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Prevalence of residual limb pain and neuromas after upper extremity amputation: A systematic review and meta-analysis. List, et al. (2025) Level of Evidence: 3a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Symptoms prevalence study Topic : Neuromas - Upper limb amputations This systematic review and meta-analysis assessed the prevalence of residual limb pain (RLP) and symptomatic neuromas after upper extremity amputation. Sixteen studies were included for a total of 1,602 patients being screened for RLP and 215 for symptomatic neuromas. The pooled prevalence of RLP was found to be 60% (95% CI: 51-67). In contrast, neuromas were less common with a 20% (95% CI: 11-40) prevalence. One of the limitation of the study was the high heterogeneity among studies, and a lack of data on sex and upper limb amputation level. Figure 2. Forest plot prevalence of residual limb pain (RLP). Figure 3. Forest plot prevalence of symptomatic neuroma. 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 high prevalence of residual limb pain (RLP) at 60% following an upper limb amputation. Prevalence of neuromas is also high with 1 in 5 people presenting with this painful condition. It therefore appears that postoperative pain management is crucial to prevent chronic RLP. It is possible that managing pain well post-operatively and establishing a light aerobic conditioning program may help with symptoms. URL : https://doi.org/10.1177/17531934251345368 Abstract Residual limb pain (RLP) and symptomatic neuromas are common complications of upper extremity amputation. There is disagreement in the literature about their true prevalence. This systematic review and meta-analysis of the prevalence of RLP and symptomatic neuroma after upper extremity amputation identified relevant studies published between 2000 and 2022 in PubMed, Cochrane and Embase. Random-effects meta-analyses of proportions were performed to determine the prevalence of RLP and symptomatic neuromas. Subgroups were identified and analysed. For RLP, the pooled prevalence was 58% (95% CI: 46 to 68). For symptomatic neuromas, the pooled prevalence was 22% (95% CI: 11 to 40). Residual limb pain was reported less frequently in Europe than in the United States. Knowledge and awareness are important for appropriate treatment and prevention. 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 outcome difference between acute bony and tendinous mallet fingers treated conservatively in children. Rubin, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Mallet finger - Kids treatment This retrospective study assessed the effectiveness of splinting for both bony and tendinous mallet finger injuries in children. A total of 31 children were included. Splinting was worn for 6 and 4 weeks for tendinous and bony mallet respectively, followed by gradual weaning of the splints. At baseline, the average extension lag was 20 degrees. The results showed that children with bony mallet were older (mean 14 years vs. 12 years). Both injury types showed excellent outcomes after treatment with extension splintage, with no significant differences in residual extension lag. Thus, the extension lag following treatment was 0-10 degrees for both 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, bony or tendinous mallet finger injuries in children can be managed conservatively with splinting. Keep in mind that for tendon injuries, 6 weeks of immobilisation is advised compared to 4 weeks for bony ones. Have a look at the following synopses if you are interested in the management of buckle , phalangeal , or upper limb fractures in children. URL : https://doi.org/10.1016/j.jht.2024.07.004 Abstract Introduction: Tendinous and bony mallet are very different injuries presenting with extensor lag at the distal interphalangeal joint. This study is aimed to evaluate the outcome difference between acute bony and tendinous mallet fingers treated conservatively with a splint in children. Materials and Methods: We collected retrospective data about patients at the time of injury with acute tendinous or bony mallet that were treated conservatively in our occupational therapy clinic. Patients were examined in the outpatient clinic. Pain, extension lag, and flexion loss were documented. Outcomes were classified according to the Crawford’s criteria. Results: We collected data on 31 patients (16 bony and 15 tendinous mallet). We found the bony mallet patients to be older (mean 13.8 vs 11.9 years), We also found that tendinous mallet injuries affected predominantly the ring finger while bony mallet injuries affected predominantly the middle finger. Both bony and tendinous mallets tend to be more frequent in male. The extensor lag on initial was the same (median −18.5° vs −20°). As for the outcome, we found both groups to have excellent outcome in regard of the extension lag (median 0° vs 0° p = 0.538) and Crawford Criteria Assessment (p = 0.570). Discussion: Mallet injuries, either tendinous or bony, are not common in children. They are often studied together and typically treated in the same way with extension splintage. Yet, the evidence in adults clearly shows there are different injuries, which present in the same way. This study reinforces these findings in children regarding demographic findings but not for the treatment 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

The string test: A novel test for diagnosing extensor carpi ulnaris tendonitis. Cooper, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : ECU tendinopathy - String test This retrospective study assessed the diagnostic accuracy of the "string test" for identifying extensor carpi ulnaris (ECU) tendinopathy in patients with ulnar-sided wrist pain. The test aims at differentiating ECU tendinopathy from other conditions like triangular fibrocartilage complex (TFCC) injuries or dorsal radiocarpal joint issues. A total of 64 patients were divided into three groups: those with confirmed ECU tendonitis and positive string test (true positives), those with negative string test despite having ECU tendonitis (false negatives), and those without ECU tendonitis and a negative string test but with other wrist pathologies (true negatives). The confirmation of ECU tendinopathy/other pathologies was obtained through MRI imaging. The test demonstrated a sensitivity of 86% and specificity of 100%, indicating its potential usefulness in differentiating ECU tendinopathy from other 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, the "string test" may be a useful adjunct when trying to differentiate between ECU tendinopathies and other ulnar-sided wrist conditions. This paper is a nice addition to the one showing that ECU tendinopathy/tenosynovitis is more common in people with TFCC injuries compared to healthy controls . URL : https://doi.org/10.1177/17531934251329775 Abstract The study presents the string test as a novel diagnostic method for extensor carpi ulnaris tendonitis, addressing the complexities of diagnosing ulnar-sided wrist pain. Findings suggest that the test is reliable, reducing misdiagnosis and the need for wrist MRI. 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

Epidemiology of acute flexor tendon injury and an analysis of outcomes: A study of 91,239 patients in England and Wales. Mawhinney, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiological/Prognostic Topic : Flexor tendon - Incidence This retrospective study assessed trends and outcomes in flexor tendon injuries treated in England and Wales over eight years (2015–2023) using Hospital statistics. A large number of patients were included in the study (more than 90,000). The researchers focused on collecting patient's demographics, socioeconomic factors, and complications/reoperations rates. The results showed that the number of flexors injuries, were highest among patients from deprived areas. Sex differences were noted, with men more frequently affected. Peak flexors injuries occurred in patients between 20 and 30 years old. Re-ruptures occurred in less than 1% of patients, and the most common reoperation was tenolysis which occured in 3% of the patients. 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 : B ased on what we know today, flexor tendon injuries tend to occur in younger patients and those from deprived socio-economic areas suggesting physically demanding work or lack of access to safety equipment may be contributing factors. Once again, it appears that social determinants of health, such as economic status and access to resources, has an impact on flexor tendon injuries. This study provides additional evidence on how social deprivation can affect flexor tendon injury/recovery , as well as recovery from several other hand and upper limb injuries . URL : https://doi.org/10.1177/17531934251342419 Abstract The purpose of this study was to investigate the epidemiology of flexor tendon injuries and operative complications post-repair on a national scale. Using Hospital Episode Statistics data we identified a total of 91,239 patients in England who underwent a flexor tendon repair in the 20-year period between 1 April 1998 and 31 March 2018. Individuals were more likely to be male (74.6%) and of lower socioeconomic status. Median age was 31 years and patients had few medical comorbidities. After primary repair, 3.1% of patients required a revision repair within 90 days and 2.8% tenolysis within two years. Complications other than rupture, adhesions and wound site infection were rare. This study has shown that flexor tendon repair is primarily a procedure of working-age men, with rupture and adhesions the most common complication. The complication rate is less than previously reported in the literature. 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

Long-term outcomes of radial shortening osteotomy for Kienböck disease: Minimum 20-year follow-up study. Suzuki, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Kienböck - surgical intervention This retrospective study assessed the long term effect of radial shortening osteotomy as a widely used surgical intervention for Kienböck disease. A total of 6 patients were followed up for more than 20 years following radial shortening osteotomy. The results showed that wrist range of movement and grip strength improved compared to before surgery, and QuickDASH scores remained unchanged. There was evidence of wrist osteoarthritis at follow up, however, the lunate collapse did not appear to have worsened. Keep in mind that there was no control group, hence, such improvements/lack of change could have been due to natural history of the condition. FIGURE 1: Radiographs of a 17-year-old man with Lichtman stage 3B Kienböck disease. A Before surgery. B At the 10-year follow-up 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, surgical options, such as radial shortening osteotomy, may be reasonable approaches for Kienböck disease management. We can provide some hope to patients by letting them know that long term follow ups seem to show improvements in range of movement and grip strength despite ongoing functional limitations. If you are interested in Kienböck disease, have a look at the this synopsis on potential genetic aetiology of the condition . URL : https://doi.org/10.1016/j.jhsa.2025.04.018 Abstract Purpose: We have been performing radial shortening osteotomies for patients with negative ulnar variance and Lichtman stage 2 or higher Kienböck disease. Although we previously reported the results of this procedure 10 years after surgery, reports on follow-up beyond 10 years remain scarce. This study aimed to investigate the results of radial shortening osteotomy for Kienböck disease based on long-term clinical and radiographic outcomes for a minimum of 20 years after surgery. Methods: The cohort comprised seven patients with eight wrists treated between 1991 and 2002, whose average age at the time of surgery was 25.9 years (range: 17–44 years). The preoperative Lichtman classification was stage 3A in one wrist, 3B in five, and stage 4 in one; the mean preoperative ulnar variance was −2.2 mm (range: −1.0 to −3.5 mm). Changes in pain, range of motion, grip strength, modified Mayo Wrist Score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and radiographs were evaluated from 10 years after surgery to the last follow-up at least 20 years after surgery. Results: Pain remained reduced in all patients at 20 years after surgery. Improvements in wrist extension and flexion observed 10 years after surgery were maintained at the last follow-up. Grip strength at 10 years after surgery was maintained at the last follow-up. The mean modified Mayo wrist score and the mean DASH score were maintained from 10 years after surgery to the last follow-up. Radiography showed no progression of lunate collapse in any case, although one case showed progression of degeneration in the radiocarpal joint and the distal radioulnar joint. Conclusions: Good clinical results observed in patients 10 years after radial shortening osteotomy are likely to remain stable at 20 years after surgery. 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

Restless arm syndrome: A rare disease? Moser, et al. (2021) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic : Restless arm syndrome - Diagnosis and management This case report describes a challenging case of restless arm syndrome (RAS) in a middle-aged patient with a long-standing history of symptoms despite multiple specialist visits. The patient experienced significant sleep disturbances and daytime fatigue due to RAS. Luckily for the patient, they encountered a physician who prescribed them with 100 mg L-dopa +25 mg benserazide (medicines commonly used for Parkinson's disease), which resolved the symptoms. Below you can find the diagnostic criteria for RAS, which are the same as restless legs syndrome but applied to the arms. 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, Restless Arm Syndrome (RAS) presents as an urge to move the upper limb due to uncomfortable sensations, often disrupting sleep and leading to significant daytime fatigue. If one of your patients presents with these symptoms, do not dismiss them. Compare their presentation to the diagnostic characteristics above and refer them back to the GP or specialist suggesting whether a trial of dopaminergic drugs could be considered. URL : https://doi.org/10.1136/bcr-2021-244890 Abstract Restless legs syndrome (RLS) is a common neurological disorder characterised by an irresistible urge to move the lower limbs, often accompanied by unpleasant sensations in the legs, typically occurring in the evening and at night and improving with movement. Restless arms syndrome (RAS) predominantly affects the arms, while the legs are rarely affected. RAS appears to be very rare, with very few cases described to date, but the diagnosis of RAS is probably made too infrequently, especially for milder and transient forms. The patient reported here even had severe symptoms for years that could have indicated RAS. He observed an immediate improvement in all RAS-related symptoms after administration of 100 mg L-dopa +25 mg benserazide, which continues to this day. Clinicians should always be alert for RLS-like symptoms in one or both arms that worsen at rest and improve with movement, thinking of possible RAS. 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 therapies for delayed-onset muscle soreness: An umbrella and mapping systematic review with meta-meta-analysis. Wiecha, et al. (2025) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : DOMS - Interventions to reduce pain This umbrella review with meta analysis assessed the scientific evidence on various post-exercise physical therapy interventions for Delayed Onset of Muscle Soreness (DOMS). The research aimed to address inconsistencies in existing systematic reviews by analysing quantitative data from multiple meta-analyses, providing a comprehensive overview of therapeutic approaches. The study focused on therapies such as massage, stretching, vibration, photobiomodulation, compression, and heat/cold applications. More than 800 unique randomised controlled trials were included. A methodological quality assessment of the included evidence was conducted to evaluate the robustness of the scientific findings (Class I highest, class V lowest). The results showed that the majority of treatments you can think of, tend to reduce DOMS within 24 hrs. As you can see from the figure below, studies with the largest effect size also appear to be the ones with the smallest number of participants, which suggest the presence of some publication bias. Overall, you could probably say that any of the interventions presented have a small to moderate effect in reducing DOMS. Forest plot demonstrating the effectiveness of various therapies on pain intensity indices at specific timepoints post-exercise. Positive Hedges’ g and 95% confidence interval (CI) values indicate an improvement with therapy interventions over control groups. h hours, I2 heterogeneity, n studies number of studies in the meta-analysis, 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, massage, stretching, vibration, photobiomodulation, compression, and heat/cold applications have some effect, albeit small, in reducing Delayed Onset of Muscle Soreness (DOMS) following exercise . If you would like to know more about resistance training options for our patients, have a look at the entire database . URL : https://doi.org/10.1007/s40279-025-02187-5 Abstract Background: Delayed-onset muscle soreness commonly arises from intense and unaccustomed physical exercise, leading to reduced muscle strength, increased pain and inflammation. A number of systematic reviews evaluating physiotherapeutic treatments for delayed-onset muscle soreness have been published since the 1990s. However, these systematic reviews frequently yield conflicting findings, further impeding clinical practice. Objectives: The primary aim of this study was to summarise the effectiveness of physiotherapy interventions in alleviating delayed-onset muscle soreness through an umbrella review. Additionally, we evaluated the risk of bias in systematic reviews, synthesised their findings, and categorised the evidence strength to provide practical insights for clinicians and researchers. Methods: An umbrella review with a meta-meta-analysis was conducted. MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PEDro and Epistemonikos were searched from 1998 to February 2024. Systematic reviews of randomised controlled trials of any treatments used post-exercise by physiotherapists to reduce delayed-onset muscle soreness in healthy adults, regardless of their physical activity, were eligible. A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) was used to evaluate the methodological quality of the included systematic reviews. Corrected covered areas were calculated to address the overlap of primary trials in the included systematic reviews. An evidence map was created to categorise and visualise the effects of interventions using a multi-dimensional approach, based on the effect size and strength of evidence (Class I–V), i.e. the number of cases, Hedges’ g, p-value, heterogeneity, Egger’s test and excess of significance bias test. Results: Twenty-nine systematic reviews with 863 unique randomised controlled trials, addressing 24 distinct physiotherapeutic treatments, met the inclusion criteria. Seventeen systematic reviews were of critically low methodological quality, with only two rated as high quality. The evidence map suggests significant effects in pain reduction immediately post-exercise for contrast therapy (Class II), cooling therapy and cryostimulation (Class IV); 24 h: massage therapy (Class III) and cooling therapy, contrast therapy, electrical stimulation, cryostimulation, phototherapy, heat therapy (Class IV); 48 h: compression, contrast therapy, kinesiotaping and cryostimulation (Class III) and cooling therapy, massage, phototherapy, heat therapy (Class IV); 72 h: kinesiotaping (Class III) and contrast therapy, cooling therapy, massage, phototherapy, vibration (Class IV); 96 h: compression, phototherapy, and contrast therapy (Class IV). The effect sizes (Hedges’ g) ranged from 0.36 (95% confidence interval 0.46, 3.18) for cooling therapy to 1.82 (95% confidence interval 0.46, 3.18) for heat therapy indicating small and large effects, respectively. Conclusions: There is a large body of evidence from predominantly low-quality systematic reviews of randomised controlled trials evaluating the effectiveness of physiotherapeutic treatments for delayed-onset muscle soreness. There is some strong evidence to support the effectiveness of cooling therapy, cryostimulation, contrast therapy, massage, phototherapy and kinesiotaping at various follow-up intervals, whereas evidence for stretching, exercises and electrical stimulation is weak. Uncertainties, heterogeneity and weaknesses of the available evidence partially limit the applicability and generalisability of the findings. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Efficacy of conservative treatment strategies for partial distal biceps tendon ruptures. A case-control study. Jansen, et al. (2025) Level of Evidence : 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Partial distal biceps tears - Management approaches This retrospective study assessed the effectiveness of conservative treatments for partial distal biceps tendon tears, comparing three approaches: wait-and-see, physiotherapy, and injection therapy. Over five years, a total of 78 participants (26 in each group) were included to assess treatment outcomes. The overall success rate across all methods was 47%, with no significant differences between the treatments at 3 and 6 months. Injection therapy yielded the fastest results when successful, but there were no meaningful distinctions in outcomes among the approaches. Importantly, conservative management did not appear to impair surgical outcomes for patients who eventually required surgery after failed nonoperative treatment. The study also found no progression of partial tears to complete ruptures regardless of treatment. Keep in mind that this was a small study without randomisation. Results at six months for each intervention. 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, for a partial distal biceps tendon tear, wait-and-see, physiotherapy, and injection therapy present with an overall 50% success rate across, without differences amongst treatments. Injection therapy showed potential for quicker results when effective, yet no significant differences were noted with other treatment approaches. If you want to know more about conservative management for distal biceps tendinopathy, have a look at this synopsis . Keep in mind that if conservative treatment fails, surgical options have a an overall positive outcome for distal biceps tears . URL : https://doi.org/10.1016/j.jse.2025.04.017 Abstract Background: Partial distal biceps tendon tears (PDBTs) are uncommon injuries that present with a range of symptoms, from mild pain to significant weakness. The optimal treatment approach for PDBTs remains debated, with a lack of consensus regarding the most effective nonoperative strategies. This study compares three nonoperative treatments: wait-and-see, physiotherapy, and injection therapy, to determine their efficacy and identify factors influencing treatment outcomes. Materials and methods: This retrospective study included 78 patients diagnosed with partial distal biceps tears from January 2017 to December 2024. Diagnosis was confirmed through clinical examination and magnetic resonance imaging. Patients were treated with one of three nonoperative strategies: a wait-and-see approach, standardized physiotherapy, or ultrasound-guided injection therapy. Functional and clinical assessments, including the Mayo Elbow Performance Score and visual analog scale for pain, were conducted at 3- and 6-months post-treatment. Results: The overall success rate for nonoperative treatment at 6 months was 47%, with no significant difference between the treatment groups (injection 50%, physiotherapy 46%, wait-and-see 46%). Injection therapy resulted in the fastest symptom relief, with most patients reporting improvement within one week. No patients progressed to complete ruptures, and those requiring surgery after treatment failure achieved full resolution. Multivariable analysis showed no significant impact of factors like inflammatory disease, diabetes, profession, smoking, grading of the tear and lesion origin (trauma vs. attrition) on treatment outcomes. Conclusion: Nonoperative treatment for PDBTs, including injection therapy, physiotherapy, and a wait-and-see approach, yields moderate success rates. Injection therapy offers the quickest relief with no detrimental effects. Surgery remains an effective option for treatment failures. 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 hand arm vibration syndrome in mine workers of khewra salt mines. Tanveer, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Aetiologic/Preventative Topic : Hand vibration - Vascular effect This cross-sectional study assessed the prevalence of Hand Arm Vibration Syndrome (HAVS) among mine workers at the Khewara Salt Mines in Pakistan. This pathology (HAVS) presents with hand discoloration, tingling sensation in upper extremities, and reduced grip strength. A total of 140 mine workers were included in the study. The results indicated that HAVS prevalence was higher in the dominant hand, suggesting increased vulnerability due to prolonged vibration exposure. The study emphasised the need for targeted clinical interventions and workplace policies to mitigate vibration exposure and enhance occupational health. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, Hand Arm Vibration Syndrome (HAVS) is associated with hand discoloration, tingling sensation, and reduced grip strength in the affected upper limb. It is likely that workplace policies aimed at reducing vibration exposure through ergonomics, education, and the use of protective equipment are they key. In addition, providing sufficient recovery periods is likely helpful in works exposed to intense vibrations. If you are interested in other vascular presentations of the hand and upper limb, have a look at the whole database . URL : https://doi.org/10.1016/j.jht.2024.11.002 Abstract Background: Hand-arm Vibration Syndrome (HAVS) is a disorder caused by prolonged exposure to hand-held vibrating instruments, commonly observed in industrial contexts such as mining, construction, and manufacturing. It involves symptoms affecting the musculoskeletal, neurological, and vascular systems of the arm and hand. Purpose: The main aim of this study is to determine the prevalence of HAVS among laborers working in the Khewra salt mines. Study Design: This study utilized a cross-sectional observational design. Methods: A total of 140 drill machine operators from the Khewra salts mines were selected through purposive sampling. Handgrip strength was assessed using the Camry-EH101 hand dynamometer and the data was collected through structured questionnaire focusing on neurological, vascular and musculoskeletal symptoms. The prevalence of HAVS was determined from the collected data and the severity of symptoms was as analyzed across different age groups and working conditions. Results: Out of the participants, n = 121 (86.4%) were found to be right-hand dominant, with average grip strength of 40.9 ± 3.1 kg, while n = 19 (13.6%) were left hand dominant, with average grip strength of 45.9 ± 2.6 kg. Compared to normative data, right-hand dominant workers showed a 15% reduction in grip strength, while left-hand dominant workers showed a 5% decreased. The most common reported neurological symptoms included prolonged hand vibration (52.9%), tingling sensation (60%) and numbness (46.4%). Vascular symptoms included discoloration of fingers (50%), felling cold (48.6%) and needle like sensations (45.7%). Musculoskeletal symptoms included reduced grip strength (51.4%), hand discomfort (46.4%) and hand cramping, tiredness or itching (46.4%). Conclusion: The high prevalence of HAVS among miners emphasizes the importance of targeted clinical interventions and workplace policies modifications to reduce vibration exposure and improve occupational health. 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

Changes in distal radioulnar joint stability with metaphyseal versus diaphyseal ulnar shortening osteotomies: A biomechanical investigation. Doermann, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Ulnar shortening osteotomy - Most DRUJ stability This cadaver study assessed the effects of different ulnar shortening osteotomy techniques on distal radioulnar joint (DRUJ) stability in the treatment of ulnar impaction syndrome. In particular, the study compared diaphyseal and metaphyseal osteotomies, focusing on their impact on DRUJ stability. A total of 12 cadavers were included and either underwent metaphyseal (n=6) or diaphyseal (n=6) osteotomy. The results showed that both techniques effectively reduce ulnar impaction, however, diaphyseal ulnar shortening osteotomy was associated with greater DRUJ stability compared to metaphyseal shortening. 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, diaphyseal or metaphyseal ulnar shortening osteotomy techniques reduce ulnar impaction at the wrist. However, metaphyseal osteotomies increase DRUJ laxity compared to diaphyseal approaches. If you are interested in the topic, have a look at other synopses on how to test for DRUJ laxity , whether we may be able to increase DRUJ stability conservatively , or whether the ulnar styloid requires repairing after distal radius fracture , the effect of widget splinting , and others . URL : https://doi.org/10.1016/j.jhsa.2025.03.015 Abstract Purpose: Diaphyseal ulnar shortening osteotomy (DUSO) is the gold standard operative treatment to address positive ulnar variance in the setting of ulnocarpal impaction syndrome. However, an alternative technique, the distal metaphyseal ulnar shortening osteotomy (DMUSO), has been described with good initial results. Previous biomechanical investigations have shown increased stiffness of the distal radioulnar (DRU) joint after DUSO, but the effect of DMUSO on DRU joint stiffness has not been studied. The primary aim of the study was to compare DRU joint motion after DMUSO compared to DUSO. The hypothesis was that there is no difference in stiffness of the DRU joint after DMUSO compared to DUSO. Methods: Twelve fresh frozen cadaveric specimens were used; six underwent DUSO, and six underwent DMUSO. A custom jig was designed and used to apply a volar and dorsal force to the distal ulnar shaft while stabilizing the carpus. Each specimen was tested before and after osteotomy in neutral rotation, 60° of forearm pronation, and 60° of forearm supination. DRU joint translation and stiffness were then compared between DUSO and DMUSO. Results:In neutral forearm rotation, there was a significant decrease in translation of the ulna after DUSO compared to DMUSO in both volar and dorsal directions. In supination, there was a significant decrease in translation of the ulna with a volar force after DUSO compared to DMUSO. No significant differences were seen in pronation. Conclusions: The results demonstrate that compared to DUSO, the DRU joints has more translation after DMUSO with the forearm in neutral and supination. Clinical relevance: The authors recommend consideration of using a DUSO if there is preoperative DRU joint laxity and, alternatively, a DMUSO if no instability exists. More studies may be helpful comparing the techniques, including in vivo 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

Predicting surgical versus nonsurgical management of acute isolated distal radius fractures in patients under age 60 using a convolutional neural network. Hsu, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : AI - Distal radius fracture diagnosis This study explores the application of artificial intelligence (AI) and machine learning in the diagnosis, management, and monitoring of distal radius fractures. It highlights advancements in AI-driven diagnostic tools that improve accuracy and speed in identifying fractures from imaging data, including X-rays and CT scans. The research also delves into predictive models using clinical registry data to forecast treatment outcomes and complications, enabling personalised care strategies. The study underscores the potential of AI to enhance diagnostic precision, streamline treatment decisions, and improve patient outcomes in orthopedic care. 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, it is possible that in the future, AI-driven tools will improve the accuracy and speed of diagnosing fractures requiring conservative or surgical management based on X-rays and CT scans. If you are interested in other uses of AI and machine learning in the field of hand therapy, have a look at the entire database . URL : https://doi.org/10.1016/j.jhsa.2025.04.015 Abstract Purpose: Distal radius fractures (DRFs) represent up to 20% of the fractures in the emergency department. Delays to surgery of more than 14 days are associated with poorer functional outcomes and increased health care utilization/costs. At our institution, the average time to surgery is more than 19 days because of the separation of surgical and nonsurgical care pathways and a lengthy referral process. To address this challenge, we aimed to create a convolutional neural network (CNN) capable of automating DRF x-ray analysis and triaging. We hypothesize that this model will accurately predict whether an acute isolated DRF fracture in a patient under the age of 60 years will be treated surgically or nonsurgically at our institution based on the radiographic input. Methods: We included 163 patients under the age of 60 years who presented to the emergency department between 2018 and 2023 with an acute isolated DRF and who were referred for clinical follow-up. Radiographs taken within 4 weeks of injury were collected in posterior-anterior and lateral views and then preprocessed for model training. The surgeons’ decision to treat surgically or nonsurgically at our institution was the reference standard for assessing the model prediction accuracy. Results: We included 723 radiographic posterior-anterior and lateral pairs (385 surgical and 338 nonsurgical) for model training. The best-performing model (seven CNN layers, one fully connected layer, an image input size of 256 × 256 pixels, and a 1.5× weighting for volarly displaced fractures) achieved 88% accuracy and 100% sensitivity. Values for true positive (100%), true negative (72.7%), false positive (27.3%), and false negative (0%) were calculated. Conclusions: After training based on institution-specific indications, a CNN-based algorithm can predict with 88% accuracy whether treatment of an acute isolated DRF in a patient under the age of 60 years will be treated surgically or nonsurgically. Clinical relevance: By promptly identifying patients who would benefit from expedited surgical treatment pathways, this model can reduce times for referral. 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

Education matters when it comes to pain: A cross-sectional study of self-reported pain competencies among physiotherapists. Hoegh, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Education - Pain management knowledge This cross sectional study assessed the effect of postgraduate studies on pain management knowledge, and critical thinking in healthcare professionals. A total of 369 physiotherapists completed the survey shared by the researchers. The results showed that educational level (Bachelor, Postgraduate, Advanced degrees) had the highest effect in determining physiotherapists pain mechanism and management knowledge. Experience had a smaller effect. The authors underscores the value of advanced degrees, like master’s programs, in fostering critical thinking and clinical competencies. Results from the post-hoc analysis with Bonferroni correction displaying the Interaction between the effects of education level and clinical experience on pain knowledge. PT-group have no formal education beyond the undergraduate physiotherapy-degree, PT+ have either clinical certificates or diplomas and PT++ have or are currently studying at MSc-level degree. Legend: EDPPQ-score refers to the total raw score, ) significantly higher than PT+, *) significantly higher than PT and PT+ 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, well-structured educational interventions enhance healthcare professionals' skills and patient outcomes. Further study and advance degrees appear to be essential for improving clinical decision-making, and an evidence based practice that ensures the application of most current and reliable evidence to patient care. This is relevant to hand therapists too and has been highlighted in previous research . URL : https://doi.org/10.1016/j.msksp.2025.103363 Abstract The increasing burden of chronic pain raises demands for improved competencies for physiotherapists. Research suggests that postgraduate training and improved prelicensure pain curriculum might enhance physiotherapists skills in the management of people with chronic pain. The aim of this cross-sectional study was to determine self-reported pain competences among physiotherapists, and to look for potential impact of experience and education. Competencies were evaluated using an online questionnaire based on The European Diploma in Pain Physiotherapy curriculum (EDPP) using the approach of Bloom's taxonomy. Questions reflected all sections of the curriculum for the EDPP. Total score of the EDPP-questionnaire was used as the primary outcome. Responses were grouped by years of professional experience (<2, 2–7, >7 years) and level of education (entry-level, professional courses, MSc-level or higher). The validity of the hypothesis was analyzed using a two-factor ANOVA. 369 physiotherapists were eligible for analysis. A large main effect of education was found, ω 2  = 0.149 (95 % CI: 0.085–0.215), p < 0.001. Additionally, a small, but significant main effect of experience was found as well, ω 2  = 0.018 (95 % CI: 0.00–0.050), p = 0.008. We conclude that physiotherapists with post-graduate education are more likely to report higher levels of pain competencies, independently of how long they have worked as physiotherapists. We speculate that this may relate to their scholarly achievements, e.g., critical thinking skills, rather than more pain education alone. 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