Exercise-based interventions are effective in the management of patients with thumb carpometacarpal osteoarthritis: A systematic review and meta-analysis of randomised controlled trials. Karanasios, S., Mertyri, D., Karydis, F. and Gioftsos, G. (2024) Level of Evidence: 1a Follow recommendation : 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic : Thumb osteoarthritis - Exercises This systematic review and meta-analysis examined the efficacy of exercise-based interventions compared to other conservative treatments in managing thumb cmcj osteoarthritis (OA). This review included 14 randomised controlled trials for a total of 1,280 participants. The results showed that exercise-based interventions provided statistically and clinically relevant improvements in pain intensity and disability at short-term follow-up compared to no treatment. There were no significant differences between exercise-based and standard treatments at mid- and long-term follow-up. 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-based interventions significantly reduce pain and disability in patients with thumb cmcj OA in the short term. These findings reinforce the importance of incorporating exercise-based treatments into clinical practice for managing thumb cmcj OA. You can still get your patients to use a splint on an intermittent basis , however, this is not necessary . URL : https://doi.org/10.3390/healthcare12080823 Abstract Exercise-based interventions are a common management strategy in patients with thumb carpometacarpal joint osteoarthritis (CMCJ OA); however, their exact effect on or the use of an optimal training programme for reducing pain and disability remains unclear. Our purpose was to evaluate the effectiveness of exercise-based interventions compared with other conservative interventions in patients with CMCJ OA. We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fourteen randomised clinical trials with 1280 patients were finally included. Exercise-based interventions present statistically and clinically better outcomes in reducing pain intensity (mean difference [MD]: −21.91; 95% confidence interval [CI]: −36.59, −7.24; p = 0.003) and wrist disability (MD: −8.1, 95% CI: −4.6, −11.5; p = 0.02) compared with no treatment at short-term follow-up. Proprioceptive exercises have statistically and clinically better outcomes compared with standard care only in pain intensity at very short-term (standardised mean difference [SMD]: −0.76; 95% CI: −1.30, −0.21; p = 0.007) and short-term (SMD: −0.93; 95% CI: −1.86, −0.01; p = 0.049) follow-up and statistically better results in wrist disability at very short-term (SMD: −0.94; 95% CI: −1.68, −0.21; p = 0.01) follow-up. No differences were found between the comparators at mid- and long-term follow-up. Low to moderate certainty of evidence suggests that exercise-based interventions can provide clinically better outcomes compared with no treatment in patients with thumb CMCJ OA, at least in the short 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

Custom-made finger splint versus prefabricated finger splint: Finger flexion stabilization. Güven, E. and Suner-Keklik, S. (2022) Level of Evidence: 2b Follow recommendation: 👍 👍 👍  (3/4 thumbs up) Type of study: Therapeutic Topic : Custom vs off the shelf splints - Finger injuries This cross-sectional study assessed the effectiveness of custom-made splint compared to prefabricated finger splint in limiting joint motion in the pipj and dipj of the index finger. Forty healthy individuals (20 women, 20 men) were included in the present study and were asked to bend their index finger whilst wearing either the custom or prefabricated splint. Range of movement at the pipj and dipj was assessed. The results showed that the custom splint limited both pipj and dipj range to a large extent. In contrast, the prefabricated splint allowed dipj and pipj movement to about 24° and 17° respectively. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today , it appears that custom-made splints limit finger's pipj and dipj to a greater extent compared to prefabricated finger splints. This may be especially useful to know for conservatively managed of finger's fracture or tendon/bony lesions such as mallet finger . URL : https://doi.org/10.1590%2F1806-9282.20220093 Abstract Finger splints are used as a treatment option in tendon, bone, and soft tissue injuries. For immobilization, custom-made splints and prefabricated finger splints are used. In splints made for immobilization, it is aimed to limit joint movement. The aim of our study is to reveal how much custom-made splints and prefabricated finger splints limit joint motion (flexion angle in proximal interphalangeal and distal interphalangeal joints). Custom-made splints and prefabricated finger splints were applied to the second fingers of the dominant side in a total of 40 individuals, 20 women and 20 men, not having any health problems. Individuals were asked to flex and joint motion was measured with the iPhone compass application. The mean distal interphalangeal joint angle values of the participants measured by prefabricated finger splints were found to be 24.27±8.29, and the mean distal interphalangeal joint angle values measured by custom-made splints was 0.52±1.50. There was a difference between the participants’ distal interphalangeal joint angle values measured by prefabricated finger splints and custom-made splints (p<0.001). Distal interphalangeal joint angle values measured with custom-made splints were significantly smaller than those measured with prefabricated finger splints. The mean of the participants’ proximal interphalangeal joint angle values measured by prefabricated finger splints was 16.55±7.90, and the proximal interphalangeal joint angle values measured by custom-made splints was “0” for all participants. There was a difference between the participants’ proximal interphalangeal joint angle values measured by prefabricated finger splints and custom-made splints (p<0.001). Distal interphalangeal joint angle values measured with custom-made splints were significantly smaller than those measured with prefabricated finger splints. According to our study, custom-made splints can significantly reduce the flexion of the finger interphalangeal joints compared to prefabricated finger splints. 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

An open-label feasibility trial of transdermal cannabidiol for hand osteoarthritis. Bawa, Z., et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Thumb osteoarthritis - Cannabidiol This feasibility study assessed the potential use of a novel 4% CBD transdermal gel on hand osteoarthritis (OA). A total of 15 participants took part in it. Over a four-week period, participants applied the gel three times daily to their most painful hand. Pain severity was assessed using the Numeric Pain Rating Scale (NPRS) and hand functionality via a grip dynamometer (connected via Bluetooth to a phone) and self-report questionnaires. Quality of life including sleep, anxiety, stiffness, and fatigue were also assessed. Significant reductions in current, average, and maximum pain were observed, alongside increases in grip strength. In addition, subjective stiffness, anxiety, and fatigue all improved. Urine tests confirmed the systemic absorption of CBD. Despite favorable pain and strength outcomes, these benefits returned to baseline post-treatment (around 7 days from treatment interruption). 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, topical cannabidiol (CBD) gels show promise as a treatment option for reducing pain and improving grip strength in patients with symptomatic hand osteoarthritis. In addition, there appeared to be improvements in quality-of-life, anxiety, stiffness, and fatigue. These findings appear to be in line with previous evidence , however, it is important to remember that we have currently limited evidence in support of this topical agent . URL : https://doi.org/10.1038/s41598-024-62428-x Abstract Hand osteoarthritis (OA) is an irreversible degenerative condition causing chronic pain and impaired functionality. Existing treatment options are often inadequate. Cannabidiol (CBD) has demonstrated analgesic and anti-inflammatory effects in preclinical models of arthritis. In this open-label feasibility trial, participants with symptomatically active hand OA applied a novel transdermal CBD gel (4% w/w) three times a day for four weeks to their most painful hand. Changes in daily self-reported pain scores were measured on a 0–10 Numeric Pain Rating Scale (NPRS). Hand functionality was determined via daily grip strength measures using a Bluetooth equipped squeeze ball and self-report questionnaire. Quality of life (QoL) ratings around sleep, anxiety, stiffness and fatigue were also measured. All self-report measures and grip strength data were gathered via smartphone application. Urinalysis was conducted at trial end to determine systemic absorption of CBD. Eighteen participants were consented and 15 completed the trial. Pain ratings were significantly reduced over time from pre-treatment baseline including current pain (− 1.91 ± 0.35, p < 0.0001), average pain (− 1.92 ± 0.35, p < 0.0001) and maximum pain (− 1.97 ± 0.34, p < 0.0001) (data represent mean reduction on a 0–10 NPRS scale ± standard error of the mean (SEM)). A significant increase in grip strength in the treated hand (p < 0.0001) was observed although self-reported functionality did not improve. There were significant (p < 0.005) improvements in three QoL measures: fatigue, stiffness and anxiety. CBD and its metabolites were detected at low concentrations in all urine samples. Measured reductions in pain and increases in grip strength seen during treatment reverted back towards baseline during the washout phase. In summary, pain, grip strength and QoL measures, using smartphone technology, was shown to improve over time following transdermal CBD application suggesting feasibility of this intervention in relieving osteoarthritic hand pain. Proof of efficacy, however, requires further confirmation in a placebo-controlled randomised trial. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Self-assisted finger stiffness splint (SFSS). Almigdad, A., Obeidat, N., Melhem, M. and Abu-Ashour, S. (2024) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Relative motion splints - Finger stiffness This technical report discussed the use of a dynamic splint facilitating active finger movement or protecting tendons from excessive loading post-surgically. The splint that you can see below can be classified as a relative motions splint, which could be used to perform self-administered stretching exercises or protect extensor tendon repair (e.g. relative motion extension splint). The authors report it particularly beneficial for pipj and mcpj stiffness, with some utility in multiple-digit stiffness. The authors also indicate that they have been using it following tenolysis of extensor tendons or after phalanx fractures to improve flexibility. 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, relative motions splints present as an option to mobilise stiff finger or protect healing tissues . These splints appear useful to mobilise or restrict movement at the pipj/dipj. If you are interested in the use of relative motion splints for hand therapy, have a look at the whole database as these splint have been utilised for all sorts of conditions including trigger finger . URL : https://doi.org/10.7759%2Fcureus.51921 Abstract Finger stiffness may arise from injuries, surgeries, or hand-related medical conditions, impacting hand function and overall well-being in daily life. Rehabilitation and hand therapy play a crucial role in restoring optimal range of motion, strength, and functionality. This article introduces the Self-Assisted Finger Stiffness Splint (SFSS), a dynamic splint designed for active finger movement applicable in post-trauma or postoperative rehabilitation. SFSS empowers patients to perform self-administered stretching exercises, expediting recovery and improving compliance. Its versatility extends to postoperative rehabilitation, covering cases like tenolysis of extensor tendons or rehabilitation after fracture healing. While particularly effective for proximal interphalangeal joint (PIPJ) and metacarpophalangeal joint (MCPJ) stiffness, SFSS remains valuable for managing isolated finger stiffness and proves beneficial in addressing multiple-digit stiffness. 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

Effectiveness of neural mobilisation for the treatment of nerve-related cervicobrachial pain: A systematic review with subgroup meta-analysis. Lascurain-Aguirrebeña, I., et al. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Neurodynamic exercises - Cervicobrachial pain This ssystematic review and meta-analysis aimed to assess the effectiveness of neural mobilisations (NM) for treating nerve-related cervicobrachial pain. A total of 27 randomized controlled trials comparing NM to no treatment, cervical traction, and exercise for pain and disability outcomes were included in the present review. All the studies were scored through the Cochrane Risk of Bias tool and the overall quality of the evidence was scored through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The results showed that NM was more effective than no treatment, traction, and standard physiotherapy alone, specifically in patients fulfilling the Wainner cluster criteria (At least 3 out of 4 positive tests: median nerve tension test, reduced Cx rotation, Cx distraction test, and Spurling's test). However, the evidence was very low to moderate due to high risk of bias, small sample sizes, and significant heterogeneity among studies. There was limited evidence about NM's medium-term and long-term effects. The study concluded that NM might be particularly beneficial for specific subgroups of patients with nerve-related cervicobrachial pain. 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, neural mobilisations (NM) exhibit variable effectiveness for treating nerve-related cervicobrachial pain, depending on specific subgroups of patients. Of note, patients classified under the Wainner cluster criteria appear to benefit the most from NM exercises, although previous evidence appears to be in contrast with these findings . Remember that if you are suspecting a radiculopathy, you should complete a full neurological assessment including myotome testing . URL : https://doi.org/10.1097/j.pain.0000000000003071 Abstract Neural mobilisations (NM) have been advocated for the treatment of nerve-related cervicobrachial pain; however, it is unclear what types of patients with nerve-related cervicobrachial pain (if any) may benefit. Medline, Web of Science, Scopus, PeDro, Cinahl, and Cochrane databases were searched from inception until December 2022. Randomised controlled trials were included if they assessed the effectiveness of NM in nerve-related cervicobrachial pain, and outcome measures were pain intensity and/or disability. Studies were classified according to their inclusion/exclusion criteria as radiculopathy, Wainner cluster, Hall, and Elvey cluster or other. Meta-analyses with subgroup analyses were performed. Risk of bias was assessed using Cochrane Rob2 tool. Twenty-seven studies were included. For pain and disability reduction, NM was found to be more effective than no treatment (pooled pain mean difference [MD] = −2.81, 95% confidence interval [CI] = −3.81 to −1.81; pooled disability standardized mean difference = −1.55, 95% CI = −2.72 to −0.37), increased the effectiveness of standard physiotherapy as an adjuvant when compared with standard physiotherapy alone (pooled pain MD = −1.44, 95% CI = −1.98 to −0.89; pooled disability MD = −11.07, 95% CI = −16.38 to −5.75) but was no more effective than cervical traction (pooled pain MD = −0.33, 95% CI = −1.35 to 0.68; pooled disability MD = −10.09, 95% CI = −21.89 to 1.81). For disability reduction, NM was found to be more effective than exercise (pooled MD = −18.27, 95% CI = −20.29 to −17.44). In most comparisons, there were significant differences in the effectiveness of NM between the subgroups. Neural mobilisations was consistently more effective than all alternative interventions (no treatment, traction, exercise, and standard physiotherapy alone) in 13 studies classified as Wainner cluster. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Efficacy of splinting the wrist and metacarpophalangeal joints for the treatment of Carpal tunnel syndrome: An assessor-blinded randomised controlled trial. Nadar, M. S., Alotaibi, N. and Manee, F. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : Carpal tunnel syndrome - Lumbricals splint This randomised controlled study, assessed the effectiveness of a normal wrist splint vs a lumbrical splint for people with carpal tunnel syndrome (CTS). A total of 59 participants with mild-to-moderate CTS, were randomly assigned to wear either a traditional wrist-only splint or a modified splint that also limited mcpj flexion for six weeks. Outcome measures included grip and pinch strength, sensory tests, and pain. The results showed that both splints improved CTS symptoms, but the lumbrical splint was more effective in improving tip and palmar pinch strength. 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 splint including the mcpj may be more effective than a simple splint in reducing symptoms for carpal tunnel syndrome. The rational for the use of such splint is that most lumbricals enter the carpal tunnel during finger flexion . If you would like to read more about lumbricals you can have a look at the full dataset . URL : https://doi.org/10.1136/bmjopen-2023-076961 Abstract Objectives: To compare the efficacy of a traditional cock-up splint, which supports the wrist only, with a modified splint that supports the wrist and the metacarpophalangeal (MCP) joints of the medial four digits in the treatment of carpal tunnel syndrome (CTS). Design: An assessor-blind randomised controlled trial.Setting Hospital-based hand therapy clinics. Participants: Fifty-nine adults with mild-to-moderate CTS were randomly assigned to wear a wrist splint (control group) or an MCP splint (intervention group) for 6 weeks. Outcome measures: The standardised outcome measures used included grip and pinch strength, the static two-point discrimination test, Phalen’s manoeuvre test, Tinel’s sign and the Boston CTS Questionnaire. Results: Both groups improved significantly from splint use in some clinical features. The wrist splint and the MCP splint groups had significant improvements in lateral pinch strength (p=0.032 and p=0.002, respectively), two-point discrimination of the thumb (p=0.003 and p=0.041, respectively), two-point discrimination of the index (p=0.035 and p=0.023, respectively) and the Phalen’s manoeuvre symptoms (p=0.025 and p=0.002, respectively). The MCP splint group had additional improvements over the wrist splint group in tip pinch (p=0.012) and Palmar pinch (p=0.011) strength. Conclusion: Splinting is a practical and effective intervention option for improving the symptoms of CTS. A wrist splint that incorporates the MCP joints is more effective than the traditional wrist-only splint, with long-lasting improvements that remained consistent after 6 months of the splint intervention. Using the more effective MCP splint may consequently reduce disability, facilitate return to work and lower the associated costs. 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

Exercise training and bone mineral density in postmenopausal women: An updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators. Mohebbi, R., et al. (2023) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 (4/4 Thumbs up) Type of study : Therapeutic Topic : Bone health – Exercise The systematic review and meta-analysis assessed the effects of exercise on bone mineral density (BMD) in postmenopausal women. The study included controlled exercise trials of at least six months. The review analyzed BMD changes at the lumbar spine (Lx), femoral neck, and total hip from 80 studies for a total of 5,581 participants. Results indicated that exercise positively impacted BMD, with small to moderate effect sizes. No significant differences were found in the type of exercise, menopausal status, or exercise supervision. 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 has a positive impact on Bone Mineral Density (BMD) in postmenopausal women, regardless of bone status (osteopenia/osteoporosis vs. normal), menopausal stage (early vs. late postmenopausal), or the level of supervision (supervised vs. non-supervised). This is supported by previous evidence suggesting that exercise has a positive effect on bone remodelling in older adults . Keep in mind that you can screen for osteopenia/osteoporosis by looking at hand x-rays and that all patients presenting with a low energy trauma leading to distal radius fracture should undergo bone mass density assessment . URL : https://doi.org/10.1007/s00198-023-06682-1 Abstract The aim of this systematic review and meta-analysis was (1) to determine exercise effects on bone mineral density (BMD) in postmenopausal women and (2) to address the corresponding implication of bone and menopausal status or supervision in postmenopausal women. A comprehensive search of eight electronic databases according to the PRISMA statement up to August 9, 2022, included controlled exercise trials ≥ 6 months. BMD changes (standardized mean differences: SMD) at the lumbar spine (LS), femoral neck (FN), and total hip (TH) were considered as outcomes. Study group comparisons were conducted for osteopenia/osteoporosis versus normal BMD, early versus late postmenopausal women, and predominantly supervised versus predominantly non-supervised study arms. We applied an inverse heterogeneity (IVhet) model. In summary, 80 studies involving 94 training and 80 control groups with a pooled number of 5581 participants were eligible. The IVhet model determined SMDs of 0.29 (95% CI: 0.16–0.42), 0.27 (95% CI: 0.16–0.39), and 0.41 (95% CI: 0.30–0.52) for LS, FN, and THBMD, respectively. Heterogeneity between the trial results varied from low (I2 = 20%, TH BMD) to substantial (I2 = 68%, LS-BMD). Evidence for publication bias/small study effects was negligibly low (FN-, TH-BMD) to high (LSBMD). We observed no significant differences (p > .09) for exercise effects on LS-, FN-, or TH-BMD-LS between studies/study arms with or without osteopenia/osteoporosis, early versus late postmenopausal women, or predominantly supervised versus non-supervised exercise programs. Using robust statistical methods, the present work provides further evidence for a positive effect of exercise on BMD in postmenopausal women. Differences in bone status (osteopenia/osteoporosis versus normal bone), menopausal status (early versus late postmenopausal), and supervision (yes versus no) did not significantly affect the exercise effects on BMD at LS or proximal femur. 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

Impact of lifestyle and clinical factors on the prognosis of tennis elbow. Zhang, C., Jia, Z., Li, J., Wang, X. and Yang, S. (2024) Level of Evidence : 3b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Prognostic Topic : Lateral epicondylalgia – NSAIDs and CSI This prospective case-control study attempted to identify prognostic factors for recovery from common extensor origin tendinopathy. The study included 265, of which 53 underwent surgery and 212 did not. The results showed that smoking, alcohol consumption, and frequent physical exercise increased the risk of surgery. In particular, heavy drinkers had a 3.74-fold higher risk, while smokers had a 4.2-fold higher risk of needing surgery. In terms of conservative treatment, the combination of oral NSAIDs and local corticosteroid injections significantly reduce the need for surgery. 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, risk factors for surgical intervention for tennis elbow include smoking and high levels of alcohol consumption as well as frequent physical exercise. Protective factors included the combination of oral nonsteroidal anti-inflammatory drugs (NSAIDs) and local corticosteroid injections. This last finding is in contrast with previous research , and it may be best to discuss with patients the lack of certainty regarding the benefits/side effects of CSI for lateral epicondylalgia. It may be valuble to remind patients that cortisone injections appear to have a similar effect to a saline injection when combined with exercise . URL : https://doi.org/10.1038/s41598-024-53669-x Abstract Tennis elbow (lateral epicondylitis) typically responds well to conservative treatment, and few patients require surgical intervention. This study aimed to investigate the influence of lifestyle and clinical factors on the prognosis of tennis elbow. This prospective, multicenter, nested case–control study included patients diagnosed with lateral epicondylitis after excluding other conditions. Patients who required surgery because of inadequate improvement after 6 months of conservative treatment were defined as the case group; the remaining patients constituted the control group. Propensity score matching was performed to eliminate baseline differences. Univariate and multivariate analyses were performed using logistic regression. This study included 265 patients (53 in the case group, 212 in the control group). Multivariate analysis revealed that smoking, alcohol consumption, and frequent physical exercise were independent risk factors for surgical intervention, whereas combined treatment with oral nonsteroidal anti-inflammatory drugs (NSAIDs) and local corticosteroid injections was a protective factor against surgery. Subgroup analysis showed that heavy drinkers had a 3.74-fold higher risk of requiring surgical treatment within 1 year than occasional drinkers. Smoking and alcohol consumption were associated with non-operative treatment failure in patients with lateral epicondylitis. Combining oral NSAIDs and corticosteroid injections is a favorable conservative treatment option. 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

Diagnosis, prevention and treatment of common shoulder injuries in sport: Grading the evidence - A statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). Liaghat, B., et al. (2023) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Preventative, Therapeutic Topic : Shoulder injury - Prevention This statement paper provided a comprehensive review on prevention strategies and treatment of common shoulder injuries in sports. The authors found that injury prevention programs, including The Oslo Sports Trauma Research Center Shoulder Injury Prevention Programme and FIFA11+ , showed moderate to large effects. Treatment involving rehabilitation programs with various exercises reduced pain and disability. The quality of evidence often ranged from very low to moderate, indicating that further high-quality research is needed to refine clinical recommendations. 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, implementing preventative programs like the Oslo Sports Trauma Research Center and FIFA11+ shoulder exercises (see links in text above) can significantly reduce the risk of shoulder injuries. These programs have demonstrated moderate to large effect sizes. In terms of treatment, active rehabilitation incorporating stretching, and strengthening exercises provide pain relief and improve disability. If you are interested in risk factors for upper limb injury in baseball, have a look at this synopsis . URL : https://doi.org/10.1136/bjsports-2022-105674 Abstract This statement paper summarises and appraises the evidence on diagnosis, prevention, and treatment of common shoulder injuries in sports. We systematically searched Medline and Embase. The Grading of Recommendations Assessment, Development and Evaluation tool was applied to evaluate the overall quality of evidence.For diagnosis, we included 19 clinical tests from mixed populations. Tests for anterior instability, biceps-labrum complex injuries and full subscapularis rupture had high diagnostic accuracy (low to moderate quality of evidence).For prevention, the Oslo Sports Trauma Research Center, the Shoulder Control, the FIFA 11+ shoulder injury prevention programmes, and a baseball-specific programme (range of motion, stretching, dynamic stability and strengthening exercises) showed moderate to large effect size in reducing the risk of shoulder injury compared with no intervention (very low to moderate quality of evidence).For treatment, a rehabilitation programme including stretching, ice packs, electrotherapy and compression, and strengthening exercises showed a large effect size in reducing pain and disability compared with no intervention in athletes with subacromial impingement syndrome (very low to moderate quality of evidence). For the treatment of supraspinatus tendinopathy, hyperthermia treatment (heating the skin to 38°C-40°C) resulted in large effect size in reducing pain and disability compared with ultrasound or pendular swinging and stretching exercises (moderate quality of evidence). Strengthening exercise alone or in combination with stretching exercises promoted a large effect in reducing shoulder pain (cohort studies, no comparators) (very low quality of evidence). The quality of evidence for most estimates was low to moderate, indicating that future high-quality research may alter our recommendations for 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

Effectiveness of proprioceptive neuromuscular facilitation therapy and strength training among post-menopausal women with thumb carpometacarpal osteoarthritis. A randomized trial. Campos-Villegas, C., et al. (2022) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : Thumb osteoarthritis - Resistance training This randomised controlled study explored the effectiveness of strength training combined with proprioceptive neuromuscular facilitation (PNF) vs strength training alone in managing thumb cmcj osteoarthritis in post-menopausal women. A total of 42 participants were included in this study and they were randomised into two groups: one receiving strength training alone (n=21) and the other receiving strength training plus PNF (n=21). Participants attended sessions three times a week for four weeks. The findings revealed that both groups showed significant improvements in disability. However, the strength training plus PNF group presented with greater improvements in pain, range of movement, and strength. 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 strength training regimen plus or minus proprioceptive neuromuscular facilitation leads to positive improvements in disability, pain, and strength in people with symptomatic thumb cmcj. There is a growing body of evidence suggesting that resistance training is beneficial for symptomatic hand osteoarthritis and in contrast to what we used to think in the past, splinting for thumb OA does not appear to be necessary but it could be utilised in a multimodal approach . URL : https://doi.org/10.1016/j.jht.2022.07.005 Abstract Background: Thumb carpometacarpal osteoarthritis (CMC OA) greatly affects post-menopausal women. It is characterized by pain and functional deficits that limit the performance of activities of daily life and affect quality of life. Purpose: Analyze the effects of 4/weeks strength training, with and without proprioceptive neuromuscular facilitation (PNF) on the disability among post-menopausal women with thumb CMC OA. Secondly, analyze the effects on pain, mobility, and strength. Study Design: Superiority randomized clinical trial. Methods 42 women were randomly allocated to strength training program (SEG, n = 21) and to a strength training plus PNF therapy program (PNFG, n = 21). The Disability (disabilities of the arm, shoulder and hand questionnaire), pain (visual analogue scale), mobility (Kapandji Test), and hand strength were evaluated pre, post intervention (at 4 weeks) and follow-up (at 8 weeks). Results: Disability was significantly reduced in both groups after intervention, but reduction was statistically superior in PNFG (between-group mean difference [MD] = -16.69 points; CI = -21.56:-11.82; P <.001; d = 2.14). Similar results were observed for secondary outcomes: pain (MD = -2.03; CI = -2.83:-1.22; P <.001; d = 1.58), mobility (MD = 0.96; CI = 0.52:1.38; P <.001; d = 1.40) and strength (grip: MD = 3.47kg; CI = 1.25:5.69; P = .003; d = 0.97, palmar: MD = 0.97kg; CI = 0.14:1.80; P = .024; d = 0.72, tip: MD = 1.12kg; CI = 0.41:1.83; P = .003; d = 0.99 and key pinch: MD = 0.85kg; CI = 0.001:1.70; P = .049; d = 0.62). These improvements were maintained at follow-up. Conclusions: The combination of PNF exercises and strength training is more effective for reducing disability pain and improve mobility and strength in post-menopausal women with CMC OA than a programme based solely on strength. 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

Clinical and ultrasonographic effectiveness of two different splints used for the treatment of lateral epicondylitis: A prospective randomized controlled study. Songur, K., Demir, Z. D., Baysan, C. and Dilek, B. (2024) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : Lateral epicondylalgia – Counterforce brace vs wrist splint This randomized controlled study assesses the clinical and ultrasonographic effectiveness of two splints for people with lateral epicondylalgia. In particular, a counterforce brace and a wrist splint were compared. A total of 159 participants diagnosed with unilateral LE were included in the study. Participants were randomised into three groups: counterforce brace, wrist splint, or an education-only group. Participants' tendon thickness was measured at baseline and after six weeks. The results showed that over course of 6 weeks, the counterforce and wrist splint groups exhibited significant improvements in the Patient-Rated Tennis Elbow Evaluation (PRTEE) scores, pain, hand grip strength, and pain sensitivity compared to the education-only group, which only showed minor improvements. Among the two splints, the counterforce brace showed superior benefits on hand grip strength and patient satisfaction. Ultrasonographic parameters, such as maximum tendon thickness did not show significant differences between splint groups and the education-only approach. 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 a counterforce brace and a wrist splint appear to be an effective treatment options for individuals with lateral epicondylitis (LE) over six weeks. The counterforce brace seemed to perform slightly better than the wrist splint, however, recent evidence suggests that the addition of splinting to a multimodal approach does not provide significant differences . That being said, if you or the patients wanted a splint for LE, a counterforce brace may be more appropriate than a wrist splint . URL : https://doi.org/10.1016/j.apmr.2023.12.010 Abstract Objective: This study compares the clinical and ultrasonographic efficacy of 2 splint types, the lateral epicondylitis band (LEB) and the wrist extensor splint (WES), for treatment of lateral epicondylitis (LE). Design: Randomized controlled single-blind trial. Setting: Outpatient clinic. Participants: 159 participants diagnosed with unilateral LE based on clinical and ultrasonographic findings, and 2-12 weeks from symptom onset, were included (N=159). Interventions: One group received joint-protection education-only (wait-and-see), while the other 2 groups were fit with splints: one the LEB and the other the WES. Both splint groups received joint-protection education. Main Outcome Measures: The primary outcome measure was the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire. Secondary outcome measures were the Visual Analog Scale (VAS) for pain, hand grip strength by dynamometry, algometric measurements, patient satisfaction, and selected ultrasonographic parameters (maximum tendon thickness measurements (MTTM) in the capitellar-radiocapitellar region and total ultrasonography scale score [TUSS]). All outcomes were assessed at baseline, 3-weeks, and 6-weeks post intervention initiation. Results: Participants’ mean age was 46.85±8.63 years. Of the participants, 40.88% (n=65) were male and 59.12% (n=94) were female. The baseline median (1Q-3Q) values of PRTEE-total scores were 58.5 (51-68) for the LEB, 63.5 (56.25-70.25) for the WES and 57 (48-68) for the education-only groups. At 6-weeks, the PRTEE-total scores had decreased by 44 points for those randomized to the LEB, 46 points to the WES and 7 points in the education-only groups(P<.001). While the LEB and WES approaches were superior to the wait-and-see approach in algometric measurements, VAS, and PRTEE scores (P<.05), no significant changes were found in MTTM and TUSS values. The LEB group was superior to the WES group in hand grip strength and patient satisfaction (P<.05). Conclusion: Using either splint for 6 weeks can be considered effective for the relief of pain and increased functionality in persons with subacute LE, although the LEB had a more positive effect on grip strength and patient satisfaction than the WES. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Is multimodal occupational therapy in addition to usual care cost-effective in people with thumb carpometacarpal osteoarthritis? A cost-utility analysis of a randomised controlled trial. Tveter, A. T., et al. (2023) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 👍 (4/4 Thumbs up) Type of study : Therapeutic Topic : Thumb osteoarthritis - Usual vs multimodal care This multicentre randomised controlled study evaluated the cost-effectiveness of a 3-month multimodal occupational therapy intervention for patients with thumb carpometacarpal osteoarthritis (CMC1 OA) compared to usual care. The study was conducted across three rheumatology departments in Norway. A total of 180 patients were randomly assigned to receive either the multimodal therapy including patient education, hand exercises, assistive devices, and thumb splinting or usual care. Over a 2-year follow-up, patients in the intervention group gained more quality-adjusted life-years and €1151 were saved in direct costs compared to the control group. The graph below provides you a visual representation of the multimodal approach compared to usual care. 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, multimodal interventions, including patient education, hand exercises, assistive devices, and splinting are cost-effective for managing thumb cmcj OA over a 2-year period. This is inline with previous research on combined interventions for thumb OA, even though the effectiveness of interventions like splinting remains debatable . Thus, integrating these conservative therapies into routine care for thumb OA is recommended to enhance patient outcomes within a cost-effective framework. It appears to be important for people with hand OA to do activities with their hands that they find meaningful (e.g. knitting ) as this does not appear to make their symptoms any worse. URL : https://doi.org/10.1136/bmjopen-2022-063103 Abstract Objective: The aim was to evaluate the cost-utility of a 3-month multimodal occupational therapy intervention in addition to usual care in patients with thumb carpometacarpal osteoarthritis (CMC1 OA). Methods: A cost-utility analysis was performed alongside a multicentre randomised controlled trial including three rheumatology departments in Norway. A total of 180 patients referred to surgical consultation due to CMC1 OA were randomised to either multimodal occupational therapy including patient education, hand exercises, assistive devices and orthoses (n=90), or usual care receiving only information on OA (n=90). The outcome measure was quality-adjusted life-years (QALYs) derived from the generic questionnaire EQ-5D-5L over a 2-year period. Resource use and health-related quality of life of the patients were prospectively collected at baseline, 4, 18 and 24 months. Costs were estimated by taking a healthcare and societal perspective. The results were expressed as incremental cost-effectiveness ratios, and a probabilistic sensitivity analysis with 1000 replications following intention-to-treat principle was done to account for uncertainty in the analysis. Results: During the 2-year follow-up period, patients receiving multimodal occupational therapy gained 0.06 more QALYs than patients receiving usual care. The mean (SD) direct costs were €3227 (3546) in the intervention group and €4378 (5487) in the usual care group, mean difference €−1151 (95% CI −2564, 262). The intervention was the dominant treatment with a probability of 94.5% being cost-effective given the willingness-to-pay threshold of €27 500. Conclusions: The within-trial analysis demonstrated that the multimodal occupational therapy in addition to usual care was cost-effective at 2 years in patients with CMC1 OA.Trial registration number NCT01794754.Data are available upon reasonable request. 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