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Anconeus syndrome: A potential cause for lateral elbow pain and its therapeutic management - A case report. Gangatharam, S. (2021) Level of Evidence : 5 Follow recommendation : 👍 (1/4 Thumbs up) Type of study : Diagnostic/Therapeutic Topic : Anconeous syndrome – Tennis elbow differential diagnosis This is a case study describing a case of a 55-year-old right-handed male with lateral elbow pain and swelling due to anconeus muscle pathology. The patient was given an elbow splint for 4 weeks, followed by eccentric and concentric strengthening to the elbow and wrist. The splint allowed for the elbow to rest in 60 degrees of flexion and neutral forearm rotation. Grip strength measurement was used to measure progress as there is no orthopaedic test that specifically targets the anconeus muscle. After 9 weeks, the patient was pain-free and returned to pre-injury work with no symptoms. 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, anconeus muscle involvement should be considered in cases of lateral elbow pain that do not respond to the usual treatment for lateral epicondylalgia. Treatment may include an elbow splint for 4-6 weeks, followed by eccentric and concentric strengthening exercises for elbow extension. Grip strength measurement appears to be limited not only in tennis elbow, but also anconeous syndrome and should therefore be used to monitor progress. If you would like to get a more complete picture about lateral epicondylalgia, have a look at the whole collection . URL : https://doi.org/10.1016/j.jht.2019.04.002 Abstract Study Design: This is a case report. Introduction: Anconeus is a small, triangular muscle in the posterior aspect of the elbow, and it functions as weak elbow extensor and abducts the ulna during pronation. The contribution of anconeus muscle can cause lateral elbow pain, which is difficult to diagnose and treat. It also does not respond to the regular treatment for lateral epicondylitis. Purpose of the Study: The purpose of this study was to report anconeus muscle irritation as a sole cause for lateral elbow pain. Methods: The patient was given an elbow splint for 4-6 weeks followed with eccentric and concentric strengthening to the elbow and wrist. Result: At the end of week 9, the patient was pain-free. Conclusion: The clients who are not responding with the usual treatment of lateral epicondylitis should be considered for any anconeus involvement. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Prevalence and clinical manifestations of the anconeus epitrochlearis and cubital tunnel syndrome. Maslow, J. I., Johnson, D. J., Block, J. J., Lee, D. H. and Desai, M. J. (2018) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Diagnostic/Therapeutic Topic : Cubital tunnel – Anconeous epithrochlearis This retrospective study assessed the prevalence of anconeus epitrochlearis (AE) muscle in patients with cubital tunnel syndrome. It was found that 14% of patients had an AE muscle present and that those with an AE experienced quicker and more reliable symptom improvement after cubital tunnel release than those without the anomalous muscle. It was also found that no patients with an AE underwent a revision operation compared with 10% of the control group. It is suggested that excision of the AE in a patient with cubital tunnel syndrome may be protective against the development of the syndrome. 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 presence of an anconeus epitrochlearis (AE) muscle is associated with cubital tunnel syndrome and has a prevalence of 14%. Patients with an AE experience quicker and more reliable symptom improvement after surgical release than those without the anomalous muscle. Preoperative MRI or US is not likely to change the decision to intervene surgically, but postoperative we may be able to further reassure patients if AE was found and released. Pre-surgical US imaging may be useful in identifying space-occupying lesions and assessing nerve morphology . URL : https://doi.org/10.1177/1558944718789412 Abstract Background: The true prevalence of the anconeus epitrochlearis (AE) and the natural history of cubital tunnel syndrome associated with this anomalous muscle are unknown. The purpose of this study was to evaluate the prevalence of AE and to characterize the preoperative and postoperative features of cubital tunnel syndrome caused by compression from an AE. Methods: All elbow magnetic resonance imaging (MRI) scans and all patients undergoing cubital tunnel surgery during a 20-year period were identified and retrospectively reviewed for the presence of an AE. All patients with an AE identified intra-operatively were matched to patients with no AE identified at surgery based on age, sex, concomitant procedures, and year of surgery. Preoperative and postoperative physical exam findings, electrodiagnostic study results, time to improvement, and reoperations were compared between the groups. Results: A total of 199 patients had an elbow MRI, and 27 (13.6%) patients were noted to have an AE present. Average time to improvement after surgical release was 23.0 days for patients with an AE and 33.2 days for patients with no AE. Twenty-seven patients with an AE noted improvement at the first postoperative visit (68%) compared to 15 patients without an AE (33%). No patients with an AE underwent reoperation for recurrent symptoms (0%) compared with four patients (10%) without an AE. Conclusions: The prevalence of AE in our study is 13.6%. These patients experience quicker and more reliable symptom improvement after surgical release than those without the anomalous muscle. 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

Elbow pain in pediatrics. Crowther, M. (2009) Level of Evidence : 5 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Diagnostic Topic : Paediatric elbow conditions - Differential diagnosis This is an expert opinion on the diagnosis and treatment of elbow pain in pediatric and adolescents. The author highlights the importance of taking a thorough history and physical examination, as well as utilising x-rays and other imaging modalities to exclude important pathologies. Common causes of elbow pain include supracondylar fractures, Nursemaid's elbow (displacement of the anular ligament with forearm traction injuries), osteochondritis dissecans of the capitellum, Panner's Disease (lack of vascular suppy to growth plateleading to capitellum flattening), olecranon apophysitis, and avulsion fractures. Treatment typically involves rest, ice, NSAIDs, compression wrappings and elbow pads, rehabilitation, splinting, and in some cases, surgical fixation. 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, common causes of elbow pain in pediatric patients include fractures, apophysitis, and other more severe conditions such as Panner's Disease and osteochondritis dissecans. If you are interested in osteochondritis dissecans, we have two synopses on its surgical and conservative management. Unfortunately, it is not always easy to predict recovery from these conditions and we need to keep a close eye on their evolution . URL : https://doi.org/10.1007/s12178-009-9049-4 Abstract The pediatric and adolescent elbow is subject to both acute and chronic overuse injuries. The practitioner should develop a classification system to evaluate all such injuries, with first focusing on whether the injury represents an acute episode or rather it represents a more chronic problem. In addition, localizing the area of pain as being either medial, lateral, or posterior can better help differentiate the diagnosis. Youth baseball pitchers and throwers are particularly at risk for overuse injuries of the elbow, most of which are related to an injury mechanism termed “valgus extension overload”. The most common entity related to this is termed “Little Leaguer’s Elbow.” Treatment is usually conservative, but for some injuries surgery may be required, especially for displaced medial epicondylar avulsion fractures. Other acute injuries also should be easily recognizable by the general clinician including annular ligament displacement (nursemaid’s elbow) which represents one of the most common upper extremity injuries presenting to emergency rooms in youngsters under the age of 6. Most studies seem to indicate a hyperpronation reduction technique may be more successful then the flexion/supination technique. It is also important to have an awareness of some of the common elbow fractures seen in the younger patient, in particularly supracondylar fractures owing to their high propensity for complications. When evaluating the elbow for fractures, it is necessary to have an understanding of the appearance of the ossification centers seen on the pediatric elbow. 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 and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma and the Orthopedic Trauma Association. Patrick, B. M., et al. (2023) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 (4/4 thumbs up) Type of study : Therapeutic Topic : NSAIDs - Fracture non-union This is a systematic review and meta-analysis assessing the efficacy and safety of NSAIDs for the treatment of acute pain following bone fractures. Nineteen studies (RCTs and retrospective studies) for a total of 51,687 participants were included in the present review. Outcomes included fracture non-union, use of opioids, and pain relief. Studies were assessed through the Risk of Bias criteria recommended by the Cochrane Review Group. The overall strength of evidence was assessed through the GRADE approach ("low", "very low", "moderate", "high"), which has also been suggested by the Cochrane group for systematic reviews. The results showed that there is very low quality of evidence suggesting that NSAIDs lead to a greater rate of fracture non-union. However, there was high-quality evidence showing that they reduce opiods intake and that they provide significant analgesia. It was therefore concluded that the benefits of NSAIDs outweigh the potential harms. 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 use of NSAIDs in adult patients with fractures appears to reduce pain, the need for opioids, and have a small effect on non-union. Overall, the benefits of NSAIDs in the treatment of acute traumatic fractures appear to outweigh the risks. This provides some clarity on previous arguments against the use of anti-inflammatories in the acute stages of tissue healing . We should therefore encourage the use of NSAIDs in patients suffering from traumatic fractures if they have been prescribed it by their doctors/orthopaedic surgeons. URL : https://doi.org/10.1136/tsaco-2022-001056 Abstract Objectives: Fracture is a common injury after a traumatic event. The efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) to treat acute pain related to fractures is not well established. Methods: Clinically relevant questions were determined regarding NSAID use in the setting of trauma-induced fractures with clearly defined patient populations, interventions, comparisons and appropriately selected outcomes (PICO). These questions centered around efficacy (pain control, reduction in opioid use) and safety (non-union, kidney injury). A systematic review including literature search and meta-analysis was performed, and the quality of evidence was graded per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The working group reached consensus on the final evidence-based recommendations. Results: A total of 19 studies were identified for analysis. Not all outcomes identified as critically important were reported in all studies, and the outcome of pain control was too heterogenous to perform a meta-analysis. Nine studies reported on non-union (three randomized control trials), six of which reported no association with NSAIDs. The overall incidence of non-union in patients receiving NSAIDs compared with patients not receiving NSAIDs was 2.99% and 2.19% (p=0.04), respectively. Of studies reporting on pain control and reduction of opioids, the use of NSAIDs reduced pain and the need for opioids after traumatic fracture. One study reported on the outcome of acute kidney injury and found no association with NSAID use. Conclusions: In patients with traumatic fractures, NSAIDs appear to reduce post-trauma pain, reduce the need for opioids and have a small effect on non-union. We conditionally recommend the use of NSAIDs in patients suffering from traumatic fractures as the benefit appears to outweigh the small potential risks. 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

On the safe position for hand immobilization. Tang, J. B. (2019) Level of Evidence : 5 Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : Position of Safe Immobilisation - Effectiveness This article discusses the use of the intrinsic plus position for hand immobilisation, which was proposed by Professor James in the 1970s. It is argued that this position is not necessary and can cause discomfort to patients. A survey of surgeons from two continents and three senior surgeons found a wide spectrum of use, with two from Asian countries using it infrequently. A randomised controlled study in 2008 compared the use of POSI vs neutral mcpj positioning in 5th metacarpal neck fractures. The results showed that similar joint range of motionwas obtained by the end of treatment. However, patient comfort was greater when the hand was splinted in mild MP flexion rather than in POSI. 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 intrinsic plus position for hand immobilisation is not always necessary and can cause discomfort to patients. A mild flexion of the MP joints is a safe position for hand immobilisation and can provide greater patient comfort. This is particularly important as discomfort/pain whilst in a splint/cast increase the chances of developing CRPS . It is important to consider the individual patient's needs when deciding on the best immobilisation position. URL : https://doi.org/10.1177/1753193419873899 No Abstract available 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

Considerations for surgical treatment of neurogenic thoracic outlet syndrome: A meta-analysis of patient-reported outcomes. Blondin, M., et al. (2023) Level of Evidence : 2a- Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Thoracic outlet - Rib resection or simple scalenectomy This systematic review and meta-analysis compared the success rates of three different surgical approaches for the treatment of neurogenic thoracic outlet syndrome (nTOS): rib-sparing scalenectomy (RSS), supraclavicular first rib resection (SCFRR), and transaxillary first rib resection (TAFRR). A total of 22 studies (1 RCT, 5 prospective, 16 retrospective) were included in this review. Results showed that RSS had the highest success rate (97.4%) and lowest complication rate (3.6%), while TAFRR had the highest mean difference between preoperative and postoperative visual analogue scale scores (5.3). When the Disability of the Arm Shoulder and Hand score were analysed, RSS provided the largest improvements compared to the other surgical procedures. Overall it appered that RSS is sufficient for treating nTOS with lower risks compared to TAFRR, which leads to pneumothorax in 4% of cases. 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, rib-sparing scalenectomy (RSS) is an effective option for the treatment of nTOS, with a higher success rate and lower complication rate than first rib resection (FRR) . If we see patients following these types of surgery, we should keep an eye on potential post-surgical complications, which include wound complications due to lymphatic system damage, pneumothorax, and temporary phrenic nerve damage. If you would like to know more about thoracic outlet syndrome, have a look at this synopsis . URL : https://doi.org/10.1016/j.jhsa.2023.03.005 Abstract Purpose: It remains unclear whether the first rib resection, performed via a supraclavicular (SCFRR) or transaxillary (TAFRR) approach, is necessary for patients with neurogenic thoracic outlet syndrome (nTOS). In a systematic review and meta-analysis, we performed a direct comparison of patient-reported functional outcomes following different surgical approaches for nTOS. Methods: The authors searched PubMed, Embase, Web of Science, Cochrane Library, PROSPERO, Google Scholar, and the gray literature. Data were extracted based on the procedure type. Well-validated patient-reported outcome measures were analyzed in separate time intervals. Random-effects meta-analysis and descriptive statistics were used where appropriate. Results: Twenty-two articles were included, with 11 discussing SCFRR (812 patients), 6 discussing TAFRR (478 patients), and 5 discussing rib-sparing scalenectomy (RSS; 720 patients). The mean difference between preoperative and postoperative Disabilities of the Arm, Shoulder and Hand score was significantly different comparing RSS (43.0), TAFRR (26.8), and SCFRR (21.8). The mean difference between preoperative and postoperative visual analog scale scores was significantly higher for TAFRR (5.3) compared to SCFRR (3.0). Derkash scores were significantly worse for TAFRR compared to RSS or SCFRR. RSS had a success rate of 97.4% based on Derkash score, followed by SCFRR and TAFRR at 93.2% and 87.9%, respectively. RSS had a lower complication rate compared to SCFRR and TAFRR. There was a difference in complication rates: 8.7%, 14.5%, and 3.6% for SCFRR, TAFRR, and RSS, respectively. Conclusions: Mean differences in Disabilities of the Arm, Shoulder and Hand scores and Derkash scores were significantly better for RSS. Higher complication rates were reported after the first rib resection. Our findings suggest that RSS is an effective option for the treatment of nTOS. 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 epidemiology of radial tunnel syndrome and its overlap with lateral epicondylitis. Zhang, J. Y., Manirajan, A. and Wolf, J. M. (2023) Level of Evidence : 2b Follow recommendation : 👍👍 (2/4 Thumbs up) Type of study : Diagnostic Topic : Posterior interosseous nerve entrapment - Prevalence This study analysed a national insurance database to determine the prevalence of radial tunnel syndrome (RTS) in the US. Out of 91 million patients' data, 83,000 were identified as presenting with RTS, showing a prevalence of 0.1% (people with RTS at one point in time). The results also showed that the mean yearly incidence was 0.01% (new patients diagnosed with RTS within one year). Of these patients, 55% were female, and 2.4% underwent RT release within 1 year. Fewer than 3% of the patients received a corticosteroid injection within 30 days of RTS diagnosis, and of those who did, 2.0% went on to undergo surgical release within 1 year. A total of 5.7% of patients with RTS also had a diagnosis of lateral epicondylitis within six months. 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 tunnel syndrome (RTS) is a relatively uncommon nerve compression disorder, with prevalence ranging from 6-79% in people who are also diagnosed with tennis elbow. Non-surgical management such as splinting or physical therapy may provide symptomatic relief . Corticosteroid injections could be utilised as a diagnostic tool and have been shown to provide lasting relief. Surgical decompression is an option for those who do not respond to non-surgical management, however, the rate of surgical intervention is low. URL : https://doi.org/10.1016/j.jhsa.2023.03.007 Abstract Purpose: Radial tunnel syndrome (RTS) is characterized by nerve compression affecting the posterior interosseous nerve branch in the forearm, and its symptoms often overlap with those of lateral epicondylitis (LE). The purpose of this study was to examine the epidemiology of RTS, frequency of injections and surgical release, and overlap of RTS with LE. Methods: We queried the PearlDiver database to identify RTS in patients older than 18 years. Demographic data, diagnostic or therapeutic injection within 30 days of diagnosis, surgical release within 1 year of diagnosis, and 90-day postoperative complication rates were evaluated. Using International Classification of Diseases, 10th Revision, laterality codes, we also determined the number of patients who had same-side RTS and LE and the proportion of patients who subsequently underwent simultaneous RT release and LE debridement. Results: The prevalence of RTS in a representative United States insurance database was 0.091%, and the annual incidence was 0.0091%. There were 75,459 patients identified with an active RTS diagnosis. The mean age at the time of diagnosis was 52 years (range, 18–81 years), 55% were women, and 1,833 patients (2.4%) underwent RT release within 1 year. Fewer than 3% of the patients received an injection within 30 days of RTS diagnosis. The 90-day postoperative complication rates were low: 5% of the patients required hospital readmission and 2.1% underwent revision surgery. Approximately 5.7% of the patients with RTS also had a diagnosis of LE on the same side within 6 months of RTS diagnosis. In patients with ipsilateral RTS and LE who underwent surgery, 59.1% underwent simultaneous RT release and LE debridement, whereas 40.9% underwent isolated radial tunnel release. Conclusions: The analysis of a large insurance database showed that the diagnosis of RTS is rarely assigned, suggesting that the incidence of this nerve compression is low. 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

Defining tennis elbow characteristics – The assessment of magnetic resonance imaging defined tendon pathology in an asymptomatic population. Paluch, A. J., et al. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Diagnostic Topic : MRI findings CEO - Asymptomatic elbows This is a cross-sectional study assessing the prevalence of common extensor origin (CEO) tendon in an asymptomatic population using magnetic resonance (MRI). A total of 30 asymptomatic participants were included in the study. All participants declined present or past history of elbow pain/trauma/diagnosis of tennis elbow. The results showed that 37% of the asymptomatic people had evidence of tendon abnormality, which increased with age and body mass index. I have plotted these results in the graph below for easy visualisation. The changes were generally mild or moderate, with one volunteer showing severe pathology. 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, pathological changes within the CEO are present in 1 person out of 3 people without a current or past history of tennis elbow. MRI changes at the CEO appear to increase in prevalence with greater age and BMI. Similar findings have been shown for " pathological" changes at the TFCC, which are more common in mature wrists . Interestingly, higher BMI is also associated with a greater risk of idiopathic elbow osteoarthritis , suggesting the potential for metabolic changes being associated with soft tissue and joint pathology. URL : https://doi.org/10.1177/17585732221146731 Abstract Background: This radiological study aims to assess the prevalence of lateral elbow pathology in an asymptomatic population using 3.0T magnetic resonance imaging (MRI). Methods: Bilateral elbow MRI was undertaken in 30 asymptomatic volunteers. Exclusion criteria included elbow pain within 3 months, elbow trauma or previous diagnosis of lateral epicondylar tendinopathy. Baseline patient-reported outcome measures were recorded along with age and body mass index (BMI). Two musculoskeletal radiologists independently graded the degree of abnormality at the common extensor tendon. Results: Thirty volunteers were categorised according to age; 35–44 (n = 10), 45–54 (n = 11), and 55–65 (n = 9) with a 1:1 male-to-female ratio. Radiological evidence of tendon abnormality was found in 37% of volunteers. The proportion with abnormal findings increased with age; 35–44 (10%), 45–54 (36%), 55–65 (67%) and BMI; 18–24.9 (23%), 25–29.9 (43%), > 30 (67%). Changes were generally ‘mild’ or ‘moderate’, with a single volunteer showing ‘severe’ pathology. Kappa for the radiographic agreement was 0.91 (0.83–0.98). Discussion: This study has demonstrated MRI findings suggestive of pathology at the common extensor tendon to be prevalent in an asymptomatic population, increasing with age and BMI. This draws into question the diagnostic and prognostic value of MRI imaging in lateral epicondylar tendinopathy, especially in older patients. 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 mobilization with movement and soft tissue mobilization on pain severity, hand grip strength and functional activity in tennis elbow patients. Shafique, S., Muneeb, H. N., Abbas, N. and Ghafoor, I. A. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Lateral epicondylalgia – Mobilisation with movement This is a randomised controlled trial asessing the effectiveness of mobilisation with movement (MWM) vs soft tissue mobilisation for treating tennis elbow. A total of 30 tennis players with lateral epicondylalgia took part in the study. Participants in both groups received 3 sessions per week for 4 weeks. One group received MWMs whilst the other group received soft tissue mobilisation. No further treatment details were provided. The results showed that MWMs (pain reduction: 5.3/10) had a greater statistically significant effect compared to soft tissue mobilisation (pain reduction: 3.7/10). The results did not however reach the 2 points clinically relevant change in 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, mobilisation with movement or manual therapy may be useful adjuncts in the treatment of tennis elbow. Given the overall positive outcomes associated with tennis elbow , this may be a temporary intervention to provide patients with some pain relief. Previous evidence suggests that the effectiveness of MWMs is modest in people with tennis elbow . URL : https://doi.org/10.36283/pjr.zu.11.1/010 Abstract BACKGROUND AND AIM: Lateral epicondylitis or tennis elbow is a pain pattern most commonly seen in tennis player due to forceful repetitive movements in a wrong way. So, the Objective was to determine the comparison of mobilization with movement and soft tissue mobilization on pain, grip strength and functional activity in patients with tennis elbow. METHODOLOGY: In this Randomized Controlled Trial, Non probability sampling technique was used. Thirty tennis players having lateral epicondylitis pain were included in the study. Two interventions were used i.e. Mobilization with movement and soft tissue mobilization. Pain, Muscle power and function activity were 3 outcome measure in both groups. RESULTS: In both groups the mean age of the participants was 24.30 ± SD 3.01. There was a significant Mean difference in the pain scores for MWM (5.34) and Soft Tissue Mobilization (3.74) after treatment. P value is significant for both group but there was greater difference with group MWM CONCLUSIONS: The present study concluded that Mobilization with movement has greater effect than the Soft Tissue Mobilization in relieving pain and improving Hand grip strength and functional activity in patients with tennis elbow. 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 role of hand therapy in returning to safe driving following an orthopedic upper extremity injury or surgery. Algar, L. and Tejeda, B. (2023) Level of Evidence : 5 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Therapeutic Topic : Return to driving - Upper limb recovery This is an expert opinion on the role of hand therapy in helping individuals return to safe driving after an orthopaedic upper extremity injury or surgery. It suggests that hand therapists can provide education and should help maximize the functional range of motion (ROM - see picture below) and strength in the upper extremity. It also proposes an Upper Extremity Driving Readiness Checklist as a tool to assess the individual's readiness to return to driving. These tests aim at determining whether the patient has enough ROM and can coordinate the upper limb to an extent that allows them to safely approach turns, curves, and avoid hazards. 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 could use the Upper Extremity Driving Readiness Checklist to assist clients in making a decision regarding whether they feel prepared to return to driving. This checklist can also be utilised to focus our rehab on the key impairments identified if the main goal of the patient is to return to driving as soon as possible. If you are interested in knowing more about return to driving post upper limb musculoskeletal injuries, have a look at this other synopsis . URL : https://doi.org/10.1016/j.jht.2021.02.003 No abstract available 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

Factors associated with persistent opioid use after an upper extremity fracture. Shah, R. F., et al. (2021) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Opioids - Is anxiety contributing to their use? This is a retrospective study assessing the relationship between opioid use and psychosocial factors in patients with upper limb fractures. A total of 734 participants with upper limb fractures were included in the present study. The results showed that anxiety, less social support, and worse general health were associated with continued opioid use two to four weeks after injury. In addition, clinics utilising programmes to reduce opioid use and prescriptions did not reduce patient satisfaction. Moreover, people utilising opioids did not appear to present with lower levels of pain compared to non-opioid users. 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, emotional distress and lower levels of social health contribute to the risk of developing opioid addiction post upper limb fractures. In addition, other factors such as the use of gabapenting pre-surgery may increase the likelihood of people utilising opioids post-surgery . Despite these risk factors, it appears that predicting who will develop opioid addiction post-hand and upper limb surgery is still difficult . URL : https://doi.org/10.1302/2633-1462.22.BJO-2020-0167.R1 Abstract Aims: The increase in prescription opioid misuse and dependence is now a public health crisis in the UK. It is recognized as a whole-person problem that involves both the medical and the psychosocial needs of patients. Analyzing aspects of pathophysiology, emotional health, and social wellbeing associated with persistent opioid use after injury may inform safe and effective alleviation of pain while minimizing risk of misuse or dependence. Our objectives were to investigate patient factors associated with opioid use two to four weeks and six to nine months after an upper limb fracture. Methods: A total of 734 patients recovering from an isolated upper limb fracture were recruited in this study. Opioid prescription was documented retrospectively for the period preceding the injury, and prospectively at the two- to four-week post-injury visit and six- to nine-month post-injury visit. Bivariate and multivariate analysis sought factors associated with opioid prescription from demographics, injury-specific data, Patient Reported Outcome Measurement Instrumentation System (PROMIS), Depression computer adaptive test (CAT), PROMIS Anxiety CAT, PROMIS Instrumental Support CAT, the Pain Catastrophizing Scale (PCS), the Pain Self-efficacy Questionnaire (PSEQ-2), Tampa Scale for Kinesiophobia (TSK-11), and measures that investigate levels of social support. Results: A new prescription of opioids two to four weeks after injury was independently associated with less social support (odds ratio (OR) 0.26, p < 0.001), less instrumental support (OR 0.91, p < 0.001), and greater symptoms of anxiety (OR 1.1, p < 0.001). A new prescription of opioids six to nine months after injury was independently associated with less instrumental support (OR 0.9, p < 0.001) and greater symptoms of anxiety (OR 1.1, p < 0.001). Conclusion: This study demonstrates that potentially modifiable psychosocial factors are associated with increased acute and chronic opioid prescriptions following upper limb fracture. Surgeons prescribing opioids for upper limb fractures should be made aware of the screening and management of emotional and social health. 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

Fencing wrist: A 10-year retrospective study of wrist injuries in fencers. de Villeneuve Bargemon, J.-B., Mathoulin, C. and Lupon, E. (2023) Level of Evidence : 5 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Diagnostic Topic : Fencers - Wrist injuries This is a letter to the editor reporting on a non-peer reviewed clinical study that assessed wrist injuries in fencers over a 10-year period. A total of 31 patients aged between 20 and 60 years old were included if they attended at least two sessions of fencing per week. A total of 37 lesions were identified, with a predominance of ulnar-sided disorders and TFCC injuries. It was suggested that gripping the foil in ulnar deviation is responsible for the predominance of ulnar-sided wrist injuries, and that novice fencers should begin training with the 'Pistol grip' to reduce the risk of ulnar-sided wrist injury. 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, fencers have an increased risk of ulnar-sided wrist injuries, particularly TFCC injuries. Novice fencers should be encouraged to use the 'Pistol grip' to reduce the risk of injury. If this is not possible during competition, a 'Pistol grip' may be appropriate during training sessions to reduce the biomechanical load through the ulnar wrist. Despite the higher level of ulnar-sided wrist injuries, advanced diagnostics may find little differences in terms of pathological changes between fencers and a control group at the TFCC . URL : https://doi.org/10.1177/17531934231162821 No Abstract available 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