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When progressing training loads, what are the considerations for healthy and injured athletes? Gabbett, T., I. Sancho, B. Dingenen and R. W. Willy (2021) Level of Evidence : 5 Follow recommendation : 👍 👍 Type of study : Therapeutic Topic : Training loads – How to progress them This is an editorial from the British Journal of Sports Medicine. The article refers to local tissue capacity and sport-specific capacity. Local tissue capacity refers to an individual structure ability to withstand load, produce force (if contractile), and perform under well controlled conditions. Sport-specific capacity refers to the tissue ability to perform in a sport action independently of tissue health. Three points on how to maintain health and rehabilitate athletes' past injury were made (see picture below). The first one suggested that both local tissue and sport-specific tissue loading are required to rehabilitate an athlete or reduce their risk of injury. The second advice was to load tissue locally while monitoring both the loading provided and pain. The third point suggested to have scheduled local tissue loading session to maintain local capacity and avoid re-injury. 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 : Information from this article can be applied to our clients who we see for an upper limb related injury. I questioned myself on how often I make sure that I consider maintaining some of their sport-specific capacity whilst allowing local tissue healing. The answer is that I don't do that enough. I should probably encourage them to take part in other aspecta of training that they are allowed to do and explain the importance to do so. The risk of not doing so is that we will follow them until their local hand/wrist/elbow injury has healed (increased local tissue capacity) and we will discharge them with a significant gap in their sport-specific capacity due to general deconditioning. The same principle possibly applies to return to work in people that have a manual job. If they are off work for an extended period of time and they become sedentary it is possible that their work-specific capacity will decrease, making them more prone to further injuries when they get back to work. Let me know what you think. Open Access URL : http://bjsm.bmj.com/content/early/2021/04/08/bjsports-2020-103769.abstract No Abstract available

Cross-sectional area of the median nerve as a prognostic indicator in carpal tunnel syndrome treated with local steroid injection. Yeom, J. W., J.-H. Cho, S. J. Kim and H. I. Lee (2021) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 thumb up) Type of study : Prognostic Topic : Carpal tunnel response to cortisone injection - morphological predictor This is a retrospective study assessing the prognostic relevance of median nerve morphological changes (cross sectional area - CSA) in people with carpal tunnel syndrome (CTS) treated with cortisone injections. Participants were included (N = 40) if they presented symptoms such as paraesthesia in median nerve distribution of the hand, atrophy of thenar muscles, positive Phalen's and Tinel's test, and if a conservative treatment trial (e.g. splinting) had failed. All participants underwent CSA ultrasound assessment of the median nerve before injection (see figure). This identified 16 participants with an increase in CSA of the median nerve proximal to the carpal tunnel (more severe compression) and 21 without such findings. The injection was performed under ultrasound guidance in all participants. The Boston Carpal Tunnel Questionnaire was utilised to assess the treatment outcomes at baseline and six months after injection. The results showed that CSA area of the median nerve was not a predictor of injection outcome. 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, median nerve cross-sectional area alone is not a predictor of cortisone injection treatment success in people with carpal tunnel syndrome. Cortisone injections for clients with carpal tunnel syndrome appear to be a useful conservative treatment intervention and they appear to be superior to night splinting for our clients (≥ 40 years old) with moderate/severe carpal tunnel syndrome . URL : https://doi.org/10.1016/j.jhsa.2021.09.022 Available through The Journal of Hand Surgery (American Volume) for HTNZ members. Available through EBSCO Health Databases for PNZ members. Abstract Purpose: Local steroid injection is an effective treatment modality for carpal tunnel syndrome. This study aimed to investigate the success rate of ultrasonography-guided local steroid injection and determine the prognostic value of the cross-sectional area (CSA) of the median nerve for steroid injection. Methods: We retrospectively evaluated 40 patients with carpal tunnel syndrome whose median nerve CSA was >15 mm2 (large-CSA group; n = 16) or ≤15 mm2 (small-CSA group; n = 24). The CSA was measured using ultrasonography, and all the patients were treated with ultrasonography-guided corticosteroid injection. Demographic characteristics, symptoms, initial QuickDASH score, Boston Carpal Tunnel Questionnaires, and results of the nerve conduction study were assessed at baseline. Treatment success was defined in this study as the absence of symptom recurrence within the entire follow-up period. Results: The treatment success rate was 45% (n = 18) after an average follow-up of 16 months. Overall, 11 patients (28%) underwent carpal tunnel release on an average of 11 months after steroid injection. The large-CSA group showed a significantly worse grade of electrodiagnostic testing at baseline than did the small-CSA group; however, there was no significant difference in final Boston Carpal Tunnel Questionnaires symptom score (1.7 vs 1.8, respectively) and the rate of continued treatment success at the last follow-up (42% vs 50%, respectively). The proportions of patients who required carpal tunnel decompression were 29% and 25% in the small-CSA and large-CSA groups, respectively. Conclusions: Local steroid injection for carpal tunnel syndrome has an overall success rate of 45% after a mean follow-up of 16 months. Preinjection CSA was not associated with whether the steroid injection was considered successful. This indicates that increased median nerve CSA does not preclude the possibility of symptomatic relief after a local steroid injection. 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

Distal intersection syndrome combined with partial attritional changes of the extensor carpi radialis brevis in tennis players. Sunagawa, T., D. Dohi and R. Shinomiya (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 23 years old right-handed recreational tennis player with right dorsal radial wrist pain. The pain was aggravated during double backhand shots during tennis. There was pain and swelling just distal and radial to Lister's tubercle. MRI findings are reported below. A cortisone injection was provided at the painful site and a wrist splinting was worn for two months. After this period of conservative treatment, they were still symptomatic. Surgery was therefore performed for diagnostic and therapeutic purposes. The surgical intervention identified a distal intersection syndrome between extensor pollicius longus (EPL), extensor carpi radialis brevis (ECRB) and longus (ECRL), associated with fraying of extensor carpi radialis brevis at the intersection with EPL. Synevectomy, extensor retinaculum release, and trimming of EPL fraying was completed. The patient's wrist was immobilised for 3 months followed by graded rehab. Three months post surgery the patient was able to return to tennis without pain after 3 months. 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, distal intersection syndrome (2nd and 3rd compartment) is a rarer condition compared to proximal intersection syndrome (abductor pollicius longus vs ECRB/ECRL). The distal intersection syndrome is characterised by pain distal and radial to the Lister's tubercle, where EPL intersects both ECRB and ECRL. If you are interested in reading about additional clinical cases reporting radial wrist pain, have a look at this synovial hemangioma , trapezium osteosarcoma , and Linburg-Comstock syndrome . Open Access URL : https://doi.org/10.1016/j.jhsg.2021.04.005 Abstract The purpose of this study is to report the cases of 2 tennis players with distal intersection syndrome, a rare pathological condition, combined with partial attritional changes of the extensor carpi radialis brevis tendon. Both individuals were able to return to their original level of performance after surgical intervention consisting of synovectomy within the distal intersection and release of the distal part of the extensor retinaculum. Physicians should familiarize themselves with distal intersection syndrome, which can cause dorsoradial wrist pain in tennis players. If pain is prolonged, tendon attrition may occur, and surgical treatment may be indicated. 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

Six weeks of resistance training (plus advice) vs advice only in hand osteoarthritis: A single-blind, randomised, controlled feasibility trial. Magni, N., P. McNair and D. Rice (2021) Level of Evidence : 1b- Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : Resistance training - application in hand OA This is a pilot randomised controlled trial assessing the feasibility of resistance training exercises for hand OA. A total of fifty-nine participants were included in this study. Participants were included if they presented with the American College of Rheumatology classification criteria, if their pain was at least 3 out of 10 on a Numerical Rating Scale, and if they had pain every day for at least three consecutive months in the year of inclusion. Participants were randomised into either high-intensity resistance training (HIT) plus advice (n = 20), blood-flow restriction training (BFR) plus advice (n = 19), or an advice only group (n = 20). Feasibility measures included exercise-induced pain (post exercise pain - pre exercise pain), pain exacerbations (increases in pain that lasted beyond 24 hrs after exercise). Efficacy of intervention was assessed through the OMERACT-OARSI criteria (a combination of pain, function, and disease burden outcome), pain (NRS), function (i.e., FIHOA), grip and pinch strength. All participants received advice as per Arthritis New Zealand pamphlet on osteoarthritis . In addition, participants in the resistance exercise groups trained three times per week for six weeks one on one with a physiotherapist. Participants in the advice only group received no additional intervention. Exercises were performed starting at 30% and 60% of maximum voluntary contraction for the BFR and HIT groups respectively. Participants were started on two sets for each exercise (gripping, pinching, and thumb-abduction). The exercises progressed both in terms of intensity (40% and 70% for BFR and HIT respectively) and number of sets (up to 4 sets). The results showed that exercise-induced pain remained unchanged despite doubling of exercise volume (sets x repetitions), see figure below. In addition, the number of pain exacerbations was low in both resistance training interventions. The number of responders was 79%, 60%, and 35% in the BFR, HIT, and advice only groups respectively. Pain improved to a clinically relevant level with resistance training interventions but not with advice only. There were no clinically relevant changes in function, grip, or pinch strength. 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, resistance training interventions do not appear to worsen pain and may actually improve symptoms in clients with hand OA. These findings are supported by another study, which showed no worsening of pain when people with interphalangeal hand OA who underwent resistance training for their hands. These results are also consistent with a systematic review and meta-analysis covered in a previous synopsis . Other activities that have been shown to be safe for clients' with hand OA include knitting . What these results suggest is that there are lots of options to keep our clients with hand OA active. In addition, if we provide treatments that our clients think will be helpful , there is a higher probability that they will report pain relief with it. URL : https://www.sciencedirect.com/science/article/pii/S2468781221001752 Available through EBSCO Health Databases for PNZ members. Abstract Background People with hand osteoarthritis (OA) may benefit from resistance training interventions. To date the feasibility of a such interventions for symptomatic hand OA, as per international guidelines, is unknown. Objective Determine the feasibility of a clinical trial comparing resistance training to an advice only control group in people with symptomatic hand OA. Design Single-blind, randomised, controlled feasibility study. Methods The American College of Rheumatology criteria for hand OA were utilised for inclusion. Participants were randomly allocated (1:1:1) to advice and blood flow restriction training (BFRT), advice and traditional high intensity training (HIT), or advice only (control). Participants receiving BFRT and HIT underwent supervised hand exercises three times a week for six weeks. Feasibility measures included recruitment rate, adherence, exercise induced pain, training acceptability, pain flares, and adverse events. Number of treatment responders, pain, grip strength, and hand function were also recorded. Results In total, 191 participants were screened, 59 (31%) were included. Retention rate was 89% for BFRT and 79% for HIT. Exercise did not worsen pain following training sessions, and training acceptability was equal between groups. Pain flares occurred in 1.6% (BFRT) and 4% (HIT) out of all the training sessions. There was one adverse event in the HIT group, with the participants withdrawing from the study due to pain. The number of treatment responders, and improvements in pain, were greater with BFRT and HIT. Grip and function did not improve. Conclusion A clinical trial comparing resistance training to advice for people with symptomatic hand OA is feasible. 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

Evaluation for Kienböck disease familial clustering: A population-based cohort study. Kazmers, N. H., Yu, Z., Barker, T., Abraham, T., Romero, R., & Jurynec, M. J. (2020) Level of Evidence : 2b Follow recommendation : 👍 👍 Type of study : Diagnostic Topic : Kienböck disease - Genetic contributions This is a retrospective study assessing whether genetic factors and extrinsic risk factors contribute to the development of Kienböck's disease. A total of 394 patients diagnosed with Kienböck's disease were included. Extrinsic risk factors included a past history of diabetes, tobacco, glucocorticoid, and alcohol use. The results showed that a person with a first-degree relative (parent, sibling, or child) affected by Kienböck disease is more likely to have the condition with a relative risk (RR) of 11 (95% CI: 1.1 to 113). However, the wide confidence interval suggests that the risk magnitude is not accurate, and the result should be interpreted with caution. Extrinsic factors increased the likelihood of being diagnosed with Kienböck's disease by 2.2 times (diabetes), 2.5 times (tobacco use), 6 times (glucocorticoid use), and 2.1 (alcohol use) times. All these factors had a tighter confidence interval suggesting that the magnitude risk is more precise. 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, Kienböck disease is a rare condition, however, hand therapists should be suspicious of this pathology when a patient's first-degree relative has been diagnosed with it. These patients may have an 11 times greater probability of having the disease. Modifiable factors such as smoking and corticosteroid use, present with the highest risk of presenting with Kienböck disease. URL : https://www.jhandsurg.org/article/S0363-5023(19)31415-7/abstract Abstract PURPOSE Kienböck disease (KD) is rare and its etiology remains unknown. As a result, the ideal treatment is also in question. Our primary purpose was to test the hypothesis that KD would demonstrate familial clustering in a large statewide population with comprehensive genealogical records, possibly suggesting a genetic etiologic contribution. Our secondary purpose was to evaluate for associations between KD and known risk factors for avascular necrosis. METHODS Patients diagnosed with KD were identified by searching medical records from a comprehensive statewide database, the Utah Population Database. This database contains pedigrees dating back to the early 1800s, which are linked to 31 million medical records for 11 million patients from 1996 to the present. Affected individuals were then mapped to pedigrees to identify high-risk families with an increased incidence of KD relative to control pedigrees. The magnitude of familial risk of KD in related individuals was calculated using Cox regression models. Association of risk factors related to KD was analyzed using conditional logistic regression. RESULTS We identified 394 affected individuals linked to 194 unrelated high-risk pedigrees with increased incidence of KD. The relative risk of developing KD was significantly elevated in first-degree relatives. There was a significant correlation between alcohol, glucocorticoid, and tobacco use and a history of diabetes, and the diagnosis of KD. CONCLUSIONS Familial clustering of KD observed in the Utah Population Database cohort indicates a potential genetic contribution to the etiology of the disease. Identification of causal gene variants in these high-risk families may provide insight into the genes and pathways that contribute to the onset and progression of KD. CLINICAL RELEVANCE This study suggests that there is a potential genetic contribution to the etiology of KD and that the disease has a significant association with several risk factors. 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 prediction model for incident hand osteoarthritis in the HUNT study. Johnsen, M. B., et al. (2020) Level of Evidence : 1a Follow recommendation : 👍 👍 👍 👍 Type of study : Prognostic Topic : Hand OA - Prognostic factors for incidence This is a prognostic study assessing the precision and validity of a statistical model to determine who will develop hand osteoarthritis (OA) in the future. A total of 35,835 participants were included in the present study. Of these, 17,153 were males and 18,682 were females. Participants were assessed over the course of 24 years. To be included, participants had to be free of hand osteoarthritis when assessed for the first time. Participants' age ranged between 35 and 70. Participants were diagnosed at follow up with hand OA if they presented with painful Heberden's or Buchard's nodes, or base of thumb OA. The prognostic model for males suggested that greater age, body mass index (BMI), education level, heavier work, and worse sleep quality all increased the chance of developing hand OA at 12 years. The prediction model for females suggested that greater age, BMI, heavier work, sedentary lifestyle, and poor general health increase the chance of developing hand OA. The prediction model was moderately precise for both males and females. However, it was more valid for males compared to females. 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, you can predict the likelihood of your clients developing hand OA at 12 years based on a few predicting factors. For males, it appears that greater BMI and worse sleep may increase the probability of developing hand OA. For females, higher BMI and inactivity increase the chance of developing hand OA. Based on these findings we may suggest our clients, both males and females, to follow the international guidelines for physical activity . In addition, if they are overweight or obese, we may refer them to a nutritionist in an attempt to reduce their BMI. For males, referral to a sleep specialist may also reduce the probability of developing hand OA. If you want to easily calculate the probability of your clients' developing hand OA, head over to this page . Open Access URL : https://doi.org/10.1016/j.joca.2020.04.005 Abstract Objective To develop and externally validate prediction models for incident hand osteoarthritis (OA) in a large population-based cohort of middle aged and older men and women. Design We included 17,153 men and 18,682 women from a population-based cohort, aged 35–70 years at baseline (1995–1997). Incident hand OA were obtained from diagnostic codes in the Norwegian National Patient Register (1995–2018). We studied whether a range of self-reported and clinically measured predictors could predict hand OA, using the Area Under the receiver-operating Curve (AUC) from logistic regression. External validation of an existing prediction model for male hand OA was tested on discrimination in a sample of men. Bootstrapping was used to avoid overfitting. Results The model for men showed modest discriminatory ability (AUC = 0.67, 95% CI 0.62–0.71). Adding a genetic risk score did not improve prediction. Similar discrimination was observed in the model for women (AUC = 0.62, 95% CI 0.59–0.64). Prediction was not improved by adding a genetic risk score or hormonal and reproductive factors. Applying external validation, similar results were observed among men in HUNT (The Nord-Trøndelag Health Study) as in the developmental sample (AUC = 0.62, 95% CI 0.57–0.65). Conclusion We developed prediction models for incident hand OA in men and women. For women, the model included body mass index (BMI), heavy physical work, high physical activity and perceived poor health. The model showed moderate discrimination. For men, we have shown that a prediction model including BMI, education and information on sleep can predict incident hand OA in several populations with moderate discriminative ability. 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 : 👍 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 23 years old right-handed recreational tennis player with right dorsal-radial wrist pain. The pain was aggravated during double backhand shots during tennis. There was pain and swelling just distal and radial to Lister's tubercle. MRI findings are reported below. A cortisone injection was provided at the painful site and a wrist splinting was worn for two months. After this period of conservative treatment, they were still symptomatic. What was it?

The impact of shoulder pathology on individuals with distal radius fracture. Doerrer, S. B., et al. (2021) Level of Evidence : 2c Follow recommendation : 👍 👍 👍 Type of study : Symptoms prevalence study Topic : Distal radius fractures - Relevance of shoulder pathology This cross-sectional study assessed the impact of post-traumatic shoulder pain onset in people with a distal radius fracture. A total of 45 participants were included in the study. Participants were included if they had a distal radius fracture and reported no shoulder impairments/pain prior to distal radius fracture. To assess the impact of shoulder injury on recovery post distal radius fracture, function, kinesiophobia, and pain intensity were assessed. The results showed that one third of participants presented with shoulder pain following a distal radius fracture. In addition, those participants who developed shoulder pain, presented with greater fear of movement and higher levels of 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, following a distal radius fracture, it is useful to screen for shoulder movemement and pain. Thosed people who present with a concurrent shoulder injury appear to be in greater overall pain and present with higher levels of kinesiophobia. Considering that kinesiophobia and pain catastrophising are associated with higher levels of disability, this group of clients may need some extra care. In addition, balance and frailty screening is important in older people with a distal radius fracture. As a matter of fact, after a distal radius fracture, frail clients are 5 times more likely to have another fracture in the coming year compared to their healthy counterparts. URL : https://doi.org/10.1016/j.jht.2021.09.002 Available through The Journal of Hand Therapy for HTNZ members. Available through EBSCO Health Databases for PNZ members. Abstract Background Shoulder pathology can occur concurrently with a distal radius fracture (DRF) but few studies have examined this population. Purpose The purpose of this study was to expand the understanding of the impact of shoulder pathology on individuals with DRF. Study Design: Mixed Methods Design. Methods A total of 45 participants with a DRF were categorized into a DRF only (n = 29) and shoulder pathology concurrent with DRF (SPCDRF) (n = 16) groups. Quantitative data gathered included demographics, Quick Disabilities of the Arm, Shoulder, and Hand, Tampa Scale of Kinesiophobia-11, Visual Analog Scale, and Compensatory Mechanism Checklist. Qualitative interviews were performed with 7 participants in the SPCDRF group. Within group correlations were analyzed via the Spearman Rank. The Mann Whitney U test was used to compare the two groups. Qualitative analysis was performed to describe the experience of participants in the SPCDRF group. A mixed methods analysis compared quantitative and qualitative data. Results Sixteen participants (35.6%) in the sample presented with shoulder pathology; 6 participants (37.5%) presented at initial evaluation due to the fall; 10 participants (62.5%) developed shoulder pathology due to compensation or disuse. Average number of days to develop shoulder pathology after the DRF was 43 days. SPCDRF participants had significantly greater pain levels (p = .02) and more activity avoidance (p = .03) than the DRF only group. Four qualitative themes emerged: It's difficult to perform occupations and changes had to be made; There is fear and uncertainty; The impact of pain; Tried to be normal but could not Mixed methods analysis found that qualitative data further illuminated quantitative findings. Conclusions Individuals with shoulder pathology concurrent with a DRF may present with higher pain levels and avoid activity more. In addition, they may describe fearfulness in using their injured upper extremity especially if they have high levels of pain. Study Design Mixed Methods Design. 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 more I do, the more I can do”: Perspectives on how performing daily activities and occupations influences recovery after surgical repair of a distal radius fracture. Collis, J. M., E. C. Mayland, V. Wright-St Clair and N. Signal (2021) Level of Evidence : 4 Follow recommendation : 👍 👍 Type of study : Therapeutic Topic : Conservative treatment - Distal radius fracture This is a qualitative prospective study assessing the experience of people involved in daily activities following open reduction and internal fixation (ORIF) of a distal radius fracture. Qualitative research is not my strength so if you spot any mistakes or incorrect interpretations, please leave a comment! A total of 21 participants were included in the study. Participants were included if they presented with a distal radius fracture ORIF, which was deemed stable and suitable for mobilisation by week 4 post-op. Participants were excluded if they had an additional fracture or surgery for the repair of other structures. In addition, if they had any other conditions impairing the use of the affected hand, they were excluded. Semi-structured interviews were utilised to collect data about participants' experiences in association with involvement in daily activities. An activity log was also completed by participants in order to gather information about the activities they were involved with. The results showed that more than 50% of participants were completing some daily activities by week 3 and that 100% of participants were engaged in some form of daily activity by week 6. The results of the interviews identified several themes. In particular, participants reported daily activities being helpful for recovery, spurring the use of the affected hand in a graded way, giving wrist movement a purpose, gradually exposing the wrist to loads and reducing fear, and challenging not only physical but also psychological aspects involved in the recovery post a distal radius fracture ORIF. 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, involvement in daily activities appears to facilitate recovery following distal radius fracture ORIF. In particular, these meaningful activities not only facilitate wrist movements but also provide clients with psychological benefits. Early mobilisation of a distal radius fracture ORIF should not be an issue and in fact, it may provide better results compared to delayed mobilisation. In particular, two weeks post-surgery, wrist mobilisation should be e ncouraged . Also remember that in certain clients with a distal radius fracture, bone density scans may be advisable . If you are interested in distal radius fractures, have a look at the full collection ! URL : https://doi.org/10.1080/09638288.2021.1936219 Available through EBSCO Health Databases for PNZ members. Abstract Purpose The study aimed to explore perceptions and experiences about how engaging in daily activities and occupations influenced recovery in the first eight weeks after surgical treatment of a distal radius fracture. Methods Twenty-one adults completed an online activity and exercise log then participated in a semi-structured interview between weeks 6 and 8 postoperatively. Interviews were transcribed and analysed using reflexive thematic analysis. Results Daily activities and occupations were highly influential in facilitating recovery of movement and function of the operated limb. Five themes provided an understanding of how occupation operated to promote recovery. Occupation was (i) a primary driver of the rehabilitative process, providing an impetus for recovery, (ii) offered ready-to-hand challenges for opportunistic, automatic movement, (iii) invited intentional use of the affected wrist, (iv) habituated the wrist to movement through repetition and confidence-building, and (iv) drew on psychosocial resources to enable reengagement with life activities and roles. Conclusions Incorporating the performance of graded, modified activities during the early weeks of rehabilitation creates opportunities for wrist movement, enhances wellbeing, and assists in the habituation of wrist movement. Activities and occupations can be used as a therapeutic strategy to promote recovery from surgical treatment of a distal radius fracture. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Severity of persistent pain and disability can accurately screen for presence of pain catastrophizing and fear of performing wrist movements in individuals with distal radius fracture. Mahdavi, M., et al. (2021) Level of Evidence : 2c Follow recommendation : 👍 👍 👍 Type of study : Symptoms prevalence study Topic : Psychology in upper limb conditions - Pain catastrophising and disability This is a cross-sectional study assessing the association between pain/function and psychological factors in participants who had a distal radius fracture six months earlier. A total of 85 participants were included in the study. Pain and function were measured through the patient-rated wrist evaluation (PRWE) questionnaire. Psychological factors measured include pain catastrophising , emotional well-being (e.g. depression, anxiety, stress), and kinesiophobia . The results showed that higher levels of pain/functional impairments were associated with greater pain catastrophising, lower emotional well-being, and greater fear of movement (kinesiophobia). 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, catastrophising, mental health issues, and fear of movement contribute to pain and disability in clients who had a distal radius fracture six months prior. These findings are consistent with a previous systematic review . Rather than immobilising these clients, pain neurophysiology education in combination with graded exercise may be a better alternative. Following tissue healing, reassuring clients by explaining that pain is probably associated with tissue sensitivity rather than actual tissue damage may be a useful approach. If you would like to test your pain neuroscience knowledge, have a look at this synopsis . URL : https://www.sciencedirect.com/science/article/pii/S2468781221001582 Available through EBSCO Health Databases for PNZ members. Abstract Background The evidence indicating presence of psychological factors concerns in individuals who report persistent residual pain and disability over a longer term after distal radius fractures (DRF) is emerging but requires further inquiry. Objectives To examine the associations of persistent wrist pain and disability at 6-months after DRF with the presence of psychological factors. Methods Eighty-five patients with DRF were evaluated for wrist pain and disability with subscales of Patient-rated wrist evaluation (PRWE), 6-months after the fracture. The associations of wrist pain and disability with these psychological factors at 6-months after DRF were examined using multivariable logistic regression models. The ability of PRWE scores at 6-months after DRF to accurately classify individuals with and without these psychological factors was examined using the area under the receiver operating characteristic curve (AUC). Results Higher PRWE-P scores were significantly associated with worse pain catastrophizing, having emotional distress, and fear of performing wrist movements. In addition, higher PRWE-F scores were also highly associated with worse pain catastrophizing, having emotional distress, and fear of performing wrist movements. The PRWE-P or PRWE-F Scores of ≥18/50 showed the best combination of sensitivity and specificity in identifying individuals with pain catastrophizing, emotional distress, and fear of performing wrist movements at 6-months after DRF (AUC values of ≥0.88). Conclusion The novel finding of this study is that scores of ≥18/50 PRWE-P or PRWEF can be used to screen for the presence of these psychological factors. 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 prospective randomized clinical trial of prescription of full-time versus as-desired splint wear for de Quervain tendinopathy. Menendez, M. E., E. Thornton, S. Kent, T. Kalajian and D. Ring (2015) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 Type of study : Treatment Topic : De Quervain - Splint wearing This is a randomised controlled trial assessing the effectiveness of full time vs part-time splint wearing in people with De Quervain tenosynovitis. Participants were included if they were diagnosed with de Quervain tendinopathy by a hand surgeon. Potential participants were excluded if they were pregnant. A total of 58 participants were allocated to either full-time splint wearing (n=26) or part-time (n=32) splint wearing. All participants were provided with a forearm-based thumb spica splint, which they were either advised to wear full time (except for showering) or as desired. Pain anxiety, the QuickDASH, pain catastrophising, numerical pain scale (NRS), and depression were assessed at baseline and follow up (7.5 weeks). The results showed that there were no statistically or clinically significant differences between groups. Both groups showed some improvement despite it not reaching clinical relevance. The results also showed that greater disability at 7.5 weeks is associated with greater depressive symptoms at baseline. 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, depression may contribute to higher levels of disability after conservative treatment in de Quervain tendinopathy. It is possible that a tailored approach to modify psychological factors in those with higher levels of mental health issues could help reduce disability in clients with de Quervain. These findings are not surprising considering that most upper limb conditions disability is mediated by mental health (e.g. kinesiophobia , depression ). URL : https://doi.org/10.1007/s00264-015-2779-6 Abstract PURPOSE: There is no consensus on the best protocol for splint wear in the non-operative management of de Quervain tendinopathy. This study aimed to determine if there is a difference between prescription of strict splint wear compared to selective splint wear in patients with de Quervain tendinopathy. We tested the primary null hypothesis that there is no difference in upper-extremity disability eight weeks after initiating splinting between patients prescribed full-time or as-desired splint wear. Secondary study questions addressed differences in grip strength, pain intensity, and treatment satisfaction. Additionally, we evaluated the influence of psychological factors on disability. METHODS: Eighty-three patients diagnosed with de Quervain tendinopathy were randomly allocated into two different splint-wearing instructions: full-time wear (N = 43) or as-desired wear (N = 40). At enrollment, patients had grip strength measured and completed measures of upper-extremity disability, pain intensity, and psychological distress. An average of 7.5 weeks later, patients returned for a second visit. Analysis was by intention-to-treat and with use of mean imputation for missing data. RESULTS: Fifty-eight patients (70 %; 26 in the full-time cohort and 32 in the as-desired cohort) completed the study. There were no statistically significant differences in disability (p = 0.77), grip strength (p = 0.82), pain intensity (p = 0.36), and treatment satisfaction (p = 0.91) between patients instructed to wear the splint full-time and those instructed to use it as desired. Disability at final evaluation correlated significantly with baseline levels of pain anxiety (p = 0.008), catastrophic thinking (p = 0.001), and symptoms of depression (p < 0.001). The best multivariable linear regression model included symptoms of depression alone and accounted for 32 % of the variability in disability (p < 0.001). CONCLUSION: There is no difference in patient-reported outcomes and grip strength with prescription of full-time or as-desired splinting, and patients can wear the splint as they prefer. These results suggest that splinting for de Quervain tendinopathy is palliative at best and strict rest is not disease modifying. 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 rare and severe case of pronator teres syndrome. Moura, F. S. E. and A. Agarwal (2020) Level of Evidence : 5 Follow recommendation : 👍 Type of study : Diagnostic/Therapeutic Topic : Median nerve entrapment - Pronator teres This is the answer to last week Sherlock Handy. The patient was a 57 years old presenting with left volar forearm pain and grip/pinch strength weakness, which developed over the course of 5 years. They had a history of cancer, which was in remission. They had no symptoms at night. There was atrophy of the thenar eminence (see picture) and reduced sensation in the thumb, index, middle finger and thenar eminence. Carpal tunnel tests were negative. Neurological examination identified no central nervous system pathology. Nerve conduction studies identified no sensory impairments but a severe left median nerve neuropathy below the elbow. During surgical exploration, entrapment of the median nerve was identified at the level of the pronator teres, and this was released. In addition, the flexor digitorum superficialis' arch, which is another potential area of median nerve entrapment, was also released. Follow up at 8 weeks showed some sensory and motor improvements, with some ability to perform thumb ipj flexion. 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, severe entrapment of the median nerve at the pronator teres entry is a rare presentation. The differential diagnosis for this presentation included cervical entrapment radiculopathy, a median nerve entrapment at the lacertus fibrosus , brachial neuritis, thoracic outlet syndrome, and carpal tunnel syndrome (CTS), or a central nervous system pathology. If you enjoyed this synopsis I am sure that you will enjoy this one too. Open Access URL : https://doi.org/10.1093/jscr/rjaa397 Abstract We present the case of a patient with severe symptoms of proximal forearm median nerve neuropathy. Over the course of 5 years his condition progressed to encompass rare features of combined pronator teres syndrome (PTS) and anterior interosseous nerve syndrome (AINS). The aetiology was found to be pronator teres compression and was managed successfully by surgical decompression. Proximal forearm median nerve compression should be considered as a continuum with two classic endpoints. At one end of the spectrum pure PTS presents with solely or mainly sensory symptoms, whereas at the other end AINS presents with pure motor symptoms. Hence, all possible anatomical sites of compression must be surgically explored in all cases of PTS or AINS, regardless of symptomatology. Timely referral to an experienced specialist is encouraged to ensure good outcomes, whenever a primary care practitioner encounters an atypical carpal tunnel syndrome-like presentation. 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