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Outcomes of limited fasciectomy, needle fasciotomy and collagenase injection for dupuytren’s disease: A systematic review and meta-analysis of individual patient data. van den Berge, et al. (2025) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic : Dupuytren's - Treatments comparisons This systematic review compared three treatments for Dupuytren’s disease: Collagenase Clostridium Histolyticum (CCH), Limited Fasciectomy (LF), and Percutaneous Needle Fasciotomy (PNF). Using individual patient data from randomised controlled trials (RCTs) and cohort studies, the research evaluated outcomes such as postoperative contracture correction, complications, and recurrence rates. A total of 300 to 700 participants per outcome (e.g. contracture, subjective outcomes) were available. The results showed that CCH was associated with a higher risk of minor complications, but achieves comparable contracture correction to LF, which consistently outperformed PNF in long-term outcomes. LF demonstrates better long-term results with fewer recurrences compared to both CCH and PNF. 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, collagenase clostridium provides reasonable outcomes with a high number of minor complications. Open fasciectomy appeared to have longest duration without recurrence. Based on previous evidence, collagenase clostridium and needle fasciectomy are equally effective , however, based on this new information, collagenase clostridium is associated with a higher number of minor complications. Health professionals have an important role in counseling patients on what to choose based on whether they are interested in minimising invasiveness or ensuring sustained outcomes. If you are interested in further information on Dupuytren's, have a look at the whole database . URL : https://doi.org/10.1177/17531934251338349 Abstract This systematic review and meta-analysis of individual patient data evaluates the outcomes of treatment for Dupuytren's disease using limited fasciectomy (LF), percutaneous needle fasciotomy (PNF) and collagenase clostridium histolyticum (CCH) injection. A total of 1423 studies were identified, of which 15 met the eligibility criteria for meta-analysis. The postoperative total extension deficit was smaller after LF than after PNF or CCH, but the difference was not clinically relevant. Minor complications were more frequent after CCH than after LF and PNF. The risk of major complications did not differ between the treatments. Recurrence occurred earlier after PNF and CCH than after LF during 36 months of follow-up. Patient-reported outcome measures showed substantial heterogeneity, which precluded meta-analysis. Overall, the clinically relevant contracture correction was comparable between LF, PNF and CCH, but CCH had a higher risk of minor complications and LF had the longest time to recurrence. Treatment decisions should consider the trade-off between complications and recurrence risk. 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

Potential misinformation in large language model descriptions of upper extremity diseases. Sayegh, et al. (2025) Level of Evidence : 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : ChatGPT - Misinformation This study evaluated the reliability of ChatGPT in providing information on upper extremity conditions. A group of hand surgeon asked questions to ChatGPT and analysed the responses. The results suggested that 75% of initial responses contained potential misinformation, primarily reinforcing unhelpful thinking and misrepresenting pathophysiology. ChatGPT often confused palliative treatments with disease-modifying ones. The authors highlight the risks of relying on large language models for medical advice, noting their tendency to mention irrelevant symptom progression or severity. These findings stress the need for cautious interpretation of AI-generated information and emphasise the importance of clear communication from healthcare professionals to promote patient agency and positive mindsets. 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 are significant limitations in the reliability of ChatGPT when providing medical advice on upper extremity conditions. In particular, around 75% of responses contained potential misinformation, which poses a risk if relied upon for health decisions. ChatGPT may also suggest negative or ineffective treatment strategies, potentially affecting patient motivation and mindset. These findings are in line with previous research suggesting that large language models have some benefits , but do not have specialist knowledge at this stage . So while AI tools have potential, clinicians have an important role in guiding patients towards accurate resources. URL : https://doi.org/10.1177/17531934241268975 Abstract When a large language model was prompted to discuss upper extremity conditions and correct instances of misinformation in responses, there was notable persistent misinformation, reinforcement of unhelpful thinking and reduction of independent management of one’s health (agency). 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

Metabolic syndrome is associated with increased complications and healthcare costs after adhesive capsulitis surgery. Khela, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study : Prognostic Topic : Metabolic syndrome - Upper limb surgery This retrospective study investigates how metabolic syndrome affects surgical outcomes and healthcare costs in patients undergoing surgery for frozen shoulder. More than 22,000 participants were included. Around 11,000 were identified as having metabolic syndrome and an additional 11,000 were age and sex matched. The results showed that metabolic syndrome significantly increases the likelihood of postoperative complications, necessitating additional treatments, and the need for additional treatments/rehabilitation. The cost of care for people with metabolic syndrome was almost twice as much as for matched controls at two years. 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, metabolic syndrome has a significant impact on surgical outcomes following upper limb surgery. In particular, metabolic syndrome significantly increases the risk of postoperative complications, which can lead to prolonged recovery, longer hospital stays, and higher healthcare costs. These findings are not surprised as it appears that low grade inflammation has negative effects on general health and complications following surgery . URL : https://doi.org/10.1016/j.jse.2025.04.008 Abstract Background: Metabolic disturbances are increasingly recognized as contributing factors in the development of adhesive capsulitis (AC). While metabolic syndrome (MetS) has been established as a risk factor for poorer surgical outcomes, there exists limited data on its impact on postoperative outcomes following surgical treatment for AC. The purpose of this study was to investigate the effects of MetS on complications and costs after surgery for AC. Methods: A retrospective cohort analysis from 2011 to 2020 was conducted in the PearlDiver database. Patients with or without MetS who underwent arthroscopic capsular release and/or manipulation under anesthesia for AC were identified using International Classification of Disease and Current Procedural Terminology diagnosis codes. Patients with active records 1 year prior to and 2 years after the initial diagnosis of adhesive capsulitis were eligible. The MetS cohort was matched 1:1 to a control group without MetS based on age, sex, and Charlson Comorbidity Index. Total cost of care at various postoperative time points was compared between cohorts using Student’s t-test. Multivariable logistic regression was performed to assess the impact of MetS on 90-day complications and secondary treatment utilization two years after surgery. A Bonferroni correction was applied to univariable analyses and multivariable regressions. Results: The overall prevalence of MetS was 37.5% (n=16,081) in a cohort of 42,862 patients undergoing AC surgery. After matching, patients with metabolic syndrome were more likely to experience 90-day hospital readmissions (OR=1.89, p<0.001), emergency department visits (OR=1.55, p<0.001), and medical complications (OR=1.10, p<0.001), including acute kidney injury (OR=2.21, p<0.001), pulmonary embolism (OR=2.76, p<0.001), myocardial infarction (OR=1.99, p<0.001), urinary tract infection (OR=1.42, p<0.001), and cardiac arrhythmia (OR=1.51, p<0.001). MetS was also associated with higher secondary treatment utilization, including physical therapy (OR=1.19, p<0.001) and intra-articular injections (OR=1.16, p<0.001). Patients with MetS had higher mean costs of care at 60 days ($2,964.1 vs. $2,726.2, p<0.001), 90 days ($3,683.2 vs. $3,305.9, p<0.001), one year ($10,110.6 vs. $7,680.9, p<0.001), and two years ($19,013.2 vs. $13,577.4, p<0.001) after surgery. Conclusion: MetS is associated with increased postoperative complications, secondary treatment utilization, and healthcare costs following surgery for AC. Further prospective studies are required to understand why this relationship exists and to test if targeted management strategies, such as metabolic control and tailored rehabilitation protocols, for this high-risk population can reduce complications and improve outcomes. 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

Effectiveness of night splints for cubital tunnel syndrome: A systematic review. Bateman, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Cubital tunnel syndrome - Splints This systematic review assessed the effectiveness of night splints for cubital tunnel syndrome (CuTS) based on studies published in English over the last 30 years. The review included two randomised controlled trials and a few single arm trials. The main results of the review are based on a single RCT. In the RCTs, splinting was compared to advice alone. The review highlighted significant heterogeneity in outcome measures, splint types (custom-made vs. off-the-shelf), and treatment durations (6 weeks to 6 months). Overall, there was very low certainty of evidence suggesting that cubital tunnel splinting had a similar effect to advice only. 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, night splints for cubital tunnel syndrome (CuTS) have limited effectiveness. To console ourselves, another study assessed the effectiveness of splinting and injection for CuTS and showed that injections achieve an even lower positive outcomes compared to splinting . The main difference between this study and the previous review is that in the previous review all sorts of study designs were included whilst in this most recent review, more weighing was given to RCTs. URL : https://doi.org/10.1177/17589983251336157 Abstract Introduction: Cubital Tunnel Syndrome (CuTS) is a common condition of the elbow that is often treated with surgical decompression of the ulnar nerve but evidence for optimal management is unclear. A previous Cochrane review from 2016 identified very limited evidence to guide conservative management, in particular, night splints. The aim of this systematic review was to update the evidence related to the effectiveness of night splints in the treatment of CuTS. Methods: We conducted an electronic search on January 15th 2025 of the MEDLINE, Embase, Emcare and CINAHL databases from the last 30 years, using a pre-defined protocol. Risk of bias was assessed using the RoB2 and ROBINS-I tools, with certainty assessed using GRADE. Results: We identified only one randomised controlled trial (RCT), with high overall risk of bias, that compared night splints to a control arm of advice only. This under-powered trial with high loss to follow-up found no difference between groups. One additional RCT and three single-arm studies, all at high/serious/critical risk of bias, suggested the majority of patients with mild/moderate CuTS improve with night splinting but it is unclear whether the effect was due to treatment or time. Evidence certainty was very low. Discussion: We identified a paucity of evidence, of low quality, regarding night splinting. The evidence identified by this review is currently insufficient to determine whether night splints should be recommended for the treatment of CuTS and there is a need for a high-quality research trial comparing night splints to a control intervention. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Evaluating the association between health literacy and patient-reported outcome measures after distal radius fracture. Miclau, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Aetiology Topic : Social determinants of health - Distal radius fracture This cross-sectional study assessed the role of health literacy in shaping healthcare outcomes and disparities following a distal radius fracture. A total of 65 participants who had had a distal radius fracture (DRF) or surgery for DRF within the previous six weeks were included in the study. Participants were asked to complete outcome measures including QuickDASH, and numerical rating scales for pain amongst several others. Other participants' characteristics like health literacy, income, preference to speak in a language other than English were also collected. The results showed that lower income and preference to speak in a language other than English were associated with higher pain and lower function whilst controlling for health literacy and lower levels of education. 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, greater social deprivation significantly impacts healthcare outcomes following a conservatively or surgically managed distal radius fracture. In particular, it appears that lower income levels and preference to speak in a language other than English were associated with worse pain and function. It therefore seems that tailored interventions are essential to address these inequities, especially for vulnerable groups. This article is an important reminder that social determinants of help have an important effect on pain and function in our patients. Have a look at the entire database for further information on the topic . URL : https://doi.org/10.1016/j.jhsa.2025.03.022 Abstract Purpose: Patient-reported outcome measures (PROMs) are used to assess patients’ outcomes during the treatment of distal radius fractures (DRFs). Limited health literacy is linked to poorer health outcomes. We asked whether limited health literacy is associated with PROM scores in patients with a DRF. Methods: This cross-sectional study enrolled adults ≥18 years of age with an isolated DRF from two urban hospitals within 6 weeks of injury or surgery. Participants completed a demographics survey, brief health literacy screen, and three PROMs: Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH); Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity v2.0 Short Form-7a (PROMIS-UE); and Numeric Rating Scale (NRS). Associations between social determinants of health (SDOH) factors (health literacy, income, education, and preferred language) and PROMs were assessed using multivariable linear regressions. Propensity score analyses to control for confounding and postmatching regressions were conducted. Results: Sixty-five patients participated in this study. In this sample, the mean age was 54 years, 65% were women, 26% had limited health literacy, 46% had public insurance, 18% completed at most a high school education, and 23% preferred a language other than English (PLOE). In multivariable analyses, limited health literacy and PLOE were associated with worse PROMIS-UE, and low income was associated with worse QuickDASH and NRS; associations between health literacy and QuickDASH and NRS were not statistically significant. Propensity score analyses indicated that all SDOH variables had confounding effects on associations between health literacy and PROMs. The postmatching regression analysis demonstrated that PLOE was associated with worse PROMIS-UE, and low income and PLOE with worse QuickDASH and NRS scores; limited health literacy was not significantly associated with any PROMs. Conclusions: Low income and PLOE were significant predictors of worse PROM scores. After adjusting for other SDOH variables, limited health literacy was not significantly associated with PROM scores. These findings underscore the importance of recognizing and addressing the multiple interconnected SDOH aspects associated with PROM scores. 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

Analysis of mechanoreceptors and free nerve endings in the lateral collateral ligament of the elbow using immunofluorescence and confocal microscopy. de Paula Costa, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : LUCL - Innervation This cadaver study investigated the lateral collateral ligament (LCL) of the elbow, focusing on its anatomical and functional aspects. Microscopic analysis reveals diverse mechanoreceptors within the LCL, including Ruffini-like receptors, free nerve endings, and blood vessels near nerve structures. The study also calculated nerve density, showing a 0.5% area fraction of nerve density in the LCL. The mechanoreceptors indentified included Ruffini (round, low threshold), Pacini (column/cone-shaped, rapidly adapting), Golgi tendon organs (spindle-shaped, connected to thicker fibers), and free nerve endings (non-myelinated, transmitting nociceptive signals). 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 lateral ulnar collateral ligament (LUCL) of the elbow contains several sensory receptors. These include Ruffini receptors detecting slow pressure changes, Pacini corpuscles responding to dynamic movements, Golgi tendon organs providing information on ligament tension. Overall, it appears that these sensory fibres make up 0.5% of the ligament tissue. Injuries or surgeries affecting the LUCL may disrupt sensory feedback, potentially contributing to persistent pain. If you are interested in knowing how to test the LUCL, have a look at this synopsis . URL : https://doi.org/10.1016/j.jse.2025.04.005 Abstract Background: The lateral collateral ligament (LCL) of the elbow is an essential static stabilizer against varus and posterolateral rotatory forces. It is hypothesized that injury to the LCL might impair elbow proprioception, although direct evidence for this impairment remains limited and warrants further investigation. This study aimed to describe the morphology and distribution of mechanoreceptors and free nerve endings within the LCL. Methods: Twenty ligaments were obtained from 10 fresh cadavers, in compliance with local legislation. Each ligament was measured, weighed, and sectioned. Histological integrity was confirmed using hematoxylin-eosin (HE) staining on 10 μm sections, while 50 μm sections underwent immunofluorescence with protein gene product (PGP) 9.5 as the primary antibody and Alexa Fluor 488 as the secondary antibody, followed by analysis with a confocal laser scanning microscope (Zeiss LMS 710). Results: The LCL was identified in 100% of dissections, with an average length of 36.2 ± 3.4 mm, width of 9.5 ± 2.24 mm, and weight of 0.8 ± 0.13 g. HE staining revealed dense, organized collagen fibers and vascular tissue. Type I (Ruffini-like) and type IV (free nerve endings) mechanoreceptors were identified, along with unclassified nerve endings. Conclusion: These findings suggest a potential additional role for the LCL in proprioception, highlighting the possible importance of neural structures preservation. However, further clinical studies are necessary to determine the actual functional impact beyond mechanical stabilization. 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

How should we treat painful sensitivity in the hand? An international e-delphi study. Hebert, et al. (2024) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Alloynia - Management This Delphi study aimed to develop international consensus recommendations for treating allodynia, a condition characterised by hypersensitivity to touch, often seen in individuals with chronic pain conditions like complex regional pain syndrome (CRPS). The research involved surveying hand therapy experts to identify effective interventions and highlight gaps in evidence. Key findings include strong support for approaches that promote returning to meaningful activities, as well as direct tactile stimulation techniques such as desensitisation or sensory modulation. However, the study notes a lack of high-quality research on allodynia-specific treatments, with most studies showing low methodological quality. Experts emphasise the importance of tailoring interventions to individual factors, including functional and psychological status, when deciding whether to touch or avoid sensitive areas. 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, allodynia refers to a condition characterised by hypersensitivity to touch. This condition can be tackle with three approaches, which include desensitisation, sensory modulation, and anxiety/depression management. Desensitisation involves slowly exposing individuals to touch, similar to gradual exposure therapy for phobias. Sensory modulation refers to adjusting sensory input to make it more manageable, potentially through methods like gentle pressure or vibrations. Clinically, we might start with gentle, non-threatening techniques like light pressure or vibrations, gradually increasing intensity. Addressing psychological aspects such as anxiety and depression, which often accompany pain, is also essential for overall improvement. If you are interested in allodynia, have a look at the database on the topic . URL : https://doi.org/10.1016/j.jht.2023.08.003 Abstract Background: Evidence synthesis suggests allodynia resulting from neuropathic pain has few interventions with clear effectiveness. As research continues to build this needed evidence base, expert consensus recommendations can address the conflicting approaches within current hand therapy practice. Purpose: This study aimed to develop consensus recommendations for the clinical management of allodynia from an international panel of hand therapists. Study Design: This was an international e-Delphi survey study. Methods: We recruited international hand rehabilitation experts to participate in an e-Delphi survey. Consensus was defined as 75% or more of participants agreeing with a recommendation, and at least 3 rounds of consensus building were anticipated. Experts were identified from 21 countries, and clinical vignettes describing a spectrum of patients with painful sensitivity in the hand were provided to elicit treatment recommendations. Initial recommendations were summarized, and consensus sought for clinical practice recommendations. Results: Sixty-eight participants were invited, with 44 more added through peer nominations. Fifty-four participants from 19 countries completed the initial survey and were invited to participate in all subsequent rounds. Over 900 treatment suggestions were provided from the initial vignettes across domains, including sensory, physical, and functional interventions, education, and cortical representation techniques: 46 ultimately reached consensus. However, important discrepancies in justification (eg, why allodynia should be covered) and implementation of techniques (eg, desensitization, sensory reeducation) were identified as the consensus exercise progressed. Conclusions: Experts recommend individually tailored programs to treat allodynia using a variety of physical/movement, sensory-based, and “top-down” approaches; this is highly aligned with contemporary theories, such as the Neuromatrix Model of Pain. However, consensus was not reached on the justification and implementation of some of these approaches, reflecting the lack of a taxonomy and supporting evidence for tactile stimulation approaches in the current literature. Trials directly comparing the effectiveness of these approaches are needed. 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

Cost-effectiveness of a preoperative 12-week smoking cessation program prior to arthroscopic rotator cuff repair. Lugo, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Economic Study Topic : Smoking cessation - Clinical and cost effectiveness This retrospective study evaluates the cost-effectiveness of a preoperative 12-week smoking cessation program for adult smokers undergoing arthroscopic rotator cuff repair (ARCR). Using decision tree analysis and Monte Carlo simulations, researchers modeled the economic and clinical benefits of implementing such a program. The results demonstrated favorable outcomes, with the smoking cessation strategy being both more effective and less costly compared to no intervention. Key findings include reduced surgical complications, improved success rates, and lower overall healthcare costs associated with the program. The study also highlights the potential alignment of such interventions with value-based healthcare goals, which prioritise improving patient outcomes while minimising costs. 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 preoperative smoking cessation program can reduce complications following upper limb surgery (clinically effective), and also be cost-effective compared to no intervention. Smoking is a well-documented risk factor for poorer surgical outcomes, including bone non-union , increased infection rates , additional upper limb surgery , post-traumatic elbow stiffness , and reduced success rates of procedures like rotator cuff repair. It is therefore extremely important to offer your smoking clients additional advice/help . URL : https://doi.org/10.1016/j.jse.2025.04.006 Abstract Purpose: This study aims to evaluate the cost-utility of Preoperative 12-week Smoking Cessation Program (SCP) in adults undergoing arthroscopic rotator cuff repair. Methods: A decision-analysis model was developed for a hypothetical adult smoker undergoing arthroscopic rotator cuff repair. Literature review data identified event probabilities, costs, and health utilities. Health outcomes were measured in Quality-Adjusted Life Years (QALYs). Base-case analysis calculated incremental cost and effectiveness of a 12-week preoperative SCP. Probabilistic sensitivity analysis evaluated model uncertainty and calculated mean incremental costs, effectiveness, and net monetary benefits. One-way sensitivity analysis identified variables with the greatest model impact. Results: The preoperative 12-week SCP was the preferred strategy in 98.4% of iterations. It demonstrated greater benefits and lower costs, with an incremental cost-effectiveness ratio below the willingness-to-pay threshold of $50,000 per QALY. The use of preoperative 12-week SCP was associated with a mean incremental net monetary benefit (INMB) of $16,338 (95% CI 15,889-16,787). One-way sensitivity analyses identified QALYs associated with avoiding revision surgery due to re-tear as a key driver of the cost-utility outcomes. Conclusion: Use of a preoperative 12-week SCP is a cost-effective approach to reduce costs related to revision surgery and providing higher QALYs at 5 years. The use of smoking cessation programs should be strongly considered as part of patient management strategies. 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 therapist identification of an undetected rotator cuff tear via a telehealth evaluation: A case report. Young, et al. (2021) Level of Evidence : 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic Topic : Rotator cuff tear - Not capsulitis A 66 years old sought a second opinion via telehealth for their shoulder injury. They reported left sided shoulder pain following a left FOOSH six weeks earlier. Some details about the patient characteristics and pain are reported in the table below. There was no obvious deformity or bruising on observation. Their active shoulder flexion, external rotation, and internal rotation were 80deg, 20deg, 50deg respectively (see pictures below). Passive range of movement of the shoulder was within normal range (see picture below). They also had a positive drop arm test. The patient was referred to an orthopaedic surgeon and after an MRI confirming a full thickness supraspinatus tear (see picture below), they underwent surgical repair. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, it is important to screen for shoulder pathology following FOOSH trauma. These injuries can result not only in an upper limb fracture but also rotator cuff tears, shoulder dislocations, or even nerve lesions. For an interesting case of nerve lesion following FOOSH, have a look at this synopsis . URL : https://doi.org/10.2519/josptcases.2021.9990 Abstract Background: The COVID-19 pandemic has highlighted the need to explore alternative methods of health care delivery, including telehealth. Minimal evidence is available regarding telehealth as a diagnostic tool for suspected orthopaedic pathology. Case Presentation: A self-referred 66-year-old man presented with left shoulder pain that had been present for 6 weeks. Mechanism of injury included 2 falls 2 weeks apart. His physician diagnosed him with adhesive capsulitis and referred him to a physical therapist near his home. No imaging studies were performed. Initial management did not improve his status, so the patient requested a second opinion. A telehealth evaluation was chosen, as he resides 220 miles away. Live 2-way video conferencing was utilized throughout the evaluation. Visual motion observation noted marked active, but not passive, limitations. Pain in active external rotation was 8/10. Special testing noted positive drop arm test and impairments in external rotation. Outcome and Follow-Up: A rotator cuff tear was suspected and the patient was referred for a surgical consultation, with subsequent surgery completed for a full-thickness supraspinatus tear. During follow-up 3 months after surgery, the patient reported that the telehealth visits were very convenient and more effective than prior management. Discussion: A telehealth evaluation performed by a physical therapist was able to identify and manage, via referral, an undetected full-thickness rotator cuff 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

Outcomes and performance following posteromedial elbow débridement in major league baseball players. Wollenman, et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic : Elbow debridement/osteophites resection - Surgical interventions This retrospective study assessed the outcomes of posteromedial elbow debridement or osteophyte resection in Major League Baseball (MLB) players, particularly focusing on return to play (RTP), performance (ball velocity - pitchers), and the need for further surgeries, such as ulnar collateral ligament (UCL) reconstruction. The study included 39 players who underwent the procedure between 2008 and 2021. The results showed a high RTP rate of 82% in MLB games, with pitchers specifically showing a 77% RTP rate. Pitching performance metrics were mostly unchanged in the short term, except for a significant decrease in fastball velocity over three years (1.5 km/hr, which may not be clinically significant). The rate of subsequent UCL reconstruction was 19% among pitchers, aligning with baseline rates for MLB pitchers. However, concerns remain over long-term outcomes, as 39% of pitchers returned to the injured list within three seasons post-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, players in the Major League Baseball can expect an 80% return-to-play following elbow debridement or osteophytes removal. Following such surgery there is no higher risk of subsequent ulnar collateral ligament (UCL) reconstruction compared to other players not having undergone surgery. Nevertheless, amongst those pitchers who had surgery, 40% are classified as re-injured at three years post injury. This study is a nice addition to the already existing research on the management of athletes with hands and wrist injuries requiring surgery . URL : https://doi.org/10.1016/j.jse.2024.05.035 Abstract Background: Overhead athletes are particularly susceptible to elbow valgus extension overload syndrome and development of pathologic changes in the posteromedial elbow. Though arthroscopic débridement/osteophyte resection is frequently performed, few studies have analyzed the outcomes of this procedure and none have specifically addressed professional level athletes. Hypothesis: We hypothesized that following posteromedial elbow débridement, Major League Baseball (MLB) pitchers would exhibit a higher rate of ulnar collateral ligament (UCL) reconstruction than baseline incidence in the existing literature, along with a decline in pitching performance. Methods: Using publicly accessible websites, MLB athletes undergoing posteromedial elbow débridement from 2007 to 2022 were identified. Demographic information, procedure details, return to play (RTP) information, return to the disabled/injured list (DL/IL), subsequent UCL reconstruction, and pitching statistics were analyzed. Pitching performance metrics included earned runs average, walks plus hits per innings pitched, innings pitched, and fastball velocity. Results: A total of 39 MLB players, including 26 pitchers, were included. Within the first three seasons after surgery, 82.1% (n = 32) of players returned to play at the MLB level at a mean time of 176.1 ± 69 days. Pitchers exhibited a RTP rate of 76.9% (n = 20) at 175.8 ± 16 days. A total of 38.5% (n = 10) of pitchers returned to the DL/IL for elbow-related issues within three seasons. Subsequent UCL reconstruction was seen only in pitchers, with a frequency of 19.2% (n = 5). No statistically significant differences between single season preoperative/postoperative pitching metrics were identified. A small but significant (P < .05) decrease in fastball velocity (94.4 vs. 92.84; P = .02) was observed over a three-season comparison. Conclusion: Contrary to our hypothesis, this study demonstrates that posteromedial elbow débridement is a viable surgery in MLB athletes, with RTP rate of 82.1% and no increase in rate of UCL reconstruction. Furthermore, there was no significant difference in single season preoperative and postoperative statistical pitching performance. However, over three years postoperatively, there was a 38.5% rate of return to the DL/IL for ongoing elbow ailment and a significant decrease in pitch velocity, raising some concern over the longevity of postoperative improvements. 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 A 66 years old sought a second opinion via telehealth for their shoulder injury. They reported left sided shoulder pain following a left FOOSH six weeks earlier. Some details about the patient characteristics and pain are reported in the table below. There was no obvious deformity or bruising on observation. Their active shoulder flexion, external rotation, and internal rotation were 80deg, 20deg, 50deg respectively (see pictures below). Passive range of movement of the shoulder was within normal range (see picture below). They also had a positive drop arm test. What is it?

How to run a cost-effective subspecialty practice. Ring, et al. (2024) Level of Evidence : 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Economic Topic : Effective and ethical practice - Advice The text discusses the need for a more cost-effective approach in hand surgery/therapy and orthopedics. Three main points were highlighted: KISS principle: Keep it simple. Do not overuse expensive treatments for common conditions like tennis elbow and joint pain. They author emphasise that many interventions may not be necessary or could be replaced by simpler, less costly alternatives such as exercises or watchful waiting. Rely on evidence-based medicine: avoiding unnecessary diagnostic tests, and considering patient values and functional outcomes rather than defaulting to aggressive treatments. Avoid stress contagion: Anxious patients can make you anxious and push you to request additional imaging or expensive treatment. Keeping these points in mind, may help you optimising care whilst minimising costs. 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, simpler treatment alternatives, such as exercises or watchful waiting, the use of evidence based practice to guide treatment decisions rather than clinical habits, acknowledging that our stress might influence treatment decisions towards more aggressive approaches, are useful strategies to maintain an ethical and efficient practice. Evidence of how anxious patients can increase clinician's stress is already available and this paper is a good reminder. The suggestions of watchful waiting is also well suited for the treatment of a large proportion of musculoskeletal presentations (e.g. tennis elbow ). Watchful waiting should be considered as a management approach rather than a no intervention approach. URL : https://doi.org/10.1016/j.hcl.2024.05.004 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