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Associations of computer gaming with incident dementia, cognitive functions, and brain structure: A prospective cohort study and Mendelian randomization analysis. Jia, et al. (2024) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Computer gaming - Cognitive decline This was a prospective study assessing the association between computer gaming frequency and cognitive functions, brain structure, and dementia risk using data from the UK Biobank. A total of 471,346 participants were included in the study. People were followed up for an average of 14 years and were asked whether they played games at baseline and if so how frequently. The results indicated that higher computer gaming frequency was associated with better cognitive performance, favorable brain structure (e.g., increased gray matter volume), and a reduced risk of dementia. These results were still holding after controlling for several confounders such as age, social deprivation, educational level, and physical activity. 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, frequent computer gaming seems to be protective for dementia. Hence, we might encourage our older patients to engage in regular game play, which seems to be much better than watching TV . It goes without saying that sedentary activities should be balanced with physical activity as per WHO and heavy lifting and impact to improve or maintain our bone mass density . URL : https://doi.org/10.1186/s13195-024-01496-7 Abstract Background: Computer gaming has recently been suggested to be associated with benefits for cognition, but its impact on incident dementia remains uncertain. We aimed to investigate the observational associations of playing computer games with incident dementia, cognitive functions, and brain structural measures, and further explore the genetic associations between computer gaming and dementia. Methods: We included 471,346 White British participants without dementia at baseline based on the UK Biobank, and followed them until November 2022. We estimated the risk of dementia using Cox proportional hazard models, and assessed the changes of cognitive functions and brain structural measures using logistic regression models and linear regression models. Mendelian randomization (MR) analyses were performed to examine the association between genetically determined computer gaming and dementia. Results: High frequency of playing computer games was associated with decreased risk of incident dementia (HR, 0.81 [95% CI: 0.69, 0.94]). Individuals with high frequency of playing computer games had better performance in prospective memory (OR, 1.46 [1.26, 1.70]), reaction time (beta, -0.195 [-0.243, -0.147]), fluid intelligence (0.334 [0.286, 0.382]), numeric memory (0.107 [0.047, 0.166]), incorrect pairs matching (-0.253 [-0.302, -0.203]), and high volume of gray matter in hippocampus (0.078 [0.023, 0.134]). Genetically determined high frequency of playing computer games was associated with a low risk of dementia (OR, 0.37 [0.15, 0.91]). Conclusions: Computer gaming was associated with a decreased risk of dementia, favorable cognitive function, and better brain structure, suggesting that computer gaming could modulate cognitive function and may be a promising target for dementia prevention. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Development and validation of a severity-focused score for the assessment of lateral epicondylitis using enhanced magnetic resonance imaging. Lee, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : MRI and symptoms - CEO tendinopathy This retrospective the correlation between magnetic resonance imaging (MRI) and lateral epicondylalgia symptoms. A total of 80 students with symptomatic lateral elbow pain were included in the study. All of the participants had undergone MRI. A series of measures, which included T2 and T1 MRI images were found to be useful for in estimating disease severity. In particular, a combined score based on the size of tear, neo-angiogenesis, involvement of all or some tendons of the CEO, and subcutaneous fat were utilised to provide a disease estimate. The results showed that a greater level of change within the CEO and sorrounding tissues, the higher the level of symptoms in this cohort of patients. Keep in mind that this was a small study without a large validation dataset. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, there is a small to moderate correlation between changes on MRI and symptoms of lateral epicondylalgia. These findings appear to be in line with the paper by Songur et al. (2025) and Clarke et al. (2010) , showing that larger tears at the CEO are associated with a poorer prognosis in people with lateral epicondylalgia. It is possible that surgery in these cases may be more suitable, although it has been shown that surgery for persistent CEO tendinopathy is not usually more effective than sham surgery . URL : https://doi.org/10.1016/j.jse.2025.01.052 Abstract Background: Magnetic resonance imaging (MRI) does not sufficiently reflect the severity of lateral epicondylitis. Although some authors have reported meaningful findings on conventional MRI, it is not widely accepted that MRI is useful for evaluating lateral epicondylitis. The aim of this study is to evaluate the relationship between the lateral epicondylitis severity score (LESS) using contrast-enhanced T1-weighted MRI and patients' perceptive pain and clinical courses. Methods: This retrospective study included 80 patients diagnosed with lateral epicondylitis and who also went contrast-enhanced 3.0-T MRI. The study cohort was split into a development (n = 50) and a validation cohort (n = 30). The patient's pain was assessed using a visual analog scale (VAS), and the involvement of the common extension tendon (CET) origin, radial collateral ligament, lateral ulnar collateral ligament, and plica were evaluated using T2-weighted images. The enhancement of CET and subcutaneous tissue was scored using a novel classification in the contrast-enhanced T1-weighted MRI. LESS was calculated from MRI findings to determine the severity of lateral epicondylitis. Pearson's correlation analysis was performed to evaluate the relationship between patients' VAS scores and MRI findings. Receiver operating characteristic curve was constructed to determine cut-off value of LESS for the surgical treatment of lateral epicondylitis. Results: The average age of the development cohort (n = 50) and the validation cohort (n = 30) were 49.8 (31-66) years and 52.3 (37-67) years, and the average VAS score were 7.3 (4-9) and 7.2 (5-10) respectively. In T2-weighted image evaluation, the correlation of VAS and grade of CET, radial collateral ligament, lateral ulnar collateral ligament, and plica were −0.03 ( P  = .87), −0.03 ( P  = .87), −0.14 ( P  = .39), and 0.36 ( P = .02). Discordant contrast enhancement in T1-weighted images compared to nonspecific T2-weighted images was observed in 46 of 50 cases (92%). A statistically significant correlation was observed between the patients' VAS and LESS scores (r = 0.67, P  < .01). Area under curve was 0.76 ( P < .01) and the optimal cut-off value of LESS for the surgical treatment of lateral epicondylitis was 5.5 (sensitivity 72.7%, specificity 70.6%). When the cut-off value was used to predict surgical treatment in the validation cohort, the sensitivity was 100% and the specificity was 75%. Conclusion: Contrast-enhanced T1-weighted images provided more detail than conventional T2-weighted images in evaluation of structural or unobserved abnormalities to assess the severity of the lateral epicondylitis, and had excellent inter- and intraobserver reliability. LESS showed significant positive correlation with pain severity. If the LESS is 5.5 or more, surgical treatment of lateral epicondylitis may need to be considered. 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 splinting after percutaneous needle fasciotomy for dupuytren’s contracture. Mon, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Splinting - Percutaneous needle fasciotomy This was a short systematic review assessing the effect of splinting after percutaneous needle fasciotomy for Dupuytren’s contracture. A total of 171 participants from four studies of which one was a retrospective, two were prospective, and one was a randomised controlled trial were included in the research. The results showed heterogeneity in splinting use, including variations in splint duration (from a few weeks to 3 months) and the absence of standardised measures for reporting contractures. Overall there did not appear to be a significant effect of splinting on functional outcomes. 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, splinting after percutaneous needle fasciotomy for Dupuytren’s contracture does not appear to be necessary. These findings appear to be in line with a previous systematic review . Despite these findings, in rare instances, it may be beneficial to provide the patient with a splint and we have a few options . If we are considering patients who are not ready for surgery yet, splinting may have some benefits . URL : https://doi.org/10.1177/17531934251350463 Abstract This review of 220 patients evaluates the effectiveness of splinting after percutaneous needle fasciotomy in reducing the total passive extension deficit, highlights inconsistent evidence and recommends individualized care. 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

Clinical thumb ulnar collateral ligament injury owing to a pathological fracture through an enchondroma of the proximal phalanx. van de Lucht, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic Topic : Enchondroma - Fracture A 27-year-old woman had a fall and was subsequently unable to move their thumb. They reported thumb pain prior to the traumatic event, but x-rays taken two years prior were clear. On objective assessment, there was laxity of the ulnar collateral ligament of the thumb mcpj. X-ray were completed and they are reported below. A lobulated, osteolytic lesion in the proximal phalanx was diagnosed as an enchondroma with an intra-articular fracture. Surgical intervention was performed one week post-injury, involving bone grafting and fracture fixation. Histopathological analysis confirmed a benign enchondroma. The thumb was immobilised for six weeks before rehabilitation began. X-rays at three months showed successful healing and functional recovery, with comparable range of motion to the contralateral thumb. 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, traumatic events associated with objective ligament lesions, should be assessed via x-ray, especially if the injury is caused by low energy trauma. In the case of fractures through enchondromas, before surgical excision of the lesion, the fracture is allowed to heal for 6-8 weeks, however, in this case, due to the joint instability, an earlier intervention was preferred. Can you identify whether there are any abnormalities in this other group of x-rays? URL : https://doi.org/10.1177/17531934251315313 Abstract A young woman presented with an acute ulnar collateral ligament injury of the thumb, owing to a pathological fracture through an enchondroma. Treatment included bone graft and fracture fixation, with successful healing and functional 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

Associations between partial common extensor tendon tears and clinical-ultrasonographic findings in patients with lateral epicondylitis. Songur, et al. (2025) Level of Evidence : 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : CEO tears - Symptoms levels This retrospective study assessed ultrasound (US) imaging features associated with worse levels of pain in people with lateral epicondylalgia (LE). A total of 227 participants with LE were reviewed. The imaging assessed features like tendon thickness, tears, and bony irregularities. About 20% of the participants presented with tears within the common extensor origin tendon. Whilst accounting for several other variables, it appears that age as well as pain were associated with the presence of tendon tears. 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, 1 in 5 people with lateral epicondylalgia present with common extensor origin tears. In these instances it appears that, whilst accounting for age, the pain is higher compared to people without a tear . These findings appear to be in line with previous evidence suggesting that larger tears are associated with greater symptoms . If you would like to know more about lateral epicondylalgia, have a look at the entire database . URL : https://doi.org/10.1097/PHM.0000000000002655 Abstract Objective: This study investigates the effect of partial common extensor tendon tears on demographic, clinical and ultrasound parameters in patients with lateral epicondylitis. The research aimed to provide a comprehensive understanding of how these ultrasound-detected partial tears influence the clinical presentation and imaging findings associated with lateral epicondylitis. Design: This is a retrospective cross-sectional study. Records of 227 patients with lateral epicondylitis met the inclusion-exclusion criteria were reviewed. The patient-rated tennis elbow evaluation questionnaire was used as the primary outcome measure. Secondary outcome measures were visual analog scale for pain, algometric measurements, hand grip strength, and ultrasound parameters (maximum tendon thickness measurements from the capitellar-radiocapitellar sides and presence of bone abnormalities). Results: Partial common extensor tendon tears detected using ultrasound were present in 22.7% (n = 54) of the patients. Patients with partial common extensor tendon tears were older (50,31 ± 9,22), had higher patient-rated tennis elbow evaluation scores (65,48 ± 12,76), capitellar-radiocapitellar maximum tendon thickness measurements (0,60 ± 0,80/0,60 ± 0,72), and incidence of bone abnormalities (40.7%, n = 32) (P < 0.05). Logistic regression analysis identified age and patient-rated tennis elbow evaluation pain score as associative factors with partial common extensor tendon tears. Capitellar-radiocapitellar maximum tendon thickness measurements greater than 0.55 cm were associated with an increased probability of partial common extensor tendon tears. Conclusions: Ultrasound-detected partial common extensor tendon tears may worsen the clinical and ultrasound parameters in patients with lateral epicondylitis. Older age, higher patient-rated tennis elbow evaluation scores, and higher maximum tendon thickness measurements were associated with partial common extensor tendon tears. 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 painful versus non-painful exercise on pain intensity, disability, and other patient-reported outcomes in adults with chronic musculoskeletal pain: An updated systematic review with meta-analysis. Tran, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Painful vs pain-free exercise - Persistent pain This systematic review and meta-analysis assessed the effects of painful versus non-painful exercise on adults with persistent musculoskeletal pain. A total of 16 trials for more than a 1,000 participants were included. The articles were assessed through the Cochrane Risk of Bias criteria and the Grading of Recommendations Assessment Development and Evaluation (GRADE) for the overall quality of evidence. The results showed very low to low certainty evidence suggesting no difference in effectiveness or safety between painful vs not-painful exercise interventions. There were no significant differences on patient-reported outcomes or adverse events. Forest plot for pain intensity 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, painful exercise in people with chronic musculoskeletal pain does not appear to be inferior to pain-free exercise. Getting people to exercise with some pain may even be beneficial in reducing fear of movement, which has been shown to influence upper limb function . This may also have a positive effect on pain catastrophising , which is another important mindset in upper limb recovery. URL : https://doi.org/10.2519/jospt.2025.13253 Abstract OBJECTIVE: To determine the effect of painful versus non-painful exercise on pain, disability, and other patient-reported outcomes in adults with chronic musculoskeletal pain. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: Electronic databases (CENTRAL, EMBASE, CINAHL, PubMed and PsycINFO) and trial registers (ClinicalTrials.gov, ANZCTR, World Health Organization International Clinical Trials Registry Platform) were searched from October 2016 to May 2024. STUDY SELECTION CRITERIA: Randomized controlled trials that compared painful exercise to non-painful exercise in adults with chronic musculoskeletal pain. DATA SYNTHESIS: Data were analyzed using random effects meta-analysis and narrative synthesis. We assessed risk of bias using the Cochrane RoB2 tool and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. RESULTS: We included 16 trials (reported across 18 studies). There was no difference in the effect of painful versus non-painful exercise on pain intensity or disability in the short-, medium-, or long-term, nor pain catastrophizing or fear avoidance in the short-term. The confidence intervals were wide. Narrative synthesis found similar results for quality of life, self-efficacy, mood, and adverse events. All trials were at high risk of bias and certainty of evidence was very low to low. CONCLUSIONS: The effect of painful versus non-painful exercise on patient-reported outcomes in adults with chronic musculoskeletal pain was unclear. Pain during exercise may not need to be avoided to allow for symptomatic and functional improvement. 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

Standardized definition of red flags in musculoskeletal care: A comprehensive review of clinical practice guidelines. Storari, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Red flags - Musculoskeletal care This systematic review of red flags in musculoskeletal conditions, focused on assessing whether there is consistency in the way that they are reported and applied in the literature. Red flags are critical for early detection of life-threatening or severe conditions, such as infections, fractures, tumors, visceral diseases, neurological issues, and cardiovascular problems. The review emphasised the importance of clinical guidelines and evidence-based approaches for physiotherapists and other healthcare professionals in recognising these indicators during physical examination, diagnosis, and referral processes. Unfortunately, the results outlined that there are inconsistencies on how red flags are reported and applied in clinical settings. 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, "red flags" are broadly defined as signs and symptoms that aim to prevent missed diagnoses of serious underlying pathologies, which are masquerading as musculoskeletal presentations. Red flags aim to detect conditions which are not always amenable to conservative management. In hand therapy we have a few "red flags" criteria, which include but are not limited to the elbow extension test , metacarpal length ratios , and upper limb arthropathies presenting alongside other systemic signs/symptom indicative of autoimmune disease . URL : https://doi.org/10.3390/medicina61061002 Abstract Background and Objectives: The aging population and the COVID-19 pandemic have led to a rise in severe conditions, including musculoskeletal (MSK) disorders. Although MSK conditions are often managed in primary care, they may sometimes mask serious illnesses requiring urgent diagnosis. The red flag (RF) concept is essential for identifying signs and symptoms of potentially severe disease. However, RF criteria vary across clinical guidelines and lack consistency. With the growing role of direct access to physiotherapy—bypassing physician referral—physiotherapists must develop strong differential diagnostic skills to identify serious pathologies that mimic MSK disorders. This review aims to systematically map how RFs are defined in MSK clinical practice guidelines (CPGs), supporting the move toward a standardized definition for clinical and research use. Materials and Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, and Cochrane databases. Included studies were CPGs and systematic reviews (SRs) of CPGs addressing MSK disorders and incorporating the RF concept. Data extraction followed a rigorous process, and RF definitions were synthesized and compared in table format. Results: Out of thirteen-thousand three-hundred and ninety-three articles identified, fourteen met inclusion criteria (seven CPGs and seven SRs of CPGs), spanning both physiotherapy and medical fields. All definitions described RFs as signs or symptoms indicating possible serious pathology requiring further investigation or referral. Some definitions referred broadly to “patterns of signs or symptoms”, while others offered more precise criteria. Conclusions: This review highlights the lack of a standardized RF definition in MSK care, leading to inconsistencies in clinical decision-making and diagnosis. To improve patient safety and guide clinicians—especially in direct-access contexts—a unified, internationally recognized definition of RFs is needed in future guidelines. 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

Lateral elbow tendinopathy: Correlation of ultrasound findings with pain and functional disability Clarke, et al. (2010) Level of Evidence : 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Intrasubstance tear CEO - Surgical management This cohort study assessed recovery with conservative treatment of people with a common extensor origin tendinopathy, focusing on the relevance of imaging findings on prognosis. A total of 62 patients were included in the present study. Patients underwent a guided exercise program under a single physiotherapist for six months. Ultrasound imaging was utilised to assess the tendon characteristics at baseline. The results showed that 30% of patients did not respond well to conservative management. Of the people who responded poorly, the majority (95%) had a large intrasubstance tear (more than 8mm tear) within the CEO and a small portion had a radial collateral ligament injury alongside the CEO tear. Those patients who responded positively to conservative treatment, the tear was smaller than 4 mm. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, large tears of the common extensor origin do not seem to respond well to conservative management compared to those people who present with smaller tears (less than 4mm). In addition, associated ligament lesions tend to be associated with worse outcomes. Based on this information, it is likely that those people with a larger tear (more than 8mm) may benefit from surgical intervention, although a trial of conservative management is warranted given the limited evidence of first line surgical approaches in tendons without obvious tears . If you identify somebody that has a mimicker of tennis elbow, but has posterolateral rotatory instability instead, this also may be best managed surgically. URL : https://doi.org/10.1177/0363546509359066 Abstract Background: Lateral elbow tendinopathy is a common condition often diagnosed by ultrasound. Debate exists regarding which ultrasound findings correlate with disease severity and prognosis. Hypothesis: Sonographic predictors for tendon healing in patients with lateral elbow tendinopathy can be found by correlating initial ultrasound findings with subsequent changes in pain and functional disability scores after a period of nonoperative management. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: Sixty-two elbows (34 right, 28 left) in 62 patients (30 male, 32 female) with a clinical diagnosis of lateral elbow tendinopathy underwent sonographic evaluation of the common extensor origin after assessment with a validated outcome measure, the Patient-Rated Tennis Elbow Evaluation (PRTEE). After 6 months of nonoperative standardized treatment (physiotherapy with eccentric loading), the PRTEE questionnaire was repeated. Results: The mean pretreatment PRTEE was 78 (range, 51-97) and posttreatment score was 29 (range, 0-91). This difference in means was found to be significant ( P < .0001). A positive correlation was identified between the presence of a lateral collateral ligament tear ( P < .0001) and the size of the largest intrasubstance tear ( P < .0001) and poor outcome. A negative correlation was identified with amount of hypoechogenicity ( P = .0009). No correlation was found with age, sex, side, duration of symptoms, thickness of tendon, or amount of neovascularity. Conclusion: The size of intrasubstance tears and presence of a lateral collateral ligament tear on ultrasound can be used to assess lateral elbow tendinopathy severity, indicate those who may not respond to nonoperative therapy, and potentially guide more invasive treatment. Those patients with a large intrasubstance tear or tears identified on ultrasound are less likely to respond to nonoperative treatment. Presence of neovascularity has little correlation with change in pain severity or functional disability and may be a poor predictor of prognosis. 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 27-year-old woman had a fall and was subsequently unable to move their thumb. They reported thumb pain prior to the traumatic event, but x-rays taken two years prior were clear. On objective assessment, there was laxity of the ulnar collateral ligament of the thumb mcpj. X-ray were completed and they are reported below. What is it?

Understanding degenerative cervical myelopathy in musculoskeletal practice. Cervellini, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study : Diagnostic Topic : Degenerative cervical myelopathy - Hand Presentation This expert opinion described degenerative cervical myelopathy and its clinical presentation. Degenerative cervical myelopathy is the most frequent cause of spinal cord impairment in adults, yet its early stages are difficult to identify because of subtle, non‑specific symptoms that may be mistaken for routine neck or hand problems. Diagnosis requires a holistic approach that integrates patient‑reported complaints with a complete neurological examination, specific motor and sensory testing, reflex assessment, and careful observation of hand function and gait. Imaging modalities such as MRI, CT, and flexion‑extension radiographs are valuable adjuncts but are not sufficient alone. The evidence favours surgical decompression - anterior, posterior or combined - as the primary treatment for moderate‑to‑severe disease, with the aim of preventing further decline and potentially restoring neurological function. In mild cases, an initial conservative strategy that includes bracing, analgesia, therapeutic exercise and activity modification may be considered, although the long‑term benefit of such interventions remains uncertain. Early recognition by clinicians, rigorous clinical reasoning, and multidisciplinary collaboration are essential to ensure timely referral to optimise patient outcomes. 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, as hand therapists we should be aware of degenerative cervical myelopathy as a differential diagnosis in patients presenting with what might look like peripheral entrapment neuropathies (e.g. carpal/cubital tunnel syndrome). Neck pain may be present in these people but it is not always the main symptom they complain of. A full neurological exam and monitoring over time of neurological function are essential. Cervical x-rays and MRIs can provide useful information regarding size of the spinal canal and whether there is evidence of demyelationion of the spinal cord (T2 images are usually useful). The benefit of early identifying people with cervical myelopathy is that surgical intervention can provide a chance for functional recovery. Evidence for long‑term benefit of conservative therapy remains limited. Other presentations that can be imitating carpal/cubital tunnel syndrome are cervical radiculopathy and neurogenic thoracic outlet . If you need a refresher for your neurological exam, have a look at this synopsis . URL : https://doi.org/10.1080/10669817.2025.2465728 Abstract Background: Degenerative cervical myelopathy (DCM) is a clinical syndrome characterized by a progressive compression of the spinal cord. DCM often looks like common symptoms of aging or bilateral carpal tunnel syndrome in its early stages, requiring careful differential diagnosis. Identifying DCM is a real challenge as no validated screening tools are available for making the DCM diagnosis. Potentially, individuals with DCM may experience misdiagnosis or substantial diagnostic delays, with an enhanced risk of irreversible neurological consequences if not promptly addressed. Despite the increasing prevalence, there is a lack of awareness about DCM among both the public and healthcare professionals. However, patients may seek physiotherapy to obtain a diagnosis or access treatment. Methods: A comprehensive (non-systematic) review of the literature about DCM epidemiology, pathophysiology, clinical presentation, diagnostic methods, and management was conducted. Results: A guide and essential knowledge to facilitate clinicians to understand DCM and to enhance clinical reasoning skills, performance and interpretation of the examination are provided. Interdisciplinary collaboration and optimal referral methods are also handled. Conclusion: The aim of this article is to summarize and enhance physiotherapists’ essential knowledge of the differential diagnosis and management of patients with DCM. 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

Predictors of successful outcomes following revision carpal tunnel release. Dondapati, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic : Carpal tunnel surgery - Revision surgery This retrospective study assessed factors associated with a positive response to carpal tunnel surgery revision. A total of 578 participants were included, of which 57 underwent surgical revision. Patient-specific factors, such as diabetes, smoking, obesity, age, gender, and body mass index (BMI), surgical characteristics, and clinical presentation were recorded. The results showed that participants undergoing revision for pain, who smoked, or were diabetic appeared to be less likely to benefit from the surgical procedure. An CSI injection prior to revision seemed to be beneficial. This is possibly due to the fact that those who had a positive response to CSI were more likely to be offered a revision 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, ongoing paraesthesia/weakness and having undergone a carpal tunnel cortisone injections seem to be correlated with a successful outcome in people undergoing carpal tunnel revision. In contrast, people who mainly report pain, who are smokers/diabetic, do not appear to have as good as a response to revision surgery . We should therefore encourage our patients to stop smoking , control weight , and take part in regular exercise to prepare them for a carpal tunnel revision. URL : https://doi.org/10.1016/j.jhsa.2025.01.007 Abstract Purpose: We sought to identify predictors of successful revision carpal tunnel release (CTR) and compare long-term patient-reported outcomes to individuals who underwent primary CTR with no revision. We hypothesized that patients undergoing revision CTR would have worse patient-reported outcomes scores compared to primary CTR at 1-year follow-up. Methods: We retrospectively compared 521 primary CTR and 57 revision CTR patients. Patients with minimum 1-year follow-up, including Patient-Reported Outcomes Measurement Information System (PROMIS) and Patient Acceptable Symptom State (PASS) scores, were included. PASS and PROMIS Upper Extremity (UE), Pain Interference (PI), and Physical Function (PF) were compared at before surgery and 1-year after surgery timepoints. Demographic and surgical data were compared using bivariate and multivariable analyses. Results: Compared with the primary CTR group, the revision group had a higher body mass index, was more likely to be male, have their dominant hand affected, have diabetes, undergo endoscopic CTR, and have concurrent cubital tunnel syndrome (CuTS). A chief complaint of pain (OR 0.23), tobacco use (OR 0.11), or diabetes (OR 0.22) were less likely to have a positive PASS response, whereas having an interval steroid injection (OR 6.2) was a predictor of a positive PASS response. PROMIS UE, PF, and PI were all similar in the primary group compared with the revision group at both before surgery and 1-year after surgery visits. None of the PROMIS modalities significantly improved at 1-year follow-up in the primary and revision groups compared to before surgery. Positive PASS response in the revision group was lower preoperatively and 1-year postoperatively compared with the primary cohort. Conclusions: Steroid injections, absence of diabetes and tobacco use, and chief symptoms of paresthesias or weakness, rather than pain, are predictors of satisfactory outcomes after revision CTR. Patients undergoing revision demonstrated lower rates of positive PASS response than primary CTR without revision at 1-year follow-up. 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

Which trigger digit is the most common?. Portney, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Symptom prevalence Topic : Trigger finger - Frequency occurrence This retrospective study assessed prevalence of trigger finger across all fingers and hands in a large national database of US patients. More than 1.5 millions participants were included in the study. The results showed that the middle finger was the most frequently diagnosed digit, followed by the thumb and ring finger, while the index and little fingers had the lowest rates. Approximately 33% of patients had multiple digit involvement, with symmetric patterns being common. The right hand was involved more often than the left. 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, trigger finger occurs most often in the middle finger, followed by the thumb and ring finger. Of note, 1 in 3 patients exhibits multiple digit involvement with symmetrical patterns. When multiple digits are involved, the ring finger is often involved alongside the middle finger. Considering that splinting is as effective as cortisone injections and that mcpj or RME splints are effective for trigger finger , we have good options for the management of this condition. If you would like to have a look at the more research on the topic, check out the entire database . URL : https://doi.org/10.1177/17531934251348815 Abstract A national database was queried to determine the frequency of trigger finger diagnoses by digit and the frequency of multiple digit involvement. The middle finger was the most diagnosed digit, with 33% of patients having multiple digit involvement. 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