Search Results

Randomized controlled trial of daily total end range time (tert) for capener splinting of the stiff proximal interphalangeal joint. Glasgow, C., Fleming, J., Tooth, L. R. and Peters, S. (2012). Treatment of proximal interphalangeal joint flexion contracture: combined static and dynamic orthotic intervention compared with other therapy intervention: a randomized controlled trial. Cantero-Téllez, R., Cuesta-Vargas, A. I. and Cuadros-Romero, M. (2015). Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : PIPJ flexion contracture - TERT These are two randomised controlled studies investigating the effect of total end range time (TERT) dosage on range of motion (ROM) for pipj flexion contractures. One of the two studies also assessed whether splinting provided better outcomes than exercise and stretching alone. A total of 82 participants with pipj flexion deformity following injury were included. The results showed that static-progressive and dynamic splinting were effective in improving active pipj extension. Exercise/stretching alone provided similar results but the combination with splinting was more beneficial. In terms of TERT dosage, there was no significant difference in ROM improvements between those who wore the splint for 10-12 hours or 12-16 hours. 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 static-progressive and dynamic orthoses is an effective treatment for extension deficits of the proximal interphalangeal (PIP) joint. The results of these studies suggest that longer application times may be beneficial, however, further research is needed to confirm this. It is possible that wearing a splint beyond 11 hrs per day provides no additional benefits. Similar findings were identified when other non-experimental studies were assessed in a recent systematic review . Glasgow et al. (2012) URL : https://doi.org/10.5014/ajot.2012.002816 Cools, A. M., et al. (2014) URL : https://doi.org/10.1016/j.jhsa.2015.01.005 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

Burden of hand osteoarthritis in the middle east and north africa (mena): An epidemiological analysis from 1990 to 2019. Hoveidaei, A. H., et al. (2023) Level of Evidence : 2c Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Symptoms prevalence study Topic : Hand OA - Epidemiology This study evaluated the epidemiology and burden of hand osteoarthritis in the Middle East and North Africa region from 1990 to 2019. The Global Burden of Disease tool was utilised to estimate the prevalence, incidence, and years lived with disability of hand osteoarthritis. The results showed an increase in the prevalence, incidence, and years lived with disability due to hand osteoarthritis in the Middle East and North Africa region from 1990 to 2019. The prevalence of hand osteoarthritis was higher in women than in men and increased with age. 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, hand osteoarthritis disability and burden varies worldwide due to a series of environmental and genetic factors. In the Middle East and North Africa region, the incidence and prevalence of hand OA have increased over the past 30 years. A surge in obesity rates in these regions has been highlighted as a risk factor for future disability due to hand OA. As shown previously, this paper reiterates that the development of hand OA is likely multifactorial and that BMI is a risk factor . URL : https://doi.org/10.1016/j.jhsa.2022.11.016 Abstract Purpose: Hand osteoarthritis (OA) is a common cause of disability in older people. Although often underemphasized, it may affect quality of life and imposes a considerable burden on the health system. This study evaluated the epidemiology of hand OA in the Middle East and North Africa (MENA) region. Methods: This epidemiological study was performed based on the Global Burden of Disease study from 1990 to 2019. The incidence, prevalence, and years lived with disability (YLD) in all 21 MENA countries during the study period were reported in rate, age-standardized, and percentage. Results: Hand osteoarthritis in MENA increased 2.7-fold, from 1.6 million cases to 4.3 million from 1990 to 2019 with an age-standardized incidence rate of 50.2 (95% CI, 38.2-66.4) per 100,000 people in 2019. Saudi Arabia had the highest age-standardized prevalence in both 1990 (2.3%) and 2019 (2.3%), whereas Turkey had the lowest (0.3%) in both years. Total YLDs due to hand osteoarthritis increased by more than 2.7-fold, from 50,335 to 135,336 during the study period. The highest rate of increase in YLD rate from 1990 to 2019 was in Iran (3.3) and the largest decrease was in Qatar (-11.5). Conclusions: In contrast to the global trend, MENA hand OA prevalence and YLDs did not decrease between 1990 and 2019 and remained constant over time. Aging and increasing obesity rates, particularly among women, might be the contributing factors. Hand OA epidemiology varies by country, possibly due to genetic, ethnic, and environmental factors. 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

Complications after volar locking plate fixation of distal radius fractures: A retrospective study of 822 patients. Perregaard, S., Jørgensen, R. W. and Landgren, M. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Prognostic Topic : Distal radius fracture – Complications This is a retrospective study investigating the complication rates following open reduction and internal fixation (ORIF) for distal radius fractures (DRF). A total of 822 participants undergoing ORIF were included in the study and they were followed up for an average of 3 years. Of these, 12% experienced a complication, with 5% experiencing a major complication and 7% experiencing a minor complication. The most common complication was carpal tunnel syndrome (2%), followed by CRPS (1%), and loss of reduction (1%). Tendon ruptures and adhesion were rare events. Revision surgery due to complications was 6%. Patient age and time from trauma to surgery were not associated with post-operative complications. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the overall complication rate following ORIF for distal radius fractures is 12% (5% major complications, 7% minor complications). Age, sex, time from trauma to surgery, and fracture type were not found to be associated with an increased risk of postoperative complications. However, based on previous evidence it appears that diabetes and smoking increase the risk of complications post-ORIF. URL : https://doi.org/10.1016/j.jhsa.2022.11.012 Abstract Purpose: With the current routine use of volar locking plates as the preferred surgical treatment option for distal radius fractures, the purpose of this study was to investigate the incidence of postoperative complications following surgery and, second, investigate the correlation between demographic factors and the risk of complications. Methods: We retrospectively reviewed all patients who had been surgically treated for a distal radius fracture with open reduction and internal fixation using volar plating and screws during a 3-year period. Relevant demographic information and all postoperative complications of the 822 patients eligible for inclusion were recorded, with a mean follow-up time of 2.8 years. Results: We identified an overall complication rate of 12.3% (101 of the 822 patients), with 4.8% defined as experiencing major complications and 7.5% defined as experiencing minor complications. The most frequent were complications that led to hardware removal, observed in 2.7% (n = 22) of the patients; wound-related problems that did not require surgical revision, observed in 2.2% (n = 18) of the patients; and carpal tunnel syndrome, observed in 1.9% (n = 16) of the patients. Binary logistic regression modeling showed no correlation between demographic factors and the risk of complications. Conclusions: In conclusion, a low overall complication rate of 12.3% was found. Further, 4.8% of the patients experienced a major complication and 7.5% of the patients experienced a minor complication following open reduction and internal fixation using volar plating of distal radius fractures. Age, sex, fracture type, and time from trauma to surgery were not found to be associated with an increased risk of postoperative complications. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Efficacy of orthotic devices for increased active proximal interphalangeal extension joint range of motion: A systematic review. Valdes, K., Boyd, J. D., Povlak, S. B. and Szelwach, M. A. (2019) Level of Evidence : 2a Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Treatment Topic : Pipj flexion deformity - Splint effect This is a systematic review and meta-analysis assessing the efficacy of splinting for pipj flexion deformity post-injury. Four studies (2 randomised controlled trials) were included in the review. Different orthoses, including a dynamic Capener splint, custom-fabricated thermoplastic mcpj block splints, and a dynamic hand based splints were utilised. The results showed that the orthoses improved range of motion by an average of 20°. The recommended wearing schedule for optimal results was found to be at least 6 hours per day for 2-4 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, pipj splint can improve flexion deformities by an average of 20° when worn for at least 6 hours/day for 8-17 weeks. Best practice suggests low force, intermittent removal for ROM exercises, and monitoring for swelling, cyanosis, or tingling. This is a useful review showing the usefulness of splinting for specific hand conditions. In contrast, splinting for De Quervain does not appear to have the same beneficial effects if worn for long periods of time. However, it may be useful for the reactive stage (acute presentation), when rest appears to be useful . URL : https://doi.org/10.1016/j.jht.2018.05.003 Abstract Study Design: Systematic review. Introduction/Purpose of the Study To determine the efficacy of orthotic devices for increased active proximal interphalangeal (PIP) joint range of motion and optimal wearing schedule of the devices to guide clinical practice. The secondary purpose is to capture the outcome measures used by the authors. The final purpose was to determine if recent studies addressed patient satisfaction and adherence in the orthotic management of a PIP joint injury. Methods: A comprehensive literature search was conducted using the search terms splint, orthotic device, hand orthotic, brace, proximal interphalangeal joint, occupational therapy, and physical therapy using PubMed, CINAHL, MEDLINE, and ProQuest. The following data were extracted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines: background statement, objectives, data sources, study eligibility criteria, participants, and interventions, study appraisal and synthesis methods, results, limitations, conclusions, and implications of key findings. Results: Best results were achieved when the PIP orthoses were worn for a longer duration especially for the treatment of extension deficits. Discussion: Studies that provided a wearing schedule of a minimum of 6 hours obtained the greatest improvements in extension deficits of the PIP joint. Conclusion Recommended orthotic dosage to treat PIP joint injury is at least 6 hours a day for 8-17 weeks. 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

Low rates of serious complications and further procedures following surgery for base of thumb osteoarthritis: Analysis of a national cohort of 43,076 surgeries. Lane, J. C., et al. (2021) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Prognostic Topic : Thumb OA surgery – Adverse events This is a retrospective study assessing the incidence of additional surgery/procedures and serious adverse events (SAEs) following surgery for base of thumb osteoarthritis. A total of 43,076 patients were included in the study. The results showed that the overall rate of further thumb base procedure was 1.4%, with the highest rates identified after arthroplasty (4%) and arthrodesis (4%). In contrast, simple trapeziectomy showed a much lower risk of complications (1.12%). Any serious complication was shown to be 0.2% within 90 days, and 0.6% (e.g. thrombosis) for systemic events within 90 days. Additional factors associated with further thumb base procedure included being younger (worse outcomes in the 40-49 years old) and being female. Clinical Take Home Message : Based on what we know today, surgery for base of thumb osteoarthritis is generally safe, with a low rate of additional surgery/interventions or serious adverse events. However, we should be aware that patients undergoing arthroplasty and arthrodesis are at an increased risk of further procedures and adverse events. In addition, smoking and diabetes have been shown to increase the likelihood of post-surgical complications and we should monitor these patients more closely. URL : https://doi.org/10.1136/bmjopen-2020-045614 Abstract OBJECTIVES: To determine the incidence of further procedures and serious adverse events (SAEs) requiring admission to hospital following elective surgery for base of thumb osteoarthritis (BTOA), and the patient factors associated with these outcomes. DESIGN: Population based cohort study. SETTING: National Health Service using the national Hospital Episode Statistics data set linked to mortality records over a 19-year period (01 April 1998-31 March 2017). PARTICIPANTS: 43 076 primary surgeries were followed longitudinally in secondary care until death or migration on 37 329 patients over 18 years of age. MAIN OUTCOME MEASURES: Incidence of further thumb base procedures (including revision surgery or intra-articular steroid injection) at any time postoperatively, and local wound complications and systemic events (myocardial infarction, stroke, respiratory tract infection, venous thromboembolic events, urinary tract infection or renal failure) within 30 and 90 days. To identify patient factors associated with outcome, Fine and Gray model regression analysis was used to adjust for the competing risk of mortality in addition to age, overall comorbidity and socioeconomic status. RESULTS: Over the 19 years, there was an increasing trend in surgeries undertaken. The rate of further thumb base procedures after any surgery was 1.39%; the lowest rates after simple trapeziectomy (1.12%), the highest rates after arthroplasty (3.84%) and arthrodesis (3.5%). When matched for age, comorbidity and socioeconomic status, those undergoing arthroplasty and arthrodesis were 2.5 times more likely to undergo a further procedure (subHR 2.51 (95% CI 1.81 to 3.48) and 2.55 (1.91 to 3.40)) than those undergoing simple trapeziectomy. Overall complication rates following surgery were 0.22% for serious local complications and 0.58% for systemic events within 90 days of surgery. CONCLUSIONS: The number of patients proceeding to BTOA surgery has increased over the last 19 years, with a low rate of further thumb base procedures and SAEs after surgery overall registered. Arthrodesis and arthroplasty had a significantly higher revision rate. 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

Thumb and fingertip ischaemia after trapeziectomy. Williams, D. C., Sánchez Ruas, J. and del Piñal, F. (2023) Level of Evidence : 5 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Diagnostic This is the answer to last week's Sherlock Handy. The patient was a 53 years old office worker who had undergone trapeziectomy with ligament reconstruction and tendon interposition. They did not present with comorbidities. Seven hours after they were discharged, they presented to ED with excruciating pain in their hand. Upon objective examination, the fingers had no capillary refill. Following assessment of a vascular surgeon, they were put on antibiotics, steroids, and aspirin. They were discharged after two days. Seven days after surgery, their hand appeared as shown in the picture below. They were assessed by another team of surgeons and there was no evidence of infection or joint range of movement limitations. An angiogram was performed, which showed a radial artery thrombosis and digital ischaemia. The artery was reconstructed with a vein graft and the patient was administered heparin and aspirin. The skin lesions healed over 6 weeks. The radial artery thrombosis was caused by an iatrogenic injury during trapeziectomy. 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, iatrogenic injuries to the vascular supply of the hand can cause devastating results. The assessment of capillary refill time and Allen's test are important aspects of the objective assessment following post-surgically interventions or insidious onset of hand conditions , which may be caused by vascular impairments. URL : https://doi.org/10.1177/17531934231151215 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

Level of Evidence : 5 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Diagnostic Have a think about this case study. Leave a diagnostic comment if you like. The patient was a 53 years old office worker who had undergone trapeziectomy with ligament reconstruction and tendon interposition. They did not present with comorbidities. Seven hours after they were discharged, they presented to ED with excruciating pain in their hand. Upon objective examination, the fingers had no capillary refill. Following assessment of a vascular surgeon, they were put on antibiotics, steroids, and aspirin. They were discharged after two days. Seven days after surgery, their hand appeared as shown in the picture below. They were assessed by another team of surgeons and there was no evidence of infection or joint range of movement limitations. What's the problem?

Effects of multidirectional elastic tape on pain and function in individuals with lateral elbow tendinopathy: A randomised crossover trial. Hill, C. E., Heales, L. J., Stanton, R. and Kean, C. O. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Lateral epicondylalgia – Kinesio taping This is a randomised crossover trial assessing the effects of multidirectional elastic tape on pain-free grip strength and pressure pain threshold in individuals with lateral elbow tendinopathy. A total of 27 participants were included in the study. The tensioned (experimental) tape was applied as shown in the image below. The placebo tape was applied without tension. These conditions were also compared to a "no tape" condition. Pain-free grip strength and pressure pain thresholds were measured immediately before and after the application of taping/no taping. The results showed that the "tensioned" kinesio tape provided no additional benefit compared to the placebo application or no tape. In terms of pain-free grip strength or pressure pain threshold. There were, however, individual variations showing that 7 participants (26%) experienced an increase in pain-free grip strength with the experimental condition. 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, tensioned multidirectional elastic tape does not appear to improve pain-free grip strength or pressure pain threshold in individuals with lateral elbow tendinopathy. This is in line with previous evidence showing that "inhibitory" Kinesio taping is no more effective than a placebo for lateral epicondylalgia (LE) . If you are interested in lateral epicondylalgia, have a look at the whole collection . Open Access URL : https://doi.org/10.1177/02692155231152817 Abstract OBJECTIVE: To investigate the effects of multidirectional elastic tape on pain and function in individuals with lateral elbow tendinopathy. STUDY DESIGN: Randomised crossover trial. SETTING: Biomechanics laboratory. SUBJECTS: 27 participants (11 females, mean (SD) age: 48.6 (11.9) years) with clinically diagnosed lateral elbow tendinopathy of at least six weeks' duration. INTERVENTIONS: Tensioned multidirectional elastic tape applied over the wrist, compared to control tape (untensioned), and no tape conditions. MAIN MEASURES: Pain-free grip strength and pressure pain threshold were recorded at three timepoints for each condition: baseline, post-application, and following an exercise circuit. Change scores were calculated as the post-application or post-exercise value minus baseline. Repeated-measure analyses of variance were used to examine differences between conditions. RESULTS: There were no statistically significant differences in pain-free grip strength between conditions (flexed position: F(2,52) = 0.02, p = 0.98; extended position: F(2,52) = 2.26, p = 0.12) or across timepoints (post-application vs post-exercise) (flexed position: F(1,26) = 0.94, p = 0.34; extended position: F(1,26) = 0.79, p = 0.38). Seven participants (26%) increased pain-free grip strength above the minimal detectable change following application of multidirectional elastic tape. There were no statistically significant differences in pressure pain threshold between conditions (affected lateral epicondyle: F(1.51,39.17) = 0.54, p = 0.54) or across timepoints (affected lateral epicondyle: F(1,26) = 0.94, p = 0.34). CONCLUSION: Tensioned multidirectional elastic tape may not immediately improve pain-free grip strength or pressure pain threshold in our lateral elbow tendinopathy population; however, individual variation may exist. 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

Development and validation of a prognostic nomogram for open elbow arthrolysis: The Shanghai Prediction model for Elbow Stiffness Surgical Outcome. Liu, W., et al. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Post-traumatic elbow stiffness - Is arthrolysis going to be successful? This is a prognostic study aiming to develop a model to predict the outcome of surgery for post-traumatic stiffness of the elbow. The type of surgery investigated was open arthrolysis. A total of 551 patients were retrospectively identified amongst a cohort of Chinese people presenting with post-traumatic elbow stiffness. A successful surgical outcome was defined as presenting with more than 120° (functional elbow range) post-surgery. Several potential predictors were included. The results showed that higher BMI, longer duration of stiffness, poorer baseline ROM, more severe pain, and more severe OA of the elbow lead to poorer functional recovery after open elbow arthrolysis. The model had a good prediction performance although further validation is required. To calculate the probability of your patients having a successful surgery, you can use the nomogram in the figure below or use the online tool that I created for you. 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 Shanghai Prediction Model for Elbow Stiffness Surgical Outcome (SPESSO) is a valid and convenient model, which can be utilised to predict the outcome of open arthrolysis of the elbow. It can be adopted in combination with clinical reasoning to counsel patients about surgical options (i.e. open arthrolysis) to reduce elbow stiffness. Considering that elbow stiffness can lead to mental health issues such as depression, it is an important impairment to resolve. In terms of conservative treatment, stretching or resistance training appear to be useful to regain range of movement. URL : https://doi.org/10.1302/0301-620x.104b4.bjj-2021-1326.r2 Abstract AIMS: The aim of this study was to develop and internally validate a prognostic nomogram to predict the probability of gaining a functional range of motion (ROM ≥ 120°) after open arthrolysis of the elbow in patients with post-traumatic stiffness of the elbow. METHODS: We developed the Shanghai Prediction Model for Elbow Stiffness Surgical Outcome (SPESSO) based on a dataset of 551 patients who underwent open arthrolysis of the elbow in four institutions. Demographic and clinical characteristics were collected from medical records. The least absolute shrinkage and selection operator regression model was used to optimize the selection of relevant features. Multivariable logistic regression analysis was used to build the SPESSO. Its prediction performance was evaluated using the concordance index (C-index) and a calibration graph. Internal validation was conducted using bootstrapping validation. RESULTS: BMI, the duration of stiffness, the preoperative ROM, the preoperative intensity of pain, and grade of post-traumatic osteoarthritis of the elbow were identified as predictors of outcome and incorporated to construct the nomogram. SPESSO displayed good discrimination with a C-index of 0.73 (95% confidence interval 0.64 to 0.81). A high C-index value of 0.70 could still be reached in the interval validation. The calibration graph showed good agreement between the nomogram prediction and the outcome. CONCLUSION: The newly developed SPESSO is a valid and convenient model which can be used to predict the outcome of open arthrolysis of the elbow. It could assist clinicians in counselling patients regarding the choice and expectations of treatment. 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 life dedicated to climbing and its sequelae in the fingers-a review of the literature. Pastor, T., et al. (2022) Level of Evidence : 4 Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Aetiologic Topic : Climbing - Hand OA This is a case study and literature review on the effects of rock climbing on the hands. It is reported that climbers have thicker pulleys, collateral ligaments and capsules, decreased range of motion, and contractures in their fingers. Bone adaptations, such as thick cortices and small medullary canals, have been found in climbers and are positively correlated with climbing years. It is unclear whether these changes are adaptations to mechanical stress or pathological reactions. The study followed an elite climber for 10 years and found that bone thickness and osteophyte size increased over the course of the study. They presented with morning stiffness but no pain. Previous research has also shown that 84% of the climbers present with objective signs of osteoarthritis, with the middle finger being the most susceptible to degeneration. However, the presence of these signs is not always associated with pain. The crimp position, which is used by 90% of climbers, maybe a contributing factor to the development of osteoarthritis. Based on what these authors said, can you tell which column (either left or right) of radiographs belongs to a 52 yrs old climber vs and age and sex match non-climber? Leave a comment with your guess! 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, elite sport climbing can lead to soft tissue and bone adaptations in the fingers. These adaptations appear to increase over time. The middle finger appears to be the most affected digit. It is important to remember that the presence of bony enlargements and/or changes on x-ray, does not equate to pain. Does this mean that you should advise your clients against rock climbing? Probably not, especially considering that taking part in rock climbing is likely to increase their likelihood of meeting the WHO guidelines for physical activity . This in turn increases life span and health span. If you would like to predict the likelihood of developing hand OA in your non-climbing clients, use the prediction model . If you are wondering whether cracking your knuckles causes hand OA , have a look at this other synopsis! Open Access URL : https://doi.org/10.3390/ijerph192417050 Abstract Fingers of sport climbers are exposed to high mechanical loads. This work focuses on the fingers of a 52-year-old active elite climber who was the first in mankind to master 8B (V13), 8B+ (V14) and 8C (V15) graded boulders, bringing lifelong high-intensity loads to his hands. It is therefore hypothesized that he belongs to a small group of people with the highest accumulative loads to their fingers in the climbing scene. Fingers were analyzed by means of ultrasonography, X-rays and physical examination. Soft tissue and bone adaptations, as well as the onset of osteoarthritis and finger stiffness, were found, especially in digit III, the longest and therefore most loaded digit. Finally, this article aims to provide an overview of the current literature in this field. In conclusion, elite sport climbing results in soft tissue and bone adaptations in the fingers, and the literature provides evidence that these adaptations increase over one's career. However, at later stages, radiographic and clinical signs of osteoarthritis, especially in the middle finger, seem to occur, although they may not be symptomatic. 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 associated factors of primary elbow osteoarthritis in the Japanese general elderly population: A Japanese cohort survey randomly sampled from a basic resident registry. Nakayama, K., et al. (2022) Level of Evidence : 2c Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Symptoms prevalence study Topic : Elbow osteoarthritis – Prevalence This is a cross-sectional study that assessed the prevalence of asymptomatic and symptomatic primary elbow osteoarthritis (PEOA) in Japan. A total of 318 participants over the age of 50 (range 50 to 89 years old) took part in the study. The prevalence of PEOA was reported to be 25%. Men had a higher rate of PEOA (27%) compared to women (23%). Despite this high prevalence, symptomatic PEOA was identified in 1% of the cohort. Factors associated with the presence of PEOA were older age and greater body mass index (BMI). In addition, long-term use of vibrating tools was shown to be a risk factor for severe radiographic PEOA. Other factors such as smoking, heavy manual labour, and participation in overhead sports were not associated with PEOA. 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, primary elbow OA identified through radiographs appears to be highly prevalent in people over the age of 50. However, only 1% of people over 50 present with symptomatic primary elbow osteoarthritis. Interestingly, higher BMI appears to be associated with greater prevalence of primary elbow osteoarthritis. Considering the the elbow is not a weighbearing joint, it is likely that this condition may be the result of low-grade inflammation or the presence of genetic factors that contribute to both greater BMI and OA. If you would like to know more about the conservative treatment for elbow OA, have a look at this synopsis . URL : https://doi.org/10.1016/j.jse.2021.07.015 Abstract Background: The epidemiology of primary elbow osteoarthritis (PEOA) remains unknown. We aimed to evaluate the prevalence and associated factors of PEOA in a cross-sectional resident cohort from a municipal registry of a Japanese town. Methods: A total of 415 residents over 50 years of age were randomly sampled from a Japanese town and were adjusted for age and gender. Those with diseases that could potentially cause a secondary osteoarthritis of the elbow were excluded. The remaining 318 subjects (150 men and 168 women) underwent bidirectional radiography of the elbow. Subjects were diagnosed with PEOA if one of their elbows was Kellgren-Lawrence (KL) grade 2 or greater. In addition, motion pain and tenderness at the elbow were examined by orthopedic surgeons. Associated factors for the PEOA were statistically analyzed. Results: The prevalence of PEOA was 25.2% (male, 27.3%; female, 23.2%), and the prevalence of symptomatic PEOA was 0.9%. The age-stratified prevalence of PEOA was as follows: 50-59, 6.2% (male, 5.0%; female, 7.3%); 60-69, 15.4% (male, 17.5%; female, 13.7%); 70-79, 29.5% (male, 35.3%; female, 25.0%); and 80-89, 55.9% (male, 55.6%; female, 56.3%). Age and body mass index were revealed as associated factors that increased the prevalence of PEOA with KL grade 2 or greater. The use of vibrating tools was demonstrated as an independent associated factor that increased the prevalence of PEOA with KL grade 4 in addition to the 2 aforementioned factors. Conclusions: The prevalence of PEOA in Japanese subjects was 25.2% for those aged 50-89 years with a mean age of 69.2 years, most of which was asymptomatic OA without motion pain or tenderness at the elbow. Age and body mass index increased the prevalence of PEOA with KL grade 2 or greater. The prevalence of PEOA increased with age, but the disease was self-accommodated by most people. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Is it time to reconsider the indications for surgery in patients with tennis elbow? Karjalainen, T. and Buchbinder, R. (2023) Level of Evidence : 5 Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Lateral epicondylalgia – Therapeutic approaches This is an expert opinion on the clinical implications of recent research findings on tennis elbow. The authors suggest that recovery from tennis elbow is usually good, with a 50% probability of recovery every three to four months, and that failed nonoperative treatment does not necessarily mean that surgery will be effective. It also suggests that biomechanical and social factors may be involved in recovery, and that future studies should explain with higher certainty what contributes most to its development and recovery. It is important to identify subgroups of patients who do not recover spontaneously and treat them with an evidence-based approach. Failure of nonoperative treatment is not an indication for surgery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, tennis elbow is a self-limiting condition in most patients, and the prognosis is usually good with most people recovering without treatment. However, there are some factors that can affect recovery, such as mechanical and social factors, which surgery does not modify. Therefore, failed nonoperative treatment should not be used as an indication for surgery unless we can reliably identify people who will recover through it. This is especially true since a recent paper has shown surgery to be no more effective than placebo . People with longstanding symptoms should be informed about the favourable prognosis instead of trying surgery as a first-line treatment. If you would like to get a more complete picture about lateral epicondylalgia, have a look at the whole collection . URL : https://doi.org/10.1302/0301-620X.105B2.BJJ-2022-0883.R1 Abstract Tennis elbow (lateral epicondylitis or lateral elbow tendinopathy) is a self-limiting condition in most patients. Surgery is often offered to patients who fail to improve with conservative treatment. However, there is no evidence to support the superiority of surgery over continued nonoperative care or no treatment. New evidence also suggests that the prognosis of tennis elbow is not influenced by the duration of symptoms, and that there is a 50% probability of recovery every three to four months. This finding challenges the belief that failed nonoperative care is an indication for surgery. In this annotation, we discuss the clinical and research implications of the benign clinical course of 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