Search Results

Comparison of 2 postoperative therapy regimens after trapeziectomy due to osteoarthritis: A randomized, controlled trial. Hermann-Eriksen, M., et al. (2021) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 👍 Type of study : Therapeutic Topic : Thumb osteoarthritis - Post-surgical management This is a randomised, single-centre, non-inferiority trial assessing the results of an early vs delayed thumb motion approach following trapeziectomy. Participants (N = 55) were randomised to either standard care (n = 27) or the experimental intervention (n = 28). The experimental intervention was equal to the standard care except that thumb mobilisation started 3 weeks earlier (at 3 weeks post-op in the experimental group compared to 6 weeks post-op in the standard care group). The primary outcomes included function and satisfaction with surgery at 3, 6, and 12 months. The exercises were initiated at 3 weeks in the experimental group and included thumb opposition, abduction, mcpj and ipj flexion/extension, and wrist extension/flexion. Two to five repetitions for each exercise were performed at least 3 times per week. The results showed that participants in both groups improved to a similar extent. 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, early thumb mobilisation post trapeziectomy is safe. Active range of movement exercises can be initiated at 3 or 6 weeks post surgery without significant differences. Keep in mind that if your clients with trapeziectomy had a cortisone injection 3 months prior to surgery, they are at greater risk of wound complications . Considering that cortisone injections are not more effective then placebo for thumb OA , the risks vs benefits should be shared with your clients. Prior to surgery, a conservative intervention trial may be worth it! Open access URL : https://doi.org/10.1016/j.jhsa.2021.08.015 Abstract Purpose: The main aim of the present study was to evaluate whether early mobilization after trapeziectomy in the first carpometacarpal joint is noninferior to a postoperative regimen comprising the use of a rigid orthosis and mobilization after 6 weeks, with regards to patient-reported activity performance and the effect of surgery in patients with first carpometacarpal osteoarthritis. Methods: In this prospective, randomized, controlled noninferiority trial, participants were assessed at baseline (before group allocation) and at 3, 6, and 12 months after surgery. The primary outcomes were activity performance, measured using the Canadian Occupational Performance Measure (1-10, where 1 = unable to perform), and the patient-reported effect of surgery on a 6-point scale ranging from "much worse" to "completely recovered." A change of 2.0 points in the Canadian Occupational Performance Measure was used as a noninferiority margin. Secondary outcomes included hand function (patient-reported in the Measure of Activity Performance of the Hand questionnaire), pain on a numeric rating scale, grip and pinch strengths, and joint mobility. We performed both intention-to-treat and per-protocol analyses. Results: Of the 59 participants (88% women) with a mean age of 65 years, 55 (93%) completed all assessments. We found no differences between the groups in primary or secondary outcomes at any time point, except for more decreased pain at rest in the intervention group (n = 28) compared with the control group (n = 27) after 12 months. The per-protocol analyses did not change these results. Fifteen participants experienced 1 or more adverse events during the first 3 months, but the types and frequencies of adverse events were similar between the 2 groups. Conclusions: A postoperative regimen with early mobilization after trapeziectomy is as safe and effective as a postoperative regimen with longer immobilization in patients with first carpometacarpal osteoarthritis. 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

Adhesions as a component of the trigger finger: A dynamic sonographic study. Ling Chuang, X. and D. A. McGrouther (2020) Level of Evidence : 3b Follow recommendation : 👍 👍 Type of study : Aetiologic Topic : Trigger finger - Is there scar tissue? This is a case series assessing trigger finger pathology through ultrasound imaging. A total of 20 participants, took part in this study. Participants were included if they presented with a Green's grade 1 to 3 (I - intermittent, II - actively correctable, III - passively correctable, IV fixed flexion deformity). Adhesions, defined as lack of differential movement between FDS and FDP during passive joint movement, were assessed through ultrasound imaging. During the assessment, isolated dipj movement was completed. In normal subjects, isolated passive dipj movement should lead to movement of FDP only. The results showed that 10 out of 20 participants lost independent movement between FDP and FDS upon passive dipj flexion and extension. The number of participants with tendon gliding impairments reported in the abstract was larger because they accounted for other US imaging findings such as a lack of clear demarcation between tendons and surrounding tissues. One of the limitations of this study is that the differential movement assessed was completed during passive movement of the dipj rather than active movement. 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, around 50% of our clients with trigger finger may lack differential movement between FDS and FDP. This is a potential biomechanical contributing factor to trigger finger development and/or maintenance. It is possible that our splinting interventions may help to differentiate FDS and FDP movement. If you would like to know when your clients with trigger finger should be referred to a hand surgeon or which of your clients are at higher risk of post-surgical infection after a trigger finger release , click on the links. URL : https://doi.org/10.1177/1753193420969293 Available through EBSCO Health Databases for PNZ members. Abstract We performed a detailed dynamic high-resolution ultrasound examination of the flexor tendons in trigger fingers and compared this with normal contralateral digits. There was a loss of defined linear tendon margins and/or traction of the flexor tendons on the surrounding soft tissue during passive flexion of the distal interphalangeal joint in 17 out of 20 trigger fingers, which indicated adherence to the surrounding tissues. The differential motion between the flexor digitorum profundus tendon and the flexor digitorum superficialis tendons was also lost in ten trigger fingers, which suggested adherence between the tendons. No signs of peritendinous or intertendinous adhesions were found in the healthy control fingers. We conclude that tendon adhesions are present in the majority of trigger fingers. We could not determine a relationship between the severity of triggering and the presence of adherence due to limited sample size. 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

Impairments in grip and pinch force accuracy and steadiness in people with osteoarthritis of the hand: A case-control comparison. Magni, N. E., P. J. McNair and D. A. Rice (2021) Level of Evidence : 3b Follow recommendation : 👍 👍 Type of study : Aetiologic Topic : Force control - Hand osteoarthritis This is a case-control study assessing impairments in motor control as well as their associations with function in people with hand OA. A total of 88 participants were included in the study. Hand OA (n = 62) was diagnosed through the American College of Rheumatology (ACR) criteria and confirmed through x-ray. Healthy participants (n = 26) were age and gender matched to the hand OA participants. Motor control was assessed by measuring participants ability to maintain a steady grip and pinch, self-reported hand function was assessed through the Functional Index of Hand Osteoarthritis (FIHOA) and the Disability of the Arm, Shoulder, and Hand (DASH). The results showed that participants with hand OA had significant lower levels of motor control (2% deficit in force steadiness) during gripping and pinching. Most of these differences between groups resolved with practice. It is unclear whether these differences between groups are clinically relevant as no study has assessed the minimal clinically important difference for this test. There was a small correlation between motor control and functional impairments. Overall, due to multitude of statistical tests performed (26 tests - ANOVAs and post hoc tests) and the number of significant findings (13 test) there is a 10% probability that the results are just due to chance. Clinical Take Home Message : Based on what we know today, clients with hand OA may present with motor control impairments that contribute to functional impairments. These impairments in ability to fine tune force levels appear to resolve with a few practice trials. If clients with symptomatic hand OA report difficulty performing precise pinch or grasp activities where force modulation is important, a series of submaximal warm up exercises may be useful to reduce impairments. We currently do not know whether these impairments are caused by pain or contribute to pain. Currently, a multidisciplinary approach to symptomatic hand OA is supported by higher quality evidence, and may be implemented first. Also, this is a synopsis of our own research group. I have tried to be critical towards what we have done. However, if you find additional limitations or have comments, please do not hesitate in posting them below! If you are interested in knowing more about the involvement of the brain in symptomatic hand OA, have a look at this previous synopsis . Open access URL : Abstract Background Symptomatic hand osteoarthritis (OA) is severely disabling condition. Limited evidence has focused on force control measures in this population. Objectives It was the aim of the present study to determine whether force matching accuracy and steadiness are impaired in people with hand OA. In addition, the relationship between force control measures (accuracy and steadiness) and measures of hand function and pain in people with symptomatic hand OA was explored. Design Case-control study. Method Sixty-two participants with symptomatic hand OA and 26 healthy pain-free controls undertook an isometric grip and pinch force matching task at 50% of their maximum voluntary contraction. Average pain hand pain was recorded. In addition, the Disability of the Arm Shoulder and Hand Questionnaire (DASH), and the Functional Index of Hand Osteoarthritis were collected. Results Grip force-matching accuracy and steadiness were significantly impaired in the hand OA group compared to controls (P < 0.05). Pinch force-matching error was greater in people with hand OA (P < 0.05), however, pinch force steadiness was not different between groups. There was a learning effect in people with hand OA, with resolution of force matching impairments with task repetition. A small positive correlation was identified between grip force control and the DASH. No association was found between other measures of force control and self-reported measures of function or pain. Conclusions People with hand OA presented with greater impairments in measures of submaximal force control. These were correlated with self-reported hand function but not pain. Future studies may wish to examine whether objective measures of functional performance are related to force-matching error and steadiness. 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 systematic review of physical activity-based interventions in shift workers. Flahr, H., W. J. Brown and T. L. Kolbe-Alexander (2018) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 Type of study : Therapeutic Topic : Night shifts - Physical intervention for chronic conditions This is a systematic review assessing the effect of physical activity interventions on body composition, fitness, and sleep in shift workers. A total of 7 randomised controlled studies, for a total of 296 participants were included in the study. All of these participants were shift workers. Participants were randomised to either aerobic and/or resistance exercise or a control intervention (no further details about the control intervention were provided). Participants were assessed at baseline and 4 to 24 weeks after initiation of the training. Outcomes included body composition (e.g. BMI), fitness (e.g. VO2 max), and sleep quality (questionnaire-based). The results showed that physical activity interventions improved body composition, fitness levels, and sleep quality. 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 appears that physical activity interventions in shift workers can improve body composition, sleep, and fitness levels. Considering that these improvements have the potential to reduce low-grade systemic inflammation , it is possible that they may reduce upper limb persistent pain in our shift workers. Thus, it appears that persistent pain in this population is mediated by low-grade inflammation . If we advised our clients to follow the international guideline for Physical Activity they may not only get healthier but their persistent upper limb pain may decrease. It may also be wise to extend our interpretation of persistent musculoskeletal pain beyond biomechanical concepts and reconsider what has been classically been described as "overuse injury" . Open Access URL : https://www.sciencedirect.com/science/article/pii/S2211335518300561 Abstract Shift workers are at increased risk of a range of chronic diseases and there is evidence to suggest that these risks can be ameliorated by physical activity. Little is known however about the efficacy of physical activity interventions in shift workers. The aim was therefore to critically review the literature to improve understanding of the efficacy of physical activity promotion initiatives for this occupational group. A systematic review of randomized controlled trials of physical activity in shift workers was conducted in 2016–2017 following the Preferred Reported Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Only seven studies were found. None of the studies measured changes in physical activity behaviour or reported on the timing or setting of the intervention protocols. Instead, most focused on health-related outcomes including body composition, fitness and sleep. Almost all provided physical activity ‘prescriptions’ with walking or ‘aerobic activity’ as the primary intervention mode and most reported significant improvements in one of the outcome measures. Although the findings suggest that physical activity may mitigate intermediate risk factors associated with non-communicable diseases (NCD) in shift workers, the studies offer little insight into physical activity behaviour change in this occupational group. Future research should assess actual changes in physical activity behaviour, and its determinants, as well as the reach and uptake of intervention strategies in this challenging population group. 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

Temporal relationship of corticosteroid injection and open release for trigger finger and correlation with postoperative deep infections. Straszewski, A. J., C. S. Lee, J. L. Dickherber and J. M. Wolf (2021) Level of Evidence : 4 Follow recommendation : 👍 👍 👍 Type of study : Prognostic Topic : Trigger finger injections - Are they worth it? This is a retrospective study assessing post-surgical infections in clients who underwent cortisone injection shortly before surgery for trigger finger release. A total of 14,686 participants, took part in this study. Of these, 9,513 (65%) did not receive a cortisone injection prior to trigger finger release, and 5,173 (35%) received at least one cortisone injection prior to surgery. The outcome assessed was the presence of infections at the surgical site within 90 days from surgery. The analyses controlled for comorbidities (e.g. diabetes) and other confounders. The results showed that the participants who underwent a cortisone injection one month prior to trigger finger release had at least twice the odds of developing an infection after surgery compared to those who had more time between the injection and surgery. We need to keep in mind that this is a retrospective study and the association between recent cortisone injections and surgery for wound complications may be mediated by a third variable which was not measured. This is therefore a limitation of the study. 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, cortisone injections within one month prior to trigger finger release appear to increase the probability of post surgical infection. In particular, it appears that close to 1 person in 50 will develop an infection if they received a cortisone injections in the month prior surgery. In contrast, it appears that 1 person in 100 will develop an infection if more than one month passes between a cortisone injections and surgery. The findings from this study are consistent with two previous studies showing that both ialuronic acid injections and cortisone injections increase the risks of post surgical complications in people 1st cmcj OA. This is also consistent with previous research showing an increase risk of post surgical infections in other joint (e.g. hip ). Our clients should be provided with this information and the risks vs benefits of having an injection just prior to surgery may be discussed. This may provide them with a chance to make an informed decision about the most suitable therapeutic option for their needs. URL : https://www.jhandsurg.org/article/S0363-5023(21)00548-7/fulltext Available through The Journal of Hand Surgery (American Volume) for HTNZ members. Available through EBSCO Health Databases for PNZ members. Abstract Purpose Previous single-institution studies have shown a relationship between corticosteroid injection and infection after surgery if open trigger release occurs within 90 days. We queried an insurance claims database to evaluate the temporal relationship between a corticosteroid injection and the development of a surgical site infection requiring secondary surgery in patients undergoing trigger release. Methods The PearlDiver database was queried for adults who underwent unilateral trigger finger release surgery from 2012 to 2018. The total number of injections, time from last injection to surgery, and preoperative antibiotic use were determined, in addition to the rates of postoperative administration of antibiotics and deep infection requiring surgery at 30, 60, and 90 days after surgery. Logistic regression analysis was used to evaluate the odds of deep infection at 30, 60, and 90 days. Results A total of 14,686 patients were included; at least 1 corticosteroid injection was administered to 5,173 patients prior to surgery. When grouped based on whether a corticosteroid injection was administered prior to surgery, the postoperative infection rates between the groups were similar at 30, 60, and 90 days. When surgery was performed within 1 month of injection, increased odds of deep infection requiring irrigation and debridement were seen at 60 (odds ratio 2.92 [1.01–7.52]) and 90 days (odds ratio 3.01 [1.13–7.25]). Postoperative antibiotic use in the groups with and without a preoperative injection was similar at all queried time points, but patients who underwent open trigger finger release within 1 month of a prior injection had significantly increased odds (odds ratio 5.77 [1.41–22.06]) of using antibiotics after surgery. Male sex, a higher Elixhauser comorbidity index, and rheumatoid arthritis were additional independent risk factors for a deep infection. Conclusions Patients who undergo open trigger release within 1 month of a corticosteroid injection are at increased odds of developing a postoperative infection requiring surgical debridement. 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

Group education, night splinting and home exercises reduce conversion to surgery for carpal tunnel syndrome: a multicentre randomised trial Lewis, K., Coppieters, M., Ross, L., Hughes, I., Vicenzino, B., & Schmid, A. (2020) Level of Evidence : 1b- Follow recommendation : 👍 👍 👍 Type of study : Therapeutic Topic : Carpal tunnel conservative intervention - Night splint and exercise This is a multicentred randomised controlled trial assessing the effectiveness of splinting and exercise vs no intervention in people with carpal tunnel syndrome (CTS). All the participants included (n = 105) were on a waiting list for CTS surgery. Diagnosis of CTS was confirmed by nerve conduction studies. Participants were randomised to a multi facet program of education, night splinting, tendon and nerve gliding exercises group (n = 52), or to a no intervention group (n = 53). The education session took place in a group setting and participants were provided with basic information regarding CTS and splinting/exercise. The exercise intervention included two median nerve gliding and four tendon gliding exercises. The first median nerve glide exercise involved a combination of elbow and wrist movements, while the second involved wrist extension and flexion only. The tendon gliding exercises included hook fist, full fist, table top, and flat fist. Participants were asked to exercise 5 times per day and to complete 5-10 repetitions of each exercise. Treatment effectiveness was assessed by rate of conversion to CTS surgery and global rate of change. The rate of conversion to surgery indicated the percentage of people that underwent CTS surgery at the follow-up assessment. Global rate of change indicated the perceived improvement or worsening of the condition. Participants were assessed at baseline, 6 weeks, and 24 weeks. Conversion to surgery was only measured at 24 weeks. The results showed that at 24 weeks, the number of patients undergoing surgery (rate of conversion to surgery) in the education, night splinting, and exercise group (59% underwent surgery) was 20% (95%CI: 38% to 3%) lower than the no intervention group (80% underwent surgery). At 6 weeks, the results showed that 15% (95%CI: 28% to 3%) more participants in the education, night splinting, and exercise group reported feeling "a good deal better" compared to the no intervention group. However, this difference was no longer present at 24 weeks. No adverse events were reported. The confidence intervals for both outcomes were quite wide, suggesting that the effect of the intervention was not consistent within groups. Clinical Take Home Message : Education, night splinting, and tendon/nerve gliding exercises may be useful in reducing the number of patients requiring CTS surgery. Hand therapists should be cognisant that there is substantial variability in the results that this treatment provides. Patients may be advised that no adverse events have been reported with this type of treatment. URL : https://www.sciencedirect.com/science/article/pii/S1836955320300242

Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain. Karjalainen, T. V., et al. (2021) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 Type of study : Therapeutic Topic : Lateral epicondylalgia – platelet-rich plasma injections This is a Cochrane systematic review and meta-analysis assessing the effectiveness of platelet-rich plasma (PRP) vs placebo or other interventions for lateral epicondylalgia. Thirty-two randomised placebo-controlled trials (RCT) and quasi-experimental studies were included for a total of 2,337 participants. All the studies were assessed through the Risk of Bias criteria recommended by the Cochrane Review Group. Interventions efficacy was assessed through improvements in pain and function. To be included in the review, studies had to compare PRP injections to placebo injections (saline) or other interventions which included but were not limited to exercises or cortisone injections. Follow-up periods ranged between 3 and 12 months. The results showed that there is moderate quality of evidence showing no statistical or clinically significant difference between PRP and placebo in terms of pain. Pain improved to a clinically significant level in both placebo and PRP injections groups (there was a median reduction in pain of 3.7 points out of 10 in both groups). Low-level quality evidence showed inconclusive findings for other 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, PRP injections do not appear to show any additional benefit on pain when compared to placebo (saline) injections. Both interventions appeared to provide a clinically meaningful improvement in pain, which is most likely due to the contextual effect of the injection treatment. This finding is in line with previous evidence showing no benefit of PRP injections over placebo in people with lateral epicondylalgia . Currently, the most effective treatment may be based on stage classification of lateral epicondylalgia . If you would like to get a more complete picture of lateral epicondylalgia, have a look at the whole collection . Open Access URL : https://doi.org/10.1002%2F14651858.CD010951.pub2 Abstract Background Autologous whole blood or platelet-rich plasma (PRP) injections are commonly used to treat lateral elbow pain (also known as tennis elbowor lateral epicondylitis or epicondylalgia). Based on animal models and observational studies, these injections may modulate tendon injuryhealing, but randomised controlled trials have reported inconsistent results regarding benefit for people with lateral elbow pain. Objectives To review current evidence on the benefit and safety of autologous whole blood or platelet-rich plasma (PRP) injection for treatment of people with lateral elbow pain. Search methods We searched CENTRAL, MEDLINE, and Embase for published trials, and Clinicaltrials.gov and the World Health Organization (WHO)International Clinical Trials Registry Platform (ICTRP) search portal for ongoing trials, on 18 September 2020. Selection criteria We included all randomised controlled trials (RCTs) and quasi-RCTs comparing autologous whole blood or PRP injection therapy to another therapy (placebo or active treatment, including non-pharmacological therapies, and comparison between PRP and autologous blood)for lateral elbow pain. The primary comparison was PRP versus placebo. Major outcomes were pain relief (≥ 30% or ≥ 50%), mean pain, mean function, treatment success, quality of life, withdrawal due to adverse events, and adverse events; the primary time point was three months. Data collection and analysis We used standard methodological procedures expected by Cochrane. Main results We included 32 studies with 2337 participants; 56% of participants were female, mean age varied between 36 and 53 years, and mean duration of symptoms ranged from 1 to 22 months. Seven trials had three intervention arms. Ten trials compared autologous blood or PRP injection to placebo injection (primary comparison). Fifteen trials compared autologous blood or PRP injection to glucocorticoid injection. Four studies compared autologous blood to PRP. Two trials compared autologous blood or PRP injection plus tennis elbow strap and exercise versus tennis elbow strap and exercise alone. Two trials compared PRP injection to surgery, and one trial compared PRP injection and dry needling to dry needling alone. Other comparisons include autologous blood versus extracorporeal shock wave therapy; PRP versus arthroscopic surgery; PRP versus laser; and autologous blood versus polidocanol. Most studies were at risk of selection, performance, and detection biases, mainly due to inadequate allocation concealment and lack of participant blinding.We found moderate-certainty evidence (downgraded for bias) to show that autologous blood or PRP injection probably does not provide clinically significant improvement in pain or function compared with placebo injection at three months. Further, low-certainty evidence(downgraded for bias and imprecision) suggests that PRP may not increase risk for adverse events. We are uncertain whether autologous blood or PRP injection improves treatment success (downgraded for bias, imprecision, and indirectness) or withdrawals due to adverse events (downgraded for bias and twice for imprecision). No studies measured health-related quality of life, and no studies reported pain relief (> 30% or 50%) at three months. At three months, mean pain was 3.7 points (0 to 10; 0 is best) with placebo and 0.16 points better (95% confidence interval (CI) 0.60 better to 0.29 worse; 8 studies, 523 participants) with autologous blood or PRP injection, for absolute improvement of 1.6% better (6% better to3% worse). At three months, mean function was 27.5 points (0 to 100; 0 is best) with placebo and 1.86 points better (95% CI 4.9 better to1.25 worse; 8 studies, 502 participants) with autologous blood or PRP injection, for absolute benefit of 1.9% (5% better to 1% worse), and treatment success was 121 out of 185 (65%) with placebo versus 125 out of 187 (67%) with autologous blood or PRP injection (risk ratio(RR) 1.00; 95% CI 0.83 to 1.19; 4 studies, 372 participants), for absolute improvement of 0% (11.1% lower to 12.4% higher). Regarding harm, we found very low-certainty evidence to suggest that we are uncertain whether withdrawal rates due to adverse events differed. Low-certainty evidence suggests that autologous blood or PRP injection may not increase adverse events compared with placebo injection. Withdrawal due to adverse events occurred in 3 out of 39 (8%) participants treated with placebo versus 1 out of 41 (2%) treated with autologous blood or PRP injection (RR 0.32, 95% CI 0.03 to 2.92; 1 study), for an absolute difference of 5.2% fewer (7.5% fewer to 14.8%more). Adverse event rates were 35 out of 208 (17%) with placebo versus 41 out of 217 (19%) with autologous blood or PRP injection (RR1.14, 95% CI 0.76 to 1.72; 5 studies; 425 participants), for an absolute difference of 2.4% more (4% fewer to 12% more). At six and twelve months, no clinically important benefit for mean pain or function was observed with autologous blood or PRP injection compared with placebo injection. Authors' conclusions Data in this review do not support the use of autologous blood or PRP injection for treatment of lateral elbow pain. These injections probably provide little or no clinically important benefit for pain or function (moderate-certainty evidence), and it is uncertain (very low-certainty evidence) whether they improve treatment success and pain relief > 50%, or increase withdrawal due to adverse events. Although risk for harm may not be increased compared with placebo injection (low-certainty evidence), injection therapies cause pain and carry a small risk of infection. With no evidence of benefit, the costs and risks are not justified. 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

Ulnar nerve morphology during elbow flexion in patients with and without cubital tunnel syndrome: A sonographic study. Matsui, Y., T. Horie and N. Iwasaki (2021) Level of Evidence : 4 Follow recommendation : 👍 👍 Type of study : Diagnostic Topic : Cubital tunnel – Hour-glass deformity This is a non-peer reviewed cross sectional study assessing ulnar nerve morphology at the cubital tunnel through ultrasound imaging (US). A total of 27 participants were included in the study, 10 healthy controls and 17 participants. Participants were included if they presented a positive Tinel's sign at the cubital tunnel, reduced sensation in the ulnar distribution below the elbow as well as on the dorsal aspect of the hand, and deficits on nerve conduction studies. The results showed that participants with cubital tunnel syndrome had significant swelling of the ulnar nerve proximally to the medial epicondyle of the elbow. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, US imaging may be useful in identifying the presence of ulnar nerve compression at the cubital tunnel. In particular, an hour-glass deformity with swelling of the proximal nerve may be particularly obvious during elbow flexion. These sort of findings have been previously described and can be seen in the picture below which was reported in a previous synopsis . Ultrasound imaging is not only useful in identifying these morphological changes in cubital tunnel syndrome, but also space-occupying lesions. Thus, these lesions are not uncommon as a source of compression at the cubital tunnel . URL : https://doi.org/10.1177/17531934211026108 Available through EBSCO Health Databases for PNZ members. No abstract available publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Traumatic osteonecrosis of the distal ulna. Yildirim, B., F. P. Bustos, M. E. Dibbern and A. R. Dacus (2021) Level of Evidence : 5 Follow recommendation : 👍 Type of study : Diagnostic/Therapeutic This is the answer to last week's Sherlock Handy. The patient was a 46 years old male presenting with ulnar side wrist pain, which developed following a volleyball injury 9 weeks prior to examination. They presented with a positive fovea sign. A trial of conservative management with splinting lead to no improvements. As a matter of fact, pain got worse over time despite splinting. The x-rays and MRI images are shown below. Given the MRI findings, the authors suspected either a bone tumor or osteonecrosis of the ulnar head. During arthroscopy, no lesions of the TFCC were identified and a larger surgery was performed to remove the radial portion of the ulnar head (similar surgery to the one utilised for some types of distal radio-ulnar joint osteoarthrosis). After 5 weeks in a Muenster cast, the patient initiated rehab and fully recovered by 9 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, osteonecrosis of the ulnar head is a rare presentation. The differential diagnosis for this presentation included a bone tumor. In this particular case, osteonecrosis of the ulnar head was more likely due to the traumatic presentation. X-ray imaging is insufficient in identifying any bone changes in the early stages and MRI is required. Other necrosis of the wrist bones may present with pain at the base of the metacarpals or any carpal bone . URL: https://doi.org/10.1016/j.jhsa.2021.05.019 Available through The Journal of Hand Surgery (American Volume) for HTNZ members. Available through EBSCO Health Databases for PNZ members. Abstract A 46-year-old male was referred to our clinic for persistent ulnar-sided wrist pain 9 weeks after sustaining a traumatic injury while playing volleyball. The patient unsuccessfully underwent nonoperative management for a suspected injury to the triangular fibrocartilage complex. After magnetic resonance imaging revealed a lesion of the distal ulna, he was treated with diagnostic wrist arthroscopy and Bowers hemiresection. The diagnosis of osteonecrosis was confirmed through histology. While traumatic osteonecrosis of the carpal bones has been described, no previous literature was found on traumatic osteonecrosis of the distal ulna. Treatment with diagnostic wrist arthroscopy and Bowers hemiresection resulted in an excellent outcome at 12 months after surgery. 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

Tailored exercise program reduces symptoms of upper limb work-related musculoskeletal disorders in a group of metalworkers: A randomized controlled trial. Rasotto, C., et al. (2015) Level of Evidence : 2b Follow recommendation : 👍 👍 Type of study : Therapeutic Topic : Work-related musculoskeletal conditions - How to reduce symptoms This is a randomised controlled study assessing the effectiveness of a personalised exercise program on upper limb symptoms in people who are at high risk of work-related musculoskeletal disorders. A total of 68 healthy metalworkers were included in the present study. By healthy, the researchers meant that they did not present with neurological conditions or uncontrolled cardiovascular disease. Participants were randomised to the intervention group (n = 34) or the control group (n = 34). The intervention group performed 2 sessions per week of 30 minutes during which they performed movement exercises of the neck and upper limb (if they reported pain) or resistance exercises of the upper limb (if they did not report pain). Effectiveness of intervention was assessed through the visual analogue scale (VAS) for pain (neck, shoulders, elbow, wrist, and hand) and active range of movement (AROM) of the neck, shoulders, elbows and wrists. These measures were assessed at baseline, 5 and 10 months since initiation of the exercise program. The results showed that the intervention group presented with statistically significant but clinically irrelevant improvements in pain and mobility across several upper limb joints from baseline. There were some statistically significant differences between groups but these were not clinically relevant. A limitation of the present study was that the control group underwent no intervention at all, leaving the potential effect shown in the intervention group possibly due to a contextual effect. 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, any form of exercise introduced in the workplace may have some small clinically irrelevant effect on pain and mobility. Overall being active appears to have some effect that may be non-specific. As hand therapists, we always have the opportunity to remind our clients to try and be as active as possible and follow the international guidelines for physical activity . Following the guidelines may not only have the benefit of getting our clients to live longer and a healthier but also indirectly benefit their upper limb conditions by reducing mental health symptoms such as depression . As you probably remember, depression is a mediator of upper limb recovery and it may hinder recovery as it has been shown in these people with scaphoid fractures . If you would like to know how to reduce other workplace-related injuries, have a look at this synopsis . URL : https://www.sciencedirect.com/science/article/pii/S1356689X14001258 Alternative URL : https://doi.org/10.1016/j.math.2014.06.007 Available through EBSCO Health Databases for PNZ members. Abstract Work-related musculoskeletal disorders (WRMDs) are a leading cause of work-related disability and loss of productivity in the developed countries; these disorders may concur with the indirect costs of an illness or injury included losses of potential output. Literature on workplace physical activity program provided a mixed but positive impact on health and important worksite outcomes. Therefore, programs of physical activity organized and performed in the workplace could reveal as essential tool to reduce musculoskeletal symptoms. This investigation aimed to assess the effectiveness of a tailored physical activity program, performed in a work-environment, to reduce the symptoms in upper extremities and neck with the novelty in personalizing the approach applied to the exercise protocol, basing on pain and disability levels, to reduce the onset and symptoms in upper extremity and neck WRMDs increasing upper-limb strength and flexibility. 68 metalworkers were recruited, 34 were randomly allocated to an intervention group (IG), while the other 34 to a control group. Primary outcomes concerned pain symptoms measured with visual analog scales while disability was measured by DASH (Disability of the Arm, Shoulder and Hand), and NPDS-I (Neck Pain and Disability Scale) questionnaires. Grip strength, upper-limb mobility, neck and shoulder range of motion were also assessed. After the 9-month intervention, IG reduced pain symptoms on neck, shoulders, elbows and on wrists. Grip strength and upper-limb mobility improved as well as scores on questionnaires. This protocol suggests that performing a tailored physical activity program is beneficial to reduce pain and disability on upper-limb WRMDs. 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

Joint position sense, motor imagery and tactile acuity in lateral elbow tendinopathy: A cross-sectional study. Wiebusch, M., B. K. Coombes and M. F. Silva (2021) Level of Evidence : 3b Follow recommendation : 👍 👍 Type of study : Aetiology Topic : Lateral epicondylalgia - Joint position sense This is a cross-sectional study assessing the effect of lateral epicondylalgia on joint position sense and brain changes. A total of 28 participants were included. Of these, 14 had unilateral tennis elbow whilst the other 14 were healthy controls. Lateral epicondylalgia was diagnosed if participants presented with tenderness at the lateral elbow, pain with gripping, pain on resisted wrist extension or middle finger extension. Joint position sense of the wrist was assessed bilaterally in all participants. Participants' wrist was passively positioned in either 20° of extension or flexion and held there for 5 seconds. Participants were then asked to reproduce the wrist position actively. Brain changes were assessed by getting participants to perform a motor imagery tasks (left/right hand discrimination) and tactile acuity tests at the lateral elbow (two-point discrimination assessment with digital callipers). The results showed that participants with lateral epicondylalgia presented with joint position sense impairments. In particular, they reproduced lower levels of wrist extension on the affected side compared to the unaffected side (roughly 3° less extension compared to the unaffected side) and also when compared to controls (roughly 3° less extension compared to the matched side of the controls). In terms of motor imagery and tactile acuity, there were no differences between groups. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, people with lateral epicondylalgia (LE) may present with reduced wrist proprioception compared to healthy controls. During the acute phase of LE we may introduce exercises of wrist repositioning with eyes closed as a form of treatment (see figure). In addition, during the acute phase of LE, it may be useful to provide rest/activity modification or advise on the use of a counterforce splint (see previous synopses on splint effectiveness and biomechanics ). During the disrepair/degenerative phase of LE (sub acute/chronic - see previous synopsis on tendinopathy grading and treatment ), graded resistance training of the wrist extensors alone may be enough to improve function and reduce pain. URL : https://www.sciencedirect.com/science/article/pii/S2468781221001065 Available through EBSCO Health Databases for PNZ members. Abstract Background Impairments of sensorimotor function are evident in individuals with lateral elbow tendinopathy (LET), although understanding of the mechanisms for this is lacking. Objectives To determine if motor imagery, tactile acuity and wrist joint position sense (JPS) are impaired in participants with unilateral LET compared to controls, whether deficits are localised to the affected side, and whether deficits relate to severity of pain. Design Cross-sectional study with control group. Methods 14 participants with unilateral LET of 6 weeks or longer and 14 matched control participants were assessed bilaterally for motor imagery (left/right hand judgement task), tactile acuity (two-point discrimination test) and wrist JPS (reposition test for flexion and extension). Pain levels were measured using a numeric rating scale. Results Significant differences in JPS were observed for wrist extension only, such that participants with LET adopted less extended postures with their affected side when compared to their unaffected side (MD = 2.97°; p = 0.01) and to the matched-affected side of controls (MD = 4.89°; p < 0.01). No differences in tactile acuity or motor imagery were observed. Conclusion Altered wrist extension JPS, but not motor imagery or tactile acuity, was found in the affected side of patients with unilateral LET when compared to non-injured side and asymptomatic controls. 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 46 years old male presenting with ulnar side wrist pain, which developed following a volleyball injury 9 weeks prior to examination. They presented with a positive fovea sign. A trial of conservative management with splinting lead to no improvements. As a matter of fact, pain got worse over time despite splinting. You have x-rays and MRI images below. What was it?