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Symptoms of depression and catastrophic thinking attenuate the relationship of pain intensity and magnitude of incapability with fracture severity. Al Salman, A., et al. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 👍 (4/4 thumbs up) Type of study : Symptoms prevalence study Topic : Upper limb fractures pain intensity - Mediating factors This is a retrospective study assessing the effect of pain catastrophising/depression on pain severity in upper limb fractures. A total of 731 participants were included. These participants presented with distal radius fractures, elbow fractures, and humerus fractures, which were classified as being mild, moderate, and severe based on radiological findings. Pain intensity was assessed in the early and late recovery through a 0 to 10 visual analogue scale. Pain catastrophising and depression were measured through patient-reported outcome measures. The results showed that pain catastrophising or depression moderated 1% of the association between fracture severity and pain. However, when people with high pain catastrophising/depression were compared to people with low levels of mental health distress, there was a clinically meaningful difference in pain (more than 2 points out of 10) given the same fracture severity (see figure). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, given the same upper limb fracture severity, the presence of depression/pain catastrophising can lead to clinically significant increases in pain intensity. This is consistent with previous evidence from a different group of upper limb researchers . It is possible that considering these factors in the rehabilitation of our clients with hand and upper limb conditions will improve their outcomes. URL : https://doi.org/10.1016/j.jpsychores.2022.110915 Abstract Objective: The relative association of pain intensity and magnitude of incapability with pathophysiology, accounting for psychological factors, is incompletely understood. Using moderation analysis, we assessed the association of pain intensity and magnitude of incapability (dependent variables) with fracture severity (independent variable) and the influence of symptoms of depression and catastrophic thinking (moderators) at early and later stages of recovery. Methods: A cohort of 731 patients recovering from a shoulder, elbow, or wrist fracture, completed self-reported measures of pain intensity, upper extremity capability, symptoms of depression, and catastrophic thinking between 2 and 4 weeks after injury and again between 6 and 9 months after injury. Fracture severity was rated by clinicians, and we used multivariable regression analysis to examine interaction effects of fracture severity, depression, catastrophic thinking, pain intensity, and magnitude of incapability at early and later stages of recovery. Results: Symptoms of depression and catastrophic thinking attenuate the relationship between pain intensity and fracture severity at earlier and later stages of recovery. Symptoms of depression and catastrophic thinking also attenuate the relationship between the magnitude of incapability and fracture severity, but only at early stages of recovery. Conclusion: The relative divergence of pain intensity and magnitude of incapability from the level of fracture severity due to the moderating effects of unhelpful thinking and distress, signals a benefit to anticipating mental health opportunities during recovery after fracture. Fracture management can incorporate measures of unhelpful thinking and symptoms of distress to better address these opportunities and ensure comprehensive optimization of 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

Elbow dislocations: A review ranging from soft tissue injuries to complex elbow fracture dislocations. Englert, C., Zellner, J., Koller, M., Nerlich, M. and Lenich, A. (2013) Level of Evidence : 5 Follow recommendation : 👍 (1/4 Thumbs up) Type of study : Diagnostic Topic : Elbow dislocation - Classification This is an expert opinion on the diagnosis and treatment of elbow dislocations. What the authors suggest is to classify elbow dislocations as simple and complex. Simple elbow dislocations may be associated with small fractures and can be reduced without anaesthesia. These injuries are usually stable and a splint limiting extension/flexion is usually advisable for a short period of time. Complex dislocations often cannot be reduced without anaesthesia and are often associated with larger displaced fractures, which require surgical interventions. The common complications of elbow dislocations include chronic instability/stiffness, and heterotopic ossification. 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, elbow dislocations may be classified as simple or complex according to the size/displacement of the fracture and the stability through range after reduction. Gross neurovascular function assessment and x-ray investigations are often required. If you are uncertain whether an x-ray is required, you can perform the elbow extension test . For the rehabilitation of simple dislocations, have a look at this other synopsis . URL : https://doi.org/10.1155/2013/951397 Abstract This review on elbow dislocations describes ligament and bone injuries as well as the typical injury mechanisms and the main classifications of elbow dislocations. Current treatment concepts of simple, that is, stable, or complex unstable elbow dislocations are outlined by means of case reports. Special emphasis is put on injuries to the medial ulnar collateral ligament (MUCL) and on posttraumatic elbow stiffness. 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

Elbow biomechanics: Soft tissue stabilizers. Kaufmann, R. A. M. D., Wilps, T. B. S., Musahl, V. M. D. and Debski, R. E. P. (2020) Level of Evidence : 5 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Anatomical Topic : Elbow ligaments - Biomechanics This is a narrative review on passive elbow structures contributing to valgus and varus joint stability. The authors report that valgus flexibility at the elbow is greatest at 30° of flexion and that the medial ulnar collateral ligament (MUCL) resists these valgus forces. The MUCL is divided into anterior and posterior bundles, with the anterior bundle being the main source of valgus stability. The MUCL (anterior bundle) tightens incrementally with elbow flexion, reaching the highest tension at 80° of elbow flexion. The lateral collateral ligaments of the elbow control varus forces and they include the lateral ulnar collateral ligament (LUCL) and the radial collateral ligament (RCL). The stabilisation role of these ligaments is debated, however, it is believed that both control varus forces and are important in the postero-lateral rotatory stability of the elbow. 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, valgus stress test of the elbow (30° of flexion) is restrained by the anterior bundle of the MUCL. Injury to the lateral collateral ligaments can be assessed through varus stress testing. Simple elbow dislocations may involve injury to a limited number of ligaments whilst complex dislocations are likely to injure multiple ligaments as well as the capsule. Have a look at these synopses for more info on the treatment and classification of elbow dislocations. URL : http://dx.doi.org/10.1016/j.jhsa.2019.10.034 Abstract The elbow positions the hand in a stable manner relative to the trunk while allowing flexion and extension as well as forearm rotation at varying shoulder positions. Its ability to perform this task without joint subluxation is accomplished through a combination of bony congruency, ligamentous restraint, and dynamic stabilization. Elbow stability is challenged repeatedly during everyday activities, particularly when the arm is abducted. Traumatic injuries that lead to an elbow dislocation or the microtrauma associated with pitching are frequent situations that destabilize the elbow. This article reviews the soft tissue stabilizers that contribute to elbow kinematics and stability. 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 functional mobilization for non-operative treatment of simple elbow dislocations: A systematic review. Catapano, M., Pupic, N., Multani, I., Wasserstein, D. and Henry, P. (2022) Level of Evidence : 2a Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : Simple elbow dislocation - Rehabilitation This is a systematic review assessing the best rehabilitation interventions for simple elbow dislocations. Simple elbow dislocations were characterised by stability through range after reduction associated or not with small fractures. A total of 15 studies were included in the review. Of these, three studies were randomised controlled studies. The two interventions most commonly utilised were either Plaster of Paris (PoP) for 21 days or early mobilisation with the intermittent use of an elbow splint. The studies adopting an early mobilisation approach performed forearm pronation/supination as well as elbow flexion/extension through a comfortable range. Most commonly, exercises were performed supine with the shoulder at 90° of flexion. In the early mobilisation group, a posterior elbow splint was utilised for three weeks and removed to perform exercises. The results showed that early mobilisation was associated with earlier return to work, reduced elbow stiffness, higher pain, and a lower likelihood of heterotopic ossification in the short term compared to 21 days of PoP cast. At one year, there was no difference between the early motion compared to PoP cast groups. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, simple elbow dislocations treated with early mobilisation appear to have better outcomes compared to PoP immobilisation for three weeks. There may be higher levels of pain in the short term but it appears that the benefit may outweigh this inconvenience. The treatment of complex elbow dislocations should follow surgeons' advice as these often need surgical management. URL : https://doi.org/10.1177/1758573220957631 Abstract Purpose: This systematic review aims to elucidate a non-operative rehabilitation program that optimizes recovery based on published approaches and outcomes. Methods: Searches of four databases from inception to 1 January 2020 were performed to identify clinical studies addressing the non-operative management of simple elbow dislocations. Results: Of 2435 studies that were eligible for title screen, 15 studies satisfied inclusion criteria. Three randomized control studies demonstrated that early mobilization expedited the return of range of motion, function and return to work or activities, however, resulted in increased pain within the six-week rehabilitation period compared to Plaster of Paris casting for 21 days. Patients returned to work sooner after early mobilization (10 vs. 18 days; p = 0.02) compared to Plaster of Paris casting. In all studies, early mobilization resulted in similar re-dislocation rates of 1.3% (3/237) versus 2.2% (12/549) in those with Plaster of Paris casting as well as lower incidence of heterotopic ossification (36% vs. 54%). No significant differences between rehabilitation protocols were determined; however, the large majority of recent papers utilized rehabilitation protocols. Conclusion: Early mobilization of simple elbow dislocations results in early return of Range-of-Motion, function and return to work with no increase in complication rates; however, increased pain during the rehabilitation period. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The impact of psychological factors on outcome after salvage surgery for wrist osteoarthritis. Swärd, E. M., Brodda-Jansen, G., Schriever, T. U., Andersson-Franko, M. and Wilcke, M. K. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Salvage surgery for wrist osteoarthritis - The role of pain catastrophising This is a retrospective study assessing the association between psychological variables and disability in participants undergoing salvage surgery for wrist osteoarthritis (OA). A total of 79 participants with wrist OA were included in the study. Psychological variables included pain catastrophising, anxiety, and depression. Disability was measured through the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire at 6 and 12 months post surgery. The results showed that greater pain catastrophising and anxiety were associated with worse disability after surgery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, pain catastrophising and anxiety are associated with recovery following salvage surgery for wrist OA. This study is in line with previous research showing that pain catastrophising explains a large proportion of pain intensity in people with thumb OA , distal radius fracture , and upper limb fractures . Open access URL : https://doi.org/10.1177/17531934221104603 Abstract This prospective longitudinal study of 80 patients analysed the effect of preoperative pain catastrophizing, anxiety, depression and sense of coherence on the Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation, quality of life, grip strength and range of motion during the first year after salvage surgery for wrist osteoarthritis. Generalized estimating equations were used to analyse the effect of the psychological factors on the outcome variables. Pain catastrophizing or a tendency for anxiety preoperatively had a strong negative impact on postoperative Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation. Anxiety also predicted a lower postoperative quality of life, whereas pain catastrophizing had a negative impact on grip strength. Sense of coherence did not influence the outcome. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Catastrophic thinking is associated with finger stiffness after distal radius fracture surgery. Teunis, T., Bot, A. G., Thornton, E. R. and Ring, D. (2015) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Finger stiffness post distal radius fracture - The effect of catastrophising This is a retrospective study assessing the association between several variables and finger stiffness following open reduction internal fixation for distal radius fracture. A total of 96 participants were included in the study. Demographic characteristics, fracture severity and psychological variables (e.g. pain catastrophising) were measured at baseline and utilised to predict finger stiffness (distance to palmar crease across four fingers) at six weeks. The results showed that greater pain catastrophising was associated with worse finger stiffness at six weeks. In particular, for every 10 points increase in catastrophising, there is a 1 cm increase (for each finger) in distance to palmar crease (see figure below). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, pain catastrophising at baseline predicts finger stiffness at six weeks after distal radius fracture open reduction internal fixation. This study contributes to the growing amount of evidence showing that pain catastrophising negatively affects recovery in upper limb conditions and upper limb function . URL : https://doi.org/10.1097/bot.0000000000000342 Abstract Objectives: To identify demographic, injury-related, or psychologic factors associated with finger stiffness at suture removal and 6 weeks after distal radius fracture surgery. We hypothesize that there are no factors associated with distance to palmar crease at suture removal. Design: Prospective cohort study. Setting: Level I Academic Urban Trauma Center. Patients: One hundred sixteen adult patients underwent open reduction and internal fixation of their distal radius fractures; 96 of whom were also available 6 weeks after surgery. Intervention: None. Main outcome measurements: At suture removal, we recorded patients' demographics, AO fracture type, carpal tunnel release at the time of surgery, pain catastrophizing scale, Whiteley Index, Patient Health Questionnaire-9, and disabilities of the arm, shoulder, and hand questionnaire, 11-point ordinal measure of pain intensity, distance to palmar crease, and active flexion of the thumb through the small finger. At 6 weeks after surgery, we measured motion, disabilities of the arm, shoulder, and hand, and pain intensity. Prereduction and postsurgery radiographic fracture characteristics were assessed. Results: Female sex, being married, specific surgeons, carpal tunnel release, AO type C fractures, and greater catastrophic thinking were associated with increased distance to palmar crease at suture removal. At 6 weeks, greater catastrophic thinking was the only factor associated with increased distance to palmar crease. Conclusions: Catastrophic thinking was a consistent and major determinant of finger stiffness at suture removal and 6 weeks after injury. Future research should assess if treatments that ameliorate catastrophic thinking can facilitate recovery of finger motion after operative treatment of a distal radius fracture. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The impact of smoking on delayed osseous union after arthrodesis procedures in the hand and wrist. Foster, B. K., et al. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Prognostic Topic : Hand arthrodesis – Smoking and non-union This is a retrospective study assessing the effect of smoking on non-union following upper limb arthrodesis. A total of 306 participants were included in the study. Of these, 73 (24%) were smokers. Participants were included if they underwent arthrodesis of wrist/carpometacarpal/metacarpalphalangeal/interphalangeal surgery. Non-union was assessed radiographically at 3 months. Symptomatic non-union was defined as the need for further surgery to correct the non-union. The statistical analyses took into account demographic, comorbidity, and affected joints information to reduce the contribution of confounding factors to the overall results. The results showed that smoking and non-smoking participants presented non-union rates of 27% and 14% of cases respectively. Symptomatic non union was present in 15% and 6% of smokers and non-smokers respectively. Overall, smokers had twice the odds of having non-union or symptomatic non-union compared to non-smokers. One limitation of this study was that there is no information regarding the blinding of the assessors determining union/non-union on x-rays. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, smoking increases the risk of lateral epicondylalgia , post-surgical infections , arthrodesis non-union, and other complications (e.g. re-operation) following distal radius fracture . We should always offer our clients advice to quit smoking . URL : https://doi.org/10.1016/j.jhsa.2022.05.016 Abstract Purpose: The purpose of this study was to evaluate the relationship between smoking and delayed radiographic union after hand and wrist arthrodesis procedures. We hypothesized that smoking would be associated with a higher rate of delayed union. Methods: All cases of hand or wrist arthrodesis procedures in patients aged ≥18 years from 2006 to 2020 were identified. Cases were included if they had >90 days of radiographic follow-up or evidence of union before 90 days. Baseline demographics were recorded for each case including smoking status at the time of surgery. Complications were recorded and all postoperative radiographs were reviewed to assess for evidence of delayed union (defined as lack of osseous union by 90 days after surgery). We compared active smokers and nonsmokers and performed a logistic regression analysis to estimate the odds of experiencing a delayed radiographic union. Results: A total of 309 arthrodesis cases were included and 24% were active smokers. Overall, radiographic evidence of a delayed union was found in 17% of cases. Smokers were significantly more likely to have a delayed union compared with nonsmokers (27% vs 14%). Results of the adjusted logistic regression analysis demonstrated that there was a significantly increased odds of experiencing a delayed union for patients who were active smokers compared with nonsmokers (odds ratio, 2.20; 95% confidence interval, 1.09–4.43). In addition, the rate of symptomatic nonunion requiring reoperation was higher in smokers (15%) compared with nonsmokers (6%). Conclusions: Smoking was associated with increased odds of delayed radiographic union in patients undergoing hand and wrist arthrodesis procedures. Patients should be counseled appropriately on the risks of smoking on bone healing and encouraged to abstain from nicotine use in the perioperative period. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Blood flow restriction resistance training in tendon rehabilitation: A scoping review on intervention parameters, physiological effects, and outcomes. Burton, I. and McCormack, A. (2022) Level of Evidence : 5 Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Blood flow restriction training - Tendinopathies This is a scoping review of studies implementing blood flow restriction (BFR) training in participants with tendinopathies and healthy tendons. A total of 13 studies were included, 10 were completed in people with healthy tendons whilst three in people with tendinopathy. Blood flow restriction was compared to high-intensity resistance training. The interventions were targeted at the upper limb or lower limb. The results showed that both BFR and high-intensity training were useful in providing positive changes within healthy tendons. When BFR training was applied to people with tendinopathy, this induced improvements in muscle strength, function, and pain. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, BFR induces positive changes in healthy tendons to a similar extent to what traditional high-intensity training provides. This form of low-load resistance training can be implemented in those people with irritable tendinopathies who cannot cope with high levels of exercise intensity. In addition to this scoping review, there is some initial evidence that BFR can be utilised in people with tennis elbow and it appears to provide better outcomes in terms of functional recovery compared to the same exercises without BFR. URL : https://doi.org/10.3389/fspor.2022.879860 Abstract Objective: To identify current evidence on blood flow restriction training (BFRT) in tendon injuries and healthy tendons, evaluating physiological tendon effects, intervention parameters, and outcomes. Methods: This scoping review was reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Databases searched included MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, Cochrane library (Controlled trials, Systematic reviews), and five trial registries. Two independent reviewers screened studies at title/abstract and full text. Following screening, data was extracted and charted, and presented as figures and tables alongside a narrative synthesis. Any study design conducted on adults, investigating the effects of BFRT on healthy tendons or tendon pathology were included. Data were extracted on physiological tendon effects, intervention parameters and outcomes with BFRT. Results: Thirteen studies were included, three on tendinopathy, two on tendon ruptures, and eight on healthy Achilles, patellar, and supraspinatus tendons. A variety of outcomes were assessed, including pain, function, strength, and tendon morphological and mechanical properties, particularly changes in tendon thickness. BFRT intervention parameters were heterogeneously prescribed. Conclusion: Despite a dearth of studies to date on the effects of BFRT on healthy tendons and in tendon pathologies, preliminary evidence for beneficial effects of BFRT on tendons and clinical outcomes is encouraging. As BFRT is a relatively novel method, definitive conclusions, and recommendations on BFRT in tendon rehabilitation cannot be made at present, which should be addressed in future research, due to the potential therapeutic benefits highlighted in this review. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Low-load resistance training with blood flow restriction is effective for managing lateral elbow tendinopathy: A randomized, sham-controlled trial. Karanasios, S., et al. (2022) Level of Evidence : 1b- Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : Blood flow restriction training - Tennis elbow This is a randomised single-blind controlled trial assessing the effectiveness of blood flow restriction (BFR) training in people with tennis elbow. Participants (N = 46) were middle-aged (mean range: 43-47 years old) and had been having pain for 6 weeks (median). Tennis elbow diagnosis was made based on the presence of pain at the lateral epicondyle, positive Mill's and/or Cozen's and/or Maudsley's test. Participants were excluded if they had a history of upper limb pathology, blood clot, cardiovascular disease, cancer, or hypertension (systolic/diastolic 140/90 mmHg). A series of exercises were delivered over the course of six weeks and included, but were not limited to, wrist extension/flexion. Exercises were performed with either BFR (50% of arterial occlusion) or with sham BFR (less than 20% of arterial occlusion). Participants attended two sessions per week. Primary outcomes included pain, function, pain-free grip strength, and the global rate of change (from much worse to completely recovered). The results showed that pain, function, and pain-free grip strength improved to a statistically significant larger extent in the BFR group compared to the sham BFR. Only function and pain-free grip strength improved to a clinically relevant level. In addition, 80% of participants reported being at least "much better" in the BFR compared to 50% in the sham BFR. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, low-load BFR exercises provide greater improvements compared to low-load exercises without BFR. BFR training leads to clinically relevant improvements in function and pain-free grip strength. BFR may be particularly appropriate in those people with high levels of pain intensity or irritability. If you would like to deliver BFR to your clients, you may be interested in using the BFR pressure calculator that I have created! URL : https://doi.org/10.2519/jospt.2022.11211 Abstract Objective: To evaluate the effect of low-load resistance training with blood flow restriction (LLRT-BFR) when compared to LLRT with sham-BFR in patients with lateral elbow tendinopathy (LET). Design: Randomized controlled trial Methods: Forty-six patients with LET were randomly assigned to a LLRT-BFR or a LLRT with sham-BFR treatment group. All patients received soft tissue massage, supervised exercises with BFR or sham-intervention (twice a week for six weeks), advice and a home exercise programme. The primary outcome measures were pain intensity, patient-rated tennis elbow evaluation (PRTEE) score, pain-free grip strength (PFGS) and global rating of change (GROC), measured at baseline, 6 weeks, and 12 weeks. Between-group differences were evaluated using mixed-effects models with participant-specific random effects for continuous data. GROC was analysed using logistic regression. Results: Statistically significant between-group differences were found in favor of LLRT-BFR compared to LLRT with sham-BFR in pain intensity at 12-weeks (-1.54, 95%CI:-2.89 to -0.18; p=0.026), PFGS ratio at 6-weeks (0.20, 95%CI:0.06 to 0.34; p=0.005) and PRTEE at 6- and 12-weeks (-11.92, 95%CI:-20.26 to -3.59; p=0.006 and -15.23, 95%CI:-23.57 to -6.9; p<0.001, respectively) follow-up. At 6- and 12-weeks, patients in the LLRT-BFR group had greater odds of reporting complete recovery or significant improvement (OR=6.0, OR=4.09, respectively). Conclusion: LLRT-BFR produced significantly better results compared to the LLRT with sham-BFR for all primary outcomes. Considering the clinically significant between-group improvement in function (>11 points in PRTEE) and the better success rates in the LLRT-BFR group, this intervention may improve recovery in LET. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Upper-extremity blood flow restriction: The proximal, distal, and contralateral effects. A randomized controlled trial. Bowman, E., Elshaar, R., Milligan, H., Jue, G., Mohr, K., Brown, P., Watanabe, D., & Limpisvasti, O. (2020) Level of Evidence : 1b- Follow recommendation : 👍 👍 👍 👍 (4/4 Thumbs up) Type of study : Therapeutic Topic : Resistance training - Blood flow restriction training This is a randomised single-blind controlled trial assessing the effectiveness of blood flow restriction (BFR) training on grip strength and forearm circumference in healthy participants. Participants (N = 24) were young (26±3.4 years old) recreational athletes. Participants were excluded if they had a history of upper limb pathology, blood clot, cardiovascular disease, or hypertension (systolic/diastolic 140/90 mmHg). Grip strength was measured through a hand held dynamometer and forearm circumference was measured through a standard measuring tape 10 cm distal to medial epicondyle. Treatment allocation was randomised and the assessor was blinded to treatment allocation. Participants were provided with either low intensity BFR training (n = 14) or low intensity training (n = 10). Participants trained twice a week for six weeks in both groups. During each session participants performed shoulder external rotation in side lying, prone shoulder horizontal abduction, triceps extensions in supine, shoulder internal rotation in standing with a pulley, and biceps curls in forearm supination. At each session, 4 sets of 30, 15, 15, 15 repetitions were completed for each exercise. An interset rest of 30 seconds was provided. Participants started to exercise at an intensity of 30% of 1-repetition maximum identified at baseline. The training weight was modified at each session to maintain the rate of perceived exertion (RPE) at 7-8/10. While exercising, the BFR group wore a pressure cuff (10cm wide) inflated at 60% of arterial occlusion around their proximal arm. The pressure cuff was worn on one upper limb only, although the exercises were performed bilaterally. The cuff was inflated for the whole duration of the session. The results showed that the BFR group improved to a significant greater level in grip strength (10%±2) and forearm circumference (4.2%±0.8) compared to the control group (grip strength: -3%±3; forearm circumference: 1.4%±0.9). The authors report no differences in RPE between groups, although the overall exercise volume for both exercise groups was not reported. This would have been useful to explain the differences between the two groups. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, we may utilise BFR training when the aim of the intervention is to increase muscle strength and high exercise intensities are contraindicated. This regime appears to provide greater strength gains when compared to traditional low-intensity exercises. URL : https://doi.org/10.1016/j.jse.2020.02.003 Abstract Background: Blood flow restriction (BFR) training with low weight is purported to induce similar physiological changes to high-weight regimens with the benefit of less tissue stress. We hypothesized that low-weight training with BFR would produce increased gains in strength and hypertrophy for muscle groups proximal, distal, and contralateral to tourniquet placement compared with low-weight training alone. Methods: In this prospective, randomized controlled trial, healthy subjects were randomized into a 6-week low-weight training program either with or without BFR on 1 extremity. Outcome measures included limb circumference and strength. Comparisons were made between the BFR and non-BFR extremities, BFR and control groups, and non-BFR extremity and control groups. Results: A total of 24 subjects (14 BFR and 10 control subjects) completed the protocol. Significantly greater gains were observed in dynamometric strength both proximal (shoulder scaption [30% greater], flexion [23%], and abduction [22%]) and distal (grip strength [13%]) to the tourniquet in the BFR limb compared with both the non-BFR extremity and the control group (P < .05). Arm and forearm circumferences significantly increased in the BFR limb compared with the non-BFR limb and control group (P = .01). The non-BFR extremity demonstrated greater grip strength than the control group (9%, P < .01). No adverse events were reported. Conclusion: Low-weight BFR training provided a greater increase in strength and hypertrophy in the upper-extremity proximal and distal muscle groups compared with the control group. The non-BFR extremity showed a significant increase in grip strength compared with the control group, indicating a potential systemic effect. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Development of a prediction model to determine responders to conservative treatment in people with symptomatic hand osteoarthritis: A secondary analysis of a single-centre, randomised feasibility trial. Magni, N., Rice, D. and McNair, P. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Exercise for hand OA - Prognostic factors This is a prognostic study identifying factors that can predict response to exercise in people with symptomatic hand osteoarthritis (OA). The data utilised were part of a randomised controlled feasibility trial . A total of 59 participants with symptomatic hand OA were included. Participants were randomised to receive advice only, or advice plus either blood flow restriction training or high-intensity training. Participants were defined as responders to treatment at six weeks based on the OMERACT-OARSI criteria (a combination of pain, function, and disease burden outcome), pain (NRS), and function (i.e., FIHOA). The prediction model was moderately accurate and it included the type of treatment, expectations of treatment, and compliance with exercises. More specifically people with positive treatment expectations, who received both exercise and advice, and who had greater compliance with exercises were more likely to be responders. Future studies will need to validate this prediction model on a separate sample of people with symptomatic hand OA. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, positive expectations, the addition of resistance exercises to advice, and high compliance with the exercise program were more likely to respond to conservative treatment in hand OA. Overall it appears that resistance training is not detrimental in people with hand OA and that several factors contribute to the development of hand OA rather than just biomechanical variables . Open Access URL : https://doi.org/10.1016/j.msksp.2022.102659 Abstract Background: Conservative treatments are beneficial for people with hand osteoarthritis (OA). Objective: It was the purpose of this study to develop and internally validate both a basic model and a more complex model that could predict responders to conservative treatments in people with hand OA. Design: This was a secondary analysis of a single-centre, randomised feasibility study. Methods: Fifty-nine participants (34 responders) with hand osteoarthritis recruited from the general population. Participants were randomised to receive either advice alone, or advice in combination with blood flow restriction training (BFRT), or traditional high intensity training (HIT). Participants underwent supervised hand exercises three times per week for six weeks. The OMERACT-OARSI criteria were utilised to determine responders vs non responders to treatment at the end of six weeks. A basic logistic regression model (treatment type, expectations, adherence) and a more complex logistic regression model (basic model variables plus pain catastrophising and neuropathic pain features) were created. Discrimination ability, and calibration were assessed. Internal model validation through bootstrapping (200 repetitions) was utilised to calculate the prediction model optimism. Results The results showed that the basic model presented with acceptable discrimination (optimism corrected c-statistic: 0.72, 95% CI 0.71–0.73) and calibration (slope = 1.41; intercept = 0.68). The more complex model had better discrimination but poorer calibration. Conclusion: A prediction tool was created to provide an individualised estimate of treatment response in people with hand OA. Future studies will need to validate this model in other groups of patients. Trial registration https://www.anzctr.org.au/- ACTRN12617001270303. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

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