Search Results

A systematic review on efficacy of different types of Platelet-Rich Plasma in the management of lateral epicondylitis. Li, S., G. Yang, H. Zhang, X. Li and Y. Lu (2022) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : Lateral epicondylalgia – platelet-rich plasma injections This is a systematic review assessing the effectiveness of leukocyte-rich vs leukocyte-poor platelet-rich plasma (PRP) injections for lateral epicondylalgia. Thirty-three studies of different designs (e.g. cohort, case series) for a total of 2,420 participants were included in this paper. All the studies were assessed through a scoring system for non-randomised controlled trials. The study outcomes included pain and upper limb function (e.g. DASH). The results showed that all types of PRP improved both pain and functional outcomes without differences between leukocyte-rich vs leukocyte-poor PRP injections. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, PRP injections improve pain and function in tennis elbow independently of their formulation. The improvements that they provide are clinically significant, however, their effectiveness does not appear to be greater than placebo (saline) injections. Another intervention that appears to have a significant placebo effect for tennis elbow is surgery . Overall, tennis elbow appears to be a benign condition with a clinical resolution of symptoms at 12 months in 90% of people . URL : https://doi.org/10.1016/j.jse.2022.02.017 Abstract Background: Platelet-rich plasma (PRP) is reported as an effective treatment for lateral epicondylitis (LE). Theoretically, different types of PRP have different therapeutic effects. However, there is controversy on the effects of different types of PRP in the treatment of LE. Purpose: To systematically compare the pain relief, functional improvement and successful rates on treatment of two different types of PRP, by reviewing and summarizing the data available in the current literature on LE after PRP injection. Methods: The PubMed, Medline, Embase, Cochrane Library and Web of science were reviewed. A computerized literature search was performed for related studies published from inception to August 2021 by terms of lateral epicondylitis, tennis elbow, tendinopathy, lateral elbow pain, PRP. PRP involved in present study were divided into leukocyte-poor PRP and leukocyte-rich PRP groups according to different preparation methods. Outcomes of interest included characteristics of the subjects, types and preparations of PRP, clinical outcomes, successful rate and safety of treatment of short-term and long-term follow-up. Results: A total of 33 studies included 2420 LE patients. There were 19 studies with LP-PRP, 13 studies with LR-PRP and 1 study involved both LP-PRP and LR-PRP. Patients had significant improved clinical outcomes post-treatment compared to pre-treatment in both groups of PRP. The mean of VAS was ranged from 6.1 to 8.0 before the treatment, 1.5 to 4.0 at short-term and 0.6 to 3.3 at the long-term follow-up in LR-PRP group. The mean of VAS was ranged from 4.2 to 8.4 before the treatment, 1.6 to 5.9 at short-term and 0.7 to 2.7 in the long-term follow-up in LP-PRP group. The DASH score of LR-PRP and LP-PRP were ranged from 47.0 to 54.3 and 30.0 to 67.7 separately before the treatment and 20.0 to 22.0 and 5.5 to 19.0 separately at long-term follow-up. LR-PRP and LP-PRP groups reflected successful rate ranged from 70%-100% and 36%-100% respectively. The complication rate lower in LP-PRP group (3.9%) than LR-PRP group (6.4%), with the major complication was temporary pain after PRP treatment (P = 0.029). Conclusion: PRP treatment demonstrated a significant improvement with pain relief and functional improvement on lateral epicondylitis regardless types of PRP. There was no significant difference between LR-PRP and LP-PRP in pain relief and functional improvement. The major complication was temporary pain after PRP injection and the complication rate in LP-PRP was lower than LR-PRP. 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

Outcomes of acute versus subacute scapholunate ligament repair. Chen, R. E., R. P. Calfee, J. G. Stepan and D. A. Osei (2022) Level of Evidence : 2c Follow recommendation : 👍 👍 Type of study : Prognostic Topic : Scapholunate repair - Delayed vs prompt surgery This is a retrospective study comparing outcomes of prompt vs delayed repair of scapholunate (SCL) injuries at long term follow-up (6-7 years). A total of 24 participants who had undergone SCL repair within 6 weeks of injury (n = 12) or between 6 and 12 weeks (n =12) were included. Outcome measures included the presence of scapholunate advanced collapse (SLAC), and alignment of scaphoid and lunate on x-rays. The results showed that there was no difference in the number of SLAC lesions or alignment between scaphoid and lunate on x-ray between the two groups. Unfortunately, the sample size of this study is small and we need larger longitudinal studies to increase our confidence in these results. 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, scapholunate repair within 12 weeks of injury provides similar long term (6-7 years) results. This information may change with bigger longitudinal studies. If you would like to know more about dissociative (scapholunate/lunotriquetral instability ) and non-dissociative instability (extrinsic ligament of the wrist) , have a look at these previous synopses. Open Access URL : https://doi.org/10.1016/j.jhsg.2021.10.007 Abstract Purpose: This study investigated the long-term outcomes of direct scapholunate ligament (SLL) repairs with or without dorsal capsulodesis performed within 6 weeks (acute repair) of a SLL tear versus 6 to 12 weeks following injury (subacute repair). Methods: A review of medical records from April 1996 to April 2012 identified 24 patients who underwent SLL repair (12 acute, 12 subacute). Patients returned to the clinic for radiographic examinations of the injured wrist, standardized physical examinations, and validated questionnaires. Results: The mean follow-up times for the acute and subacute groups were 7.2 and 6.2 years, respectively. At the final examination, patients with acute surgery regained more wrist extension (acute = 55°, subacute = 47°). The total wrist flexion-extension arcs, grip strengths, pinch strengths, and patient-rated outcome scores were found to be similar between groups. The final scapholunate gap, scapholunate angle, and the prevalence of arthritis were also found to be similar between the acute and subacute groups. Conclusions: Although SLL repair is more commonly recommended for treatment of acute SLL injuries, there were no significant long-term differences between acute and subacute SLL surgeries (repair ± capsulodesis). 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

Value of ultrasound in the management of cubital tunnel syndrome with associated space-occupying lesions. Yang, F., M. Li and Y. Qiu (2020) Level of Evidence : 4 Follow recommendation : 👍 👍 Type of study : Diagnostic Topic : Cubital tunnel – Ultrasound to screen for space occupying lesions This is a non-peer reviewed restrospective study assessing the usefulness of Ultrasound imaging (US) in identifying space occupying lesions causing cubital tunnel syndrome prior to surgical release. A total of 274 participants were included in the study. Only participants with symptoms of cubital tunnel syndrome, identified clinically, were included. US testing identified a space occupying lesion in 19 participants which was confirmed during surgical exploration. Only one case was missed by US assessment and identified at the time of surgery. This suggests the incidence of space occupying lesion in 7% of people presenting with cubital tunnel syndrome (consistent with what has been previously reported in the literature, which varies between 3% to 8%). On US imaging, the presence of these lesions was identified by hypo-echoic areas (low brightness) or the presence of nerve swelling just proximal to the space invading lesion (see picture 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, US assessment may be useful for the identification of space occupying lesions responsible for cubital tunnel syndrome. These lesions are reasonably rare and you would expect to identify them in 1 client out of 10 or 1 out of 30 among those presenting with a cubital tunnel syndrome to your clinical practice. URL : https://doi.org/10.1177/1753193420943029 Available through EBSCO Health Databases for PNZ members. 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 utility of the biceps palpation-rotation test in diagnosing partial distal biceps tendon tears. Caputo, V., et al. (2022) Level of Evidence : 4 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Diagnostic Topic : Biceps tendon pathology - Physical test This is a retrospective analysis on the sensitivity and specificity of the palpation-rotation test for the diagnosis of distal biceps partial tear. If a test is very sensitive and its result is negative, you can be more certain that the patient does not have the condition. If the test is specific and its result is positive, you can be more certain that the patient has the condition. A total of 34 participants were included in the present study. The palpation-rotation test consisted in the palpation of the radius tuberosity in forearm pronation (see picture). The test was deemed positive when it caused pain. MRI was utilised as the gold standard against which the physical tests was assessed. The results showed that the BPT was 97% specific and sensitive to include or exclude the presence of a distal biceps partial tear. The study had however a small sample size and there was no variety in elbow conditions. We may therefore find a high number of false positive/negative if we were to apply it to clinical populations. 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 palpation-rotation test may be useful in palpating the insertion of the distal biceps. However, the specificity and sensitivity reported in this study need further validation. Another test, which may be useful in identifying distal biceps pathology is the biceps provocation test, which has been covered in another synopsis . URL : https://doi.org/10.1016/j.jse.2022.02.012 Abstract Background: Partial tears of the distal biceps tendon can be difficult to diagnose based on clinical examination and magnetic resonance imaging (MRI). Methods: Patients from a single surgeon’s practice from 2000-2018 with a partial distal biceps tendon tear were retrospectively reviewed to determine the utility of the distal biceps palpation rotation test in the detection of partial tears. This test is performed by palpating the bicipital tuberosity at the lateral forearm while ranging the forearm from supination to pronation with the arm adducted at the patient’s side and elbow flexed to 90 degrees. A positive test elicits tenderness at the tuberosity with the arm in pronation but not in supination. Examination findings were correlated with MRI reports confirming a partial tear. Twelve cadaveric arms were dissected to determine overall pronosupination range of motion, the degree of pronation at which the bicipital tuberosity is maximally palpable, and anatomic measurements of the bicipital tuberosity to guide optimal technique when carrying out the maneuver. Results: Ninety-nine patients were diagnosed with a partial distal biceps tendon, of which 34 had available MRI reports and complete physical examination documentation. 33/34 patients (97%) had partial tears on MRI. The hook test was negative in all cases. All patients had tenderness with resisted supination. In those with MRI-confirmed partial tears, the palpation rotation test was positive in all patients (100% sensitivity). The bicipital tuberosity was maximally palpated at the dorsolateral forearm at a mean 20 degrees of pronation, and the proximal and distal boundaries of the radial tuberosity were 2.5 cm and 5.3 cm, on average, distal to the radial head, respectively. Conclusion: A positive palpation rotation test was seen in 33/33 patients (100% sensitivity), as correlated with MRI. The combination of an intact distal biceps tendon within the antecubital fossa, tenderness on resisted supination, and a positive palpation rotation test are highly suggestive of a partial distal biceps tendon tear. 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

Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: A systematic review and meta-analysis of cohort studies. Momma, H., R. Kawakami, T. Honda and S. S. Sawada (2022) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 (4/4 thumbs up) Type of study : Preventative, Therapeutic Topic : Resistance training - All-cause mortality & Cardiovascular disease This is a systematic review and meta-analysis assessing the effect of resistance training alone or in combination with aerobic exercise in reducing all-cause mortality, cancer risk, and diabetes. Prospective studies that followed participants for at least two years and assessed their resistance training programs were included. A total of 16 studies were included. A tool for the assessment of prospective studies was utilised to evaluate each study and the GRADE system was utilised to assess the overall quality of evidence. Very-low to low-quality evidence suggested that resistance training activities between 30 and 60 minutes per week reduced mortality by 10-20% independently of aerobic exercise. The combination of resistance training and aerobic exercise appeared to further reduce mortality risk by 30%. Resistance training exercises beyond 140 minutes per week appeared to be counterproductive for health except for diabetes. 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, short duration resistance training exercise appears to reduce mortality independently of aerobic exercise by 10-20%. If we combine it with aerobic exercise it appears that we obtain an even greater reduction in mortality risk. Considering that several of our clients are at higher risk of cardiovascular disease (e.g. hand osteoarthritis ) and may present with general frailty (e.g. older clients with distal radius fracture ), they may benefit from general resistance training. In addition, we can include resistance training to regain range of movement in our clients affected by upper limb impairments. Open Access URL : http://dx.doi.org/10.1136/bjsports-2021-105061 Abstract Objective: To quantify the associations between muscle-strengthening activities and the risk of non-communicable diseases and mortality in adults independent of aerobic activities. Design: Systematic review and meta-analysis of prospective cohort studies. Data sources: MEDLINE and Embase were searched from inception to June 2021 and the reference lists of all related articles were reviewed. Eligibility criteria for selecting studies: Prospective cohort studies that examined the association between muscle-strengthening activities and health outcomes in adults aged ≥18 years without severe health conditions. Results: Sixteen studies met the eligibility criteria. Muscle-strengthening activities were associated with a 10–17% lower risk of all-cause mortality, cardiovascular disease (CVD), total cancer, diabetes and lung cancer. No association was found between muscle-strengthening activities and the risk of some site-specific cancers (colon, kidney, bladder and pancreatic cancers). J-shaped associations with the maximum risk reduction (approximately 10–20%) at approximately 30–60 min/week of muscle-strengthening activities were found for all-cause mortality, CVD and total cancer, whereas an L-shaped association showing a large risk reduction at up to 60 min/week of muscle-strengthening activities was observed for diabetes. Combined muscle-strengthening and aerobic activities (versus none) were associated with a lower risk of all-cause, CVD and total cancer mortality. Conclusion: Muscle-strengthening activities were inversely associated with the risk of all-cause mortality and major non-communicable diseases including CVD, total cancer, diabetes and lung cancer; however, the influence of a higher volume of muscle-strengthening activities on all-cause mortality, CVD and total cancer is unclear when considering the observed J-shaped associations. 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

Psychological distress mediates the relationship between pain and disability in hand or wrist fractures. Ross, C., et al. (2015) Level of Evidence : 2c Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Symptoms prevalence study Topic : Hand fracture disability - Mediating factors This is a cross-sectional study assessing the mediation effect of depression and stress on the relationship between pain and disability. A total of 594 participants were included. Of these participants 34% had a distal radius/ulnar fracture, 39% had a metacarpal fracture, and the remaining 27% had scaphoid/multiple fractures/other carpal fractures. Participants were recruited for the study between 2 and 4 weeks from injury. Participants' pain and disability were measured through the numerical rating scale (NRS) and QuickDASH respectively. Mental health was assessed through the Depression, Anxiety, and Stress scale (DASS-21). The results showed that pain explained 12% of the disability experienced by participants. This relationship was partially mediated by depression and stress. 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, disability following hand/wrist fractures is partially mediated by depression and stress within the first month of injury. This is supported by previous evidence showing that fracture tenderness on palpation is mediated by psychological factors . In addition, other psychological factors such as fear of movement also appear to contribute to disability reported by our clients . URL : https://doi.org/10.1016/j.jpain.2015.05.007 Abstract Upper limb fracture is a common musculoskeletal injury and can lead to marked pain-related disability. Unlike other common painful musculoskeletal conditions, such as low back pain, little consideration has been given to the role that psychological variables may play in explaining the relationship between pain and disability during early fracture recovery. This cross-sectional study aimed to determine if psychological distress (symptoms of depression, anxiety, and/or stress) mediate the relationship between pain and disability in acute hand/wrist fractures. Self-reported data from a consecutive sample of 594 patients with acute hand/wrist fracture were used. Mediation analyses were conducted to determine the role of depression, anxiety, and stress in the relationship between pain and disability, controlling for relevant demographic and fracture-related variables. Depression and stress, but not anxiety, significantly mediated the relationship between pain and disability. That is, although each psychological distress variable was associated with pain (P < .001), only depression (b1 = 0.27, P = .03) and stress (b3 = .23, P = .02) were significantly associated with disability and fulfilled recommended criteria for establishing a mediating variable. Increased depression and stress, but not anxiety, explain the relationship between pain and disability and may be novel targets for interventions designed to reduce pain-related disability after upper limb 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

Conservative treatment for stable osteochondritis dissecans of the elbow before epiphyseal closure: Effectiveness of elbow immobilization for healing. Takahara, M., et al. (2022) Level of Evidence : 4 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Therapeutic Topic : Osteochondritis dissecans - Treatment This is a retrospective study of a case series assessing the effectiveness of immobilisation vs no immobilisation on the healing of stable osteochondritis dissecans in preteenagers/teenagers. A total of 43 participants with an average age of 12 were included. To be included in the present study, participants had to present with osteochondritis dissecans of the capitellum. Potential participants were excluded if they presented with persistent pain, locking of the elbow, irregularity in the joint contour, fragment displacement, or severe elbow AROM limitations. Potential participants were included if the lesion was stable and if they had an open epiphysis at the elbow. All participants included were provided with activity limitation advice. In particular, they were advised against any heavy use of the affected limb (e.g. using a racket, throwing). Aerobic exercise without upper limb involvement was encouraged. Participants then received either elbow casting (n = 12) or splint immobilisation (n = 9). The control group did not receive anything in addition to advice (n = 22). The casting group had a cast on for 4 weeks followed by 7 weeks of elbow splint. The splint group wore the splint for 9 weeks. The effectiveness of the intervention was measured by the number of months prior to return to sport and radiographic evidence of healing. Return to sport was allowed if there was no pain while playing sport and normalisation of the lateral aspect of capitellum. Radiographic evidence of healing was defined as ossification of the central aspect of the lesion or complete resolution of the lesion on x-ray. The results showed that healing occurred more quickly with casting (see graphs). In addition, in the casting group, 80% of participants were able to return to sport on average at 4 months post-injury compared to 6 and 8 for the splinting and advice only 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, casting followed by splinting appears to be the most effective approach to the management of osteochondritis dissecans in preteenagers/teenagers. On average, clients treated with this approach can return to sport between 4 to 5 months from injury and 80% of them will be fully healed (radiographically) by 12 months. If you are interested in the management of more severe elbow osteochondritis dissecans, have a look at this synopsis . URL : https://doi.org/10.1016/j.jse.2022.01.148 Abstract Background: Stable lesions of osteochondritis dissecans (OCD) of the capitellum have been treated with activity restriction (AR) and the complete healing requires one or two years. Little is known about the effectiveness of elbow immobilization. Hypothesis: Elbow immobilization has positive effects on healing of stable OCD. Methods: The study subjects were 43 patients (mean age, 12.2 years) with 43 stable OCD lesions of the pre-matured elbow (mean skeletal age score, 17.1 points of 0-27 points system). The subjects were divided into three: Group A, AR without elbow immobilization, 22 cases; Group B, splint (mean, 8.8 weeks) followed by AR, 9 cases; and Group C: cast (mean, 3.7 weeks) followed by splint (mean, 7.3 weeks) and AR, 12 cases. The mean nonoperative observation period was 17.5 months (minimum three months). On anteroposterior radiographs of the elbow at 45 degrees of flexion, five observers independently assessed the healing of the capitellum, and the inter- and intra-observer reliabilities were examined. The differences in outcomes among three groups were also examined. Results: The inter- and intra-observer reliabilities of the radiographic assessment were almost perfect (Cohen kappa value: 0.82 and 0.91). There were no significant differences in age, sports played, or stage of the lesion before the treatment. The proportion of patients returning to sports and the mean period required were 77% and 8.2 months in Group A, 78% and 5.7 months in Group B, and 83% and 4.4 months in Group C. The proportion of patients showing ossification in the central aspect of the capitellum and the mean period required were 67% and 8.2 months in Group A, 63% and 4.9 months in Group B, and 91% and 1.9 months in Group C. The proportion of patients showing complete healing and the mean period required were 41% and 16.4 months in Group A, 67% and 7.0 months in Group B, and 92% and 5.5 months in Group C. Compared to Group A, Group C showed a significantly earlier return to sports (P = .034), a significantly shorter period required for ossification (P < .001), and significantly higher proportion of patients with complete healing (P = .012) within a significantly shorter period (P = .009). Conclusion: Elbow immobilization had positive effects on healing and enabled both an early return to sports and complete healing. Cast immobilization is recommended as a first choice of nonoperative treatment for stable OCD lesions of the elbow before epiphyseal closure. 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

A case of an elderly patient with rubber band syndrome. Amemiya, E., et al. (2021) Level of Evidence : 5 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Diagnostic/Therapeutic This is the answer to last week's Sherlock Handy. The patient was a 71 years old man presenting with numbness tingling, swelling, and limited finger mobility in the left hand. They visited a hospital where they were given antibiotics to treat what they believed to be cellulitis. This treatment led to no resolution of the presentation and they were referred for a second opinion. Objectively, they presented with 0 deg of wrist flexion, 60 deg of wrist extension and a circumferential scar at the proximal wrist. Blood tests revealed no signs of infection. X-rays identified some indentations on the radius. MRI was also completed and identified compression of the median nerve by a cord-like structure. Surgery was performed and it identified and removed a rubber band from the wrist. 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, rubber band syndrome is a rare presentation. This syndrome is more common in babies, people with cognitive disabilities, and older adults with cognitive/memory impairment. This syndrome may be misdiagnosed and we should therefore remain vigilant in clients who are at higher risk. URL : https://doi.org/10.1016/j.jhsg.2021.07.005 Abstract Rubber band syndrome is a relatively rare disease in which a rubber band around a limb becomes embedded under the skin, resulting in tissue damage. Most reported cases are in children, and its occurrence in adults is considered extremely rare. We present a case of a 71-year-old patient with cognitive impairment, in whom a rubber band around the wrist became embedded under the skin. The examination of the distinctive circumferential scar, ultrasonography, x-ray, and magnetic resonance imaging led to the diagnosis of rubber band syndrome. To avoid further damage to the tissue, surgical removal of the band was conducted. When elderly patients with cognitive impairment present with chief complaints of swelling and contracture in the limbs due to an unknown cause, accompanied by a circumferential scar on the affected limb, rubber band syndrome should be considered. Due to risk of deep tissue necrosis, prompt band removal is necessary. 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

A high rate of children and adolescents return to sport after surgical treatment of osteochondritis dissecans of the elbow: A systematic review and meta-analysis. Cohen, D., et al. (2021) Level of Evidence : 1a- Follow recommendation : 👍 👍 Type of study : Therapeutic Topic : Osteochondritis dissecans - Treatment This is a systematic review and meta-analysis assessing return to sport following surgery for osteochondritis dissecans in adolescents (10 to 19 years old). A total of 31 case series for a total of 548 participants were included in the present study. Eighty per cent of participants played baseball, 10% were involved in gymnastics, and the remaining 10% were involved in other sports. All studies underwent quality assessment through the Methodological Index for Non-Randomised Studies (MINORS). Amongst the many outcomes, return to sport (at the pre-injury level) and post-operative rehabilitation protocols were reported. The results showed that between 70% and 90% of participants returned to sport at the pre-injury level (see Forest plot). The most commonly adopted post-operative rehabilitation protocol involved immobilisation of the elbow in neutral forearm rotation for 2 weeks post-surgery and return to sport at the 6 months mark. In the early phase of rehabilitation, rehabilitation focused on regaining elbow range of movement on the affected side, as well as general conditioning and strength training of unaffected body segments. This was followed by graded resistance training for the affected side and sport-specific exercises. 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, a moderate to large proportion (70-90%) of adolescents undergoing surgical treatment for osteochondritis dissecans of the elbow, return to sports at pre-injury levels. The average time to return to sport is 6 months. A surgical approach is often undertaken for unstable or extensive lesions. Post-surgical rehabilitation often focuses on maintaining conditioning and gradually regaining range of movement and strength of the affected limb. If you are interested in the conservative management of less severe elbow osteochondritis dissecans, have a look at this synopsis . URL : https://doi.org/10.1007/s00167-021-06489-9 Abstract Purpose: The purpose of this systematic review was to determine the return to sport rates following surgical management of ostechondritis dissecans of the elbow. Methods: The databases EMBASE, PubMed, and MEDLINE were searched for relevant literature from database inception until August 2020 and studies were screened by two reviewers independently and in duplicate for studies reporting rates of return to sport following surgical management of posterior shoulder instability. A meta-analysis of proportions was used to combine the rates of return to sport using a random effects model. A risk of bias assessment was performed for all included studies using the MINORS score. Results: Overall, 31 studies met inclusion criteria and comprised of 548 patients (553 elbows) with a median age of 14 (range 10–18.5) and a median follow-up of 39 months (range 5–156). Of the 31 studies included, 14 studies (267 patients) had patients who underwent open stabilization, 11 studies (152 patients) had patients who underwent arthroscopic stabilization, and 6 studies (129 patients) had patients who underwent arthroscopic–assisted stabilization. The pooled rate of return to any level of sport was 97.6% (95% CI 94.8–99.5%, I2 = 32%). In addition, the pooled rate of return to the preinjury level was 79.1% (95% CI 70–87.1%, I2 = 78%). Moreover, the pooled rate of return to sport rate at the competitive level was 86.9% (95% CI 77.3–94.5%, I2 = 64.3%), and the return to sport for overhead athletes was 89.4% (95% CI 82.5–95.1%, I2 = 59%). The overall return to sport after an arthroscopic procedure was 96.4% (95% CI 91.3–99.6%, I2 = 1%) and for an open procedure was 97.8% (95% CI 93.7–99.9%, I2 = 46%). All functional outcome scores showed improvement postoperatively and the most common complication was revision surgery for loose body removal (19 patients). Conclusion: Surgical management of osteochondritis dissecans of the elbow resulted in a high rate of return to sport, including in competitive and overhead athletes. Similar rates of return to sport were noted across both open and arthroscopic procedures. 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 : 👍 (1/4 thumbs up) Type of study : Diagnostic/Therapeutic Have a think about this case study. Leave a diagnostic comment if you like. I will publish the diagnosis reported by the paper next week. The patient was a 71 years old man presenting with numbness tingling, swelling, and limited finger mobility in the left hand. They visited a hospital where they were given antibiotics to treat what they believed to be cellulitis. This treatment led to no resolution of the presentation and they were referred for a second opinion. Objectively, they presented with 0 deg of wrist flexion, 60 deg of wrist extension and a circumferential scar at the proximal wrist. Blood tests revealed no signs of infection. X-rays identified some indentations on the radius. What is it?

Eccentric exercise improves joint flexibility in adults: A systematic review update and meta-analysis. Diong, J., P. C. Carden, K. O'Sullivan, C. Sherrington and D. S. Reed (2022) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 (4/4 thumbs up) Type of study : Therapeutic Topic : Eccentric training - Range of movement improvements This is a systematic review and meta-analysis assessing the effectiveness of eccentric exercises on joint range of movement. Thirty-two RCTs were included in the systematic review, for a total of 1,122 participants. Participants' average age ranged from 20 to 70 years old. Only healthy participants were recruited. Twenty-seven studies were included in the meta-analysis. All studies were assessed through the PEDro risk of bias criteria. The overall strength of evidence was assessed through the GRADE approach ("low", "very low", "moderate", "high"), which has also been suggested by the Cochrane group for systematic reviews. Eccentric exercises were compared to no intervention, concentric or general exercises. Efficacy of intervention was assessed through active or passive range of movement of lower and upper limb joints, or fascicle length (measured through ultrasound). Intervention duration ranged between 5 and 16 weeks, with a maximum training frequency of 3 times per day and a minimum of 2 times per week. The assessment time points varied significantly, and they ranged from 5 to 16 weeks. High-quality evidence showed that eccentric exercises improve range of movement compared to a control group. Low-quality evidence showed that eccentric exercises improved fascicle lenght compared to a control group. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, eccentric exercises may provide better range of movement compared to other forms of exercise. Low load eccentric exercises may therefore be a good option if the goal of our treatment is to regain range of movement and there is moderate to high irritability. A useful progression would then be performing resistance training, which has been shown to be as effective as stretching to improve range of movement . URL : https://doi.org/10.1016/j.msksp.2022.102556 Abstract Background: Eccentric exercise is thought to improve joint flexibility, but the size of the effect is not known. We aimed to quantify the overall effect of eccentric exercise on joint flexibility in adults. Design: Systematic review, meta-analysis. Data sources: AMED, CINAHL, MEDLINE, EMBASE, SportDiscus. Participants: Adults. Intervention: Eccentric exercise compared to no intervention or to a different intervention. Outcome measures: Joint range of motion or muscle fascicle length. Data extraction and synthesis: Descriptive data of included trials and estimates of effect sizes were extracted. Standardised mean differences (SMD) of range of motion or fascicle length outcomes were meta-analysed using random effects models. Overall quality of evidence was assessed using the GRADE scale. Results: 32 trials (1122 participants, 108 lost to follow-up) were included in the systematic review. The mean (SD) PEDro score was 5.2 (1.3). Four trials reported insufficient data for meta-analysis. Data from 27 trials (911 participants, 82 lost to follow-up) were meta-analysed. Eccentric exercise improved joint flexibility in adults (pooled random effects Hedges' g SMD = 0.54, 95% CI 0.34 to 0.74). The true effect size is different across studies and 50% of the variance in observed effects is estimated to reflect variance in true effects rather than sampling error (I2 = 50%, Q = 67.6, d.f. = 34, p = 0.001). Overall quality of evidence ranged from ‘low’ to ‘high’. Conclusion: Eccentric exercise improves joint flexibility in adults. The overall standardised mean effect of eccentric exercise was moderately large, and the narrow width of the 95% confidence interval indicates the effect was estimated with good precision. Registration: Open Science Foundation (https://osf.io/mkdqr); PROSPERO registration CRD42020151303. 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

Normal values of the second interosseous pinch: A measurement of pure ulnar-innervated intrinsic muscles of the hand. Shackleford, T., et al. (2021) Level of Evidence : 3b Follow recommendation : 👍 (1/4 thumbs up) Type of study : Diagnostic test Topic : Second interosseous pinch – Normative values This is a cross-sectional study assessing the normative values for the second interosseous pinch (2IP) test. A total of 238 participants (130 females, 108 males) older than 18 years old, were included in the study. During the 2IP test, a pinchmeter was placed between the index and middle finger. People are then asked to squeeze the pinchmeter as hard as possible (see figure). Care was taken to avoid the contribution of the thumb in this test. This test may be a good indicator of the ulnar nerve function as this innervates all the intrinsic muscles of the hand. The results from this test were repeated three times. The results showed that the average strength in the 2IP test was 2.9 kg in the dominant hand and 2.8 kg in the non-dominant hand. The results also showed that with ageing, strength in the 2IP test reduced. Normative values for the 2IP test based on age/sex, are reported in the table. 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 second interosseous pinch (2IP) test may be utilised to assess ulnar nerve function. This test may be a useful addition to the use of pinch and grip strength to identify ulnar nerve impairments . We need to keep in mind, however, that nerve variations such as Martin‐Gruber anastomosis (MGA) may partially mask a severe ulnar nerve motor involvement. Another test that we can perform to gather overall upper limb strength is the push-off test . URL : https://doi.org/10.1016/j.jhsa.2021.09.024 Abstract Purpose: The second palmar interosseous muscle is innervated solely by the ulnar nerve, and second palmar interosseous pinch (2IP) strength may be a good indicator of ulnar nerve motor function. The goal of this study was to describe the 2IP test and establish its normative values, stratified by age, sex, and dominance. Methods: Volunteers were recruited to participate in this study at various community locations. Patients over the age of 18 years were eligible for this study. Demographic information on all subjects was collected. The volunteers were asked to pinch a hydraulic pinch gauge between the index and middle finger proximal phalanges with the proximal and distal interphalangeal joints flexed and without recruiting the thumb. Three 2IP measurements were taken for each hand. Descriptive statistics and analysis of covariance were performed to determine the effect of age, sex, dominance, and side on 2IP. We analyzed the 2IP strength using the 2IP test across 3 trials to determine whether it was affected by repeated testing. Results: Two hundred thirty-eight patients met the inclusion criteria (45 ± 21 years, 55% women, 87% right-hand dominant). There was no statistically significant difference between dominant and nondominant hands or among the 3 trials. There was a statistically significant correlation between age and 2IP strength ranging between 0.32 and 0.44 kg. Age and sex showed a statistically significant association with 2IP strength, with patients of older age and women having weaker 2IP. Conclusions: We determined normative values for 2IP strength using a sample from a normal population. More studies are needed to validate these results. Clinical relevance Second interosseous pinch strength may be a useful tool to assess ulnar nerve function. 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