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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 assessed radiographically for a suspected triquetrum fracture, which was confirmed with further investigations. However, during the radiographic assessment of the patient, an additional bone or fracture was identified between the scaphoid, trapezium, trapezoid, and capitate. Considering the presentation of ulnar wrist pain only, what do you think it is?

Is pain contagious? Innocuous stimulation can be transformed into the pain experience by observational learning. Buglewicz-Przewoźnik, E., Adamczyk, W. M. and Bąbel, P. (2022) Level of Evidence : 5 Follow recommendation : 👍 (1/4 Thumbs up) Type of study : Aetiologic Topic : Allodinia - Observational conditioning This is an experimental study assessing the effect of observing somebody in pain on the likelihood of somebody else experiencing allodynia (non-nociceptive stimulus perceived as painful). A total of 88 healthy participants took part in the study. Participants underwent a procedure to identify an electric current level that they could perceive on the hand without it being perceived as painful (non-nociceptive stimulus). After this threshold was identified, participants were randomised to different procedures (groups). In all procedures, participants received the same non-nociceptive stimulus 15 times and they had to rate the pain experienced on a scale from 0 to 10. The control group was given the stimuli while they were alone in a room. In contrast, the experimental groups were given the stimuli in the room with an actor who received sham stimuli but pretended them to be painful (between 2 and 6/10). The results showed that the control group reported no pain with repeated non-nociceptive stimuli. However, the experimental groups all reported allodynia (pain caused by a non-painful stimulus) (See graphs below). In addition, the likelihood of participants reporting pain was moderately associated with fear of pain (questionnaire). 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, our clients can present with allodynia if they perform an action/receive a stimulus that appears to have caused pain in somebody else. This suggests that if we communicate pain through body language or we verbally suggest that a specific action will cause pain, they are more likely to report pain or perceive pain in the near future. Pain has been shown to have a learning component and there is growing evidence showing that clients' thoughts about it (e.g. pain catastrophising) are associated with pain intensity . URL : https://doi.org/10.1016/j.jpain.2022.07.015 Abstract Studies indicate that classical and operant conditioning have potential to play a role in the formation of the allodynic effect. Only a few studies have examined the role of observational learning in pain induction. Due to some methodological challenges, evidence that the allodynic effect can be learned through observation is limited. In the present study, healthy participants (n = 88) received two series of innocuous electrocutaneous stimuli: at the beginning of the study and after observation of a model who rated all the stimuli as painful. Participants and the model rated all the stimuli alternately (real-time group), or the participant first observed the model and then rated the stimuli, while the model stayed in (post-hoc+ group) or left (post-hoc- group) the laboratory. There was no model in the control group. The study demonstrated that allodynia can be induced by observational learning. Furthermore, this effect was shown to be similar, regardless of whether stimuli were received during the observation of the model and rated immediately afterwards, or when the observation and stimuli reception were time-separated. The mere presence of the model during the stimuli reception also did not affect the magnitude of this effect. This research may contribute to our understanding of the mechanisms of chronic pain development and assist in the development of suitable treatment for it. Perspective. This article presents study results on the role of observational learning in allodynia induction without tissue injury. The results may contribute to our understanding of the mechanisms of chronic pain development and assist in the development of suitable treatment for it. 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

Extensor hood injuries in elite boxers: injury characteristics, surgical technique and outcomes. Matharu, G. S., Gatt, I. T., Delaney, R., Loosemore, M. and Hayton, M. J. (2022) Level of Evidence : 5 Follow recommendation : 👍 (1/4 Thumbs up) Type of study : Diagnostic/Therapeutic Topic : Extensor hood injuries – Boxing This is a prospective study assessing outcomes following extensor hood repairs in professional or international amateur boxers. A total of 45 participants were included in the study. Extensor hood pathology was defined as pain in the metacarpophalangeal joint (mcpj) with acute or gradual onset. The authors report that these presentations often present with tenderness on palpation over the sides of the extensor hood, crepitus on movement, and potentially limitation in mcpj flexion. Upon surgical exploration, a variety of lesions were identified including central splits between the tendon (e.g. extensor digitorum and extensor indicis), pseudobursas, capsular tears, and adherent tissues (e.g. tendon adherent to capsule). Post-surgery, participants underwent assessment and treatment through a hand therapist/physiotherapist and initiated mobilisation exercises within a week. Gentle active range of movement of the mcpj, pipj, dipj was encouraged and progressed. No splinting was provided. At week 4 participants initiated isometric strengthening of gripping and intrinsic muscles, which was progressed until week 8. Following these 8 weeks, progressive impact was resumed until week 12-14 when boxers were able to return to full sparring. A total of 98% of boxers return to their pre-injury boxing level within 8 months (range 1-24 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, extensor hood injuries can be managed surgically with good outcomes in elite and amateur boxers. This type of injury has a faster recovery and greater probability of return to pre-injury level compared to cmcj (II to V) fusion for instability . Following surgery, early active movements should be encouraged followed by strengthening from week 4 post-op. Other common boxing injuries include boxer's elbow , boxer's knuckle , and cmcj instability . URL : https://doi.org/10.1177/17531934221123139 Abstract We describe our experience of managing extensor hood injuries in boxers (57 fingers). The diagnosis was mostly clinical, with imaging only if the diagnosis was equivocal. The middle (61%) and index (26%) digits were most frequently injured. On exploration, 26% had no hood tear, however all required tenolysis from the adherent capsule. Of 42 hood tears, 15 were central splits between adjacent extensor tendons in the index or little fingers,15 tears were on the ulna side of the extensor tendon and 12 tears were on the radial side. A pseudobursa was encountered in 35%, capsular tears in 28% and chondral injury in one patient. Longitudinal curved metacarpophalangeal joint incisions were used, with hood repair performed in flexion using a locked running suture. Mean postoperative metacarpophalangeal joint flexion was 90°. Ninety-eight per cent returned to the same level of boxing at a mean of 8 months (range 1–24) from surgery. One finger was revised for re-rupture 6 months later. A reproducible technique for treating these injuries is described, with patients able to return to boxing with little risk of 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

The effect of diabetes mellitus on the outcome of surgery for cubital tunnel syndrome. Stirling, P. H. C., Harrison, S. J. and McEachan, J. E. (2022) Level of Evidence : 1b Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Symptoms prevalence study Topic : Cubital tunnel surgery - diabetes and functional recovery This prospective study assessed the effect of diabetes on functional recovery following surgery for cubital tunnel syndrome. Functional recovery was measured through the QuickDASH questionnaire, and the presence of diabetes was self-reported by participants. A total of 131 participants were recruited at baseline and they were assessed pre-surgery and one-year post-surgery. Of these participants, 22 had diabetes. The results showed that neither group improved to a clinically relevant level on the QuickDASH at 12 months. In addition, the functional improvement in the diabetes group was lower compared to the control. The difference between the two groups was statistically significant at 12 months post-op, but was not clinically relevant. 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 diabetes does not affect recovery, to a clinically meaningful level, after cubital tunnel release. People with diabetes may present with a slower recovery, however, this does not appear to be relevant ( QuickDASH minimal clinically important difference ranges between 10 and 18 ). Similar results have been reported following carpal tunnel release, showing that diabetes has a small effect on recovery . URL : https://doi.org/10.1177/17531934221143500 Abstract The aims of this study were to investigate the effect of diabetes mellitus (DM) on patient-reported outcome measures (PROMs) and satisfaction after surgery for cubital tunnel syndrome (CuTS). Pre- and 1-year postoperative QuickDASH, normal hand, and satisfaction scores were prospectively collected from 107 patients over a 6-year period. Patients without DM reported a significant QuickDASH improvement after surgery (preoperative 34.1 versus postoperative 20.5; p < 0.001), but patients with DM did not (preoperative 46.5 versus postoperative 43.2; p = 0.554). Postoperative QuickDASH (43.2 versus 20.5) and normal hand (65 versus 80) scores were significantly worse in patients with DM. Satisfaction rates were excellent in both groups (88% versus 82%; p = 0.480). Our study showed that surgery for CuTS did not lead to an improvement in QuickDASH score in patients with DM and consequently patients with DM reported worse postoperative PROMs compared with those without. However, lack of improvement in PROMs does not affect patient satisfaction. 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

Hand carpometacarpal joint instability in elite boxers: Injury characteristics, surgical technique, and outcomes. Matharu, G. S., et al. (2022) Level of Evidence : 2c Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Diagnostic/Therapeutic Topic : Cmcj instability – Boxing This is a retrospective study assessing outcomes following fixation of carpometacarpal (cmcj) II to V instability in boxers. A total of 38 elite boxers were included in the study. Carpometacarpal instability onset was either traumatic or gradual. The carpal seesaw test (see figure below) was utilised in combination with imaging to make the diagnosis. Surgery involved fusion of the affected carpometacarpal joints with bone graft, wires, or screws. Rehabilitation started soon after surgery to maintain range of movement. On average, radiographic union occured at 4 months. After union was observed onx-ray, grip strengthening was started as well as a gradual exposure to contact (e.g. water bags, pads). At 8 months, 80% of boxers returned to their pre-injury level. 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, most elite boxers undergoing cmcj (II to V) fusion for instability return to pre-injury levels at 8 months post-surgery. Early gentle active movements followed by strengthening once fusion is confirmed on radiograph, appear to be useful in achieving return to sport. Carpometacarpal joint instability is another upper limb pathology that we need to keep in mind when assessing patients involved in boxing. Other common conditions in boxers include boxer's knuckle and boxer's elbow . URL : https://doi.org/10.1016/j.jhsa.2022.07.021 Abstract Purpose: We describe a single-surgeon’s experience of managing hand carpometacarpal joint (CMCJ) instability in elite boxers, focusing on injury characteristics, surgical technique, and outcomes. Methods: This retrospective cohort included consecutive elite boxers undergoing surgery for hand CMCJ instability from 2009 to 2021. CMC joint instability is usually clear on clinical examination using a ‘seesaw’ test. All cases had a plain radiograph and in equivocal cases for instability advanced imaging such as MRI or ultrasound scan. CMCJs were accessed via longitudinal incisions between index/middle rays, and additionally ring/little. Often marked deficiency in the CMCJ ligamentous capsule was seen. The articular surfaces were decorticated to cancellous bone and autogenous bone graft impacted. The CMCJs were fixed in extension using various methods, latterly memory staples. Outcomes included radiographic fusion, return to boxing, and complications. Results: Forty hands had surgery in 38 boxers. In total, 101 CMCJs were fused, with an average of 2.5 joints per patient. Patients were mainly young (mean age 24.1 years), male (37/38) with the trailing hand more commonly affected (trailing hand 87.5%, leading hand 12.5%). The most frequently fused CMCJ was the index (97.5%, n = 39), then middle (95%, n = 38), ring (45%, n = 18), and little (15%, n = 6). There were 82% (31/38) of patients who returned to the same level of boxing at a median of 8 months from surgery (range 3–27 months). Three patients had revision surgery for non-union, a median of 10.3 months after initial surgery (range 9.4–133.1 months): 2 for index/middle and one for the little CMCJ. All 3 revisions fused and the patients returned to boxing at the same level, although the little CMCJ required a second bone graft and fixation. Conclusions: Patients can achieve full recovery after treatment of CMCJ instability, and most can return to boxing at the same level with little risk of 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

Brief psychological screening for trapeziectomy: Identifying patients at high risk of a poor functional outcome. Larson, D., Nunney, I., Champion, R., Edwards, C. and Chojnowski, A. (2022) Level of Evidence : 2c Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Symptoms prevalence study Topic : Trapeziectomy - Psychological factors and recovery This is a prospective study assessing the association between psychological variables and recovery post-trapeziectomy. Participants (N = 83) with thumb OA underwent trapeziectomy and were assessed pre-surgery, 6, 16, and 52 weeks post-surgery. Psychological variables included the score on the STarT-Psych screening tool (See figure below - 0 to 5, 0 being no psychological factors, 5 being the highest amount of psychological factors). Participants were defined as presenting 'low-risk' if they scored 0-3/5 and 'high-risk' if they scored 4-5/5. Pain intensity (NRS) and QuickDASH were also assessed at these time points. The results showed that people at 'high-risk' presented with a slower recovery (NRS and QuickDASH) at all time points compared to the 'low-risk' group (see figure). 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, people at 'high-risk' when screened through the STarT-Psych tool, present with slower recovery after trapeziectomy for thumb OA. This paper is in line with previous evidence showing that other psychological aspects (e.g. pain catastrophising, depression) contribute to the level of pain in people with hand OA or acute upper limb fractures . Recognising these aspects in our clients may help predict their recovery timeframes and provide them with better care. URL : https://doi.org/10.1177/17589983221120839 Abstract Introduction: This study investigates if the psychological subscale from the STarT Back Screening Tool (STarT Psych-sub) identifies patients at high risk of a poor functional outcome after a trapeziectomy based on modifiable psychological factors. Methods: A total of 83 patients completed the STarT Psych-sub, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand), Patient Evaluation Measure (PEM) and a numeric pain rating scale (NPRS) before trapeziectomy. QuickDASH, PEM and NPRS were completed at 6 weeks, 16 weeks and 1 year after the trapeziectomy. Results: The STarT Psych-sub stratified 24 patients (29%) as 'high-risk' and 59 (71%) as 'not high-risk' of a poor outcome. The 'high-risk' group reported worse function and pain (QuickDASH = 72.7, PEM = 81.1, NPRS = 8.3) at baseline than the 'not high-risk' group (QuickDASH = 56.1, PEM = 66.4, NPRS = 7.2). This difference remained constant at all time points after the trapeziectomy with 1-year scores on the QuickDASH = 39.6; PEM = 47.1 and NPRS = 3.7 for the 'high-risk' group and QuickDASH = 24.3; PEM = 33.3 and NPRS = 1.9 for the 'not high-risk' group. Conclusions: Brief psychological screening shows that patients with psychological risk factors experience improved pain and function outcomes following trapeziectomy, however their outcomes are significantly worse than patients who do not have psychological risk 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

Abnormal MRI signal intensity of the triangular fibrocartilage complex in asymptomatic wrists. Wang, Z., et al. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Diagnostic Topic : MRI findings ulnar wrist - Asymptomatic wrists This is a cross-sectional study assessing the prevalence of Triangular Fibrocartilage Complex (TFCC) full-thickness tears in asymptomatic people. A total of 154 healthy participants took part in the study. They all underwent MRI of their dominant wrists. The average age was 41 with a range between 21 and 79 years old. The results showed that MRI identified abnormal findings in 56% of the asymptomatic sample. In addition, there was a strong correlation between age and the number of abnormal findings (see figure). Disk perforations were present in more than 50% of people over the age of 40. 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 TFCC are present in more than 50% of asymptomatic people over the age of 40. These changes increase in prevalence with ageing. These findings are in line with previous research suggesting that MRI alone cannot discriminate between people with and without ulnar wrist pain in a cohort of tennis players . These studies add to the growing amount of evidence suggesting that history, physical assessment, and x-rays are sufficient to provide quality care for a large proportion of people with ulnar wrist pain . URL : https://doi.org/10.1177/17531934221141986 Abstract We investigated abnormal MRI findings of the triangular fibrocartilage complex in 154 asymptomatic volunteers (21-79 years). Except prevalence, we focused on the morphological features of abnormal signals in relation to age. The majority of full-thickness tears were located in the articular disc (63 participants). The incidence of disc perforation with characteristics of ulnar impaction syndrome increased significantly with age. Asymptomatic full-thickness tears of the ulnar attachment were found in ten participants (seven over 60 years old). The proximal and distal laminae of the ulnar attachment could not be differentiated in 36 participants. In conclusion, MRI is of limited value for the elderly in diagnosing triangular fibrocartilage disorders. For young subjects, MRI is still valuable, especially in diagnosing ulnar detachment, although the ability to distinguish between proximal and distal laminae remains questionable. Disc perforations in volunteers mimicked ulnar impaction syndrome, therefore age, clinical signs and other factors should also be considered in clinical diagnosis. 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 effects of taping on de Quervain’s disease: A systematic review and meta-analysis. Drapeza, R. C., Navasca, S. B., Dones, V. and Rimando, C. R. (2022) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : De Quervain - Taping This is a systematic review and meta-analysis on the effect of taping compared to other conservative interventions for De Quervain. A total of 241 participants were included across the seven randomised controlled studies analysed. Participants were either randomised to kinesiotape/rigid tape or other conservative interventions including infrared radiation, ultrasound, manual therapy, paraffin bath, and transcutaneous electrical stimulation. Outcomes assessed included pain and function. All the studies were included in the meta-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. The results showed that there is very low-quality of evidence suggesting that taping is not more effective than any other intervention for pain or function. 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, taping is not more effective than any other conservative intervention in relieving pain/improving function in people with De Quervain syndrome. Overall it seems that conservative treatments for De Quervain have small effect sizes . Cortisone injections seem to be a viable alternative and they appear to provide relief in 70% of people , although they may be less effective in people with diabetes . It is important to remember that despite cortisone injections being an effective intervention, these have not been assessed against placebo injections . URL : https://doi.org/10.1016/j.jbmt.2022.05.004 Abstract Background: Therapeutic taping may be a useful modality in relieving pain, improving strength, and restoring the function of patients with De Quervain's Disease (DQD). Evidence on the effectiveness of therapeutic taping for DQD patients in mitigating its clinical signs and symptoms is not established. However, reviews report Kinesio Taping effects on musculoskeletal pains not specific to DQD. Methods: The study followed the guideline statement of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two researchers (RD and SN) searched the electronic databases and hand-searched for relevant journals. The relevant articles were selected using keywords found in titles and abstracts and, consequently, full-text manuscripts. A third researcher (VCDIII) resolved the disagreements between the two researchers. They used Review Manager 5.4 for risk of bias assessment and meta-analysis. Data were pooled to determine the therapeutic taping's overall effect. Heterogeneity was assessed by Higgin's (I2) statistic. The random-effects model was used if heterogeneity was high (>60%). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Approach determined the certainty of evidence. Results: Seven high-risk of bias clinical-controlled trials comprising 241 participants were included in the meta-analysis. The reported outcome measures were the Visual Analogue Scale (VAS) for pain, Patient-Rated Wrist/Hand Examination for Function and Power, and precision grip strength using a hand-held dynamometer and pinch gauge. Therapeutic taping did not improve the pain, power grip, grip strength, and function of participants with DQD (p > 0.05). Therapeutic taping compared to other physical therapy interventions did not reduce the VAS scores of 241 participants with DQD [SMD (95% CI) = −1.08 (−2.55,0.39), p = 0.15]. Kinesio taping with low-level laser therapy compared to ultrasound and exercise did not improve the function of 60 participants with DQD [SMD (95% CI) = 0.56 (−4.71,3.60), p = 0.79]. Therapeutic taping compared to ultrasound and Mulligan Pain Releasing Phenomenon did not improve the power grip strength of 50 participants with DQD [SMD (95% CI) = 1.24 (−0.83,3.31), p = 0.24]. Therapeutic taping was not better than phonophoresis in improving the precision grip strength of 50 participants with DQD [SMD (95% CI) = 0.43 (−1.95,2.80), p = 0.72]. Conclusions: There is insufficient evidence to recommend the use of therapeutic taping in treating patients with DQD. Therapeutic taping was no better than other treatment modalities in mitigating the clinical signs and symptoms of DQD (p > 0.05). Therapeutic taping did not affect wrist pain, handgrip, pincer strength, and function of participants with DQD (p > 0.05). publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

An unusual presentation of Boxer’s knuckle in the little finger: A case report. Leon Lam, W., Bruyere, A., & Leclercq, C. (2020) Level of Evidence : 5 Follow recommendation : 👍 (1/4 Thumbs up) Type of study : Diagnostic/Therapeutic Topic : Mcpj injury – Surgical treatment This is a case report of an uncommon clinical presentation of boxer's knuckle. The patient was a 34 year old male who had been experiencing worsening pain in the dorsal aspect of the little finger mcpj for 2 months following a professional boxing competition. They presented with swelling and pain on the dorsal aspect of the mcpj of the little finger. In addition, they reported a snapping sensation on the dorsal aspect of the little finger mcpj when going from extension to flexion. Conservative treatment for 2 months had provided no relief. Ulstrasound investigations confirmed the presence of a dorsal expansion lesion between extensor digiti minimi (EDM) and extensor digitorum communis (EDC). Upon surgical examination, a pseudo-mass had developed between EDM and EDC. This was removed in association with part of the joint capsule as the two could not be separated. An extensive repair had to be performed to re-establish the integrity of the dorsal aponeurosis of the mcpj. Surgery was followed by six weeks of resting in a position of safe immobilisation. This allowed them to return to their competitive boxing without further 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, we may refer clients presenting with a boxer's knuckle for x-ray and ultrasound. Delaying care may result in ongoing symptoms with the development of soft tissue masses, which may be difficult to repair if surgery is required. In addition to mcpj lesions, boxers are likely to get other injuries in the upper limb such as anterior/posterior elbow impingement, otherwise called boxer's elbow . URL : https://doi.org/10.1177/1753193420934072 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

Effectiveness of corticosteroid injections in diabetic patients with de quervain tenosynovitis. Buddle, V. P., DeBernardis, D., Lutsky, K. F., Beredjiklian, P. K. and Matzon, J. L. (2022) Level of Evidence : 2b- Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : De Quervain and diabetes - Cortisone injections This is a retrospective study on the failure rate of cortisone injections for De Quervain syndrome in people with diabetes mellitus. A total of 169 participants were retrospectively identified through a USA-based hospital database. Participants were included if the insurance code indicated the presence of De Quervain and diabetes. Failure of injection was defined as the need for a second injection or surgical intervention. The results showed that in 49% of participants, the first injection was successful. The second and third injection was successful in 67% of participants (see figure below). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the first cortisone injection for De Quervain syndrome is less effective in people with diabetes (50%) compared to people without this comorbidity (70%) . This result may be due to confounding factors such as age. Thus, previous research in a large sample of people treated for De Quervain did not find significant effects for this comorbidity whilst controlling for several other variables. URL : https://doi.org/10.1097%2FMD.0000000000027067 Abstract PURPOSE: We sought to determine the effectiveness of corticosteroid injections (CSIs) for de Quervain tenosynovitis in patients with diabetes mellitus. METHODS: We retrospectively identified all patients with diabetes receiving a CSI for de Quervain tenosynovitis by 16 surgeons over a 2-year period. Data collected included demographic information, medical comorbidities, number and timing of CSIs, and first dorsal compartment release. Success was defined as not undergoing an additional CSI or surgical intervention. The mixture of a corticosteroid and local anesthetic provided in each injection was at the discretion of each individual surgeon. RESULTS: Corticosteroid injections were given to 169 wrists in 169 patients with diabetes. Out of 169 patients, 83 (49%) had success following the initial CSI, 44 (66%) following a second CSI, and 6 (67%) following a third CSI. A statistically significant difference was identified in the success rates between the first and second CSIs. Ultimately, 36 of 169 wrists (21%) underwent a first dorsal compartment release. CONCLUSIONS: Patients with diabetes mellitus have a decreased probability of success following a single CSI for de Quervain tenosynovitis in comparison to nondiabetic patients, as described in the literature. However, the effectiveness of each additional CSI does not appear to diminish. 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

Primary elbow osteoarthritis: Evaluation and management. Martinez-Catalan, N. and Sanchez-Sotelo, J. (2021) Level of Evidence : 5 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Therapeutic Topic : Elbow osteoarthritis – Treatment This is an expert opinion on the management of symptomatic primary elbow osteoarthritis (OA) (non-traumatic). This condition often presents with pain and range of movement limitations. It is not uncommon for this condition to be associated with ulnar nerve impingement and joint locking due to loose bodies. X-rays are often required for the differential diagnosis, If the clinical presentation is characterised by pain without locking or severe range of movement limitations, conservative treatment is appropriate. This may include activity modification and the use of pain-relieving medications in adjunct with exercises to recover the available range of movement and strength. At times, it is not possible to regain the full range of movement due to osteophytes. If locking or severe range of movement limitations are present, open or arthroscopic surgery may be effective in resolving these symptoms. Postoperatively, active range of movement should be initiated from day one and gradually progressed to regain function. Splinting may be utilised at night for the first 3-4 weeks for comfort. In severe cases of elbow OA, joint replacement may be beneficial, however, this approach limits the return to recreational activities (e.g. weight lifting) that people enjoy. 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 may be treated conservatively if there is no locking or severe range of movement limitations. In contrast, open or arthroscopic surgery is utilised for more severe cases. Post-surgical rehabilitation involves early active motion in combination with night splinting for 3-4 weeks for comfort. Finally, in people with symptomatic elbow OA, we need to assess motor (e.g. pinch strength) and sensory function (e.g. light touch, pinprick) of the ulnar never as this is often entrapped at the cubital tunnel due to osteophytes. URL : https://doi.org/10.1016/j.jcot.2021.05.002 Abstract Most patients with primary osteoarthritis of the elbow report a history of heavy lifting with the affected upper extremity - Conservative treatment, including activity modifications, nonsteroidal anti-inflammatory drugs and the occasional intraarticular corticosteroid injection, may provide adequate pain relief in earlier stages - When surgery is required, and despite the presence of cartilage wear, many patients with primary elbow osteoarthritis experience substantial pain improvement with joint preserving procedures - The ulnar nerve needs to be carefully assessed and addressed at the time of surgery - Although open debridement procedures are effective, arthroscopic osteocapsular arthroplasty has emerged as the surgical procedure of choice - Total elbow arthroplasty is very successful in terms of pain relief and function, but it is reserved for patients with end-stage osteoarthritis who are relatively older and have failed joint preserving procedures. 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

Impaired median nerve mobility in patients with carpal tunnel syndrome: A systematic review and meta-analysis. Lin, M. T., Liu, I. C., Chang, H. P. and Wu, C. H. (2022) Level of Evidence : 1a Follow recommendation : 👍 👍 👍 👍 (4/4 Thumbs up) Type of study : Therapeutic Topic : Nerve gliding - Median nerve This is a systematic review and meta-analysis assessing whether people with carpal tunnel syndrome present with a reduction in median nerve gliding. A total of 14 studies, which included experimental, quasi-experimental, and cross-sectional designs were included. Across all studies, 671 participants were included (395 with carpal tunnel syndrome and 296 healthy controls). Median nerve excursion was assessed in all studies through ultrasound imaging. The results showed that the carpal tunnel group presented with a sliding reduction of at least 0.5 cm compared to the healthy controls. 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, median nerve gliding is impaired in people with carpal tunnel syndrome. It is possible that people with carpal tunnel syndrome present with this deficit bilaterally, especially considering that there is a strong genetic component to carpal tunnel syndrome . It is unclear at this stage whether nerve gliding exercises are effective at improving nerve movement and symptoms to a clinically relevant level . Evidence-based interventions include night splinting plus exercise for six weeks , cortisone injections , or carpal tunnel surgery . URL : https://doi.org/10.1007/s00330-022-09262-9 Abstract OBJECTIVES: This systematic review and meta-analysis investigated the mobility of the median nerve (MN) in carpal tunnel syndrome (CTS) patients compared to healthy people. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed and the electronic databases including PubMed, Scopus, EMBASE, and Cochrane Library were searched up to April 2022. All published observational studies comparing the excursion of MN between participants with and without CTS were included. The quality of research was assessed by the Newcastle-Ottawa Scale tool. The primary outcome was the excursion of the MN under dynamic examination, representing nerve mobility quantified by the standardized mean difference (SMD) for random effect meta-analysis. RESULTS: Fourteen studies were included in the qualitative review, and twelve entered the meta-analysis involving a total of 375 CTS patients and 296 healthy controls. The forest plot revealed that the mobility of the MN significantly decreased in the CTS group compared to the non-CTS control (SMD = -1.47, 95% CI: -1.91, -1.03, p < 0.001, heterogeneity 82%). In subgroup analysis, both transverse and longitudinal methods for nerve excursion showed less nerve mobility in CTS than in non-CTS. CONCLUSIONS: This meta-analysis showed that the patients with CTS exhibited less mobility of the MN than those without CTS, suggesting MN mobility as a potential CTS marker. KEY POINTS: • The patients with CTS revealed less mobility of the median nerve than those without CTS. • The mobility of the median nerve could be regarded as a potential CTS marker. 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