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Multiple compression syndromes of the same upper extremity: Prevalence, risk factors, and treatment outcomes of concomitant treatment. Mendelaar, N. H. A., et al. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Symptoms prevalence study Topic : Multiple entrapment neuropathies - Risk factors This study examined the prevalence, risk factors, and treatment outcomes of multiple nerve compression syndromes in a surgical cohort of 7,867 patients. It was found that 2.9% of patients underwent multiple decompressions for the same upper extremity within one year. Risk factors for this were severe symptoms, younger age, and smoking. Treatment outcomes of concomitant carpal tunnel release (CTR) and cubital tunnel release (CubTR) showed similar results to CTR alone and CubTR alone, with a shorter total return to work time. 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, multiple nerve compression syndromes can co-occur. Patients who are younger, smokers, and those with severe symptoms are at a higher risk of having multiple compression syndromes surgically treated within one year. Furthermore, concomitant treatment of both compression syndromes (CTR and CubTR) can achieve similar treatment results to CubTR alone, with a shorter total return to work time. If you are interested in learning about unusual nerve compression presentations of the wrist, have a look at this synopsis . URL : https://doi.org/10.1016/j.jhsa.2023.01.024 Abstract Purpose: Multiple nerve compression syndromes can co-occur. Little is known about this coexistence, especially about risk factors and surgical outcomes. Therefore, this study aimed to describe the prevalence of multiple nerve compression syndromes in the same arm in a surgical cohort and determine risk factors. Additionally, the surgical outcomes of concomitant treatment were studied. Methods: The prevalence of surgically treated multiple nerve compression syndromes within one year was assessed using a review of patients’ electronic records. Patient characteristics, comorbidities, and baseline scores of the Boston Carpal Tunnel Questionnaire were considered as risk factors. To determine the treatment outcomes of simultaneous treatment, patients who underwent concomitant carpal tunnel release (CTR) and cubital tunnel release (CubTR) were selected. The treatment outcomes were Boston Carpal Tunnel Questionnaire scores at intake and at 3 and 6 months after the surgery, satisfaction 6 months after the surgery, and return to work within the first year. Results: A total of 7,867 patients underwent at least one nerve decompression between 2011 and 2021. Of these patients, 2.9% underwent multiple decompressions for the same upper extremity within one year. The risk factors for this were severe symptoms, younger age, and smoking. Furthermore, the treatment outcomes of concomitant CTR and CubTR did not differ from those of CubTR alone. The median time to return to work after concomitant treatment was 6 weeks. Patients who underwent CTR or CubTR alone returned to work after 4 weeks. Conclusions: Approximately 3% of the patients who underwent surgical treatment for nerve compression syndrome underwent decompression for another nerve within 1 year. Patients who report severe symptoms at intake, are younger, or smoke are at a greater risk. Patients with carpal and cubital tunnel syndrome may benefit from simultaneous decompression. The time to return to work may be less than if they underwent decompressions in separate procedures, whereas their surgical outcomes are comparable with those of CubTR alone. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Failure rates and analysis of risk factors for percutaneous A1 pulley release of trigger digits. Jeon, N., Yoo, S. G., Kim, S. K., Park, M. J. and Shim, J. W. (2023) Level of Evidence : 4 Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Trigger finger - A1 percutaneous release This study analysed the long-term success rate and risk factors for failure of percutaneous A1 pulley release in 406 patients with trigger digits. After excluding patients with severe osteoarthritis, history of surgery on the involved digit and rheumatoid arthritis, 251 patients for a total of 331 digits were enrolled in the study. Results showed that 87% of cases achieved complete resolution. This intervention failed in 13% of cases, with the index, middle or ring fingers presenting with the highest failure rates. In contrast, release of A1 pulley at the thumb presented with the lowest failure rate. No major complications were reported. 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, percutaneous A1 pulley release is a safe and effective procedure for the treatment of trigger digits, with a long-term success rate of 87%. The failure rate is highest when the index, middle or ring fingers are treated. The thumb presented with the lowest failure rate and this may be due to the more complex anatomy and adherences between FDS and FDP in the other digits . If you would like to know more about trigger fingers, have a look at the whole database . URL : https://doi.org/10.1177/17531934231161764 Abstract This study aimed to identify the rates and risk factors for failure of percutaneous A1 pulley release. We retrospectively analysed patients who underwent percutaneous A1 pulley release between 2015 and 2019. We defined failure as (1) pain or discomfort at the final follow-up, (2) when open release or revision percutaneous release was performed, or (3) when steroid injections were administered three or more times for symptom control. A total of 331 digits from 251 patients were included. The mean follow-up duration was 47 months (minimum 24 months). Complete resolution was achieved in 287 cases (87%), but 21% required steroid injection before symptoms settled. There was failure in 44 cases (13%). Involvement of the index, middle and ring fingers was significantly different between the successful and failure groups. Percutaneous A1 pulley release has a long-term success rate of 87%. The failure rate was higher when the procedure was performed on the index, middle or ring fingers. 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

Swelling, stiffness, and dysfunction following proximal interphalangeal joint sprains. Cheesman, Q. T., et al. (2023) Level of Evidence : 2c Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Symptoms prevalence study Topic : PIPJ sprain recovery - Swelling This prospective, longitudinal survey study determined the duration of subjective finger swelling, stiffness, and dysfunction following a proximal interphalangeal joint (pipj) sprain. A total of 93 participants with pipj sprain were included. The results showed that 63% of participants reported full resolution of swelling within 1 year of injury, however, only 42% of this group reported no limitations in range of motion. Around 40% of the participants reported swelling of the involved finger after 12 months from pipj sprain. Risk factors such as age, sex, involved finger, days from injury to presentation, body mass index, smoking status, diabetes, gout, and rheumatoid arthritis were similar between the resolution cohort and the no-resolution cohort. 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, pipj swelling resolves within 12 months from injury in the majority of patients. However, about 40% of people still present with swelling beyond 12 months post-injury. Unfortunately, it is not possible to predict who will have a delayed recovery. After the initial stage of joint protection, it is advised to avoid immobilisation of the pipj as this may contribute to the development of stiffness. However, the combination of low-load prolonged stretching through a splint and stretching, has been shown to help regain pipj extension in those patients who develop pipj flexion contractures . URL : https://doi.org/10.1016/j.jhsa.2023.01.025 Abstract Purpose: Proximal interphalangeal (PIP) joint sprains are common injuries that often result in prolonged swelling, stiffness, and dysfunction; however, the duration of these sequelae is unknown. The purpose of this study was to determine the duration of time that patients experience finger swelling, stiffness, and dysfunction following a PIP joint sprain. Methods: This was a prospective, longitudinal, survey-based study. To identify patients with PIP joint sprains, the electronic medical record was queried monthly using International Classification of Disease, Tenth Revision, codes for PIP joint sprain. A five-question survey was emailed monthly for 1 year or until their response indicated resolution of swelling, whichever occurred sooner. Two cohorts were established: patients with (resolution cohort) and patients without (no-resolution cohort) self-reported resolution of swelling of the involved finger within 1 year of a PIP joint sprain injury. The measured outcomes included self-reported resolution of swelling, self-reported limitations to range of motion, limitations to activities of daily living, Visual Analog Scale (VAS) pain score, and return to normalcy. Results: Of 93 patients, 59 (63%) had complete resolution of swelling within 1 year of a PIP joint sprain. Of the patients in the resolution cohort, 42% reported return to subjective normalcy, with 47% having self-reported limitations in range of motion and 41% having limitations in activities of daily living. At the time of resolution of swelling, the average VAS pain score was 0.8 out of 10. In contrast, only 15% of patients in the no-resolution cohort reported return to subjective normalcy, with 82% having self-reported limitations in range of motion and 65% having limitations in activities of daily living. For this cohort, the average VAS pain score at 1 year was 2.6 out of 10. Conclusions: It is common for patients to experience a prolonged duration of swelling, stiffness, and dysfunction following PIP joint sprains. 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

Avascular necrosis of the scaphoid-preiser disease: Outcomes of 39 surgical cases. Amundsen, A., et al. (2023) Level of Evidence : 4 Follow recommendation : 👍 (1/4 Thumbs up) Type of study : Therapeutic Topic : Preiser disease - Scaphoid AVN This is a case series of patients treated surgically for Preiser Disease, a rare condition of the scaphoid bone. A total of 39 participants were included in the study. Treatment for the condition is still controversial, and the optimal surgical treatment remains unclear. The study found that vascular bone grafts and salvage procedures had similar functional and pain outcomes improvements without loss of grip strength. Complications included further surgery for 9 patients. The demographics of the patients showed that women were affected almost twice as frequently as men. 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, Preiser Disease is a rare condition of idiopathic avascular necrosis of the scaphoid bone. Vascular bone grafts appear to be able to preserve the scaphoid in 70% of the cases. A slender scaphoid is potentially more common in patients with Preiser disease. It is possible that, like for Kienböck disease , Preiser Disease may be more common in people with a family history of the disease. If you are interested in the topic, this synopsis covers avascular necrosis of other carpal bones whilst this other synopsis shows a mimicker of avascular necrosis, which is instead a rare vestigial carpal bone . URL : https://doi.org/10.1016/j.jhsa.2021.10.023 Abstract PURPOSE: There is no established treatment standard for patients with idiopathic avascular necrosis of the scaphoid, also known as Preiser Disease. We evaluated outcomes of operative interventions performed for patients diagnosed with Preiser Disease and assessed scaphoid morphology in the contralateral wrists. METHODS: We performed a retrospective review of all patients undergoing surgery for Preiser disease between 1987 and 2019 at our institution. A total of 39 wrists in 38 patients were identified. The mean age was 37 years at the time of surgery, and the median follow-up time was 5.3 years. The patients were classified according to the Herbert and Kalainov classifications. Pre- and postoperative pain and functional outcomes were evaluated, and Mayo Wrist Scores were calculated. Reoperations for complications were recorded. Scaphoid shapes were assessed for wide/type 1 and slender/type 2 scaphoids in the contralateral unaffected wrist in patients with unilateral disease. RESULTS: Overall, pain and Mayo Wrist Scores improved, while flexion/extension decreased slightly and grip strength remained stable. In a comparison of the 2 main surgery groups, 17 wrists with a pedicled vascular bone graft and 12 wrists with salvage surgery (4-corner fusion/proximal row carpectomy) showed similar functional outcomes. Similar outcome scores were found regardless of preoperative Herbert or Kalainov classifications. Radiographic morphologic evaluation of the contralateral side determined that 4 of 8 patients had a slender scaphoid shape, which has been shown to have a more limited vascular network when compared to full scaphoids. CONCLUSIONS: A treatment algorithm of Preiser disease is lacking and the optimal surgical treatment remains controversial. Pedicled vascular bone grafts had similar functional outcomes as salvage procedures, but preserving the scaphoid was possible in 70% of the pedicled vascular bone graft cases. A slender scaphoid is potentially more common in patients with Preiser disease who undergo surgery. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The effectiveness of neuromobilization in patients with cervical radiculopathy: A systematic review with meta-analysis. Paraskevopoulos, E., Koumantakis, G. and Papandreou, M. (2022) Level of Evidence : 2a Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : Neural mobilisation - cervical radiculopathy This meta-analysis assessed the effectiveness of neuromobilisation exercises in patients with cervical radiculopathy. A total of seven clinical trials were included in the analysis and they 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. Moderate quality of evidence suggests that neuromobilisation is superior to no treatment for pain, function, and range of motion. However, it was not found to be superior to other interventions. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, neuromobilisation exercises may be an effective treatment for cervical radiculopathy, providing pain relief, improved function, and increased range of motion. Neuromobilisation also appear to be useful for people with isolated carpal tunnel syndrome . Despite evidence of some positive benefits of neurodynamic exercises, research suggests that their addition to a global exercises regime does not provide significant improvements in people with neck and arm pain . URL : https://doi.org/10.1123/jsr.2022-0259 Abstract CONTEXT: Neuromobilization exercises (NE) could be a useful therapeutic tool to induce analgesia and increase function and range of motion (ROM) in patients with musculoskeletal pathologies with neuropathic components; however, the effectiveness of this intervention in patients with cervical radiculopathy (CR) is unknown. OBJECTIVE: To determine the effectiveness of NE in CR on pain, function, and ROM. DESIGN: Systematic review and meta-analysis. EVIDENCE ACQUISITION: An electronic search was performed in the MEDLINE, Scopus, PEDro, and EBSCO databases from inception until June 2022. The authors included randomized clinical trials that evaluated the effectiveness of NE against control groups or other interventions that aimed to treat patients with CR. EVIDENCE SYNTHESIS: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 5 studies were included. For the studies that compared NE with a control group, the standardized mean difference for pain was -1.33/10 (95% confidence interval [CI], -1.80 to -0.86; P < .01; I2 = 0%), for function with the Neck Disability Index was -1.21/50 (95% CI, -1.67 to -0.75; P < .01; I2 = 0%), and for neck flexion and extensions was 0.66 (95% CI, 0.23 to 1.10; P < .01; I2 = 0%) and 0.47 (95% CI, 0.04 to 0.90; P < .01; I2 = 0%), respectively, with evidence of clinical effectiveness. These findings were based on moderate-quality evidence according to the Grading of Recommendation, Assessment, Development, and Evaluation rating. In studies that compared NE with other interventions, the meta-analysis failed to demonstrate the statistical or clinical superiority of NE. CONCLUSIONS: Moderate quality of evidence suggests that NE may be superior to no treatment for pain, function, and ROM in patients with CR. In contrast, NE are not superior to other interventions in the same outcomes, based on low- to very low-quality evidence. More high-quality research is needed to assess the consistency of these results. 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

Return to work after surgery for trapeziometacarpal joint osteoarthritis in relation to occupational hand force requirements. Kirkeby, L., Svendsen, S. W., Hansen, T. B. and Frost, P. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Prognostic Topic : Thumb osteoarthritis - Return to work This is a retrospective study assessing return to work (RTW) of patients with first-time surgery for trapeziometacarpal joint osteoarthritis in public hospitals in Denmark from 2001-2017. A total of 2,090 participants were included in the study. The results showed that 50%, 87%, and 91% of patients had returned to work within 16, 52, and 104 weeks respectively. Medium and high occupational hand force requirements were associated with a slower return to work, with adjusted hazard ratios of 0.84 and 0.59 respectively compared to low hand force requirements. In particular, for patients who had high-demand gripping occupations, the median return to work was 8 weeks longer compared with jobs requiring low hand force. Female sex and frequent sickness leave were also associated with slower RTW. It was concluded that the overall prognosis regarding RTW after surgery for TMC joint OA was good, but patients with higher occupational hand force requirements could expect slower RTW. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, patients with higher occupational hand force requirements may take longer to return to work after surgery for trapeziometacarpal joint osteoarthritis. Having this knowledge may help patients decide what is the best course of action for the management of their thumb OA. An alternative to surgery may include a trial of conservative treatment including education, exercise , and/or cortisone injections . If patients do decide to undergo surgery, early mobilisation appears to be a feasible option for their post-surgical recovery . URL : https://doi.org/10.1016/j.jhsa.2022.12.008 Abstract Purpose: This study evaluated the hypothesis that higher occupational hand force requirements are related to slower return to work (RTW) after surgery for trapeziometacarpal joint osteoarthritis. Methods: Patients treated surgically for trapeziometacarpal joint osteoarthritis from 2001 to 2017 were identified in the Danish National Patient Register. Sustainable RTW (sRTW) was defined as the first period of 4 consecutive weeks without health-related public transfer payments, according to the Danish National Register on Public Transfer Payments. Occupational codes from the Danish Employment Classification Module were linked to a hand-arm job exposure matrix to obtain occupational hand force requirements for each patient. Cox regression models were used to analyze time until sRTW in relation to hand force requirements with adjustment for age, sex, type of surgery, preoperative sick leave, and calendar year of surgery. Results: The study included 2,090 patients. Within 104 weeks, 91% sustainably returned to work. The percentage of individuals in the subgroups that did not RTW was 8% of low-force− and medium-force−exposed patients and 14% of high-force-exposed patients. Medium and high occupational hand force requirements were associated with slower sRTW. The adjusted hazard ratio for sRTW was 0.84 (95% confidence interval, 0.74–0.95) for medium and 0.59 (95% confidence interval, 0.50–0.68) for high compared with low hand force requirements. Among patients who returned to work, patients with medium and high hand force requirements had median periods until sRTW of 16 and 18 weeks, respectively, compared with 10 weeks among patients with low hand force requirements. Conclusions: The prognosis regarding RTW after surgery for trapeziometacarpal joint osteoarthritis is generally good, but patients with higher occupational hand force requirements can expect slower RTW. 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

Resistance training induces improvements in range of motion: A systematic review and meta-analysis. Alizadeh, S., et al. (2023) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 (4/4 thumbs up) Type of study : Therapeutic Topic : Resistance training with or without stretching - Range of movement improvements This systematic review and meta-analysis investigated the effects of resistance training on range of motion compared to a control condition, stretch training, or a combination of resistance training and stretch training. A total of 52 studies were included in the review. All studies were assessed through the PEDro risk of bias criteria. The results showed that resistance training with external loads can improve range of motion to a moderate magnitude, and that there were no significant differences between resistance training and stretch training. Additionally, meta-regression showed no effect of age, training duration, or frequency. It was concluded that additional stretching prior to or after resistance training may not be necessary to enhance 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, stretching in combination with resistance training does not provide better range of movement results compared to resistance training alone. In addition, it appears that untrained and sedentary individuals present with greater improvements in ROM compared to trained or active individuals. These results are consistent with previous evidence showing that eccentric exercises improve ROM and that resistance exercise or stretching utilised in isolation are equally effective . This information is extremely useful for the treatment of post-traumatic elbow stiffness , which if untreated has the potential to negatively affect the mental wellbeing of patients . URL : https://doi.org/10.1007/s40279-022-01804-x Abstract Background: Although it is known that resistance training can be as effective as stretch training to increase joint range of motion, to date no comprehensive meta-analysis has investigated the effects of resistance training on range of motion with all its potential affecting variables. Objective: The objective of this systematic review with meta-analysis was to evaluate the effect of chronic resistance training on range of motion compared either to a control condition or stretch training or to a combination of resistance training and stretch training to stretch training, while assessing moderating variables. Design: For the main analysis, a random-effect meta-analysis was used and for the subgroup analysis a mixed-effect model was implemented. Whilst subgroup analyses included sex and participants’ activity levels, meta-regression included age, frequency, and duration of resistance training. Data Sources: Following the systematic search in four databases (PubMed, Scopus, SPORTDiscus, and Web of Science) and reference lists, 55 studies were found to be eligible. Eligibility Criteria: Controlled or randomized controlled trials that separately compared the training effects of resistance training exercises with either a control group, stretching group, or combined stretch and resistance training group on range of motion in healthy participants. Results: Resistance training increased range of motion (effect size [ES] = 0.73; p < 0.001) with the exception of no significant range of motion improvement with resistance training using only body mass. There were no significant differences between resistance training versus stretch training (ES = 0.08; p = 0.79) or between resistance training and stretch training versus stretch training alone (ES = − 0.001; p = 0.99). Although “trained or active people” increased range of motion (ES = 0.43; p < 0.001) “untrained and sedentary” individuals had significantly (p = 0.005) higher magnitude range of motion changes (ES = 1.042; p < 0.001). There were no detected differences between sex and contraction type. Meta-regression showed no effect of age, training duration, or frequency. Conclusions: As resistance training with external loads can improve range of motion, stretching prior to or after resistance training may not be necessary to enhance flexibility. 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

Effects of using rigid tape with bandaging techniques on wrist joint motion during boxing shots in elite male athletes. Gatt, I. T., Allen, T. and Wheat, J. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Strapping and taping – Boxing This study investigated the effects of bandaging and strapping techniques on wrist motion on impact during different shot types in elite male boxers. A total of 18 elite male boxers were assessed through digital wearable goniometers under different conditions. In particular, they were tested with bandaging vs bandaging vs bandaging plus tape during bent arm and straight arm boxing shots. Data was processed using Visual 3D and the peak wrist angle on impact was measured. The results showed that adding tape to bandage reduced wrist motion by 25-30% compared to bandage only. In addition, there was a 1.2-1.4 increase in time to peak wrist angle on impact. These findings suggest that adding tape to bandage may reduce the risk of hand-wrist injuries in boxing. 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, adding tape to a bandaging technique can provide an additional 25-30% reduction in wrist motion compared to bandage only. This information can help to better protect patients from hand-wrist injuries such as carpometacarpal instability in boxing and other sports. If you are interested in boxing injuries, have a look at these other synopses ( boxer's knuckle and boxer's elbow ). URL : https://doi.org/10.1016/j.ptsp.2023.03.002 Abstract Objectives: To investigate the effects of bandaging techniques on wrist motion on impact during different shot types in elite male boxers. Design: Repeated-measures study. Setting Field Experiment Participants Two shot types, straight and bent arm, were assessed with 18 elite male boxers wearing either bandage only or bandage plus tape. Main Outcomes Measures: Wrist motions and time to peak wrist angles, on impact, were measured with an electromagnetic tracking system. Results: Wrist motion on impact occurred concurrently in flexion and ulnar deviation for both shot types. For both motions, significant (p < 0.001) effects for bandaging techniques (η2 = 0.580–0.729) and shot types (η2 = 0.165–0.280) were observed. For straight and bent arm shots, wrist motion on impact occurred within 50% and 40% respectively of total active wrist motion for bandage only compared to within 20% and 15% for bandage plus tape. Time to peak wrist angle on impact increased significantly (p < 0.001) for both shot types when adding tape to bandage. Conclusions: Adding tape provided an additional 25–30% reduction in wrist motion compared to bandage only, with a 1.2–1.4 increase in time to peak wrist angle, on impact for both shot types. This information could assist various individuals and organisations towards better hand-wrist protection. 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 medial and lateral forearm fascia contribute to overhead elbow extension in displaced olecranon fractures: A biomechanical study. Gedailovich, S., Deegan, L., Hayes, W., Koehler, S. M. and Aibinder, W. R. (2023) Level of Evidence : 4 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Therapeutic Topic : Olecranon fractures - Overhead triceps extension This is a cadaver stusy assessing the contribution of the medial and lateral cubital retinacula to elbow extension in the setting of a displaced olecranon fracture. A total of eight cadavers were assessed. The results showed that intact retinacula allowed for overhead extension, while transection of either the medial or lateral retinaculum prevented it. Extension was possible in two of four specimens with transection of both medial and lateral cubital retinacula, but the force needed to generate extension was significantly higher. Future studies should identify imaging modalities that allow the assessment of retinacula integrity to determine whether this is associated with the ability of overhead triceps extension in clinical populations. 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, with a displaced olecranon fracture, overhead triceps extension may be maintained if either the lateral or medial cubital retinaculum remains in continuity with the distal ulna. This suggests that nonoperative management of displaced olecranon fractures may be feasible in elderly, low-demand, and medically unwell patients. Determining the integrity of the fascial structures preoperatively may help select candidates for nonoperative treatment of displaced olecranon fractures. URL : https://doi.org/10.1016/j.jse.2023.01.005 Abstract Background: In nonoperative management of displaced olecranon fractures, patients are able to maintain overhead extension despite a persistent nonunion. It has been hypothesized that this is feasible due to an intact lateral cubital retinaculum. The purpose of this biomechanical study was to determine the contribution of the medial and lateral cubital retinacula to overhead extension in the setting of a displaced olecranon fracture. Methods: Eight fresh-frozen cadaveric upper extremity specimens were used in this study. The triceps muscle was loaded through a pulley system operated by an Instron 8874 Biaxial Servohydraulic Fatigue Testing System (Norwood, MA, USA) at a rate of 10 mm/sec to simulate overhead elbow extension. Each specimen was tested in four states: 1. Native with an olecranon intact; 2. A transverse olecranon fracture; 3. Transection of one cubital retinaculum (medial or lateral); 4. Transection of both medial and lateral cubital retinacula. The primary outcome was the ability to perform overhead extension. The secondary outcome was the force needed to generate extension. Results: Elbow extension was noted in each specimen for trials one through three. Only when both the lateral and medial fascia were transected was elbow extension not achieved. There was no significant difference in the force required to generate extension in the first three trials (p = 0.99). There was no significant difference in the change in maximal force required to achieve extension between the specimens with the medial side transected only compared to those with the lateral side transected only (p = 0.07). Discussion: In the setting of an olecranon fracture, this biomechanical study suggests that if either the lateral or medial cubital retinaculum remains in continuity with the distal ulna, active overhead extension can be maintained. This may explain positive clinical outcomes of nonoperative management of displaced olecranon fractures in the elderly patient population. Determining the integrity of the fascial structures preoperatively may help select candidates for nonoperative treatment of displaced olecranon 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

A prospective randomised comparative study of dynamic, static progressive and serial static proximal interphalangeal joint extension orthoses. Glasgow, C. and Ballard, E. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : PIPJ flexion deformity - Splint selection This is a randomised trial, comparing the effects of different orthosis types on the improvements of proximal interphalangeal joint flexion deformity. A total of 50 participants were randomised to either a static progressive (cast), dynamic, or volar orthosis (see picture below). All participants received exercises and were assessed at both baseline and after 4 weeks. At baseline, the abbreviated Weeks Test was performed. This consisted of a static pipj stretching applied by the healthy hand to the affected pipj whilst providing head treatment to the affected hand. Improvement in PROM following this test was assessed. The results showed that the abbreviated Weeks Test was significantly associated with improvement in active PIP joint extension after 4 weeks, and that females made significantly greater gains in PIP extension than males. The study also found that there were no statistically significant differences in outcome between the three orthoses groups. Factors such as adequate TERT, comfort, biomechanical effectiveness and compliance with treatment are important for a positive outcome. 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, no single orthosis is superior in the treatment of PIP joint flexion deformity. Factors such as adequate total end range time, comfort, biomechanical effectiveness and compliance with treatment are important for a positive outcome. The abbreviated Weeks Test is associated with treatment outcome and may provide a more suitable means of examining the likely response to treatment in a busy clinical environment. After 4 weeks, we should expect an improvement of 10deg in pipj extension and with extended treatment (8-17 weeks) range of movement may even reach 20deg improvement . These findings are in line with previous research which assessed predictors of pipj improvement with conservative treatment and the effect of TERT on pipj ROM outcomes . URL : https://doi.org/10.1177/17589983211070658 Abstract Introduction: Many different types of proximal interphalangeal (PIP) joint extension orthoses exist, yet evidence guiding orthosis choice is largely theoretical. The primary aim of this study was to evaluate the clinical effectiveness of three different PIP joint extension orthoses, over 4 weeks of treatment. Secondly, we aimed to explore the relationship between an abbreviated version of the Weeks test (WT) assessment of joint stiffness, and treatment outcome. Lastly, we wished to better understand participants’ satisfaction with orthotic treatment. Methods: Using a randomised comparative study design, 61 participants were allocated to a serial static, dynamic or static progressive orthosis, 50 had follow-up data. Blinded assessment of function was completed before and after 4 weeks of orthotic intervention and a standardised therapy program. Participants were blinded to alternative groups. Results: Baseline active PIP extension ranged from 14° to 65°. The average improvement in active PIP extension was −9.1° (95% CI −11.0°, −7.1°). There were no statistically significant differences in outcome between the three orthoses groups. However, a trend was observed with greater improvement in active extension for those in the dynamic Capener (−11.5°) compared to the static progressive belly gutter (−7.3°) or serial cast (−8.7°) groups, with less total end range time required. The abbreviated WT was significantly associated with improvement in active extension (p = 0.001). Participants reported a high degree of satisfaction with their orthosis regardless of type. Conclusions: No single orthosis demonstrated statistically greater effectiveness, although the dynamic Capener orthosis appeared more efficient. The abbreviated WT is associated with treatment outcome. 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

Conservative treatment of ulnar nerve compression at the elbow: A systematic review and meta-analysis. Natroshvili, T., et al. (2023) Level of Evidence : 2a- Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : Cubital tunnel syndrome - Splinting This is a systematic review and meta-analysis assessing the effectiveness of conservative treatments for cubital tunnel syndrome. A total of 19 studies were included in the study. Quality assessment was performed using a score ranging from 0 to 10 points. The most common interventions included steroid/lidocaine injection, splinting, physical therapy, therapeutic ultrasound, and laser therapy. The results of the subgroup meta-analyses showed that 1 in 2 patients improved after receiving a steroid/lidocaine injection and 9 in 10 patients improved after using a splint device. It is unclear whether the improvements were clinically relevant as the outcome measures utilised were different across all the papers. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, splinting, physical therapy, education, and activity modification can be effective for treating ulnar nerve compression at the elbow. Splinting is preferred over injections, as it shows a higher rate of improvement. If patients have not undergone any investigations first, an US and x-ray may be beneficial to exclude space-invading lesions compressing the ulnar nerve . X-rays may be beneficial in excluding the presence of bone spurs leading to ulnar entrapment . URL : https://doi.org/10.1055/s-0042-1757571 Abstract Background: The clinical results of conservative treatment options for ulnar compression at the elbow have not been clearly determined. The aim of this review was to evaluate available conservative treatment options and their effectiveness for ulnar nerve compression at the elbow. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, a systematic review and meta-analysis of studies was performed. Literature search was performed using Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Results: Of the 1,079 retrieved studies, 20 were eligible for analysis and included 687 cases of ulnar neuropathy at the elbow. Improvement of symptoms was reported in 54% of the cases receiving a steroid/lidocaine injection (95% confidence interval [CI], 41-67) and in 89% of the cases using a splint device (95% CI, 69-99). Conclusions: Conservative management seems to be effective. Both lidocaine/steroid injections and splint devices gave a statistically significant improvement of symptoms and are suitable options for patients who refuse an operative procedure or need a bridge to their surgery. Splinting is preferred over injections, as it shows a higher rate of improvement. 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 of peripheral nerve decompression surgery during pregnancy and the first year after delivery in finland from 1999 to 2017: A retrospective register-based cohort study. Nyrhi, L., et al. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Prognostic Topic : Maternity - Carpal tunnel syndrome This is a retrospective study assessing the incidence of carpal tunnel release (CTR) during pregnancy and the first year after delivery. The study was completed in Finland from 1999 to 2017 and a total of 24,634 women took part in it. The result showed that the incidence of CTR during pregnancy was 38 per 100,000 person-years, with an incidence rate ratio of 0.5 compared to the general population. The incidence of CTR in the first postpartum year increased during the first 4 months and was similar to that of the general population after 8 months. Active smoking before pregnancy was associated with increased incidences of CTR both during and after pregnancy. The yearly incidence of CTR varied greatly during the study period, with a generally decreasing trend. 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, carpal tunnel release (CTR) is performed less frequently during pregnancy and the postpartum period than in the general age-matched female population. Smoking before pregnancy is associated with increased incidences of CTR both during pregnancy and the first year after delivery. If you are interested in learning more about CTS, have a look at the full database . URL : https://doi.org/10.1016/j.jhsa.2023.01.013 Abstract Purpose: We aimed to report the incidence of peripheral nerve decompression surgery during pregnancy and 12 months after delivery in Finland from 1999 to 2017. Methods: Using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register, all women of potentially childbearing age (15–49 years) who underwent peripheral nerve decompression surgery or had a pregnancy ending in delivery from January 1, 1999, to December 31, 2017, were included. Incidence rates and incidence rate ratios for operations were calculated for both childbearing women and the age-adjusted general female population. Results: In total, 308 women underwent carpal tunnel release (CTR) during pregnancy, and an additional 675 women underwent CTR within 12 months after delivery. The incidence of CTR during pregnancy was 38 per 100,000 person-years, with an incidence rate ratio of 0.5 (95% CI, 0.4–0.6), when compared with that in the general population. Women who were active smokers before becoming pregnant were more likely to undergo CTR during pregnancy (odds ratio, 2.4; 95% CI, 1.8–3.0). The highest rates of CTR were observed during the first trimester. The incidence of CTR in the first postpartum year increased steadily during the first 4 months to 79 per 100,000 person-years. During the latter 8 months, incidences were similar to those in the general population (incidence rate ratio, 1.0; 95% CI, 0.9–1.2). Women who smoked were more likely to undergo CTR during the first postpartum year (odds ratio, 1.6; 95% CI, 1.3–1.9). Conclusions: Carpal tunnel release is performed more rarely during pregnancy than in the age-matched general population. Postpartum incidences increased toward the end of the first year, reaching those observed in the general population after the first 4 months. Smoking before pregnancy is associated with increased incidences of CTR both during pregnancy and the first year after delivery. 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