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From tissue to system: What constitutes an appropriate response to loading? Gabbett, et al. (2025) Level of Evidence : 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Tissues response - Loading This expert opinion explored how different tissues respond to exercise loads, highlighting varying recovery times influenced by factors such as tissue type and injury history. It emphasises the need to monitor both external loads (e.g., exercise intensity) and internal responses (e.g., physiological changes). A comprehensive monitoring framework that incorporates subjective measures like pain or mood and objective assessments such as muscle strength is proposed and suggested to be used in clinical practice. Advances in technology, including wearable devices and imaging techniques will be extremely valuable in the future as they will allow us to more precisely measure external and internal load2 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, different tissues respond to exercise loads and frequencies in different ways. For example, this framework could be utilised to manage your patients with tendinopathy. If you are getting to the point that you can increase the intensity of your exercises to make the tendon more resilient, patients should have at least 48hrs in between exercise session (see figures above). In contrast, for joint pathologies and fractures, greater exercise volume of much lower intensity can be provided at smaller intervals of time. URL : https://doi.org/10.1007/s40279-024-02126-w Abstract Optimal loading involves the prescription of an exercise stimulus that promotes positive tissue adaptation, restoring function in patients undergoing rehabilitation and improving performance in healthy athletes. Implicit in optimal loading is the need to monitor the response to load, but what constitutes a normal response to loading? And does it differ among tissues (e.g., muscle, tendon, bone, cartilage) and systems? In this paper, we discuss the “normal” tissue response to loading schema and demonstrate the complex interaction among training intensity, volume, and frequency, as well as the impact of these training variables on the recovery of specific tissues and systems. Although the response to training stress follows a predictable time course, the recovery of individual tissues to training load (defined herein as the readiness to receive a similar training stimulus without deleterious local and/or systemic effects) varies markedly, with as little as 30 min (e.g., cartilage reformation after walking and running) or 72 h or longer (e.g., eccentric exercise-induced muscle damage) required between loading sessions of similar magnitude. Hyperhydrated and reactive tendons that have undergone high stretch–shorten cycle activity benefit from a 48-h refractory period before receiving a similar training dose. In contrast, bone cells desensitize quickly to repetitive loading, with almost all mechanosensitivity lost after as few as 20 loading cycles. To optimize loading, an additional dose (≤ 60 loading cycles) of bone-centric exercise (e.g., plyometrics) can be performed following a 4–8 h refractory period. Low-stress (i.e., predominantly aerobic) activity can be repeated following a short (≤ 24 h) refractory period, while greater recovery is needed (≥ 72 h) between repeated doses of high stress (i.e., predominantly anaerobic) activity. The response of specific tissues and systems to training load is complex; at any time, it is possible that practitioners may be optimally loading one tissue or system while suboptimally loading another. The consideration of recovery timeframes of different tissues and systems allows practitioners to determine the “normal” response to load. Importantly, we encourage practitioners to interpret training within an athlete monitoring framework that considers external and internal load, athlete-reported responses, and objective markers, to contextualize load–response data. 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

Clinical and imaging findings of wrist tuberculosis: A study of 47 patients. Wei , et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Wrist tuberculosis - What does it look like? This retrospective study assessed the clinical and radiological presentation of wrist tubercolosis (TB). A total of 47 patients with confirmed diagnosis of TB alongside wrist pain and swelling were included in the study. Based on x-ray findings, wrist TB was defined as stage I, which presented with normal x-rays but synovitis and stage II characterised by bony erosion. Wrist pain was common across all stages, however, night sweats and weight loss were characteristic of stage II. Fatigue was another common symptom in addition to range of movement limitations. Diagnosis was confirmed through synovial fluid testing, X-rays, or MRIs. 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, wrist tuberculosis (TB) of the can occur without pulmonary involvement. Early diagnosis is crucial, as delays can lead to significant joint destruction and long-term functional impairment. The clinical presentation of wrist TB, can include night sweats, weight loss, fatigue, alongside local wrist pain and range of movement restrictions, which are present in all patients with wrist TB. Early treatment is has generally positive outcomes. If you are interested in odd x-ray wrist presentations, have a look at this other synopsis . URL : https://doi.org/10.1016/j.jhsa.2025.05.015 Abstract Purpose: This study aimed to describe the clinical and imaging features of patients with wrist tuberculosis (TB) and to explore the importance of magnetic resonance imaging (MRI) in the evaluation and treatment of wrist TB. Methods: The clinical and imaging data of 47 patients with wrist TB, diagnosed through a combination of pathological (microbiological culture, polymerase chain reaction, and histopathological examination) and clinical methods, were retrospectively analyzed. The demographic characteristics, clinical symptoms, laboratory tests, and imaging findings of these patients were recorded. Results: The mean age of the patients was 53.9 ± 15.3 years, and the time from the onset of the patient’s symptoms to the diagnosis of wrist TB was 16.2 ± 25.6 months. The main clinical manifestations included wrist pain (100%), wrist swelling (97.9%), and limited wrist joint movement (89.4%). According to the X-ray findings, wrist TB was classified into the synovitis stage (stage I, n = 22; 46.8%) and the bone erosion/destruction stage (stage II, n = 25; 53.2%). The MRI manifestations included bone destruction (87.2%) and synovitis (100%), and other manifestations included joint space narrowing (44.7%), tendon sheath involvement (66.0%), abscess formation (42.6%), and rice body formation (12.8%). Early bone destruction, not seen on plain radiographs (46.8%), was detected by MRI examination. There was an increase in the proportions of dorsal soft tissue abscesses and distal radioulnar joint abscesses detected by MRI examination in stage II patients compared with stage I patients. Conclusions: MRI can serve as an important adjunct in the diagnosis of wrist TB, offering valuable insights into bone, joint, and soft tissue involvement that may not be visible on plain radiographs. 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

Indications for total elbow arthroplasty revision: A systematic review. Satalich, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic/Prognostic Topic : Elbow arthroplasty - Revision This systematic review assessed revision rates for Total Elbow Arthroplasty (TEA) and the potential aetiology (causes) leading to these complications. A total of 46 studies were included, of which one was an RCT and several retrospective studies. The most common post surgical complications included aseptic loosening (49%) followed by infections (20%) and periprostetic fractures. Complications occured most frequently in people who had to undergo TEA for a fracture non-union and inflammatory conditions. Despite significant advancements of implants and surgical approaches, the complication rate of TEA is still much higher compare to total knee replacements for example. 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, total elbow arthroplasty (TEA) revisions are common, especially due to aseptic loosening, infections, and periprostetic fractures. This is in line with previous papers showing that revision rates are higher than other joint replacements at 10 years , independently of the fact that the surgery is for a hemi or total elbow arthroplasty . If you are interested to learn more about elbow replacements, have a look at the full database on the topic . URL : https://doi.org/10.1016/j.jse.2025.05.024 Abstract Background: The purpose of this systematic review is to evaluate the indications for revision total elbow arthroplasty (TEA). Methods: The PubMed (MEDLINE), Cochrane, and Embase databases were queried for all studies published before July 9, 2024, that investigated TEA failure and reasons for revision surgery. Studies were included if they investigated revision surgery following TEA and reported indications for revision. Studies that did not report reason for revision, articles that studied outcomes after revision TEA rather than primary TEA, case reports, non-English studies, and abstract-only studies were excluded. Results: A total of 589 studies were identified in the initial search, 46 of which met criteria for inclusion in the study. The eligible studies comprised a total of 8,911 primary TEAs, 1,166 (13.1%) of which required revision surgery. The most common reason for revision surgery was aseptic loosening (48.5%) followed by infection (19.4%) and periprosthetic fractures (10.3%). Patients who underwent primary TEA for diagnoses of nonunion and inflammatory arthritis had higher revision rates (24.7% and 13.4%, respectively) than patients who underwent TEA in the setting of acute traumatic injury or post-traumatic sequelae (9.7% and 9.2%, respectively). Conclusion: TEA revision rates have remained high despite technical advances and improvements in implant design. In this study, we found the most common mode of failure requiring revision to be aseptic loosening, which may be a consequence of the known biomechanical challenges inherent to elbow arthroplasty. A broadening of the indications for TEA in recent years has likely played a role, as well, and may have offset any gains derived from superior engineering and surgical technique. This updated information regarding failure mechanisms following TEA is important information for surgeons to counsel their patients on preoperatively and highlights the importance of close follow-up of high-risk patients. Overall, this systematic review highlights the need for future studies examining contributors to TEA failure. 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

Socioeconomic factors associated with poor patient-reported outcomes of 17,478 patients after a distal radial fracture. Jakobsson, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Distal radius fracture - Factors associated with good outcomes This retrospective study assessed whether social and mental health were associated with recovery trajectories of people following distal radius fractures (DRF). A total of 17,468 participants were included in the study. Several variables including immigration status, economic factors, and the number of comorbidities (Charlson Comorbidity Index - CCI), and smoking status were collected. Patients also completed the Short Musculoskeletal Function Assessment (SMFA) at the time of injury and one year later. The results showed that people with better outcomes at one year were more likely to be younger, males, have a less complex/displaced fracture with low energy trauma not requiring surgery, not being immigrant, being in a happy relationship, having a higher educational level, having more financial resources, not smoking, being mentally healthy, and having a lower number of comorbidities. 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, several social, psychological, immigration status, and general health factors play an important role in the recovery from distal radius fractures. Thus, having stable residency, high financial indipendence, lower comorbities, not smoking, and higher educational levels all positively contribute to a good recovery. Addressing modifiable factors like improving access to rehabilitation, managing comorbidities, supporting smoking cessation , inviting them to be physically active (benefits mental health as well), invest in their skills, and take time to care for their mental health is crucial to reducing disability post distal radius fracture. URL : https://doi.org/10.1177/17531934241293426 Abstract This study aimed to investigate the association of socioeconomic factors, country of birth and comorbidities with poor patient-reported outcome 1 year after a distal radial fracture. The patient population was obtained from the Swedish Fracture Register. In the study, 17,468 patients 18 years or older were included. Poor outcome was the dependent variable in a multivariate logistic regression analysis. The factors with the strongest association with poor outcome were country of birth outside the European Union (odds ratio (OR) = 2.28; 95% CI = 1.91–2.73), high-energy trauma mechanism (OR = 1.76; 95% CI = 1.46–2.12), a history of anxiety or depression (OR = 1.46; 95% CI = 1.26–1.70), and a Charlson comorbidity index ≥3 (OR = 1.51; 95% CI = 1.17–1.94). Alleviating the effects of these factors could potentially decrease the proportion of patients with a disability after a distal radial 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 EMU manipulation study: A randomized trial investigating the efficacy of matched or unmatched cervical/thoracic manipulations on neck pain. Swanson, et al. (2025) Level of Evidence : 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Neck pain - Specific vs unspecific spinal manipulations This quadruple blind randomised controlled trial assessed the efficacy of manual cervical and thoracic spine manipulations in individuals with neck pain, focusing on whether targeting specific hypomobile segments (identified via clinical tests) yielded better outcomes compared to non-targeted manipulations. A total of 40 participants were randomly assigned to receive either matched (targeted) or unmatched (non-targeted) manipulations. The results showed that both groups experienced similar improvements in pain intensity, cervical range of motion, and functional disability scores at both immediate post-treatment and 1-week follow-up assessments. 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, both targeted and non-targeted manual cervical and thoracic spine manipulations yield similar positive outcomes for individuals with neck pain. These findings appear to be in line with a previous systematic review showing that cervical and thoracic manipulations are equally effective in people with neck pain . The lack of significant differences between the two approaches suggests that precision in identifying specific hypomobile segments may not be critical, potentially simplifying treatment plans without compromising effectiveness. Also considering that cervical manipulations present with a higher risk of complications, thoracic manipulations may be a viable option. URL : https://doi.org/10.1016/j.msksp.2025.103382 Abstract Introduction: Neck pain is common, and cervical and thoracic thrust joint manipulation are recommended treatments. The Cervical Thoracic Differentiation Test (CTDT) is proposed to differentiate pain of cervical or thoracic origin, but its value in guiding choice of manipulation remains unclear. This study aimed to evaluate the utility of the CTDT in selecting treatment for non-specific mechanical neck pain. Methods: A quadruple-blinded, two-arm randomized trial enrolled adults aged 18–65 with neck pain ≥3/10. Forty participants completed the Neck Disability Index (NDI), cervical ROM (ROM), VAS for pain (rest and movement), and CTDT. They were equally allocated to a single session of either matched or unmatched manipulation based on CTDT results. Pain and ROM were assessed immediately post-manipulation and 38 participants were assessed at a one-week follow-up. Results: Forty participants (mean age 24.8 ± 9.9 years, 51.2 % female) were included. Significant differences in the primary outcome of pain with movement were found across all time points (F2, 72 = 60.455, p < 0.001). Significant pain reductions were observed from pre-manipulation to immediately post-manipulation and continued at one-week. There were no differences between matched/unmatched manipulations at either time point (p > 0.05). There were no significant differences in pain at rest, NDI scores, or ROM changes between groups. Conclusions: Both matched and unmatched manipulations significantly reduced pain with movement, with no differences based on CTDT results. In the context of a rigorously blinded trial, cervical and thoracic manipulations appear to be equally efficacious for managing neck pain regardless of CTDT outcomes, although clinical outcomes may differ. 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 of the variations in the tendons of the extensor digitorum communis among the burmese population. Win, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Anatomical Topic : EDC - Tendon variations This cadaver study investigated anatomical variations of the extensor digitorum communis (EDC) tendon in the Burmese population. A total of 64 hands were assessed. The findings revealed consistencies and variations in EDC tendon distribution across fingers. For the index finger, one EDC tendon was consistently present in all cases (100%). The middle finger had between one to three slips, while the ring finger (RF) exhibited one to four slips. The little finger showed either no EDC tendon (60% of the sample) or up to two slips. Of note, symmetrical variations were present in 60% of people. 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, EDC to the little finger is absent in 2 out of 3 people. In addition, anatomical variations are only symmetrical in 2 out of 3 people. These findings may explain why different posterior interosseous lesions are associated with inconsistent finger extension impairments. For an example on this, have a look at this case study . URL : https://doi.org/10.1016/j.tria.2025.100390 Abstract Introduction: The extensor digitorum communis (EDC) is essential in finger extension. Its tendons vary in distribution among and between different populations. These variations in anatomy can be very important for the diagnosis and management of hand injuries among hand surgeons, anatomists, and clinicians. This study is done to assess the variation of EDC tendons among the Burmese population and assess their distribution patterns on both hands. Methods: This is a cross-sectional anatomical study involving 32 cadavers (16 formalin-preserved and 16 fresh-frozen-acquired) from various medical institutions in Myanmar. A total of 64 dissected hands were observed for the number, pattern, and distribution of EDC tendons to the index (IF), middle (MF), ring (RF), and little fingers (LF). The Chi-square test was used to determine the statistical significance of tendon variations among the hands. Results: All IF had a single EDC tendon (100 %). The MF had single (50 %), double (37.5 %), and triple (10.9 %) tendons. The ring finger displayed single (9.4 %), double (50 %), triple (35.9 %), and quadruple (4.7 %) tendons. The LF showed an absent EDC tendon (60.9 %), a single tendon (34.4 %), and a double tendon (4.7 %). Asymmetrical tendon distribution was observed in 62 % of cadavers. Statistical analysis confirmed significant variations in EDC tendon distribution (p < 0.001). Conclusion: This study represents valuable data on anatomical variations in EDC tendons among a Burmese population and emphasises an individualised approach to surgery when dealing with tendon repair or hand reconstruction. The high incidence of asymmetrical patterns may alter functional and biomechanical results. Further investigation with advanced imaging techniques and samples of larger sizes is recommended regarding clinical implications. 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 displaced fleck sign: Description of a radiographic finding consistent with grade III thumb ulnar collateral ligament tears with Stener lesions. Daryoush, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Fleck sign - Stener lesion This was a retrospective review of patients presenting with a ulnar collateral licament (UCL) lesion at the mcpj of the thumb. A total of 228 patients with acute UCL lesions were included. Amongst these patients, a small proportion (n =17, 7.5%) had a small avulsion fragment displaced proximal to the joint line on the ulnar side called "fleck sign". All of these patients were clinically unstable. Of these, 14 patients had evidence of Stener lesion intra-operatively. Interestingly, an additional 19 patients who did not present with a fleck sign, had evidence of a Stener lesion intra-operatively. 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 displaced fleck sign is highly suggestive of a Stener lesion, warranting immediate surgical repair, especially if patients are willing to undergo such treatment . Nevertheless, the absence of a fleck sign on x-ray does not exclude a Stener lesion. In this last subgroup, it may be worth trialing eight weeks of immobilisation followed by re-assessment. Thus, it does not seem that delaying surgery has negative repercussions on people's functional outcomes . Furthermore, advanced imaging may present with limitations which reduce their relevance in the diagnosis of this condition . URL : https://doi.org/10.1016/j.jhsa.2024.12.003 Abstract Purpose: Controversy exists regarding the optimal imaging modality (magnetic resonance imaging, ultrasound, stress radiographs) for identification of patients with grossly unstable thumb metacarpophalangeal (MCP) ulnar collateral ligament (UCL) injuries or Stener lesions. We characterize a radiographic sign for this purpose. The “displaced fleck sign” is a small avulsion fracture from the ulnar proximal phalanx base that is displaced proximal to the MCP joint line. Methods: Patients with thumb UCL injuries evaluated by hand surgeons were identified at a single, tertiary institution. Patients who were skeletally immature, had chronic injuries (>3 months old), and those with MCP arthritis were excluded. Two attending hand surgeons independently reviewed radiographs to identify the displaced fleck sign. Presence/absence of a Stener lesion was extracted from operative notes. Results: Of 228 patients, 17 (7.5%) had a positive displaced fleck sign. Excellent interobserver reliability was observed (κ = 0.94). All 17 (100%) demonstrated gross instability with no end point in clinic, and all underwent surgical repair. Grade III ruptures were noted for all. Specifically, 14 (94.1%) had a Stener lesion, and one patient (7%) had a bony avulsion from the metacarpal. The displaced fleck sign had a positive predictive value of 100% for Grade III rupture and 94.1% for a Stener lesion. Conclusions: Presence of a displaced fleck sign has implications for offering surgery to patients with thumb UCL injuries because of a high likelihood of a Stener lesion. When present, surgeons may consider proceeding with surgical repair without additional imaging and associated follow-up visits. 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

Reliability and validity of the ten test for the assessment of digit sensation. Ozdag, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Ten Test - Sensory loss This study evaluates the reliability and validity of the Ten Test for assessing digit sensation compared to two-point discrimination (2PD). The Ten Test involves patients rating their finger sensation on a 1-10 scale, using an unaffected finger as a reference. A total of 201 participants, who had some injury to the affected side (no detailed information is provided in this regard), self-assessed the sensation on the affected hand across all the five finger tips. Their assessment was compared to a clinician assessment of 2PD. The results showed that the Ten Test had low sensitivity (53%) and reasonable specificity (84%) when compared to 2PD. 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 Ten Test is a low quality option to the two-point discrimination test when assessing light touch in our patients. This test may be useful when remote consultations are completed. Remember that both two-point discrimination and light touch only test a subgroup of large nerve fibres and that for milder entrapment neuropathies you are more likely to only have changes in small fibre, which can be assessed with pinprick . URL : https://doi.org/10.1016/j.jhsa.2024.12.015 Abstract Purpose: The ten test (TT) is a sensory assessment used to quantify the sensation of each digit. Because it does not require additional equipment, it may have utility in telemedicine. Our purpose was to evaluate the validity and reliability of the TT. Methods: Adult patients with nontrauma upper-extremity complaints were evaluated within an academic outpatient clinic. Two examiner groups (hand surgeons [group 1] and residents/physician assistants [group 2]) administered the TT and static two-point discrimination (2PD). Hand surgeons were blinded to the results obtained by the initial examiners. The TT is administered by having the patient define an area of normal sensation with their uninvolved index finger and then rate digital sensation against the involved hand on a 1–10 scale, with 10 defined as perfectly normal sensation. A cut-point analysis was employed, and both sensory assessments were categorized as either normal (2PD ≤5 mm, TT ≥9) or abnormal sensation for the entire median-nerve distribution and individual digit level. Agreement statistics including sensitivity (Sn) and specificity (Sp) were calculated for the TT, using static 2PD as the reference standard. Interrater reliability was compared between the groups of examiners. Results: A total of 201 patients (1,005 digits) were examined. The Sn/Sp for the TT was 53%/84% and 54%/85% at the digit-level and median-nerve distribution level, respectively. Interrater reliability for the TT between the groups of examiners was substantial at the digit level (κ = 0.68, SE = 0.02). Conclusions: The Sn/Sp for the TT was 53%/84% when using static 2PD as the reference standard. Interrater reliability for TT was substantial (κ = 0.68). The TT can serve as an alternative to other sensory assessments that require instrumentation. As telemedicine programs continue to evolve within upper-extremity surgery, the TT may be a useful tool with virtual applications. 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

Physical inactivity is the most important unhealthy lifestyle factor for pain severity in older adults with pain: A share-based analysis of 27,528 cases from 28 countries. Núñez-Cortés, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic Topic : Persistent pain - Physical activity This cross sectional study assessed the association between physical activity and pain severity in older adults using data from Survey of Health, Ageing and Retirement in Europe (SHARE) dataset. In this study, a total of 27,528 participants over 50 years old from multiple European countries were included. Variables such as demographics, co-morbidities, pain sites, physical activity, sleep problems, diet, and smoking were collected. The results showed that low levels of physical activity were strongly correlated with severe pain. Other lifestyle factors such as sleep problems, smoking, and inadequate diet were associate with pain levels too, however, to a lesser extent. Keep in mind that correlation is not causation. 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, there is a significant association between physical activity levels and pain severity in older adults, with physical inactivity emerging as a key determinant of severe pain. The bidirectional relationship between pain and physical activity highlights suggests the potential importance of addressing both pain levels as well as increasing physical activity levels in sedentary people. Remember that physical activity does not necessarily need to be pain-free, as pain whilst exercising does not appear to have a detrimental effect in people with musculoskeletal conditions . URL : https://doi.org/10.1016/j.msksp.2025.103270 Abstract Background: Limited knowledge exists on the association between lifestyle factors and pain severity in older adults. Objective: To assess the associations between unhealthy lifestyle variables and pain severity in the European population of older adults with pain. Design: Cross-sectional. Methods: Data were retrieved from the ninth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), a representative survey of individuals aged >50 years living in 27 European countries and Israel. Associations between lifestyle factors (sleep, smoking, diet and physical inactivity) and pain severity (mild, moderate, severe) were assessed using multivariable multinomial regression adjusted for age, sex, geographic region, education, history of chronic disease and mutually adjusted for each lifestyle. Results: 27,528 cases were included (73.1 ± 9.76 years; 63.3% female). A significant association was observed between those who hardly ever or never engaged in activities that required a moderate level of energy and severe pain (OR: 4.35; 95% CI: 3.85 to 4.92). Sleep problems (OR: 1.83; 95% CI: 1.69 to 1.99), smoking (OR: 1.21; 95% CI: 1.13 to 1.34) and an inadequate diet (OR: 1.78: 95% CI: 1.22 to 2.61) were also significantly associated with severe pain, but with lower odds. Given the cross-sectional design, the bidirectionality of these relationships should be considered. Conclusion: Physically inactive older adults were particularly more likely to experience severe pain, while other lifestyle factors were more weakly associated with pain. As these lifestyle factors are modifiable, the results may be useful in prioritising appropriate preventive measures to attenuate pain and ensure healthy ageing. 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

Early postoperative complications following partial distal biceps tendon surgical repair. Fones, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic : Partial distal biceps tears - Surgical repair This retrospective study assessed the complication rate after surgery for partial distal biceps. A total of 112 participants underwent the partial biceps repair. The most common repair approach (106 participants) involved the full detachment of the biceps and re-attachment, whilst a small proportion of participants underwent repair of the partial tear only. A total of 21% of people had complications. The most common complication included sensory deficits of the musculocutaneous nerve whilst a few more severe complications included re-ruptures, infections, and joint stiffness. 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, 1 in 5 people with have minor to severe complications following a distal biceps repair. Sensory involvement of the lateral cutaneous branch of the musculocutaneous nerve is the most common complication. Less frequent complications included re-ruptures, infections, and joint stiffness due to heterotopic ossificaiton. These findings appear to be in line with previous evidence . Given the potential complications, distal biceps repairs, especially if they are partial tears only, should be reserved for very active individuals only . URL : https://doi.org/10.1016/j.jhsa.2025.04.012 Abstract Purpose: There are sparse data on complications following partial distal biceps tendon (PDBT) repair. The purpose of this study was to analyze the early complication rate following operative repair of PDBT tears. We hypothesized that a minority of patients would experience a complication and that most complications would be minor and self-limited, regardless of surgical technique. Methods: A retrospective chart review identified patients treated with surgical repair of PDBT tears at a large orthopedic subspecialty practice over a 6-year period. Patients’ records were reviewed for surgical approach and method, demographics, and complications. Complications were classified as major if they necessitated reoperation within 12 weeks. Results: In total, 112 patients underwent PDBT repair via either a single-incision (71 patients; 63.4%) or two-incision (41 patients; 36.6%) technique. Within the first 3 months after surgery, complications were noted in 23 patients (rate 20.5%); 19 (82.6%) were minor, and four (17.4%) were major complications requiring return to the operating room within 12 weeks. Most minor complications were sensory nerve symptoms (56.5%). The rate of sensory symptoms was significantly higher with the single-incision (16.9%; 12/71) compared to two-incision technique (2.4%; 1/41). Major complications included two acute reruptures, one vascular injury, and one deep infection requiring anterior incision irrigation and debridement. Of the 13 patients with sensory symptoms, two later underwent removal of hardware and neurolysis for persistent symptoms outside the acute postoperative period. Conclusions: The early complication rate following PDBT repair was 20.5%. Of the patients who experienced complications, 83% were considered minor, and 90% of minor complications resolved without additional surgical intervention. 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 update on osteoporosis screening: Advances, applications, and the role of hand surgeons and allied health providers. Luan, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study : Diagnostic Topic : Osteoporosis screening - Who needs it? This osteoporosis screening updated discusses recent advancements and insights from orthopedic literature regarding osteoporosis and fragility fractures, particularly focusing on wrist and hand injuries. Research highlights the importance of bone mineral density (BMD) assessment in diagnosing osteoporosis, with studies demonstrating the effectiveness of using hand radiographs for BMD evaluation. These methods show promise as non-invasive screening tools for identifying individuals at risk of fractures. Additionally, several studies emphasise the relationship between wrist fractures and an increased likelihood of subsequent fractures, underscoring the need for early intervention and comprehensive management plans. The literature also highlights gender-specific differences, particularly noting that men often receive inadequate evaluation and treatment following wrist injuries, indicating missed opportunities for addressing underlying osteoporosis. Below you can find a set of screening criteria. 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, early identification and intervention in patients with underlying osteopenia/osteoporosis who present to our clinic with hand fractures is warranted. You can easily calculate an estimate of bone density from a hand x-ray by looking at the second metacarpal . A simple assessment utilising the FRAX may also be useful . Screening our patients for osteopenia/osteoporosis may improve their quality of life and health since the screening itself appears to be associated with a reduction in the probability of additional fractures . Remember that if our patients are willing to go to the gym, heavy lifting has been shown to improve bone mass density by a significant amount . URL : https://doi.org/10.1016/j.jhsa.2025.05.009 Abstract Osteoporosis and osteopenia are highly prevalent and undertreated. Both are characterized by low bone mineral density and contribute to fragility fractures and their subsequent morbidity and mortality. Recent advances in diagnostic modalities and pathways have demonstrated the potential to expand screening and treatment for patients with low bone mineral density. Hand surgeons will encounter patients with osteoporosis and osteopenia regardless of whether they have sustained fragility fractures and therefore must maintain an understanding of diagnostic and management considerations. This article provides an updated review on current methods of screening and the role of the hand surgeon in the evaluation and treatment of osteoporosis and osteopenia. 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

Prognostic factors for poor recovery in active-duty military personnel with musculoskeletal disorders: A systematic review with meta-analysis. Olivotto, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study : Prognostic Topic : Better recovery determinants - Musculoskeletal conditions The systematic review and meta-analysis assessed prognostic factors for recovery from musculoskeletal disorder amongst active military personnel. A total of 28 studies, which included retrospective and prospective designs were included. The Cochrane Risk of Bias criteria was utilised to assess each study. The findings suggested that low initial pain intensity and the absence of psychiatric disorders (e.g. anxiety or depression) were positive prognostic factors in recovery from musculoskeletal conditions. Prognostic factors for short-term restricted duty. 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, lower initial pain levels and the absence of depression/anxiety are positive prognostic factors in the recovery from musculoskeletal conditions. These findings are in line with the paper by Aasdahl et al. (2021) , which showed that the overall trajectory of pain was similar across multiple musculoskeletal presentations and higher levels of initial pain intensity were associated with persistent pain. In addition, a large amount of previous evidence has shown the greater levels of depression and anxiety are associated with a greater disease burden. Don't forget that having better social determinants of health also help with the overall recovery of patients. URL : https://doi.org/10.1016/j.msksp.2025.103383 Abstract Background: Military personnel are twice as likely as civilians to experience chronic musculoskeletal pain. Identifying prognostic factors for poor recovery from musculoskeletal disorders may support the development of tailored care pathways to improve outcomes. Objectives: Identify prognostic factors for poor recovery in active military personnel with musculoskeletal disorders. Design: Systematic review of prognostic studies including prospective, retrospective, and secondary analyses of randomised controlled trials. Methods: MEDLINE, EMBASE, AMED, PsychInfo, Cinahl, Scopus, and SPORTDiscus databases were searched from inception to March 2025. Studies were included if they evaluated prognostic factors for association with recovery outcomes (pain, disability, work status, or perceived recovery) in active military personnel with any musculoskeletal disorder. Two reviewers independently screened eligible studies and assessed methodological quality using the Quality in Prognostic Studies (QUIPS) tool. Descriptive analysis of multivariate data was undertaken with meta-analyses performed where possible. Results: Twenty-eight studies were included in this review. The factor most strongly associated with poor short-term outcome (disability) was initial pain severity [OR 3.88 (95 %CI 1.50–10.07)] followed by male sex (outcome restricted duty) [OR 2.63 (95 %CI 1.57–4.40)]. The factor most strongly associated with poor long-term outcome (restricted duty) was the presence of comorbid psychiatric diagnosis [RR 6.02 (95 % 4.25–8.51)]. Conclusions: Assessing initial pain severity and psychological stressors may help clinicians identify military personnel with musculoskeletal disorders at risk of poor outcome. Understanding the interaction between occupational psychological stressors and pain symptoms may identify modifiable factors that can be targeted to improve recovery. 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