Search Results

Early functional mobilization for non-operative treatment of simple elbow dislocations: A systematic review. Catapano, M., Pupic, N., Multani, I., Wasserstein, D. and Henry, P. (2022) Level of Evidence : 2a Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : Simple elbow dislocation - Rehabilitation This is a systematic review assessing the best rehabilitation interventions for simple elbow dislocations. Simple elbow dislocations were characterised by stability through range after reduction associated or not with small fractures. A total of 15 studies were included in the review. Of these, three studies were randomised controlled studies. The two interventions most commonly utilised were either Plaster of Paris (PoP) for 21 days or early mobilisation with the intermittent use of an elbow splint. The studies adopting an early mobilisation approach performed forearm pronation/supination as well as elbow flexion/extension through a comfortable range. Most commonly, exercises were performed supine with the shoulder at 90° of flexion. In the early mobilisation group, a posterior elbow splint was utilised for three weeks and removed to perform exercises. The results showed that early mobilisation was associated with earlier return to work, reduced elbow stiffness, higher pain, and a lower likelihood of heterotopic ossification in the short term compared to 21 days of PoP cast. At one year, there was no difference between the early motion compared to PoP cast groups. 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, simple elbow dislocations treated with early mobilisation appear to have better outcomes compared to PoP immobilisation for three weeks. There may be higher levels of pain in the short term but it appears that the benefit may outweigh this inconvenience. The treatment of complex elbow dislocations should follow surgeons' advice as these often need surgical management. URL : https://doi.org/10.1177/1758573220957631 Abstract Purpose: This systematic review aims to elucidate a non-operative rehabilitation program that optimizes recovery based on published approaches and outcomes. Methods: Searches of four databases from inception to 1 January 2020 were performed to identify clinical studies addressing the non-operative management of simple elbow dislocations. Results: Of 2435 studies that were eligible for title screen, 15 studies satisfied inclusion criteria. Three randomized control studies demonstrated that early mobilization expedited the return of range of motion, function and return to work or activities, however, resulted in increased pain within the six-week rehabilitation period compared to Plaster of Paris casting for 21 days. Patients returned to work sooner after early mobilization (10 vs. 18 days; p = 0.02) compared to Plaster of Paris casting. In all studies, early mobilization resulted in similar re-dislocation rates of 1.3% (3/237) versus 2.2% (12/549) in those with Plaster of Paris casting as well as lower incidence of heterotopic ossification (36% vs. 54%). No significant differences between rehabilitation protocols were determined; however, the large majority of recent papers utilized rehabilitation protocols. Conclusion: Early mobilization of simple elbow dislocations results in early return of Range-of-Motion, function and return to work with no increase in complication rates; however, increased pain during the rehabilitation period. 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 impact of psychological factors on outcome after salvage surgery for wrist osteoarthritis. Swärd, E. M., Brodda-Jansen, G., Schriever, T. U., Andersson-Franko, M. and Wilcke, M. K. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Salvage surgery for wrist osteoarthritis - The role of pain catastrophising This is a retrospective study assessing the association between psychological variables and disability in participants undergoing salvage surgery for wrist osteoarthritis (OA). A total of 79 participants with wrist OA were included in the study. Psychological variables included pain catastrophising, anxiety, and depression. Disability was measured through the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire at 6 and 12 months post surgery. The results showed that greater pain catastrophising and anxiety were associated with worse disability after 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, pain catastrophising and anxiety are associated with recovery following salvage surgery for wrist OA. This study is in line with previous research showing that pain catastrophising explains a large proportion of pain intensity in people with thumb OA , distal radius fracture , and upper limb fractures . Open access URL : https://doi.org/10.1177/17531934221104603 Abstract This prospective longitudinal study of 80 patients analysed the effect of preoperative pain catastrophizing, anxiety, depression and sense of coherence on the Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation, quality of life, grip strength and range of motion during the first year after salvage surgery for wrist osteoarthritis. Generalized estimating equations were used to analyse the effect of the psychological factors on the outcome variables. Pain catastrophizing or a tendency for anxiety preoperatively had a strong negative impact on postoperative Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation. Anxiety also predicted a lower postoperative quality of life, whereas pain catastrophizing had a negative impact on grip strength. Sense of coherence did not influence the 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

Catastrophic thinking is associated with finger stiffness after distal radius fracture surgery. Teunis, T., Bot, A. G., Thornton, E. R. and Ring, D. (2015) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Finger stiffness post distal radius fracture - The effect of catastrophising This is a retrospective study assessing the association between several variables and finger stiffness following open reduction internal fixation for distal radius fracture. A total of 96 participants were included in the study. Demographic characteristics, fracture severity and psychological variables (e.g. pain catastrophising) were measured at baseline and utilised to predict finger stiffness (distance to palmar crease across four fingers) at six weeks. The results showed that greater pain catastrophising was associated with worse finger stiffness at six weeks. In particular, for every 10 points increase in catastrophising, there is a 1 cm increase (for each finger) in distance to palmar crease (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, pain catastrophising at baseline predicts finger stiffness at six weeks after distal radius fracture open reduction internal fixation. This study contributes to the growing amount of evidence showing that pain catastrophising negatively affects recovery in upper limb conditions and upper limb function . URL : https://doi.org/10.1097/bot.0000000000000342 Abstract Objectives: To identify demographic, injury-related, or psychologic factors associated with finger stiffness at suture removal and 6 weeks after distal radius fracture surgery. We hypothesize that there are no factors associated with distance to palmar crease at suture removal. Design: Prospective cohort study. Setting: Level I Academic Urban Trauma Center. Patients: One hundred sixteen adult patients underwent open reduction and internal fixation of their distal radius fractures; 96 of whom were also available 6 weeks after surgery. Intervention: None. Main outcome measurements: At suture removal, we recorded patients' demographics, AO fracture type, carpal tunnel release at the time of surgery, pain catastrophizing scale, Whiteley Index, Patient Health Questionnaire-9, and disabilities of the arm, shoulder, and hand questionnaire, 11-point ordinal measure of pain intensity, distance to palmar crease, and active flexion of the thumb through the small finger. At 6 weeks after surgery, we measured motion, disabilities of the arm, shoulder, and hand, and pain intensity. Prereduction and postsurgery radiographic fracture characteristics were assessed. Results: Female sex, being married, specific surgeons, carpal tunnel release, AO type C fractures, and greater catastrophic thinking were associated with increased distance to palmar crease at suture removal. At 6 weeks, greater catastrophic thinking was the only factor associated with increased distance to palmar crease. Conclusions: Catastrophic thinking was a consistent and major determinant of finger stiffness at suture removal and 6 weeks after injury. Future research should assess if treatments that ameliorate catastrophic thinking can facilitate recovery of finger motion after operative treatment of a distal radius fracture. 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 impact of smoking on delayed osseous union after arthrodesis procedures in the hand and wrist. Foster, B. K., et al. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Prognostic Topic : Hand arthrodesis – Smoking and non-union This is a retrospective study assessing the effect of smoking on non-union following upper limb arthrodesis. A total of 306 participants were included in the study. Of these, 73 (24%) were smokers. Participants were included if they underwent arthrodesis of wrist/carpometacarpal/metacarpalphalangeal/interphalangeal surgery. Non-union was assessed radiographically at 3 months. Symptomatic non-union was defined as the need for further surgery to correct the non-union. The statistical analyses took into account demographic, comorbidity, and affected joints information to reduce the contribution of confounding factors to the overall results. The results showed that smoking and non-smoking participants presented non-union rates of 27% and 14% of cases respectively. Symptomatic non union was present in 15% and 6% of smokers and non-smokers respectively. Overall, smokers had twice the odds of having non-union or symptomatic non-union compared to non-smokers. One limitation of this study was that there is no information regarding the blinding of the assessors determining union/non-union on x-rays. 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, smoking increases the risk of lateral epicondylalgia , post-surgical infections , arthrodesis non-union, and other complications (e.g. re-operation) following distal radius fracture . We should always offer our clients advice to quit smoking . URL : https://doi.org/10.1016/j.jhsa.2022.05.016 Abstract Purpose: The purpose of this study was to evaluate the relationship between smoking and delayed radiographic union after hand and wrist arthrodesis procedures. We hypothesized that smoking would be associated with a higher rate of delayed union. Methods: All cases of hand or wrist arthrodesis procedures in patients aged ≥18 years from 2006 to 2020 were identified. Cases were included if they had >90 days of radiographic follow-up or evidence of union before 90 days. Baseline demographics were recorded for each case including smoking status at the time of surgery. Complications were recorded and all postoperative radiographs were reviewed to assess for evidence of delayed union (defined as lack of osseous union by 90 days after surgery). We compared active smokers and nonsmokers and performed a logistic regression analysis to estimate the odds of experiencing a delayed radiographic union. Results: A total of 309 arthrodesis cases were included and 24% were active smokers. Overall, radiographic evidence of a delayed union was found in 17% of cases. Smokers were significantly more likely to have a delayed union compared with nonsmokers (27% vs 14%). Results of the adjusted logistic regression analysis demonstrated that there was a significantly increased odds of experiencing a delayed union for patients who were active smokers compared with nonsmokers (odds ratio, 2.20; 95% confidence interval, 1.09–4.43). In addition, the rate of symptomatic nonunion requiring reoperation was higher in smokers (15%) compared with nonsmokers (6%). Conclusions: Smoking was associated with increased odds of delayed radiographic union in patients undergoing hand and wrist arthrodesis procedures. Patients should be counseled appropriately on the risks of smoking on bone healing and encouraged to abstain from nicotine use in the perioperative period. 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

Blood flow restriction resistance training in tendon rehabilitation: A scoping review on intervention parameters, physiological effects, and outcomes. Burton, I. and McCormack, A. (2022) Level of Evidence : 5 Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Blood flow restriction training - Tendinopathies This is a scoping review of studies implementing blood flow restriction (BFR) training in participants with tendinopathies and healthy tendons. A total of 13 studies were included, 10 were completed in people with healthy tendons whilst three in people with tendinopathy. Blood flow restriction was compared to high-intensity resistance training. The interventions were targeted at the upper limb or lower limb. The results showed that both BFR and high-intensity training were useful in providing positive changes within healthy tendons. When BFR training was applied to people with tendinopathy, this induced improvements in muscle strength, function, and pain. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, BFR induces positive changes in healthy tendons to a similar extent to what traditional high-intensity training provides. This form of low-load resistance training can be implemented in those people with irritable tendinopathies who cannot cope with high levels of exercise intensity. In addition to this scoping review, there is some initial evidence that BFR can be utilised in people with tennis elbow and it appears to provide better outcomes in terms of functional recovery compared to the same exercises without BFR. URL : https://doi.org/10.3389/fspor.2022.879860 Abstract Objective: To identify current evidence on blood flow restriction training (BFRT) in tendon injuries and healthy tendons, evaluating physiological tendon effects, intervention parameters, and outcomes. Methods: This scoping review was reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Databases searched included MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, Cochrane library (Controlled trials, Systematic reviews), and five trial registries. Two independent reviewers screened studies at title/abstract and full text. Following screening, data was extracted and charted, and presented as figures and tables alongside a narrative synthesis. Any study design conducted on adults, investigating the effects of BFRT on healthy tendons or tendon pathology were included. Data were extracted on physiological tendon effects, intervention parameters and outcomes with BFRT. Results: Thirteen studies were included, three on tendinopathy, two on tendon ruptures, and eight on healthy Achilles, patellar, and supraspinatus tendons. A variety of outcomes were assessed, including pain, function, strength, and tendon morphological and mechanical properties, particularly changes in tendon thickness. BFRT intervention parameters were heterogeneously prescribed. Conclusion: Despite a dearth of studies to date on the effects of BFRT on healthy tendons and in tendon pathologies, preliminary evidence for beneficial effects of BFRT on tendons and clinical outcomes is encouraging. As BFRT is a relatively novel method, definitive conclusions, and recommendations on BFRT in tendon rehabilitation cannot be made at present, which should be addressed in future research, due to the potential therapeutic benefits highlighted in this review. 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-load resistance training with blood flow restriction is effective for managing lateral elbow tendinopathy: A randomized, sham-controlled trial. Karanasios, S., et al. (2022) Level of Evidence : 1b- Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : Blood flow restriction training - Tennis elbow This is a randomised single-blind controlled trial assessing the effectiveness of blood flow restriction (BFR) training in people with tennis elbow. Participants (N = 46) were middle-aged (mean range: 43-47 years old) and had been having pain for 6 weeks (median). Tennis elbow diagnosis was made based on the presence of pain at the lateral epicondyle, positive Mill's and/or Cozen's and/or Maudsley's test. Participants were excluded if they had a history of upper limb pathology, blood clot, cardiovascular disease, cancer, or hypertension (systolic/diastolic 140/90 mmHg). A series of exercises were delivered over the course of six weeks and included, but were not limited to, wrist extension/flexion. Exercises were performed with either BFR (50% of arterial occlusion) or with sham BFR (less than 20% of arterial occlusion). Participants attended two sessions per week. Primary outcomes included pain, function, pain-free grip strength, and the global rate of change (from much worse to completely recovered). The results showed that pain, function, and pain-free grip strength improved to a statistically significant larger extent in the BFR group compared to the sham BFR. Only function and pain-free grip strength improved to a clinically relevant level. In addition, 80% of participants reported being at least "much better" in the BFR compared to 50% in the sham BFR. 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, low-load BFR exercises provide greater improvements compared to low-load exercises without BFR. BFR training leads to clinically relevant improvements in function and pain-free grip strength. BFR may be particularly appropriate in those people with high levels of pain intensity or irritability. If you would like to deliver BFR to your clients, you may be interested in using the BFR pressure calculator that I have created! URL : https://doi.org/10.2519/jospt.2022.11211 Abstract Objective: To evaluate the effect of low-load resistance training with blood flow restriction (LLRT-BFR) when compared to LLRT with sham-BFR in patients with lateral elbow tendinopathy (LET). Design: Randomized controlled trial Methods: Forty-six patients with LET were randomly assigned to a LLRT-BFR or a LLRT with sham-BFR treatment group. All patients received soft tissue massage, supervised exercises with BFR or sham-intervention (twice a week for six weeks), advice and a home exercise programme. The primary outcome measures were pain intensity, patient-rated tennis elbow evaluation (PRTEE) score, pain-free grip strength (PFGS) and global rating of change (GROC), measured at baseline, 6 weeks, and 12 weeks. Between-group differences were evaluated using mixed-effects models with participant-specific random effects for continuous data. GROC was analysed using logistic regression. Results: Statistically significant between-group differences were found in favor of LLRT-BFR compared to LLRT with sham-BFR in pain intensity at 12-weeks (-1.54, 95%CI:-2.89 to -0.18; p=0.026), PFGS ratio at 6-weeks (0.20, 95%CI:0.06 to 0.34; p=0.005) and PRTEE at 6- and 12-weeks (-11.92, 95%CI:-20.26 to -3.59; p=0.006 and -15.23, 95%CI:-23.57 to -6.9; p<0.001, respectively) follow-up. At 6- and 12-weeks, patients in the LLRT-BFR group had greater odds of reporting complete recovery or significant improvement (OR=6.0, OR=4.09, respectively). Conclusion: LLRT-BFR produced significantly better results compared to the LLRT with sham-BFR for all primary outcomes. Considering the clinically significant between-group improvement in function (>11 points in PRTEE) and the better success rates in the LLRT-BFR group, this intervention may improve recovery in LET. 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

Upper-extremity blood flow restriction: The proximal, distal, and contralateral effects. A randomized controlled trial. Bowman, E., Elshaar, R., Milligan, H., Jue, G., Mohr, K., Brown, P., Watanabe, D., & Limpisvasti, O. (2020) Level of Evidence : 1b- Follow recommendation : 👍 👍 👍 👍 (4/4 Thumbs up) Type of study : Therapeutic Topic : Resistance training - Blood flow restriction training This is a randomised single-blind controlled trial assessing the effectiveness of blood flow restriction (BFR) training on grip strength and forearm circumference in healthy participants. Participants (N = 24) were young (26±3.4 years old) recreational athletes. Participants were excluded if they had a history of upper limb pathology, blood clot, cardiovascular disease, or hypertension (systolic/diastolic 140/90 mmHg). Grip strength was measured through a hand held dynamometer and forearm circumference was measured through a standard measuring tape 10 cm distal to medial epicondyle. Treatment allocation was randomised and the assessor was blinded to treatment allocation. Participants were provided with either low intensity BFR training (n = 14) or low intensity training (n = 10). Participants trained twice a week for six weeks in both groups. During each session participants performed shoulder external rotation in side lying, prone shoulder horizontal abduction, triceps extensions in supine, shoulder internal rotation in standing with a pulley, and biceps curls in forearm supination. At each session, 4 sets of 30, 15, 15, 15 repetitions were completed for each exercise. An interset rest of 30 seconds was provided. Participants started to exercise at an intensity of 30% of 1-repetition maximum identified at baseline. The training weight was modified at each session to maintain the rate of perceived exertion (RPE) at 7-8/10. While exercising, the BFR group wore a pressure cuff (10cm wide) inflated at 60% of arterial occlusion around their proximal arm. The pressure cuff was worn on one upper limb only, although the exercises were performed bilaterally. The cuff was inflated for the whole duration of the session. The results showed that the BFR group improved to a significant greater level in grip strength (10%±2) and forearm circumference (4.2%±0.8) compared to the control group (grip strength: -3%±3; forearm circumference: 1.4%±0.9). The authors report no differences in RPE between groups, although the overall exercise volume for both exercise groups was not reported. This would have been useful to explain the differences between the two groups. 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 utilise BFR training when the aim of the intervention is to increase muscle strength and high exercise intensities are contraindicated. This regime appears to provide greater strength gains when compared to traditional low-intensity exercises. URL : https://doi.org/10.1016/j.jse.2020.02.003 Abstract Background: Blood flow restriction (BFR) training with low weight is purported to induce similar physiological changes to high-weight regimens with the benefit of less tissue stress. We hypothesized that low-weight training with BFR would produce increased gains in strength and hypertrophy for muscle groups proximal, distal, and contralateral to tourniquet placement compared with low-weight training alone. Methods: In this prospective, randomized controlled trial, healthy subjects were randomized into a 6-week low-weight training program either with or without BFR on 1 extremity. Outcome measures included limb circumference and strength. Comparisons were made between the BFR and non-BFR extremities, BFR and control groups, and non-BFR extremity and control groups. Results: A total of 24 subjects (14 BFR and 10 control subjects) completed the protocol. Significantly greater gains were observed in dynamometric strength both proximal (shoulder scaption [30% greater], flexion [23%], and abduction [22%]) and distal (grip strength [13%]) to the tourniquet in the BFR limb compared with both the non-BFR extremity and the control group (P < .05). Arm and forearm circumferences significantly increased in the BFR limb compared with the non-BFR limb and control group (P = .01). The non-BFR extremity demonstrated greater grip strength than the control group (9%, P < .01). No adverse events were reported. Conclusion: Low-weight BFR training provided a greater increase in strength and hypertrophy in the upper-extremity proximal and distal muscle groups compared with the control group. The non-BFR extremity showed a significant increase in grip strength compared with the control group, indicating a potential systemic effect. 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 of a prediction model to determine responders to conservative treatment in people with symptomatic hand osteoarthritis: A secondary analysis of a single-centre, randomised feasibility trial. Magni, N., Rice, D. and McNair, P. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Exercise for hand OA - Prognostic factors This is a prognostic study identifying factors that can predict response to exercise in people with symptomatic hand osteoarthritis (OA). The data utilised were part of a randomised controlled feasibility trial . A total of 59 participants with symptomatic hand OA were included. Participants were randomised to receive advice only, or advice plus either blood flow restriction training or high-intensity training. Participants were defined as responders to treatment at six weeks based on the OMERACT-OARSI criteria (a combination of pain, function, and disease burden outcome), pain (NRS), and function (i.e., FIHOA). The prediction model was moderately accurate and it included the type of treatment, expectations of treatment, and compliance with exercises. More specifically people with positive treatment expectations, who received both exercise and advice, and who had greater compliance with exercises were more likely to be responders. Future studies will need to validate this prediction model on a separate sample of people with symptomatic hand OA. 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, positive expectations, the addition of resistance exercises to advice, and high compliance with the exercise program were more likely to respond to conservative treatment in hand OA. Overall it appears that resistance training is not detrimental in people with hand OA and that several factors contribute to the development of hand OA rather than just biomechanical variables . Open Access URL : https://doi.org/10.1016/j.msksp.2022.102659 Abstract Background: Conservative treatments are beneficial for people with hand osteoarthritis (OA). Objective: It was the purpose of this study to develop and internally validate both a basic model and a more complex model that could predict responders to conservative treatments in people with hand OA. Design: This was a secondary analysis of a single-centre, randomised feasibility study. Methods: Fifty-nine participants (34 responders) with hand osteoarthritis recruited from the general population. Participants were randomised to receive either advice alone, or advice in combination with blood flow restriction training (BFRT), or traditional high intensity training (HIT). Participants underwent supervised hand exercises three times per week for six weeks. The OMERACT-OARSI criteria were utilised to determine responders vs non responders to treatment at the end of six weeks. A basic logistic regression model (treatment type, expectations, adherence) and a more complex logistic regression model (basic model variables plus pain catastrophising and neuropathic pain features) were created. Discrimination ability, and calibration were assessed. Internal model validation through bootstrapping (200 repetitions) was utilised to calculate the prediction model optimism. Results The results showed that the basic model presented with acceptable discrimination (optimism corrected c-statistic: 0.72, 95% CI 0.71–0.73) and calibration (slope = 1.41; intercept = 0.68). The more complex model had better discrimination but poorer calibration. Conclusion: A prediction tool was created to provide an individualised estimate of treatment response in people with hand OA. Future studies will need to validate this model in other groups of patients. Trial registration https://www.anzctr.org.au/- ACTRN12617001270303. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Preoperative patient-reported data indicate the risk of prolonged opioid use after hand and upper extremity surgeries. Shipp, M. M., et al. (2022) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Opioids - Who will use them post-surgery? This is a retrospective study attempting to identify predictors of opioid use post-hand/upper limb surgery. A total of 2,144 participants were included. Participants were followed up at 3 months after surgery. Several variables including demographic characteristics, mental health, and pain prior to surgery were entered into the prediction model. The results showed that we are currently unable to predict who will start using opioids following hand/upper limb 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, we are unable to predict who will start using opioids following hand and upper limb surgery. Some evidence suggests that in carpal tunnel syndrome, clients who use gabapentinoids prior to surgery have greater odds of starting using opioids post carpal tunnel release . This study, however, showed an association which is not the same as a prediction. URL : https://doi.org/10.1016/j.jhsa.2022.06.026 Abstract Purpose: Opioids play an important role in pain management after surgery but also increase the risk of prolonged opioid use in patients. The identification of patients who are more likely to use opioids after intended short-term treatment is critical for employing alternative management approaches or targeted interventions for the prevention of opioid-related problems. We used patient-reported data (PRD) and electronic health record information to identify factors predictive of prolonged opioid use after surgery. Methods: We used our institutional registry containing data on all patients who underwent elective upper extremity surgeries. We evaluated factors associated with prolonged opioid use in the cohort from the year 2018 to 2019. We then validated our results using the 2020 cohort. The predictive variables included preoperative PRD and electronic health record data. Opioid use was determined based on patient reports and/or filled opioid prescriptions 3 months after surgery. We conducted bivariate regression, followed by multivariable regression analyses, and model validation using area under the receiver operating curve. Results: We included 2,114 patients. In our final model on the 2018–2019 electronic health records and PRD data (n = 1,589), including numerous patient-reported outcome questionnaire scores, patients who were underweight and had undergone trauma-related surgery had higher odds of being on opioids at 3 months. Additionally, each 5-unit decrease in the preoperative Patient-Reported Outcomes Measurement Information System Global Physical Health score was associated with a 30% increased odds of being on opioids at 3 months. The area under the receiver operating curve of our model was 70.4%. On validation using data from the 2020 cohort, the area under the receiver operating curve was 60.3%. The Hosmer-Lemeshow test indicated a good fit. Conclusions: We found that preoperative questionnaire scores were associated with prolonged postoperative opioid use, independent of other variables. Furthermore, PRD may provide unique patient-level insights, alongside other factors, to improve our understanding of postsurgical pain management. 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

Does the number of preoperative corticosteroid injections affect clinical and radiographic outcomes of trapeziectomy and suspensionplasty? Thomas, O. J., Hassebrock, J. D., Buckner-Petty, S. A. and Renfree, K. J. (2022) Level of Evidence : 2c Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : 1st cmcj OA injections - Do they affect thumb metacarpal subsidence This is a retrospective study assessing the long-term effect of corticosteroid injections on thumb metacarpal subsidence following suspension arthroplasty for thumb OA. A total of 60 participants were included. Of these, 16 received no injection, 19 received one injection, and 25 participants received two or more injections. Thumb metacarpal subsidence was measured at follow-up and compared to baseline measurements. Subsidence simply meant the reduction in space from the base of the metacarpal to the scaphoid. In suspension arthroplasty, this sinking is due to the compression of the suspension arthroplasty created with the tendon. Participants were followed up to 8 years post-surgery. The results showed that there was no difference in thumb metacarpal subsidence between those who receive no pre-operative cortisone injection or several cortisone injections. 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 number of cortisone injections prior to suspension arthroplasty does not affect thumb metacarpal subsidence after surgery. However, we need to keep in mind that cortisone injections 3 months prior to trapeziectomy increase the odds of complications , including infections. Considering that the effectiveness of cortisone injections for 1st cmcj OA is not superior to placebo , their use may be questionable. URL : https://doi.org/10.1016/j.jhsa.2022.06.004 Abstract Purpose: This study aimed to determine whether an increasing number of preoperative corticosteroid injections is associated with greater radiographic subsidence of the thumb metacarpal at long-term follow-up after abductor pollicis longus suspensionplasty, secondary to steroid-induced pathologic weakening of capsuloligamentous restraints surrounding the thumb carpometacarpophalangeal joint and greater extension of the lunate, but neither affect patient-reported outcomes nor revision rates. Methods: A retrospective chart review was performed of patients who underwent primary trapeziectomy and abductor pollicis longus suspensionplasty by a single surgeon over a 10-year period. The number of preoperative corticosteroid injections in the trapeziometacarpal joint was documented, and patients were separated into 4 subgroups: 0, 1, 2, or 3 or more injections. Preoperative and final radiographs were evaluated for a change in the distance between the base of the thumb metacarpal and the distal pole of the scaphoid as a measure of thumb metacarpal subsidence and radiolunate angle as a measure of nondissociative carpal instability, which has been reported as a complication after basal joint arthroplasty. Additionally, the final patient-reported outcomes (Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation) and revision rates were also assessed. Results: Of a total of 60 patients with an average age of 64 years that were included in the study, 16 (26.7%) received 0, 19 (31.7%) received 1, 12 (20%) received 2, and 13 (21.7%) received 3+ preoperative injections. The median postoperative follow-up was 92 months. The mean distance between the base of the thumb metacarpal and the distal pole of the scaphoid decreased by 2 mm, and the mean radiolunate angle increased by 4° across the entire cohort. When comparing subgroups, no differences were observed in either parameter or the final Patient-Rated Wrist Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand scores. Conclusions: This study demonstrates no apparent detrimental effect of an increased number of preoperative corticosteroid injections on radiographic thumb metacarpal subsidence, increase in extension of radiolunate angle (nondissociative carpal instability), patient-reported outcomes, or revision rates at an average of almost 8 years after trapeziectomy and abductor pollicis longus suspensionplasty. 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 therapists' knowledge and practice-related beliefs about pain science: A survey study. Stern, B. Z. and T. H. Howe (2020) Level of Evidence : 5 Follow recommendation : 👍 Type of study : Therapeutic Topic : Hand Therapists – Pain science knowledge This is a cross-sectional survey study to assess Hand Therapists understanding of acute and persistent pain. The reason why this is important is that both acute and persistent pain clients would benefit from an understanding of pain that is beyond the traditional biomedical approach. A total of 366 (11% of the total contacted) American Hand Therapists tool part in the study. These participants completed a survey, which included the Revised Neurophysiology of Pain Questionnaire (R-NPQ). Participants reported seeing clients with persistent pain of the elbow, wrist, and/or hand routinely/often, which makes pain neurophysiology understanding relevant. The results showed that the scores on the R-NPQ ranged from 5/12 to 12/12, with greater scores representing greater knowledge. The mean R-NPQ score was 9/12. Have a go at testing your pain neurophysiology understanding by taking the same questionnaire as these participants did! Don't worry if you scored low, I have linked a few resources in the clinical take home message, which you may find useful. 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, pain science knowledge is important for hand therapists when treating clients with acute and persistent pain. Thus, it has been shown that pain neuroscience education in combination with exercise has a clinically relevant effect in clients with musculoskeletal pain. As a matter of fact, the words that we use can increase or decrease our clients' pain . Suggesting clients that doing certain activities will increase their pain is likely to augment their pain response through a conditioning mechanism. It is also important to reduce fear of movement in our clients as this is associated with upper limb disability . It would be good to follow expected healing time-frames for hand conditions rather than clients' reported pain. Pain is often mediated by other factors and is not a good indicator of healing in several uncomplicated hand fractures and scaphoid fractures . Finally, being empathetic and smiling has also been shown to reduce pain in our clients . URL : https://doi.org/10.1016/j.jht.2020.07.007 Available through The Journal of Hand Therapy for HTNZ members. Available through EBSCO Health Databases for PNZ members. Abstract INTRODUCTION: Identifying hand therapists' knowledge and beliefs about pain can illuminate familiarity with modern pain science within hand therapy. PURPOSE OF THE STUDY: The primary aim was to identify hand therapists' knowledge of pain neurophysiology. Secondary purposes were to explore demographic variation in knowledge, describe practice-related beliefs about pain science, and explore associations between knowledge and beliefs. STUDY DESIGN: Cross-sectional descriptive survey study. METHODS: An electronic survey, including the Revised Neurophysiology of Pain Questionnaire (R-NPQ) and Likert-type questions about practice-related beliefs, was distributed to American Society of Hand Therapists members. RESULTS: Data from 305 survey responses were analyzed. R-NPQ accuracy ranged from 42% to 100%, with a mean of 75% (9/12 ± 1.5). Certified hand therapists scored, on average, 0.8 points lower than their noncertified peers. Participants with a doctoral degree scored 0.7 or 0.6 points higher, respectively, than those with a bachelor's or master's degree. Objective knowledge of pain neurophysiology was positively associated with perceived knowledge of pain science (ρ = .31, P < .001). Associations between R-NPQ and perceived importance of knowing pain science; confidence in pain-related evaluation, treatment, and education; and frequency of incorporating pain science principles into practice were small but statistically significant (ρ = .12-.25, P = <.001-.04). CONCLUSIONS: Although hand therapists recognized the importance of knowing pain science, they had objective and subjective limitations in that knowledge. Specific errors in their R-NPQ responses suggest misconceptions related to the modern differentiation between nociception and pain. Blurring of these constructs may relate to participants' self-reported practice emphasis on acute versus chronic conditions. Future studies should explore knowledge, attitudes, and beliefs about pain beyond R-NPQ scores to understand variation in practice and training needs. 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

What is the effect of vitamin C on finger stiffness after distal radius fracture? A double-blind, placebo-controlled randomized trial. Özkan, S., Teunis, T., Ring, D. C. and Chen, N. C. (2019) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 👍 (4/4 thumbs up) Type of study : Therapeutic Topic : Radius fracture - effect of vitamin C on stiffness and pain This is a double-blind randomised controlled study assessing the effect of vitamin C on pain and finger stiffness following surgical management of distal radius fracture. A total of 134 participants were randomised to a daily dose of either vitamin C (500mg) or placebo pills for 42 days following their distal radius fracture. The effectiveness of vitamin C was assessed through finger range of movement (distance from the palmar crease for all fingers) and pain (NRS 0 to 10) at 6 weeks and 6 months. The results showed no difference in range of movement or pain between the vitamin C and placebo group. 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, 500mg of vitamin C taken daily for 40-50 days post distal radius fracture does not appear to reduce stiffness or improve pain. However, previous research suggests that this dosage of vitamin C reduces the risk of developing CRPS following a distal radius fracture . If you would like to know how to predict whether somebody can be classified as having CRPS at 4 months post-hand or wrist fracture, have a look at this synopsis . I would also suggest looking at what hand therapists in the UK have done to reduce the incidence of CRPS following a distal radius fracture . Open Access URL : https://doi.org/10.1097/corr.0000000000000807 Abstract Background: It is proposed that vitamin C administration can reduce disproportionate pain and stiffness after distal radius fracture; however, randomized trials that tested this hypothesis have had inconsistent results. Questions/purposes: (1) Is administering vitamin C after distal radius fracture associated with better ROM, patient-reported upper extremity function, and pain scores? (2) What factors are associated with post-fracture finger stiffness and worse upper extremity function? Methods: This is a double-blind, randomized, placebo-controlled, noncrossover study. Between August 2014 and July 2017, we approached 204 consecutive patients, of which 195 were eligible, and 134 chose to participate. Participants were randomized to receive once-daily 500 mg vitamin C (67 participants) or placebo (67 participants) within 2 weeks after distal radius fracture. All patients received usual care at the discretion of their surgeon. The mean age of participants was 49 ± 17 years, 99 patients (74%) were women, and 83 (62%) were treated nonoperatively. The primary outcome was the distance between the fingertip and distal palmar crease 6 weeks after fracture. This measure is easy to obtain and previously has been shown to correlate with aggregate ROM of all finger joints. The secondary outcomes were total active finger motion, total active thumb motion, upper extremity-specific limitations, and pain intensity. An a priori power analysis suggested 126 patients would provide 80% power to detect a difference of 2 cm (SD 4.0) fingertip distance to palmar crease with α set at 0.05 using a two-tailed Student's t-test. Accounting for 5% lost to followup, we included 134 patients. All analyses were intention-to-treat. Ten participants of the intervention group and five of the placebo group were lost to followup. Their missing data were addressed by multiple imputation, after which we performed linear regression analysis for our outcome variables. Results: Administration of vitamin C was not associated with ROM, function, or pain scores at 6 weeks (distance to palmar crease: β -0.23; 95% CI -1.7 to 1.2; p = 0.754; finger ROM: β 4.9; 95% CI, -40 to 50; p = 0.829; thumb ROM: β 0.98; 95% CI, -18 to 20; p = 0.918, Patient-Reported Outcomes Measurement Information System [PROMIS] score: β 0.32; 95% CI, -2.6 to 3.2; p = 0.828; pain score: β -0.62; 95% CI, -0.62 to 0.89; p = 0.729) nor at 6 months (PROMIS score: β -0.21; 95% CI, -3.7 to 3.3; p = 0.904; pain score: β 0.31; 95% CI, -0.74 to 1.4; p = 0.559). At 6 weeks, we found that more finger stiffness was mildly associated with greater age (β -1.5; 95% CI, -2.8 to -0.083; p = 0.038). Thumb stiffness was mildly associated with greater age (β -0.72; 95% CI, -1.3 to -0.18; p = 0.009) and strongly associated with operative treatment (β -32; 95% CI, -50 to -13; p = 0.001). Greater pain interference was modestly associated with greater functional limitations at 6 weeks (β -0.32; 95% CI, -0.52 to -0.12; p = 0.002) and 6 months (β -0.36; 95% CI, -0.60 to -0.11; p = 0.004). Conclusions: Vitamin C does not seem to facilitate recovery after distal radius fracture, but amelioration of maladaptation to nociception (pain interference) merits greater attention. Level of Evidence Level I, therapeutic study. 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