Search Results

Identifying clinically meaningful changes and predictors of improvement for patient- reported outcome measures in patients who undergo arthroscopic arthrolysis of Post-traumatic elbow stiffness. Ben et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Elbow stiffness - Arthroscopic surgery This retrospective study aimed at identifying the effectiveness of arthroscopic elbow arthrolysis for people with post-traumatic stiffness. A total of 65 participants were included in the study. Statistical as well as patient reported subjective improvements were utilised to assess the effectiveness of surgery at one-year follow up. The outcomes assessed included Visual Analog Scale (VAS), elbow function, and range of motion improvements. The results showed that all the patients presented with statistically relevant improvements. However, very few patients were satisfied with pain and function compared to pre-surgery. Predictors for achieving favorable outcomes included younger age, lower body mass index, and shorter symptom duration. 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, one year after arthroscopic surgery for post-traumatic elbow stiffness, most patients are still not fully satisfied with their elbow function and pain. This has both physical and mental health negative repercussions . As previous research has shown, pre-surgical predictors of favorable outcomes include lower BMI, shorter symptom duration, and pre-existing elbow pathology . Given all these findings, it is important to counsel our patients to the estimated recovery times, which often can extend beyond one year. URL : https://doi.org/10.1016/j.jse.2025.05.042 Abstract Background: Clinically meaningful outcome thresholds, including patient acceptable symptom state (PASS), minimal clinically important difference (MCID), and substantial clinical benefit (SCB), have rarely been evaluated after arthroscopic arthrolysis for post-traumatic elbow stiffness. This study therefore aimed to determine PASS, MCID, and SCB values for the pain visual analog scale (pVAS), Single Assessment Numeric Evaluation (SANE), Mayo Elbow Performance Score (MEPS), and range of motion difference (ROMD) after arthroscopic elbow arthrolysis. Methods: Sixty-five patients who underwent arthroscopic elbow arthrolysis were evaluated at a minimum of 1 year postoperatively using anchor-based methods for PASS and SCB, and a distribution-based method for MCID. Anchor questions were used to define clinically meaningful thresholds. Univariate and multivariate logistic regression analyses were performed to determine predictors of improvement for surgical outcomes. Results: All four measures demonstrated acceptable discriminative ability (area under the curve >0.70) for PASS and SCB. The PASS, MCID, and SCB thresholds were 2.5, 1.2, and 2.5 for pVAS; 65.0, 11.9, and 12.5 for SANE; 87.5, 9.5, and 17.5 for MEPS; and 113, 15, and 58 for ROMD. Lower preoperative scores were associated with significantly higher odds ratios (ORs) for achieving all thresholds. Longer symptom duration and the presence of ulnar nerve symptoms were associated with significantly lower ORs for achieving PASS for SANE. Younger age was significantly associated with achieving higher ORs for PASS for MEPS. For ROMD, younger age, shorter symptom duration, lower BMI, and the presence of preoperative ulnar nerve symptoms were associated with significantly higher ORs for achieving PASS. Conclusion: After arthroscopic elbow arthrolysis, reliable PASS, MCID, and SCB thresholds were identified for pVAS, SANE, MEPS, and ROMD. Favorable outcomes were more likely in patients with poorer preoperative scores, younger age, lower BMI, and shorter symptom duration, while preoperative ulnar nerve symptoms were negatively associated with achieving PASS. 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

Intra-articular corticosteroid injection versus suprascapular nerve block for adhesive capsulitis: A systematic review and meta-analysis of level I randomized controlled trials. Harley et al. (2025) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Nerve block - Frozen shoulder This systematic review and meta-analysis assessed the effectiveness of suprascapular nerve blocks (SSNB) vs intra-articular corticosteroid injections (CSI) for treating frozen shoulder. Eight randomised controlled trials for a total of 452 participants were included in the study. Pain relief, shoulder function, and range of movement were assessed at 3-4 weeks, 6-7 weeks, and 12 weeks. The individual studies were scored according to the Cochrane risk of bias criteria and the overall quality of the evidence was scored through the GRADE system. The results showed that low quality evidence supports the use of SSNB compared to CSI for potentially clinical relevant improvement in pain, and clinically relevant improvements in function (8 points difference on SPADI) and range of movement (14deg difference). 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, suprascapular nerve blocks are likely superior for pain relief, shoulder function, and active abduction by 12 weeks compared to intra-articular cortisone injections. Interestingly, hydrodalitation also appears to be superior to cortisone injections alone . The addition of cortisone to hydrodilatation appears to provide marginal improvements . Remember that to avoid higher shoulder disability in our patients with multiple upper limb trauma, wrist immobilisation should be kept to a minimum . URL : https://doi.org/10.1016/j.jse.2025.05.037 Abstract Background: Intra-articular corticosteroid injection and suprascapular nerve block are both options for nonoperative management of adhesive capsulitis. While numerous studies support the benefits of steroid injections, the use of suprascapular nerve blocks is less established. Published randomized trials comparing steroid injections and suprascapular nerve blocks for managing adhesive capsulitis have reported mixed results. This study aimed to perform a systematic review and meta-analysis of published level I studies to compare outcomes for patients with adhesive capsulitis following intra-articular corticosteroid injection or suprascapular nerve block. Methods: The study was performed according to the preferred reporting items for systematic reviews and meta-analysis. Three databases were searched for randomized controlled trials comparing an intra-articular steroid injection to a suprascapular nerve block in patients with adhesive capsulitis. Trials were excluded if either group received another procedure or included patients with concomitant ipsilateral shoulder pathology. Outcomes were patient-reported pain intensity and shoulder function, range of motion, and time to symptom resolution. Meta-analysis was performed for pain, shoulder function, and range of motion using random-effects models. Results: Eight studies with a total of 452 patients were included. Pain was assessed using the Shoulder Pain and Disability Index (SPADI) pain subscale and the visual analog scale. Functional outcomes were assessed using the SPADI and Constant-Murley Score. Range of motion assessments included active and passive movements in abduction, forward flexion, external rotation, and internal rotation. Random-effects comparisons at baseline, 3-4 weeks, 6-7 weeks, and 12 weeks were performed for pain and SPADI scores, and at baseline and 12 weeks for active abduction. Suprascapular nerve blocks were superior to steroid injections for pain at 3-4 weeks (standardized mean difference [SMD]: 0.63, 95% CI: 0.06-1.19, P = .03), 6-7 weeks (SMD: 0.49, 95% CI: 0.01-0.96, P = .046), and 12 weeks postintervention (SMD: 1.68, 95% CI: 0.30-3.06, P = .017). Nerve blocks were superior to steroid injections in reducing SPADI scores at 12 weeks postintervention (MD = 8.94, 95% CI: 1.44-16.44, P = .020). Nerve blocks were superior to steroid injections for active abduction at 12 weeks postintervention (MD = 14.44°, 95% CI: 11.05°-17.83°, P < .001). Heterogeneity was considerable for all meta-analyses. There were no other significant differences between groups at any time point. Conclusions: In patients with adhesive capsulitis, suprascapular nerve blocks provide greater pain relief at 3-4, 6-7, and 12 weeks, greater improvements in shoulder function at 12 weeks, and greater active abduction at 12 weeks, compared to intra-articular corticosteroid injections. 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

Total joint arthroplasty versus trapeziectomy for trapeziometacarpal joint arthritis: 5-year follow-up of a randomized controlled trial. Bonhof-Jansen, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Thumb OA - Trapeziectomy vs joint replacement This is a secondary analysis of a randomised controlled trial comparing total joint replacement and trapeziectomy for 1st cmcj OA. A total of 54 participants were included in the analysis. Severel ouctomes including hand function (primary outcome), grip, tip to tip, key pinch strength, and satisfaction were measured at 5-year follow-up. The results showed no significant difference between groups except for key pinch strength and satisfaction, suggesting that there is 12% probability that these significant cases were due to chance. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, total joint replacement and trapeziectomy, for thumb OA both showed similar results in terms of function, grip, and tip to tip pinch strength . However, trapeziectomy still remains the procedure with the least number of complications compared to other surgical approaches for thumb OA . If you are interested in early motion following trapeziectomy and return to work timeframes , have a look at the linked synopses. URL : https://doi.org/10.1177/17531934251357456 Abstract This study presents 5-year results of a randomized controlled trial comparing total joint arthroplasty (TJA) with the Maïa prosthesis and trapeziectomy for trapeziometacarpal joint osteoarthritis. Sixty-two women aged 40 and older scheduled for surgery were randomized. The primary outcome was daily hand function using the Michigan Hand Outcomes Questionnaire (MHOQ). Secondary outcomes included MHOQ subscales, range of motion, strength, satisfaction, complications and survival. Follow-up data were available for 28 TJA and 26 trapeziectomy patients. At 5-years, TJA did not show superior patient reported outcomes on the MHOQ compared with trapeziectomy. Grip and tip pinch strength differences were not statistically significant or clinically relevant. However, key pinch strength, satisfaction and willingness to undergo the same treatment again favoured TJA. There was no statistically significant difference in revision rates between the groups. Five-year survival was 73% for trapeziectomy and 93% for TJA. 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

Secondary metacarpal fracture after malunion of the little metacarpal. Zhang, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : 5th metacarpals - Secondary fractures This retrospective study assessed the likelihood of same location secondary metacarpal fractures in the little finger. A total of 19 patients with secondary fractures of the little finger metacarpal were included in the study. Of these, 9 patients had had a metacarpal neck fracture and 10 a shaft fracture. The results showed that an additional fracture of the 5th metacarpal occurred on average at 6 years after the first fracture. The majority (80%) of people who had a previous 5th metacarpal neck fracture fractured another area of the 5th metacarpal. In contrast, those people with a 5th metacarpal shaft fracture re-fractures the same area (80%). a) Secondary injury occurred at the original fracture site of the little metacarpal shaft. (b) Malunion of the little metacarpal neck fracture with a secondary fracture at the base of the little metacarpus. (c) Malunion of the little metacarpal shaft with a secondary fracture of the ring metacarpal neck. (d) Secondary fractures are likely at initial sites if the force direction is parallel to the long axis of the metacarpus. (e) Secondary fractures owing to shearing force occur at distinct sites when the force direction is not parallel to the long axis of the metacarpus and (f) the angular malunion of the little metacarpal fractures results in shortening, concentrating stress on the middle and ring metacarpals. 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, 5th metacarpal shaft fractures are more likely to re-fracture at the same location compared to neck fractures. It appears that bowing stress due to shaft angulation is the most likely biomechanical factor responsible for this finding. Most of the 5th metacarpal neck fractures can be managed conservatively with buddy strapping or splinting , however, shaft fractures require more careful consideration considering due to the potential for same site re-injury. URL : https://doi.org/10.1177/17531934251313978 Abstract Nineteen patients presenting with a secondary metacarpal fracture after a previously fractured little metacarpal were retrospectively reviewed. The new injury was more likely to be at the original fracture site in patients with shaft fractures than those with neck fractures. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Incidence and presentation of periprosthetic joint infection after primary metacarpophalangeal and proximal interphalangeal arthroplasty. Schluttenhofer, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic/Prognostic Topic : Pipj or mcpj replacement - Peri-prosthetic risk This retrospective study assessed the number of peri-prosthetic joint infections following proximal interphalangeal and metacarpophalangeal joint replacements. A total of 642 participants underwent 1418 replacements (average of two replacements per patient). The results showed that only 6 fingers developed a peri-prosthetic infection, which is 0.4% of the whole number of surgeries completed. The most frequent timeframe for periprosthetic infection was within 3 months from surgery, however, one person had one a 3.5 years after surgery. It was not possible to identify surgical or patient's factors associated with the risk of peri-phrostetic joint infections. This is most likely due to the low number of people in the infection group. Smith & Nephew pyrocarbon joint replacement 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, peri-prosthetic joint infections following pipj or mcpj replacement happen in 1 out of 200 or 300 people most often within the first three months after surgery. Very rarely, these infections can occur 3-4 years after surgery. In contrast, superficial infections occur in 5-10% of people after hand surgery surgery . Peri-prosthetic infections of the pipj and mcpj are so rare that it is difficult to identify risk factors for them. However, post-surgical infections seem to be more common in smokers , as well as in immunocompromised people or those with diabetes . Also remember that cortisone injections in close proximity to the surgical have the potential to increase the risk of infection if delivered within 3 months prior to surgery. This is not the case if the injection is delivered to other distant joints . URL : https://doi.org/10.1016/j.jhsa.2024.12.008 Abstract Purpose: Periprosthetic joint infection (PJI) is a devastating complication that has been extensively investigated in large joint arthroplasty. However, this has been inconsistently reported after metacarpophalangeal (MCP) and proximal interphalangeal (PIP) arthroplasty. The objective of the study was to report the presentation and treatment of patients with PJI after MCP or PIP joint arthroplasty. Methods: We performed a retrospective review of 1418 primary MCP or PIP arthroplasties in 642 patients with a minimum of 180 days of follow-up (mean 9.0 years) at a single institution from 1991 to 2020. We also analyzed the association of patient (body mass index, smoking, diabetes, and immunocompromised status) and surgical (digit, implant, operative time, and reoperation) factors with infection. Results: There were six joints, all in separate patients, that developed PJI (0.4%). The median time to PJI was 91.5 days. Of the six patients with PJI, five had no systemic symptoms and a normal leukocyte count. The most common cultured organism was Staphylococcus aureus. PJI was most commonly treated with hardware removal and antibiotics. Conclusions: PJI is uncommon after MCP or PIP arthroplasties. It commonly presents without systemic symptoms or leukocyte count and is most frequently caused by Staphylococcus aureus. More studies are needed to identify the optimal diagnostic criteria, treatment, and preventive strategies of PJI of the MCP and PIP joints. 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

Preoperative hand therapy instructions do not improve short-term outcomes in carpal tunnel and trigger finger surgery. Kalimian, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Pre-surgical instructions - Carpal tunnel and trigger finger release This non-registered, not blinded randomised controlled study assessed whether structured preoperative instructions from a hand therapist improved short-term outcomes after carpal tunnel (CT) and trigger finger (TF) release surgeries. A total of 87 patients were randomly assigned to either receive detailed preoperative guidance from a hand therapist or brief verbal instructions from the surgeon prior to their procedure. The preoperative instructions included edema management, exercises, pain control strategies, and expectations of recovery. Assessments were completed pre-surgery, and 2 and 6 weeks post-surgery. The primary outcome was Quick DASH at 6 weeks, however, there were other outcomes including pain, pinch and grip strength. The results showed no significant differences between groups on both objective and subjective measures. 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, structured preoperative instructions from hand therapists do not significantly improve short-term recovery outcomes after carpal tunnel or trigger finger release surgeries. It is possible that different types of surgery, that have lower satisfaction rates for patients, may benefit from pre-surgical consultations . URL : https://doi.org/10.1177/17531934251313763 Abstract The impact of preoperative structured instructions by a hand therapist on recovery after carpal tunnel and trigger finger releases was assessed in 87 patients. No significant differences in recovery, satisfaction, or outcomes were found, suggesting limited benefit. 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

Long-term survival of acumed anatomical radial head implant for mason type iii-iv fractures: A 15-year follow-up. Tarallo, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Radial head replacement - Survival expectations This retrospective study assessed the survival and complications following radial heal replacement. A total of 149 patients comprising 73 women and 76 men were included in the study. All patients had undergone radial replacements for Mason III and IV fractures (comminuted and displaced fractures) from 2005 to 2020. Post-surgery the average range of motion was elbow e/f of 10/130 degrees with supination/pronation of 80/80 degrees with good functional outcomes overall. Heterotopic ossification was observed in 50% of patients. In terms of complications, 10% presented with stiffness and 5% had implant loosening. Of those that required implant removal, this occured, on average at 1.5 years from surgery. Kaplan-Meier survival curve showed 95% implant survival at 15 years. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, radial head replacements for comminuted and/or displaced fractures have a positive outlook with 95% survival at 15 years from surgery. The most common complication was stiffness (10%) followed by implant loosening (5%). In contrast to radial head replacements, total elbow replacement or hemiatroplasty have worse outcomes with significant lifting limitations. For further stories and fun facts on elbow replacements, have a look at the entire database on the topic . URL : https://doi.org/10.1016/j.jse.2025.05.038 Abstract Background: Radial head fractures account for 1.7% to 5.4% of all skeletal fractures and approximately one-third of elbow fractures. These injuries are often associated with other concurrent injuries, such as fractures of the coronoid, ligamentous injuries of the elbow, or trauma to other regions of the upper limb. Intra-articular fractures, especially Mason type III and IV, often require anatomical reduction to restore the articular surface, but such procedures can yield suboptimal results, highlighting the role of radial head implants in complex cases. Materials and methods: This retrospective study evaluated patients treated with Acumed Anatomical Radial Head implant from 2008 to 2023, specifically those with Mason type III and IV fractures. A total of 149 patients were included, with an average follow-up of 7 years. Results: Clinical outcomes, assessed using the Mayo Elbow Performance Score, showed an average score of 90, with an average range of motion of 130° in flexion and 78° in pronation and supination. Implant survival at 15 years exceeded 95%, confirming the long-term effectiveness of anatomical radial head implants. The most common complications included: heterotopic ossification with reduced joint mobility (35%), postoperative stiffness with functional limitations (9.4%), and implant loosening (4.7%). Conclusions: Radial head implants offer a reliable treatment for complex Mason type III and IV fractures, with good functional and survival outcomes and a low incidence of complications. However, careful implant sizing is crucial to avoid complications such as premature loosening, joint stiffness, and pain. 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

Tendon impingement of the extensor digiti minimi: Clinical cases series and cadaveric study. Yoo, et al. (2012) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic/Anatomical Topic : EDM impingement - Ulnar sided pain This article reports on two cases of extensor digiti minimi (EDM) tendon impingement and one on EDM tenosinovitis due to anatomical variations. The two traumatic cases had wrist hyperflexion in a full fist position as a mechanism of injury. Through surgical exploration, the EDM bifurcation was found to be impinging at the entry of the sheet (see surgical and anatomical picture below). Through dissections of 49 cadavers, the authors showed that 40% of people had an EDM bifurcation very close to the synovial septum (asterisk in surgical picture), which caused impingement during full little finger flexion. 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 reporting pain in the dorsal ulnar aspect of the hand, who have had a wrist hyperflexion injury whilst holding a full fist, may be presenting with extensor digiti minimi (EDM) impingement or traumatic tenosynovitis. This is because some people have EDM bifurcations very close to the synovial septum (see pictures above). The large majority of people present with EDM, hence this pathology has the potential to occur in a good chunk of our patients given the right mechanism of injury. It is much less likely for extensor digitorum communis (EDC) to present with this pathology as the majority of people do not have a slip going to the little finger . URL : https://doi.org/10.1002/ca.22017 Abstract The authors describe two unique clinical cases of closed extensor digiti minimi (EDM) tendon injuries after hyperflexion of the wrist with full finger flexion and one case of chronic tenosynovitis around the EDM tendon. All three cases were thought to be related to the bifurcation of the EDM tendon and synovial septum. Subsequently, variations in EDM tendons were investigated in 49 cadaveric hands with a focus on patterns of tendon bifurcation and their relationships with the surrounding synovial sheath. The EDM tendon was found to be bifurcated in 74% (n = 36) of hands and all of these hands contained a synovial septum. In 9 (25%) hands, the EDM tendon bifurcated proximal to the retinaculum, in 15 (42%), it bifurcated distal to the retinaculum, and in the other 12 hands (33%), the tendon bifurcated at the retinacular level. In 6 of the 15 hands with an infraretinacular bifurcation, the tendon was found to impinge on the synovial septum during passive flexion of the wrist with full finger flexion, and the mean distance between the synovial septum and the bifurcation point in these specimens was 0.6 cm (range, 0.4–0.7 cm), which was differed significantly from hands not showing impingement (P = 0.01). This study shows that distal bifurcation of the EDM tendon may lead to tendon impingement on the septum and suggests that this is a potential etiology of chronic tenosynovitis of the fifth compartment and of acute closed tendon injuries. 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

Ulnar-sided wrist pain: Systematic clinical approach and principles of treatment. Satria, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Ulnar wrist pain - Objective tests This is an expert opinion on ulnar sided wrist pain. The authors highlight how ulnar wrist pain can be a diagnostic challenge due to its anatomy and symptoms presentation. A comprehensive approach involving detailed medical history, physical examination, and imaging is reported as being fundamental for accurate diagnosis. Common diagnoses include ECU tendinopathy, TFCC sprains, ulnar impaction syndrome, as well as more severe traumatic presentations like DRUJ laxity, lunotriquetral ligament injuries or fractures, hook of hamate fractures and non-union, with potential progression to DRUJ and pisotriquetral osteoarthritis. Other differential diagnoses include nerve-related issues, such as Guyon’s canal syndrome, and vascular problems like hypothenar hammer syndrome. Last but not least this article describes the DRUJ compression test, which is performed by asking the patient to perform pronation-supination whilst the clinician indirectly applies compressive forces to the DRUJ at the mid-distal forearm (see picture below). The DRUJ compression test is also the first test that is shown in the video below. Also, if you would like to see a positive DRUJ ballottement test, go to the minute 1:38 of the video. 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 DRUJ compression test could be utilised to assess whether approximation of the radius and ulna contribute to symptoms during pronation/supination in our patients. Keep in mind that often there is more that one pathology involved with ulnar wrist pain and that ECU tendinopathy can be often present with TFCC tears . In addition to the most common musculoskeletal conditions of the ulnar wrist described above, it is important to exclude less common differential diagnoses, such as nerve-related issues (e.g., Guyon’s canal syndrome) or vascular problems (e.g., hypothenar hammer syndrome). In the next few months you will see a case study on vascular problems coming through on HandyEvidence. On a final note, make sure you always test the contralateral limb of patients as I have seen bilateral positive DRUJ ballotement , which was not associated with trauma/symptoms. If you are interested in ulnar sided wrist stories and information, have a look at the whole dataset . URL : https://doi.org/10.2147/ORR.S506374 Abstract The source of ulnar-sided wrist pain is difficult to determine because the history and physical examination findings of various illnesses frequently coincide, and are multifactorial. Pain on the ulnar side of the wrist can be identified on the basis of the tissue from which it arises. Knowledge of the anatomy of the ulnar side of the wrist is required for correct diagnosis, as in numerous diagnostic tests. Given the complex nature of disease diagnosis, various methods have been proposed. This article discusses systematic methods for obtaining a patient’s medical history, physical examination, and treatment principles to assist surgeons in determining the source of common ulnar-sided wrist pain. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Ultrasound imaging for the rheumatologist II. Ultrasonography of the hand and wrist. Filippucci, et al. (2006) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : US imaging - Hand and upper limb diagnoses This is an expert opinion on the use of diagnostic ultrasound (US) in assessing inflammatory and degenerative hand and wrist pathologies. The authors suggest how US is valuable for detecting synovitis, characterised by joint effusion and synovial hypertrophy, bone erosion, often seen in early rheumatoid arthritis. This imaging modality also helps in identifying tenosynovitis, which involves tendon sheath widening due to synovial fluid accumulation. The median nerve can also be measured to assess changes like increased cross-sectional area (proximal to the carpal tunnel), which is a common sign of carpal tunnel syndrome. Representative examples of hand and wrist US pathological findings. A-B. Rheumatoid arthritis. Proliferative synovitis (s) of a MCP joint on dorsal longitudinal (A) and transverse (B) views. C. Heberden node. Dorsal longitudinal scan showing osteophytes (arrow heads). D. Rheumatoid arthritis. Partial rupture (arrow) of the extensor carpi ulnaris tendon (t). E-F. Carpal tunnel syndrome. Marked thickening of the median nerve (n) at the proximal entrance of the carpal tunnel both on tranverse (E) and longitudinal (F) views. m = metacarpus; pp = proximal phalanx; mp = middle phalanx; dp = distal phalanx; u = ulna; lu = lunate bone; ca = capitate bone; r = radius. 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, ultrasound (US) imaging plays a crucial role in the assessment of hand and wrist conditions, particularly in autoimmune (rheumatoid arthritis) and musculoskeletal presentations. Synovitis, joint effusion, synovial hypertrophy, bone erosion, and median nerve edema can all be assessed with US imaging. US imaging has also been shown to correlate with nerve conduction studies for cubital tunnel syndrome and can be utilised to assess elbow joint effusion . Have a look at all the case studies and papers related to the use of US imaging in our database . URL : https://pubmed.ncbi.nlm.nih.gov/16762144/ Abstract The hand is one of the anatomical regions most frequently explored by ultrasonography (US) in rheumatology. The last generation US systems equipped with high frequency probes allow for a quick and accurate assessment of even minimal pathological changes in patients with rheumatic conditions affecting the small joints and the soft tissues of the hand and wrist. Several studies have demonstrated the great value of US imaging of the hand and wrist in rheumatology but there are still controversial issues which yet have to be adequately addressed, particularly with regard to US semi-quantitative evaluation of synovitis and bone erosions in patients with chronic arthritis. This paper provides the basic knowledge, reviews the available evidence and discusses the potential of US in the evaluation of the hand and wrist. 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

Influence of flexor pronator muscle contraction on medial elbow joint space distance in high school baseball players: A cross-sectional study. Suzuki, et al. (2025) Level of Evidence : 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : Medial elbow stability - Pronator teres This cross-sectional study assessed the effect of specific forearm muscles effect on medial joint space at the elbow in high school baseball players. A total of 36 players were included. Nine different contraction types which involved pronator teres, flexor carpi radialis, palmaris longus, and flexor digitorum superficialis were trialled. Utilising ultrasound imaging, medial joint space of the elbow was assessed. The results showed that pronator teres contraction in isolation or in combination with other flexors led to a statistical significant narrowing of the medial elbow joint space. 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, pronator teres contractions reduce medial elbow joint space during contraction. This research seems to be in line with a previous paper assessing the effect of gripping on medial elbow joint gapping . It is therefore possible that increasing the resilience of the pronator teres complex may help stabilising elbows presenting with medial elbow ligament insufficiency. By increasing resilience I mean strength and endurance of the pronator teres muscle. URL : https://doi.org/10.1016/j.jse.2024.12.025 Abstract Background/Hypothesis: The contraction of the flexor pronator muscles (FPMs) plays an important role in stabilizing the elbow joint in baseball players. However, the influence of different types of contractions on the medial joint space (MJS) in high school baseball players is not well understood. This study aimed to elucidate the effects of individual or combined contractions of the FPMs, specifically the flexor carpi ulnaris, flexor digitorum superficialis (FDS), pronator teres (PT), palmaris longus, and flexor carpi radialis, on the MJS in high school baseball players. We hypothesized that contractions, particularly of the FDS, PT, and flexor carpi radialis, would lead to a narrowing of the MJS. Methods: The study included 36 high school baseball players who executed 9 different contraction tasks related to the FPMs (including a resting state) in a randomized order. The MJS was measured using ultrasound equipment and compared with the resting state. The Friedman test, as a repeated-measures one-way analysis of variance, was performed, followed by Steel's test for multiple comparisons. All analyses were conducted using EZR software, with a significance level set at 5%. Results: The repeated-measures one-way analysis of variance and the Friedman test revealed a significant difference among the 9 contraction tasks (P < .001). Using Steel's test, a significant reduction in the MJS (mean ± standard deviation) was observed compared with the resting state (4.8 ± 1.2 mm), particularly in contraction tasks involving the PT (4.0 ± 1.0 mm, P = .017), FDS and PT (4.0 ± 1.1 mm, P = .007), and flexor carpi ulnaris, FDS, and PT (4.0 ± 1.1 mm, P = .008). Conclusions: Incorporating the PT into contraction tasks significantly reduced the MJS, emphasizing the important role of the PT in elbow joint stability. More work is required to see if the results of this study can be used to develop injury prevention and rehabilitation strategies. 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 importance of active exercise in treatment of tendinous mallet finger: Insights from a randomized controlled clinical trial. Zhu, et al. (2025) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Tendon mallet - Pinning vs conservative management This randomised controlled trial compared the effectiveness of surgical treatment versus conservative management of acute tendinous mallet finger injuries. A total of 41 participants were included in the study. Participants were randomised to either k-wire pinning or thermoplastic splinting. Range of movement of the dipj in extension and flexion were collected prior to randomisation, at the end of treatment and at four months from randomisation. The results showed that there was no difference between the two interventions. Furthermore, both groups presented with a dipj lag immediately after k-wire/splint removal, which improved by the four months follow up (see pictures 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, surgical and conservative treatments for tendinous mallet finger obtain similar outcomes. Furthermore, independently of the type of intervention, dipj presented with a lag when initiating splinting weaning/k-wire removal, which subsequently resolved. Remember that not all mallet finger injuries can be treated conservatively. If patients present with a large bony fragment, that may be best managed with surgery. To figure out whether that is the case, the new concentric circles method should be used to assess distal and middle phalanx joint congruency . URL : https://doi.org/10.1016/j.jhsa.2024.12.011 Abstract Purpose: Tendinous mallet finger lacks high-level evidence guiding optimal treatment. In this study, we compared the results of thermoplastic splints with those of surgical treatment using Kirschner wire (K-wire) fixation in the management of tendinous mallet finger injuries. Method: Forty-eight patients were enrolled and randomly assigned to the thermoplastic splint group (n = 23) and K-wire group (n = 25). An evaluation was performed 16 weeks after treatment, mainly focusing on DIP joint extension and flexion angles, and extension lag. The results were graded using the Abouna-Brown and Crawford scores, and factors affecting the outcomes were analyzed. Results: There was no significant difference in the outcomes between the groups in terms of final extension and extension lag after 16 weeks. The final extension of the DIP joint in both groups correlated with the extension degree under fixation (R = 0.60) and the maximal extension of the contralateral fingers (Rho = 0.54). Slight extension loss was observed in the early stage after the removal of the form of immobilization (K-wires or splints), which was partially improved by routine active exercise. Conclusions: Both K-wire fixation and thermoplastic splinting are effective treatments for tendinous mallet fingers, showing similar patterns of DIP joint extension loss and recovery during rehabilitation. Sustained active exercise appears to support DIP joint extension recovery. 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