to assess pain intensity, the Shoulder Pain and Disability Index (SPADI) to measure shoulder disability, the Pain Self-Efficacy Questionnaire (PSEQ-10) for self-efficacy, and a likert scale to measure treatment expectations. Adherence was measured by Exercise Adherence Assessment Scale (EAAE-Br). Results A total of 23 individuals (48.93%) adhered to the home exercise program. The most commonly cited barriers were pain and health-related issues, while the most cited facilitators were pain improvement and symptom relief. Barriers associated with adherence were time constraints and other commitments, while the facilitator associated with adherence was enjoying the exercises. Binary logistic regression analysis revealed that shoulder disability, self-efficacy, and treatment expectations were unable to predict adherence to home exercises in individuals with shoulder pain [F (1,47) = 2.384; p = 0.130; R2 = 0.056]. Conclusion The study revealed barriers and facilitators to home exercise in individuals with shoulder pain. Disability, self-efficacy, and treatment expectations were not able to predict adherence. 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

Are there differences in pain reduction and functional improvement among splint alone, steroid alone, and combination for the treatment of adults with trigger finger? Atthakomol, P., Wangtrakunchai, V., Chanthana, P., Phinyo, P. and Manosroi, W. (2023) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Splinting alone or with cortisone - Trigger finger This randomised study assessed the effect of three conservative interventions on pain reduction and functional improvement in people with trigger finger. A total of 120 participating were included. Participants were randomised to either splinting alone (see picture below), steroid injection alone, or a combination of both. The outcomes measures included the Visual Analog Scale (VAS) for pain and the Michigan Hand Outcomes Questionnaire (MHQ) assessed at 6, 12, and 52 weeks. The results showed no clinically important differences in pain reduction or functional improvement among the groups at any time point (see graph below). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, splinting alone is recommended for the initial treatment of trigger finger. Thus, there is a lack of clinically important differences between splinting alone, steroid injection alone, or a combination of the two in terms of pain reduction and functional improvement up to one year. If you want to read more about trigger finger, including splinting options , have a look at the whole database . URL : https://doi.org/10.1097/CORR.0000000000002662 Abstract Background Steroid injection and splinting, which are commonly recommended nonsurgical treatments in adults with trigger finger, have been demonstrated to effectively relieve pain and improve function. However, to our knowledge, there have been no direct comparisons of pain relief and function improvement with splinting alone, steroid injection alone, or a combination of splinting and steroid injection in patients with this diagnosis. Question/purpose Are there differences in pain reduction and functional improvement in adults with trigger finger treated with splinting alone, steroid injection alone, and a combination of splinting and steroid injection at 6, 12, and 52 weeks after the intervention? Methods Between May 2021 and December 2021, we treated 165 adult patients for trigger finger at an academic university hospital. Based on prespecified criteria, all patients we saw during that period were eligible, but 27% (45 of 165) were excluded because they had received a previous local corticosteroid injection (n = 10) or they had concomitant carpal tunnel syndrome (n = 14), first carpometacarpal joint arthritis (n = 3), osteoarthritis of the hand (n = 6), de Quervain disease (n = 3), multiple-digit trigger finger (n = 6), or pregnancy during the study period (n = 3). After screening, 120 patients were randomized to receive either splinting (n = 43), steroid injection (n = 40), or splinting plus steroid injection (n = 37). Patients were randomly assigned to the different treatments using computer-generated block randomization (block of six). Sequentially numbered, opaque, sealed envelopes were used in the allocation concealment process. Both the allocator and the outcome assessor were blinded. Splinting involved the patient wearing a fixed metacarpophalangeal joint orthosis in the neutral position at least 8 hours per day for 6 consecutive weeks. Steroid injection was performed using 1 mL of 1% lidocaine without epinephrine and 1 mL of triamcinolone acetonide (10 mg/mL) injected directly into the flexor tendon sheath. No patients were lost to follow-up or had treatment failure (that is, the patient had persistent pain or triggering with the trigger finger treatment and requested additional medical management including additional splinting, steroid injection, or surgery) at 6 or 12 weeks after the intervention, and at 52 weeks, there was no difference in loss to follow-up among the treatment groups. An intention-to-treat analysis was performed with all 120 patients, and a per-protocol analysis was conducted with 86 patients after excluding patients who were lost to follow-up or had treatment failure. Primary outcomes evaluated were VAS pain reduction and improvement in Michigan Hand Outcomes Questionnaire (MHQ) scores at 6, 12, and 52 weeks after the intervention. The minimum clinically important difference (MCID) values were 1 and 10.9 for the VAS and MHQ, respectively. Results There were no clinically important differences in VAS pain scores among the three treatment groups at any timepoint, in either the intention-to-treat or the per-protocol analyses. Likewise, there were no clinically important differences in MHQ scores at any timepoint in either the intention-to-treat or the per-protocol analyses. Conclusion Splinting alone is recommended as the initial treatment for adults with trigger finger because there were no clinically important differences between splinting alone and steroid injection alone in terms of pain reduction and symptom or functional improvement up to 1 year. The combination of steroid injection and splinting is disadvantageous because the benefits in terms of pain reduction and symptom or functional improvement are not different from those achieved with steroid injection or splinting 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

Value of physical tests in diagnosing cervical radiculopathy: A systematic review Thoomes, E., van Geest, S., van der Windt, D., Falla, D., Verhagen, A., Koes, B., Thoomes-de Graaf, M., Kuijper, B., Scholten-Peeters, W., & Vleggeert-Lankamp, C. (2018) Level of Evidence : 1a Follow recommendation : 👍 👍 👍 👍(4/4 Thumbs Up) Type of study : Diagnostic Topic : Cervical radiculopathy – Physical tests This is a systematic review assessing the usefulness of physical tests in making a diagnosis of cervical radiculopathy in patients with a disk herniation or osteoarthritic changes. Five papers, which compared physical test results against MRI/CT scans or surgical findings were included. The variables of interest were the sensitivity and specificity of physical tests. If a test is very sensitive and its result is negative, you can be more certain that the patient does not have the condition. If the test is specific and its result is positive, you can be more certain that the patient has the condition. Spurling’s test and cervical distraction test showed high specificity and low sensitivity. Upper limb neurodynamic tests showed high sensitivity and low specificity. The arm squeeze test showed high sensitivity and high specificity. The arm squeeze test is performed by compressing the anterior and posterior mid portion of the patient’s arm. The test is considered positive if compression of the arm is 3/10 points more painful than squeezing the patient’s shoulder joint. The cervical distraction test showed high specificity and low sensitivity. The cervical distraction test is considered positive when manual cervical traction relieves symptoms in the upper limb. Clinical Take Home Message : Based on what we know today, hand therapists may use a combination upper limb neurodynamic test, and arm squeeze test to rule out a radiculopathy. If neurodynamic tests do not elicit pain and the arm squeeze test is negative, the presence of a radiculopathy is less likely. A diagnosis of cervical radiculopathy can be made if the arm squeeze test and Spurling’s test are positive, and if the cervical distraction test relieves pain. URL : https://www.thespinejournalonline.com/article/S1529-9430(17)30918-X/fulltext

Diagnostic accuracy of clinical tests to rule out elbow fracture: A systematic review. Breda, G., De Marco, G., Cesaraccio, P. and Pillastrini, P. (2023) Level of Evidence: 1a- Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Elbow fractures - Objective testing This is as a systematic review on the diagnostic accuracy of clinical tests for detecting or excluding elbow fractures. A total of 12 studies involving 4,485 participants were included. Three tests were assessed and they included the elbow full range of motion test, the elbow extension test, and the elbow extension combined with point tenderness test. The results demonstrated high sensitivity for these tests, with values reaching up to 99%, but specificity varied widely from 24% to 70%. While these tests are useful, particularly in ruling out fractures in adults when results are negative, their specificity is quite low. 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 tests for elbow fractures, such as the elbow full range of motion test, elbow extension test, and elbow extension combined with point tenderness test, present high sensitivity values, making them potentially useful to exclude fractures when results are negative. Keep in mind that factors like depression and catastrophising can significantly modulate pain in patients with upper limb fractures and that tenderness on palpation of fractures is not a reliable indicator. URL : https://doi.org/10.5397/cise.2022.00948 Abstract Elbow traumas represent a relatively common condition in clinical practice. However, there is a lack of evidence regarding the most accurate tests for screening these potentially serious conditions and excluding elbow fractures. The purpose of this investigation was to analyze the literature concerning the diagnostic accuracy of clinical tests for the detection or exclusion of suspected elbow fractures. A systematic review was performed using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines. Literature databases including PubMed, Cumulative Index to Nursing and Allied Health Literature, Diagnostic Test Accuracy, Cochrane Library the Web of Science, and ScienceDirect were searched for diagnostic accuracy studies of subjects with suspected traumatic elbow fracture investigating clinical tests compared to imaging reference tests. The risk of bias in each study was assessed independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist. Twelve studies (4,485 patients) were included. Three different types of index tests were extracted. In adults, these tests were very sensitive, with values up to 98.6% (95% confidence interval [CI], 95.0%–99.8%). The specificity was very variable, ranging from 24.0% (95% CI, 19.0%–30.0%) to 69.4% (95% CI, 57.3%–79.5%). The applicability of these tests was very high, while overall studies showed a medium risk of bias. Elbow full range of motion test, elbow extension test, and elbow extension and point tenderness test appear to be useful in the presence of a negative test to exclude fracture in a majority of cases. The specificity of all tests, however, does not allow us to draw useful conclusions because there was a great variability of results obtained. 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

Do therapeutic exercises impact supraspinatus tendon thickness? Secondary analyses of the combined dataset from two randomised controlled trials in patients with rotator cuff-related shoulder pain. Dubé, M.-O., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Tendon thickness - Exercise This study is a secondary analysis of two existing randomised controlled trials assessing whether supraspinatus tendon thickness changes with therapeutic exercises in people with rotator cuff pathology. The primary focus was on comparing high-load and low-load strengthening exercises, while secondary aims included examining variations in tendon thickness among different tendinopathy subgroups (reactive vs. degenerative) and their associations with clinical outcomes like disability. A total of 159 participants were included in the study. The results showed that tendon thickness changed over time differently based on the type of tendinopathy. In particular, thickness increased in degenerative tendons, decreased in reactive tendons, and remained unchanged in normal tendons. However, no significant differences in tendon thickness were observed based on exercise modality. The study found no association between changes in tendon thickness and disability scores, suggesting that tendon behavior over time might normalise irrespective of intervention type. 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 type of therapeutic exercise does not appear to impact supraspinatus tendon thickness in patients with rotator cuff-related shoulder pain. However, tendon thickness changes over time depending on the tendinopathy type. These findings seem to be supported by recent studies showing that any form of exercise seems to be useful for tendinopathy without a specific approach being superior. URL : https://doi.org/10.1016/j.jse.2024.03.055 Abstract Background: The mechanistic response of rotator cuff tendons to exercises within the context of rotator cuff-related shoulder pain (RCRSP) remains a significant gap in current research. A greater understanding of this response can shed light on why individuals exhibit varying responses to exercise interventions. It can also provide information on the influence of certain types of exercise on tendons. The primary aim of this article is to explore if changes in supraspinatus tendon thickness (SSTT) ratio differ between exercise interventions (high load vs. low load). The secondary aims are to explore if changes in SSTT ratio differ between ultrasonographic tendinopathy subgroups (reactive vs. degenerative) and if there are associations between tendinopathy subgroups, changes in tendon thickness ratio, and clinical outcomes (disability). Methods: This study comprises secondary analyses of the combined dataset from two randomized controlled trials that compared high and low-load exercises in patients with RCRSP. In those trials, different exercise interventions were compared: 1) progressive high-load strengthening exercises, and 2) low-load strengthening with or without motor control exercises. In one trial, there was also a third group that was not allocated to exercises (education only). Ultrasound-assessed SSTT ratio, derived from comparing symptomatic and asymptomatic sides, served as the primary measure in categorizing participants into tendinopathy subgroups (reactive, normal and degenerative) at baseline. Results: Data from 159 participants were analyzed. Two-way repeated measures ANOVAs revealed significant Group (p<0.001) and Group X Time interaction (p<0.001) effects for the SSTT ratio in different tendinopathy subgroups, but no Time effect (p=0.63). Following the interventions, SSTT ratio increased in the "Degenerative" subgroup (0.14 [95% CI: 0.09 to 0.19]), decreased in the "Reactive" subgroup (-0.11 [95% CI: -0.16 to -0.06]), and remained unchanged in the "Normal" subgroup (-0.01 [95% CI: -0.04 to 0.02]). There was no Time (p=0.21), Group (p=0.61), or Group X Time interaction (p=0.66) effect for the SSTT ratio based on intervention allocation. Results of the linear regression did not highlight any significant association between the tendinopathy subgroup (p=0.25) or change in SSTT ratio (p=0.40) and change in disability score. Conclusion: Findings from this study suggest that, over time, SSTT in individuals with RCRSP tends to normalize, compared to the contralateral side, regardless of the exercise intervention. Different subgroups of symptomatic tendons behave differently, emphasizing the need to potentially consider tendinopathy subtypes in RCRSP research. Future adequately powered studies should investigate how those different tendinopathy subgroups may predict long-term clinical outcomes. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings