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The natural history of bone stress injuries in athletes: From inception to resolution. Crunkhorn, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Preventative Topic: Stress fractures - Assessment and management This expert opinion on bone stress injuries in athletes presents an integrated approach to assessment, prevention, and treatment. Despite stress fractures being less common in the upper limb, volleyball and tennis players can present with them in the ulna or humerus, making it an often missed presentation. Authors provide a structured framework for addressing these injuries across three phases: primary, secondary, and tertiary prevention. Primary prevention focuses on mitigating risk factors such as overtraining, inadequate nutrition, and hormonal imbalances by promoting healthy training practices and monitoring energy availability, particularly in female athletes. Secondary prevention involves early detection through screening programs during the latent period of disease, allowing for timely intervention to prevent injury progression. Tertiary prevention addresses known cases of BSIs, prioritising treatment strategies such as rest, controlled mechanical loading, and rehabilitation to optimise healing and reduce recurrence risk. The best imaging currently available to assess the presence of stress fractures and bone metabolism is MRIs. Repeated MRIs over the course of 8 months for at risk athletes appears to be an acceptable way to track pathological changes and healing. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, primary prevention or in other words "risk mitigation" is fundamental to avoid stress fractures. This may include reviewing mechanical loading as well as identifying an energy deficit associated with an eating disorder. Secondary prevention would include early detection through screening programs of athletes who are at high risk due to training demands or underlying conditions. Tertiary prevention would be implemented to avoid progression of pathology (e.g. full fracture) via rest, controlled mechanical loading, and rehabilitation. Despite stress fractures in the upper limb being less likely in the upper limb, they do occur and we should keep this in mind as a differential diagnosis. It is important to remember that collaboration among dietitians, psychologists, and physiotherapists is critical, especially when addressing underlying causes like energy deficiency or eating disorders. Unfortunately, the presence of stress fractures alongside eating disorders is a strong hint to reduced bone mass density and we should therefore keep in mind for our older patients who present with such history. URL: https://doi.org/10.1007/s40279-025-02280-9 Abstract Bone stress injury (BSI) occurrence is common in athletic populations, resulting in high periods of time loss from sports participation. Minimising incidence and reducing severity presents a challenge for the prevention and clinical management of bone stress injuries (BSIs) for sports practitioners. An understanding of the aetiology and mechanisms for BSIs in athletic populations can assist with the design and implementation of prevention programmes. Application of established health frameworks allows practitioners to identify and manage the complex and dynamic interplay of factors that alter the susceptibility of an athlete to the onset, and subsequent progression of BSIs. The natural history of disease describes well-defined sequential stages of disease progression, sequenced from pathological onset through to disease outcome that occurs in the absence of clinical intervention. The purpose of this review is to synthesise and map the current evidence on BSIs to the natural history of disease. This review will provide sports medicine practitioners with a clinically applied framework that aligns current evidence to stages of disease, with reference to intervention and management. In addition, targeted prevention strategies are described and mapped to primary, secondary and tertiary levels of prevention along the BSI continuum. Despite the extensive body of evidence detailing BSIs in sport, this paper is the first to integrate and map BSIs to the natural history of disease. 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

From upper extremity pain and digital ischemia to hypothenar hammer syndrome in a matter of days: A case report of a semi-professional volleyball player. Magni, et al. (2026) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: Finger ischemia - Hypothenar hammer syndrome A 19 yrs old left-handed semi-professional volleyball player presented with left shoulder pain, tingling in the left forearm, pain in the ulnar hand, and intermittent finger ischemia in the left middle finger tip. These symptoms initiated following an intense spiking session during volleyball training, which forced them to stop. Upon objective assessment, there was no evidence of finger ischemia, and they had full upper limb range of movement. Tingling in the forearm was reproduced with median nerve neurodynamic testing. Five days following the first appointment, the patient made contact with the health provider as the finger blanching (see pictures below) was now lasting 1.5 hrs after training. An urgent ultrasound for the left hand and shoulder, alongside cervical x-rays were completed. X-rays were clear, showing no cervical rib or long transverse processes. Shoulder ultrasound excluded an arterial thoracic outlet or involvement of the posterior circumflex artery of the shoulder. A thrombosis of the superficial branch of the ulnar artery was identified via hand ultrasound. The patient was discussed with a hand surgeon and a referral to ED was initiated. Antithrombotic therapy was initiated and the patient returned to full volleyball training six months after injury. For a diagnostic guideline on digital ischemia in overhead athletes, have a look at the last figure below. Diagnostic guide for digital ischemia in overhead athletes. 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, finger ischemia can be a benign presentation (e.g. Raynaud's disease) or a thrombosis caused by arterial thoracic outlet or posterior circumflex humeral artery embolism. Finger ischemia lasting for more than 30 minutes is a medical emergency and referral for management is fundamental. If you are interested in other finger vascular presentations, have a look at these posts on Achenbach's syndrome (post 1, post 2). URL: https://doi.org/10.2519/josptcases.2026.0167 Abstract BACKGROUND: Ulnar artery thrombosis in the hand is a rare presentation. This condition is also called hypothenar hammer syndrome, and it can be caused by local hand trauma or insults to proximal shoulder arteries leading to thromboembolism. CASE PRESENTATION: A 19 years-old male left-handed semi-professional volleyball player was referred by a physiotherapy clinic for a second opinion. The athlete developed left sided shoulder, arm, forearm, and hand pain during an intense spiking session, which led him to discontinue training. During the session, he also developed blanching of the left middle fingertip, which resolved within minutes. Within two weeks after initial symptoms onset, finger blanching developed into persistent discoloration with reduction in hand temperature compared to the unaffected side. An emergency ultrasound imaging revealed thrombosis of the ulnar artery at the hand and the patient was hospitalized. OUTCOME AND FOLLOW-UP: The athlete was referred to the emergency department where physicians excluded proximal arterial insults responsible for the hand ischemia. A diagnosis of hypothenar hammer syndrome was made, and he was prescribed with antithrombotic therapy. The patient remained in the hospital for one week to exclude cardiovascular and systemic pathologies responsible for the thrombosis. The patient returned to high levels of competition within six months from injury. DISCUSSION: The case described presented with hypothenar hammer syndrome associated with local trauma to the hand. The presence of proximal shoulder and arm symptoms was incidental and unrelated to the hand ischemia. Overall, the patient experience had been stressful due to the uncertainty regarding return to sport during the initial treatment phase. 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 forgotten DOMS: Recognising delayed muscle soreness in hand rehabilitation. Tedeschi, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic Topic: Hand DOMs - Do they exist? This expert opinion explores delayed onset muscle soreness (DOMS) in hand rehabilitation, emphasising its underappreciated clinical implications. DOMS is distinct from muscle tears, with transient symptoms like localised tenderness and mild stiffness, compared to muscle tears, which would present with more severe manifestations, such as significant strength deficits, bruising, and elevated biomarkers. The article highlights the importance of distinguishing between these two presentations for effective management, suggesting strategies like patient education and symptom-specific interventions for DOMS, compared to a more strict and tailored exercise protocols for muscle tears. It also underscores the lack of research on DOMS in hand muscles and calls for future studies to develop evidence-based management approaches. 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, Delayed Onset Muscle Soreness (DOMS) is a benign, yet under investigated presentation of hand pain. Hand muscle tears are completely different from DOMS and often present with bruising and ongoing pain, requiring more structured rehabilitation. If you don't think that muscle tears can happen in the hand, think again, as our beloved lumbricals can be injured. This can occur especially in climbers when the middle or ring finger undergo a forceful extension whilst the other fingers are flexing. Another muscle pathology that you do not want to miss is compartment syndrome, which has been previously described in the literature. URL: https://doi.org/10.1136/bjsports-2024-109541 No Abstract available publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The concurrent validity of a portable ultrasound probe for muscle thickness measurements. Homer, et al. (2025) Level of Evidence: 3b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic: Muscle thicknes - Portable ultrasound This cross sectional study assessed the concurrent validity of a portable ultrasound probe for measuring muscle thickness compared to a gold standard ultrasound system. A total of 18 participants were included in the present study. Muscle thickness was measured at five sites: biceps brachii, triceps brachii, quadriceps femoris, hamstrings (biceps femoris), and gastrocnemius. Scans were completed with both the portable and gold standard non-portable US system. The results showed acceptable agreement between the portable probe and the reference system, when the biceps and triceps were assessed in the arm. The difference in measurement between the gold standard and the portable ultrasound was 1-2 mm. 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, portable ultrasound probes show acceptable agreement with the reference system for biceps and triceps in the upper limb. It is therefore possible to measure atrophy and hypertrophy in our patients if we are assessing them after injury/surgery and following a period of rehabilitation. US imaging is becoming more and more relevant for hand therapists as we can visualise mutliple tissues, helping with diagnosis (e.g . fractures) and treatment tracking. URL: https://doi.org/10.1111/cpf.12901 Abstract Ultrasound imaging is extensively used by both practitioners and researchers in assessing muscle thickness (MT); however, its use in the field is constrained by the transportability of stationary devices. New portable ultrasound probes pose as a cost-effective and transportable alternative for field-based assessments. This study evaluated the concurrent validity of a portable probe (Lumify) against a laboratory-based device (Vivid S5) in measuring MT. Eighteen participants (nine males and nine females) visited the laboratory and their MT measurements were collected using each device at five different sites (anterior and posterior arm, anterior and posterior thigh, and posterior lower leg). Bland-Altman plots (systematic and proportional bias, random error, and 95% limits of agreement), Pearson's product–moment correlation coefficient (r), and paired samples t-tests with Cohen's d effect sizes (ES) were used to assess the concurrent validity of the Lumify device. Systematic bias was low at all sites ( ≤ 0.11 cm) while proportional bias was detected only at the posterior lower leg (r2 = 0.217 [r = 0.466]). The difference in MT between devices was significant only at the anterior thigh (p < 0.05); however, ES for all sites were considered trivial (ES ≤ 0.131). Linear associations were found between the devices at each site of measurement (r ≥ 0.95). These results highlight that the Lumify probe can be used interchangeably with the Vivid S5 for MT measurements, providing practitioners and researchers with a more cost-effective and portable alternative for field-based assessments. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic A 19 yrs old left-handed semi-professional volleyball player presented with left shoulder pain, tingling in the left forearm, pain in the ulnar hand, and intermittent finger ischemia in the left middle finger tip. These symptoms initiated following an intense spiking session during volleyball training, which forced them to stop. Upon objective assessment, there was no evidence of finger ischemia, and they had full upper limb range of movement. Tingling in the forearm was reproduced with median nerve neurodynamic testing. Five days following the first appointment, the patient made contact with the health provider as the finger blanching (see pictures below) was now lasting 1.5 hrs after training. What is it?

Resistance exercise training in individuals with and without cardiovascular disease: 2023 update: A scientific statement from the american heart association. Paluch, et al. (2024) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic/Preventive Topic: Resistance training - Health implications This is an update on resistance exercise training on health benefits across diverse populations and conditions. Evidence supports its effectiveness in improving muscle strength, physical performance, and overall health outcomes, including cardiovascular and metabolic health, particularly when integrated into long-term lifestyle interventions. The review emphasises adherence to guidelines for frequency (2–5 sessions weekly), rest intervals (1–3 minutes per set), and protein intake for optimal muscle repair and growth. Studies underscore the positive impact of resistance training on chronic conditions like diabetes, kidney disease, and cardiovascular disorders, as well as in older adults and those with cognitive decline or dementia. Guidelines from organizations such as the American Heart Association and American Diabetes Association reinforce its role in preventing complications and improving quality of life. Challenges in adherence to strength training are noted, suggesting a need for tailored strategies to enhance participation and long-term sustainability. Overall, resistance exercise remains a critical component of health promotion and disease management across all ages and conditions. 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, resistance training (RT) performed twice a week is beneficial for improving muscle strength, physical performance, and overall health outcomes. Similar benefits of RT are evidence in chronic conditions such as diabetes by improving insulin sensitivity and reducing blood pressure in cardiovascular disorders. It also benefits older adults with cognitive decline through potential improvements in brain function and social interaction. The combination of resistance training and aerobic conditioning seems to have better health outcomes than resistance training alone. We should therefore always encourage our patients to go to the gym given the extensive evidence in favour of resistance training. Resistance training has also important benefits for bone density. URL: https://doi.org/10.1161/CIR.0000000000001189 Abstract Resistance training not only can improve or maintain muscle mass and strength, but also has favorable physiological and clinical effects on cardiovascular disease and risk factors. This scientific statement is an update of the previous (2007) American Heart Association scientific statement regarding resistance training and cardiovascular disease. Since 2007, accumulating evidence suggests resistance training is a safe and effective approach for improving cardiovascular health in adults with and without cardiovascular disease. This scientific statement summarizes the benefits of resistance training alone or in combination with aerobic training for improving traditional and nontraditional cardiovascular disease risk factors. We also address the utility of resistance training for promoting cardiovascular health in varied healthy and clinical populations. Because less than one-third of US adults report participating in the recommended 2 days per week of resistance training activities, this scientific statement provides practical strategies for the promotion and prescription of resistance training. 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

Simplifying strength assessment and prescription. Predictive model for biceps 1rm based on isometric dynamometry and biometric data: A pilot study. de la Lama, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: How much can patients curl - Biceps This cross sectional study assessed the feasibility of utilising an isometric biceps test to estimate one-repetition maximum (1RM) biceps curl. A total of 31 participants were included in the present study. A series of measurements including grip strength, forearm circumference, and static biceps strength assessed with a dynamometer were collected. These measures were correlated with 1RM of the biceps. The results showed a strong correlation between isometric peak force and 1RM of the biceps, with an R² value of 0.74, indicating that biceps dynamometry can reasonably predict 1RM. You can utilise the app below to calculate how much your patient's maximum biceps curling weight. The app below will ask you to enter the static force they can generate in kg and return how many kgs they can dynamically curl. 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, static biceps strength can predict the biceps strength during a curl. This would require you to utilise a dynamoter like the tindeq. Once you got the measurement in kg, you can enter it in the app above and get their maximum curling weight for 1RM. Another way of predicting isometric biceps strength is by measuring their grip strength. URL: https://doi.org/10.1016/j.jbmt.2025.05.064 Abstract Background: Estimating one-repetition maximum (1RM) is critical for safe and effective resistance training prescription, yet traditional testing can be time-consuming or contraindicated in some populations. This study aimed to develop a predictive model for biceps curl 1RM using biometric measures and handheld dynamometry. Methods: Thirty-one adults (15 trained and 16 sedentary) participated. Data collected included age, height, weight, sex, peak isometric elbow flexion force (via handheld dynamometer), and handgrip strength. Due to significant biometric differences between groups, statistical analysis focused on sedentary participants. Pearson correlation and linear regression were used to evaluate the relationship between 1RM and isometric strength. Results: Isometric biceps strength showed a strong correlation with 1RM (R = 0.8608). Linear regression demonstrated substantial predictive value (R2 = 0.74, p < 0.001). Trained participants exhibited significantly higher 1RM-to-isometric strength ratios compared to sedentary individuals (73.17 % vs. 52.93 %, p < 0.01). Conclusion: Isometric elbow flexion force measured via handheld dynamometry is a strong predictor of biceps curl 1RM. These preliminary findings suggest its potential utility in guiding resistance training prescriptions, particularly in populations where maximal testing is impractical or unsafe. 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

Concomitant ligament injuries can be left untreated during surgery of distal radial fractures. Bakker, et al. (2023) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: DRUJ and SL laxity - Do they need need treatment This prospective study investigated the outcomes of surgically treated distal radial fractures with or without concomitant distal radio-ulnar joint (DRUJ) instability or scapholunate (SL) dissociation. A total of 62 patients who underwent distal radius fracture open reduction internal fixation (ORIF). DRUJ laxity was assessed after ORIF intra-operatively and SL was assessed with dynamic x-ray to determine whether the scaphoid was moving synchronously with the lunate. A total of 58% and 27% participant presented with DRUJ and SL laxity respectively immediately after surgery. Post-surgical immobilisation was not affected by the presence or not of DRUJ/SL laxity. No patients were treated for DRUJ or SL laxity following distal radius fracture ORIF. Of the participants who presented with DRUJ laxity post operatively, 63% had stable joints at 6 months follow-up. Function, grip strength, and range of movement was not different between people with and without DRUJ or SL laxity. 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: Base on what we know today, patients with and without ligamentous injuries (DRUJ or SL laxity) following distal radius fracture showed comparable functional outcomes, suggesting that treating the fracture alone may suffice. A significant portion of patients who were lax immediately post surgery, regained stability of the DRUJ at six months follow up. These findings appear to be in line with previous research showing that the DRUJ complex does not require taking care of as long as the distal radius fracture is taken care of. Remember that if the distal radius undergoes ORIF, these patients do much better if they are mobilised within two weeks from surgery. URL: https://doi.org/10.1177/17531934231177424 Abstract Instability of the distal radioulnar joint and scapholunate dissociation may cause pain, functional impairment and subsequent arthrosis. There is no consensus about whether these injuries should be treated acutely in patients undergoing surgery for distal radial fractures. We conducted a prospective cohort study to determine whether concomitant distal radioulnar joint instability or scapholunate dissociation negatively influence patient-related outcomes in these patients. The primary outcome was the patient-reported wrist/hand evaluation at 6 and 12 months after surgery. Out of 62 patients, 58% and 27% had intraoperative distal radioulnar joint instability and scapholunate dissociation, respectively. No significant differences were found in patient-reported scores at follow-up between patients with stable and unstable distal radioulnar joints, nor between patients with and without scapholunate dissociation. Sixty-three per cent of patients with an unstable distal radioulnar joint during surgery were stable on retesting after 6 months. Our study suggests that a wait-and-see policy in these patients therefore seems reasonable. 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

Management of acute distal radioulnar joint instability following a distal radius fracture: A systematic review and meta-analysis. Xiao, et al. (2021) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: DRUJ laxity management - Distal radius fracture ORIF This was a systematic review and meta-analysis comparing stabilisation vs no stabilisation of the distal radio ulnar joint (DRUJ) during open reduction internal fixation (ORIF) of a distal radius fractures. The study included 8 articles for a total of 258 wrists being analysed. Outcomes assessed included grip strength, range of motion, DASH scores, and Mayo Wrist Scores across treatment modalities: cast immobilisation (post ORIF), K-wire stabilization, and TFCC repair. Results indicated no significant differences in overall functional outcomes or persistent instability rates (1.5%) between groups. TFCC repair was associated with reduced grip strength and range of motion compared to other treatments. Immobilisation post ORIF appeared to provide better pronation/supination compared to TFCC repair. 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, stabilising the distal radioulnar joint (DRUJ) during distal radius fractures ORIF does not appear to provide better outcomes to simply fixing the distal radius fracture. As a matter of fact, it may be that not fixing it provides patients with better range of movement in pronation/supination. This seems to be in line with one of this week's studies showing that the presence or absence of DRUJ or SL laxity does not matter the the distal radius fracture undergoes ORIF. URL: https://doi.org/10.1016/j.jhsg.2021.02.005 Abstract Purpose: We sought to review the clinical outcomes of conservative and operative treatment options for acute distal radioulnar joint (DRUJ) instability associated with distal radius fractures in adult patients. Methods: A systematic search of PubMed, MEDLINE, and EMBASE for articles published between 1990 and 2020 involving DRUJ instability associated with distal radius fractures was performed. The primary outcomes analyzed included clinical grip strength; range of motion; the disability of the arm, shoulder and hand (DASH) score; and the modified Mayo wrist score (MMWS). Results: Of the 531 articles identified in the literature search, 8 met our defined criteria and were included in the final analysis. The cumulative sample size was 258 patients at a mean follow-up of 11.1 months (range, 3–16.9 months). Treatment groups included cast immobilization in supination, K-wire stabilization, and triangular fibrocartilage complex (TFCC) repair. Statistical analysis revealed no difference across groups in active flexion-extension or DASH scores. A significant decrease in grip strength was found in patients who underwent TFCC repair compared with that in those who underwent both cast immobilization (P = .04) and K-wire stabilization (P = .02). Furthermore, we found a significant decrease in active pronation-supination between patients who underwent TFCC repair and those who underwent cast immobilization (P = .03). Patients who underwent TFCC repair were also found to exhibit decreased MMWS as compared with those who underwent K-wire stabilization (P = .05). Overall, persistent DRUJ instability was only found in 4 patients (1.5%), without a significant difference between treatment groups. Conclusions: This study suggests functional advantages of certain treatment modalities over others, with the range of motion being highest in patients who underwent cast immobilization and grip strength being highest in patients who underwent K-wire stabilization. However, the mean DASH scores showed no difference across all groups, calling into question the clinical need to pursue operative treatment via K-wire stabilization or TFCC repair over conservative treatment via cast immobilization. This study will hopefully serve as a foundation for future prospective studies to help improve and standardize treatment algorithms in patients with DRUJ instability and distal radius fractures. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Nine reasons why hand surgeons should do musculoskeletal ultrasound. Özçakar, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: Ultrasound imaging - Hand therapists This expert opinion discussed the importance of musculoskeletal ultrasound (US) in hand surgery and rehabilitation, highlighting several key reasons why it should be integrated into clinical practice. Below I have reported the top three: Foreign bodies can easily be detected prior to referring for an x-ray Fractures identification (see picture below) and callus formation Assess whether tendons are intact (e.g. flexor tendon repairs) In addition to the above, US is a radiation-free, cost-effective, non-invasive imaging modality that is portable, patient-friendly, and suitable for diverse patient populations. It also enables dynamic assessment of mobile structures like tendons, muscles, and nerves, providing real-time insights into injuries during movement. US can be utilise to visualise painful tissues and determine the likely origin of symptoms (e.g. reactive tendinopathies). 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, hand therapists should integrate ultrasound use into their clinical practice for several reasons. These include the detection of foreign bodies, identification of fractures and callus formation, and assessment of tendon response to loading (e.g. tendinopathies) and integrity of tendon repair. All the reasons mentioned above are nice additions to an existing paper on the use of ultrasound imaging in clinicians dealing with upper limb presentations. URL: https://doi.org/10.1016/j.hansur.2025.102136 No Abstract available publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The underestimation of antidepressants role in risk of fractures: Clinical and public health implications. Donzelli, et al. (2019) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Preventative Topic: Antidepressants - Bone health This letter to the editor, highlights the significant role of depression in increasing risks of osteoporotic fractures and bone loss, suggesting that addressing depression could reduce these risks. However, the authors emphasise that antidepressant medications, particularly SSRIs and TCAs, may independently contribute to fracture risk through mechanisms such as reduced bone metabolism and increased fall risk. Despite some studies showing an indirect effect when controlling for antidepressants, the potential autonomous contribution of these drugs remains a concern. The authors list numerous side effects associated with antidepressants, ranging from gastrointestinal issues to cardiovascular problems, underscoring their broader health impact. They advocate for prioritising alternative treatments like healthier diets, physical activity, and psychotherapy over pharmacological interventions, particularly given the rising long-term use of antidepressants in the US. Their recommendations aim to mitigate both depression and fracture risks through non-pharmacological approaches. 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 complex interplay between antidepressants and bone metabolism. It appears that long term use of these medications increases the odds of osteoporotic fractures and bone loss. Non-pharmacological interventions to help with depression, such as healthier diets, encouraging physical activity, and incorporating psychotherapy, can play a significant role in mitigating both mental health issues and the need for these medications. Being aware of this risk factor may further help in identifying people who require bone density screening. URL: https://doi.org/10.1007/s00198-018-4681-8 No Abstract available publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Building a positive online reputation in hand surgery: Quantitative analysis of factors linked to patient five-star reviews. Richman, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic/Prognostic Topic: Online reputation - Factors This cross sectional study explored what factors influenced online reputation of hand surgeons, focusing on comments contributing to 5-star ratings. A total of 448 five starts rating alongside 691 comments were included in the study. Four major factors where identified as drivers of positive online reputation. These included: A clear treatment plan Good outcomes Physician professionalism Staff professionalism Additional factors that contributed to positive reviews included the provision of alternative treatment plans, short wait times, and longer time with the provider. For a full list of compliments by prevalence, have a look at the table 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, both clinical expertise and interpersonal skills are essential for positive clinic reputation. Key findings reveal that effective communication of treatment plans, positive outcomes, clinician and staff professionalism drive 5-star ratings. Conversely, poor bedside manner and lengthy waits lead to negative reviews, underscoring the importance of respectful and timely interactions. This is in line with previous evidence showing how interpersonal skills and positive relationships with patients can have positive effects. This also seems in line with the importance of pre-operative session to clarify expectations in patients with upper limb presentations scheduled for surgery. URL: https://doi.org/10.1016/j.jhsa.2025.06.012 Abstract Purpose: Online physician review websites have changed the health care landscape by offering patients accessible platforms to evaluate and share their experiences. Physician review websites, such as Google Reviews, Yelp, and Healthgrades, may influence patient preferences and health care delivery. This study aimed to identify both clinical and nonclinical factors associated with five-star reviews to provide actionable insights for surgeons to improve patient experience and satisfaction. Methods: Fifty fellowship-trained hand surgeons practicing in 10 major metropolitan areas were randomly selected from the American Society for Surgery of the Hand directory. Reviews from Google.com rated five stars were analyzed, with a maximum of 20 reviews per surgeon. Compliments were categorized as clinical (eg, treatment plans, diagnoses, outcomes, and pain management) or nonclinical (eg, physician/staff professionalism, wait times, scheduling, and cost) and classified as surgical or nonsurgical. Two independent reviewers analyzed the reviews, with discrepancies resolved by a third reviewer. Univariate analysis and chi-square tests were used to assess categorical variables. Results: A total of 448 five-star reviews containing 691 compliments were analyzed. Clinical compliments constituted 43.8%, whereas 56.2% were nonclinical. Common clinical compliments included clear treatment plans (21.1%) and good outcomes (19.7%). Nonclinical compliments frequently highlighted physician professionalism (51.4%) and staff professionalism (23.2%). Surgical patients were more likely to mention good outcomes (44.0% vs 5.9%) and pain control (10.4% vs 1.4%), whereas nonsurgical patients emphasized physician professionalism (55.3% vs 44.4%) and staff professionalism (26.8% vs 16.8%). Private practice surgeons received more five-star reviews than academic surgeons, although average overall ratings were similar. Conclusions: Physician interpersonal skills and staff professionalism play critical roles in positive online reviews. Clinical outcomes are key drivers for surgical patients, whereas nonsurgical patients prioritize communication and alternative care options. Clinical relevance: This study identifies key factors associated with five-star reviews in hand surgery, offering actionable insights to enhance patient satisfaction. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings