Systematic review of distal biceps tendon rupture in athletes: Treatment and rehabilitation. Pitsilos, C., I. Gigis, K. Chitas, P. Papadopoulos and K. Ditsios (2022) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 (4/4 thumb up) Type of study : Therapeutic Topic : Distal biceps rupture in athletes - Rehabilitation This systematic review assessed rates of return to sport and time to return to sport in athletes with a distal biceps rupture. Ten articles were included for a total of 157 athletes with distal biceps ruptures. All of them underwent surgical repair. Patients' age ranged from 18 to 61 years old (average age = 41). The results showed that 98% of patients returned to sport and this occurred on average at 6 months post-surgery. Return to sport was slower if the surgical repair occurred later than 3 weeks from injury. Post-surgery, rehabilitation consisted of immobilisation of the elbow between 2 days and 6 weeks, followed by range of movement exercises. Progressive resistance training was initiated between 4 and 10 weeks after surgery (see table). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the surgical treatment of distal biceps ruptures leads to a high return to sport in athletes. Prompt referral to an orthopaedic surgeon is required as repairs completed beyond 3 weeks from injury delay return to sport. Following surgery, a short period of immobilisation (2 to 3 weeks) is followed by range of movement exercises. Resistance training is initiated at 7-10 weeks pos-surgery. It is important to remember that despite better strength and endurance outcomes, surgery for distal biceps repair has a higher risk of complications . URL : https://doi.org/10.1016/j.jse.2022.02.027 Abstract Background: Distal biceps tendon rupture is a rare injury associated to decreased elbow flexion and forearm supination strength. This impairment is not tolerated by high demand patients like athletes. Purpose: To review treatment and rehabilitation applied to injured athletes and study their impact in return to sports. Methods: MEDLINE, Cochrane, Web of Science and Scopus online databases were searched. A systematic review was conducted using the PRISMA guidelines; studies published on distal biceps tendon rupture treatment and rehabilitation of athletes until 30 June of 2021, were identified. A quantitative synthesis of factor related to return to preinjury sport activity was made. Results: Ten articles were identified, including 157 athletes. Mean age was 40.5 years and dominant arm was injured in 66%. Rupture was acute in 77% and mean follow-up was 25.7 months. A 97.5% of return to sport was found within a mean time of 6.2 months. Surgical treatment was followed in all cases. One-incision technique was chosen in 73% and suture anchor fixation in 33%. No postsurgical immobilization was reported in 24% and immobilization for 2 weeks in 79%. Decreased supination-pronation and flexion-extension arc was found in 40% and 17%, respectively. Earlier return to sport was associated with non-dominant side (p=0,007) and acute (p<0,001) injuries, participation in weightlifting (p=0,001), double-incision approach (p=0,005), cortical button fixation (p<0,001) and absence of supination-pronation restriction (p=0,032). Time of return to sport activity was independent of rehabilitation, including immobilization (p=0,539) and strengthening (p=0,155), and decreased flexion-extension arc (p=0,059). Conclusion: Athletes sustaining distal biceps tendon rupture have a high postoperative return to sport rate, independently of selected surgical technique or rehabilitation program. However, a relation between the surgical technique and time of return to sport was found. Rehabilitation did not influence time of return to sport. 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

Two-year changes in magnetic resonance imaging features and pain in thumb base osteoarthritis. van Beest, S., et al. (2021) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 👍 (4/4 thumbs up) Type of study : Symptoms prevalence study Topic : Thumb osteoarthritis - Pain progression This is a longitudinal study, assessing change in thumb osteoarthritis (OA) pain across two years. Participants (N = 165) were included if they presented with the Americal College of Rheumatology (ACR) criteria for hand osteoarthritis. Of these participants, 145 (indirectly calculated from Figure 2 and legend in the article) presented with signs or symptoms of thumb OA. Out of these participants, 93 (56%) frequently reported pain in the thumb. Self-reported hand pain was assessed through the 0-100 VAS. Participants were followed up at 2 years. The results showed that at two years follow-up, 26 participants (16%) reported an improvement in pain, 18 participants (11%) reported higher levels of pain, and 121 reported pain being unchanged (70%). 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, symptomatic thumb OA is symptomatic in over half of people who present signs or symptoms (e.g. pain on palpation) of thumb OA. This suggests that a large proportion of people with objective evidence of thumb OA is asymptomatic. In a large proportion of people, symptoms remain unchanged after two years. In those people who present with pain, there is a 20-30% probability that pain will either get better or worse. If you would like to know what is the current most valuable conservative treatment approach for thumb OA, have a look at this synopsis . Open Acces URL : https://doi.org/10.1002/acr.24355 Abstract Objective: To investigate the two-year course of pain and osteoarthritic features on magnetic resonance imaging (MRI) in the thumb base. Methods: Patients in the Hand Osteoarthritis in Secondary Care (HOSTAS) cohort who had received radiographic examination, MRI, and clinical examination of the right thumb base at baseline and who had a 2-year follow-up period were studied. Pain on palpation of the thumb base was assessed on a 0-3 scale. MRIs were analyzed with the Outcome Measures in Rheumatology (OMERACT) thumb base osteoarthritis MRI scoring system for synovitis, bone marrow lesions (BMLs), subchondral bone defects, cartilage space loss, osteophytes, and subluxation. Radiographs were assessed for osteophytes and joint space narrowing. We studied the associations of changes in synovitis and BMLs with changes in pain using a logistic regression model adjusted for radiographic damage, with values expressed as odds ratios (ORs) and 95% confidence intervals (95% CIs). Results: Of 165 patients, 83% were women and the mean age was 60.7 years. At baseline, 65 patients had thumb base pain. At 2-year follow-up, pain had decreased in 32 patients and increased in 33 patients. MRI features remained stable in most patients. Structural MRI features generally deteriorated, while synovitis and BMLs improved in some individuals and deteriorated in others. Change in radiographic osteophytes rarely occurred (n = 10). Increased synovitis (odds ratio [OR] 3.4 [95% CI 1.3-9.3]) and increased BMLs (OR 5.1 [95% CI 2.1-12.6]) were associated with increased pain. Decreased BMLs appeared to be associated with decreased pain (OR 2.7 [95% CI 0.8-8.9]), and reductions in synovitis occurred too infrequently to calculate associations. Conclusion: Over 2 years, thumb base pain fluctuated, while MRI features changed in a minority of patients with hand osteoarthritis. Changes in synovitis and BMLs were associated with changes in pain on palpation, even after adjustment for radiographic damage. 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

Elbow extension test to rule out elbow fracture: Multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. Appelboam, A., et al. (2008) Level of Evidence : 1c Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Diagnostic Topic : Elbow fractures - Elbow extension test This is a retrospective study on the specificity and sensitivity of the elbow extension test for elbow fractures. If a test is very sensitive and its result is negative, you can be more certain that the patient does not have the condition. If the test is specific and its result is positive, you can be more certain that the patient has the condition. Only participants (n = 1,736) presenting with an acute elbow injury (less than 3 days) and without previous elbow extension limitation were included (see box below). The elbow extension test required participants to flex their shoulders to 90 degrees and fully extend both their elbow. The affected and unaffected sides were visually compared and if there were no obvious limitations of range of movement, the test was defined as negative. The results showed that if the elbow extension test was negative (participants were able to fully extend their elbow) the probability of an elbow fracture was moderately (children) to largely (adults) reduced (Making the test highly sensitive). Nevertheless, the ability of a positive test to detect an elbow fracture if positive (inability to fully extend the elbow) was quite low (Making the test not very specific). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the presence of full elbow extension reduces the probability of an elbow fracture in clients with an acute elbow injury. In such instances, an x-ray may not be required. It is however important to remember that intermittent limitations in elbow extension (locking) in adolescents requires an x-ray to exclude osteochondritis dissecans . Open Access URL : https://doi.org/10.1136/bmj.a2428 Abstract Objective: To determine whether full elbow extension as assessed by the elbow extension test can be used in routine clinical practice to rule out bony injury in patients presenting with elbow injury. Design: Adults: multicentre prospective interventional validation study in secondary care. Children: multicentre prospective observational study in secondary care. Setting: Five emergency departments in southwest England. Participants: 2127 adults and children presenting to the emergency department with acute elbow injury. Intervention: Elbow extension test during routine care by clinical staff to determine the need for radiography in adults and to guide follow-up in children. Main outcome measures: Presence of elbow fracture on radiograph, or recovery with no indication for further review at 7-10 days. Results: Of 1740 eligible participants, 602 patients were able to fully extend their elbow; 17 of these patients had a fracture. Two adult patients with olecranon fractures needed a change in treatment. In the 1138 patients without full elbow extension, 521 fractures were identified. Overall, the test had sensitivity and specificity (95% confidence interval) for detecting elbow fracture of 96.8% (95.0 to 98.2) and 48.5% (45.6 to 51.4). Full elbow extension had a negative predictive value for fracture of 98.4% (96.3 to 99.5) in adults and 95.8% (92.6 to 97.8) in children. Negative likelihood ratios were 0.03 (0.01 to 0.08) in adults and 0.11 (0.06 to 0.19) in children. Conclusion: The elbow extension test can be used in routine practice to inform clinical decision making. Patients who cannot fully extend their elbow after injury should be referred for radiography, as they have a nearly 50% chance of fracture. For those able to fully extend their elbow, radiography can be deferred if the practitioner is confident that an olecranon fracture is not present. Patients who do not undergo radiography should return if symptoms have not resolved within 7-10 days. 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 on efficacy of different types of Platelet-Rich Plasma in the management of lateral epicondylitis. Li, S., G. Yang, H. Zhang, X. Li and Y. Lu (2022) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : Lateral epicondylalgia – platelet-rich plasma injections This is a systematic review assessing the effectiveness of leukocyte-rich vs leukocyte-poor platelet-rich plasma (PRP) injections for lateral epicondylalgia. Thirty-three studies of different designs (e.g. cohort, case series) for a total of 2,420 participants were included in this paper. All the studies were assessed through a scoring system for non-randomised controlled trials. The study outcomes included pain and upper limb function (e.g. DASH). The results showed that all types of PRP improved both pain and functional outcomes without differences between leukocyte-rich vs leukocyte-poor PRP injections. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, PRP injections improve pain and function in tennis elbow independently of their formulation. The improvements that they provide are clinically significant, however, their effectiveness does not appear to be greater than placebo (saline) injections. Another intervention that appears to have a significant placebo effect for tennis elbow is surgery . Overall, tennis elbow appears to be a benign condition with a clinical resolution of symptoms at 12 months in 90% of people . URL : https://doi.org/10.1016/j.jse.2022.02.017 Abstract Background: Platelet-rich plasma (PRP) is reported as an effective treatment for lateral epicondylitis (LE). Theoretically, different types of PRP have different therapeutic effects. However, there is controversy on the effects of different types of PRP in the treatment of LE. Purpose: To systematically compare the pain relief, functional improvement and successful rates on treatment of two different types of PRP, by reviewing and summarizing the data available in the current literature on LE after PRP injection. Methods: The PubMed, Medline, Embase, Cochrane Library and Web of science were reviewed. A computerized literature search was performed for related studies published from inception to August 2021 by terms of lateral epicondylitis, tennis elbow, tendinopathy, lateral elbow pain, PRP. PRP involved in present study were divided into leukocyte-poor PRP and leukocyte-rich PRP groups according to different preparation methods. Outcomes of interest included characteristics of the subjects, types and preparations of PRP, clinical outcomes, successful rate and safety of treatment of short-term and long-term follow-up. Results: A total of 33 studies included 2420 LE patients. There were 19 studies with LP-PRP, 13 studies with LR-PRP and 1 study involved both LP-PRP and LR-PRP. Patients had significant improved clinical outcomes post-treatment compared to pre-treatment in both groups of PRP. The mean of VAS was ranged from 6.1 to 8.0 before the treatment, 1.5 to 4.0 at short-term and 0.6 to 3.3 at the long-term follow-up in LR-PRP group. The mean of VAS was ranged from 4.2 to 8.4 before the treatment, 1.6 to 5.9 at short-term and 0.7 to 2.7 in the long-term follow-up in LP-PRP group. The DASH score of LR-PRP and LP-PRP were ranged from 47.0 to 54.3 and 30.0 to 67.7 separately before the treatment and 20.0 to 22.0 and 5.5 to 19.0 separately at long-term follow-up. LR-PRP and LP-PRP groups reflected successful rate ranged from 70%-100% and 36%-100% respectively. The complication rate lower in LP-PRP group (3.9%) than LR-PRP group (6.4%), with the major complication was temporary pain after PRP treatment (P = 0.029). Conclusion: PRP treatment demonstrated a significant improvement with pain relief and functional improvement on lateral epicondylitis regardless types of PRP. There was no significant difference between LR-PRP and LP-PRP in pain relief and functional improvement. The major complication was temporary pain after PRP injection and the complication rate in LP-PRP was lower than LR-PRP. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Outcomes of acute versus subacute scapholunate ligament repair. Chen, R. E., R. P. Calfee, J. G. Stepan and D. A. Osei (2022) Level of Evidence : 2c Follow recommendation : 👍 👍 Type of study : Prognostic Topic : Scapholunate repair - Delayed vs prompt surgery This is a retrospective study comparing outcomes of prompt vs delayed repair of scapholunate (SCL) injuries at long term follow-up (6-7 years). A total of 24 participants who had undergone SCL repair within 6 weeks of injury (n = 12) or between 6 and 12 weeks (n =12) were included. Outcome measures included the presence of scapholunate advanced collapse (SLAC), and alignment of scaphoid and lunate on x-rays. The results showed that there was no difference in the number of SLAC lesions or alignment between scaphoid and lunate on x-ray between the two groups. Unfortunately, the sample size of this study is small and we need larger longitudinal studies to increase our confidence in these results. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, scapholunate repair within 12 weeks of injury provides similar long term (6-7 years) results. This information may change with bigger longitudinal studies. If you would like to know more about dissociative (scapholunate/lunotriquetral instability ) and non-dissociative instability (extrinsic ligament of the wrist) , have a look at these previous synopses. Open Access URL : https://doi.org/10.1016/j.jhsg.2021.10.007 Abstract Purpose: This study investigated the long-term outcomes of direct scapholunate ligament (SLL) repairs with or without dorsal capsulodesis performed within 6 weeks (acute repair) of a SLL tear versus 6 to 12 weeks following injury (subacute repair). Methods: A review of medical records from April 1996 to April 2012 identified 24 patients who underwent SLL repair (12 acute, 12 subacute). Patients returned to the clinic for radiographic examinations of the injured wrist, standardized physical examinations, and validated questionnaires. Results: The mean follow-up times for the acute and subacute groups were 7.2 and 6.2 years, respectively. At the final examination, patients with acute surgery regained more wrist extension (acute = 55°, subacute = 47°). The total wrist flexion-extension arcs, grip strengths, pinch strengths, and patient-rated outcome scores were found to be similar between groups. The final scapholunate gap, scapholunate angle, and the prevalence of arthritis were also found to be similar between the acute and subacute groups. Conclusions: Although SLL repair is more commonly recommended for treatment of acute SLL injuries, there were no significant long-term differences between acute and subacute SLL surgeries (repair ± capsulodesis). publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Value of ultrasound in the management of cubital tunnel syndrome with associated space-occupying lesions. Yang, F., M. Li and Y. Qiu (2020) Level of Evidence : 4 Follow recommendation : 👍 👍 Type of study : Diagnostic Topic : Cubital tunnel – Ultrasound to screen for space occupying lesions This is a non-peer reviewed restrospective study assessing the usefulness of Ultrasound imaging (US) in identifying space occupying lesions causing cubital tunnel syndrome prior to surgical release. A total of 274 participants were included in the study. Only participants with symptoms of cubital tunnel syndrome, identified clinically, were included. US testing identified a space occupying lesion in 19 participants which was confirmed during surgical exploration. Only one case was missed by US assessment and identified at the time of surgery. This suggests the incidence of space occupying lesion in 7% of people presenting with cubital tunnel syndrome (consistent with what has been previously reported in the literature, which varies between 3% to 8%). On US imaging, the presence of these lesions was identified by hypo-echoic areas (low brightness) or the presence of nerve swelling just proximal to the space invading lesion (see picture below). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, US assessment may be useful for the identification of space occupying lesions responsible for cubital tunnel syndrome. These lesions are reasonably rare and you would expect to identify them in 1 client out of 10 or 1 out of 30 among those presenting with a cubital tunnel syndrome to your clinical practice. URL : https://doi.org/10.1177/1753193420943029 Available through EBSCO Health Databases for PNZ members. No abstract available publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The utility of the biceps palpation-rotation test in diagnosing partial distal biceps tendon tears. Caputo, V., et al. (2022) Level of Evidence : 4 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Diagnostic Topic : Biceps tendon pathology - Physical test This is a retrospective analysis on the sensitivity and specificity of the palpation-rotation test for the diagnosis of distal biceps partial tear. If a test is very sensitive and its result is negative, you can be more certain that the patient does not have the condition. If the test is specific and its result is positive, you can be more certain that the patient has the condition. A total of 34 participants were included in the present study. The palpation-rotation test consisted in the palpation of the radius tuberosity in forearm pronation (see picture). The test was deemed positive when it caused pain. MRI was utilised as the gold standard against which the physical tests was assessed. The results showed that the BPT was 97% specific and sensitive to include or exclude the presence of a distal biceps partial tear. The study had however a small sample size and there was no variety in elbow conditions. We may therefore find a high number of false positive/negative if we were to apply it to clinical populations. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the palpation-rotation test may be useful in palpating the insertion of the distal biceps. However, the specificity and sensitivity reported in this study need further validation. Another test, which may be useful in identifying distal biceps pathology is the biceps provocation test, which has been covered in another synopsis . URL : https://doi.org/10.1016/j.jse.2022.02.012 Abstract Background: Partial tears of the distal biceps tendon can be difficult to diagnose based on clinical examination and magnetic resonance imaging (MRI). Methods: Patients from a single surgeon’s practice from 2000-2018 with a partial distal biceps tendon tear were retrospectively reviewed to determine the utility of the distal biceps palpation rotation test in the detection of partial tears. This test is performed by palpating the bicipital tuberosity at the lateral forearm while ranging the forearm from supination to pronation with the arm adducted at the patient’s side and elbow flexed to 90 degrees. A positive test elicits tenderness at the tuberosity with the arm in pronation but not in supination. Examination findings were correlated with MRI reports confirming a partial tear. Twelve cadaveric arms were dissected to determine overall pronosupination range of motion, the degree of pronation at which the bicipital tuberosity is maximally palpable, and anatomic measurements of the bicipital tuberosity to guide optimal technique when carrying out the maneuver. Results: Ninety-nine patients were diagnosed with a partial distal biceps tendon, of which 34 had available MRI reports and complete physical examination documentation. 33/34 patients (97%) had partial tears on MRI. The hook test was negative in all cases. All patients had tenderness with resisted supination. In those with MRI-confirmed partial tears, the palpation rotation test was positive in all patients (100% sensitivity). The bicipital tuberosity was maximally palpated at the dorsolateral forearm at a mean 20 degrees of pronation, and the proximal and distal boundaries of the radial tuberosity were 2.5 cm and 5.3 cm, on average, distal to the radial head, respectively. Conclusion: A positive palpation rotation test was seen in 33/33 patients (100% sensitivity), as correlated with MRI. The combination of an intact distal biceps tendon within the antecubital fossa, tenderness on resisted supination, and a positive palpation rotation test are highly suggestive of a partial distal biceps tendon tear. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: A systematic review and meta-analysis of cohort studies. Momma, H., R. Kawakami, T. Honda and S. S. Sawada (2022) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 (4/4 thumbs up) Type of study : Preventative, Therapeutic Topic : Resistance training - All-cause mortality & Cardiovascular disease This is a systematic review and meta-analysis assessing the effect of resistance training alone or in combination with aerobic exercise in reducing all-cause mortality, cancer risk, and diabetes. Prospective studies that followed participants for at least two years and assessed their resistance training programs were included. A total of 16 studies were included. A tool for the assessment of prospective studies was utilised to evaluate each study and the GRADE system was utilised to assess the overall quality of evidence. Very-low to low-quality evidence suggested that resistance training activities between 30 and 60 minutes per week reduced mortality by 10-20% independently of aerobic exercise. The combination of resistance training and aerobic exercise appeared to further reduce mortality risk by 30%. Resistance training exercises beyond 140 minutes per week appeared to be counterproductive for health except for diabetes. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, short duration resistance training exercise appears to reduce mortality independently of aerobic exercise by 10-20%. If we combine it with aerobic exercise it appears that we obtain an even greater reduction in mortality risk. Considering that several of our clients are at higher risk of cardiovascular disease (e.g. hand osteoarthritis ) and may present with general frailty (e.g. older clients with distal radius fracture ), they may benefit from general resistance training. In addition, we can include resistance training to regain range of movement in our clients affected by upper limb impairments. Open Access URL : http://dx.doi.org/10.1136/bjsports-2021-105061 Abstract Objective: To quantify the associations between muscle-strengthening activities and the risk of non-communicable diseases and mortality in adults independent of aerobic activities. Design: Systematic review and meta-analysis of prospective cohort studies. Data sources: MEDLINE and Embase were searched from inception to June 2021 and the reference lists of all related articles were reviewed. Eligibility criteria for selecting studies: Prospective cohort studies that examined the association between muscle-strengthening activities and health outcomes in adults aged ≥18 years without severe health conditions. Results: Sixteen studies met the eligibility criteria. Muscle-strengthening activities were associated with a 10–17% lower risk of all-cause mortality, cardiovascular disease (CVD), total cancer, diabetes and lung cancer. No association was found between muscle-strengthening activities and the risk of some site-specific cancers (colon, kidney, bladder and pancreatic cancers). J-shaped associations with the maximum risk reduction (approximately 10–20%) at approximately 30–60 min/week of muscle-strengthening activities were found for all-cause mortality, CVD and total cancer, whereas an L-shaped association showing a large risk reduction at up to 60 min/week of muscle-strengthening activities was observed for diabetes. Combined muscle-strengthening and aerobic activities (versus none) were associated with a lower risk of all-cause, CVD and total cancer mortality. Conclusion: Muscle-strengthening activities were inversely associated with the risk of all-cause mortality and major non-communicable diseases including CVD, total cancer, diabetes and lung cancer; however, the influence of a higher volume of muscle-strengthening activities on all-cause mortality, CVD and total cancer is unclear when considering the observed J-shaped associations. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

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

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

A case of an elderly patient with rubber band syndrome. Amemiya, E., et al. (2021) Level of Evidence : 5 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Diagnostic/Therapeutic This is the answer to last week's Sherlock Handy. The patient was a 71 years old man presenting with numbness tingling, swelling, and limited finger mobility in the left hand. They visited a hospital where they were given antibiotics to treat what they believed to be cellulitis. This treatment led to no resolution of the presentation and they were referred for a second opinion. Objectively, they presented with 0 deg of wrist flexion, 60 deg of wrist extension and a circumferential scar at the proximal wrist. Blood tests revealed no signs of infection. X-rays identified some indentations on the radius. MRI was also completed and identified compression of the median nerve by a cord-like structure. Surgery was performed and it identified and removed a rubber band from the wrist. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical take home message : Based on what we know today, rubber band syndrome is a rare presentation. This syndrome is more common in babies, people with cognitive disabilities, and older adults with cognitive/memory impairment. This syndrome may be misdiagnosed and we should therefore remain vigilant in clients who are at higher risk. URL : https://doi.org/10.1016/j.jhsg.2021.07.005 Abstract Rubber band syndrome is a relatively rare disease in which a rubber band around a limb becomes embedded under the skin, resulting in tissue damage. Most reported cases are in children, and its occurrence in adults is considered extremely rare. We present a case of a 71-year-old patient with cognitive impairment, in whom a rubber band around the wrist became embedded under the skin. The examination of the distinctive circumferential scar, ultrasonography, x-ray, and magnetic resonance imaging led to the diagnosis of rubber band syndrome. To avoid further damage to the tissue, surgical removal of the band was conducted. When elderly patients with cognitive impairment present with chief complaints of swelling and contracture in the limbs due to an unknown cause, accompanied by a circumferential scar on the affected limb, rubber band syndrome should be considered. Due to risk of deep tissue necrosis, prompt band removal is necessary. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

A high rate of children and adolescents return to sport after surgical treatment of osteochondritis dissecans of the elbow: A systematic review and meta-analysis. Cohen, D., et al. (2021) Level of Evidence : 1a- Follow recommendation : 👍 👍 Type of study : Therapeutic Topic : Osteochondritis dissecans - Treatment This is a systematic review and meta-analysis assessing return to sport following surgery for osteochondritis dissecans in adolescents (10 to 19 years old). A total of 31 case series for a total of 548 participants were included in the present study. Eighty per cent of participants played baseball, 10% were involved in gymnastics, and the remaining 10% were involved in other sports. All studies underwent quality assessment through the Methodological Index for Non-Randomised Studies (MINORS). Amongst the many outcomes, return to sport (at the pre-injury level) and post-operative rehabilitation protocols were reported. The results showed that between 70% and 90% of participants returned to sport at the pre-injury level (see Forest plot). The most commonly adopted post-operative rehabilitation protocol involved immobilisation of the elbow in neutral forearm rotation for 2 weeks post-surgery and return to sport at the 6 months mark. In the early phase of rehabilitation, rehabilitation focused on regaining elbow range of movement on the affected side, as well as general conditioning and strength training of unaffected body segments. This was followed by graded resistance training for the affected side and sport-specific exercises. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, a moderate to large proportion (70-90%) of adolescents undergoing surgical treatment for osteochondritis dissecans of the elbow, return to sports at pre-injury levels. The average time to return to sport is 6 months. A surgical approach is often undertaken for unstable or extensive lesions. Post-surgical rehabilitation often focuses on maintaining conditioning and gradually regaining range of movement and strength of the affected limb. If you are interested in the conservative management of less severe elbow osteochondritis dissecans, have a look at this synopsis . URL : https://doi.org/10.1007/s00167-021-06489-9 Abstract Purpose: The purpose of this systematic review was to determine the return to sport rates following surgical management of ostechondritis dissecans of the elbow. Methods: The databases EMBASE, PubMed, and MEDLINE were searched for relevant literature from database inception until August 2020 and studies were screened by two reviewers independently and in duplicate for studies reporting rates of return to sport following surgical management of posterior shoulder instability. A meta-analysis of proportions was used to combine the rates of return to sport using a random effects model. A risk of bias assessment was performed for all included studies using the MINORS score. Results: Overall, 31 studies met inclusion criteria and comprised of 548 patients (553 elbows) with a median age of 14 (range 10–18.5) and a median follow-up of 39 months (range 5–156). Of the 31 studies included, 14 studies (267 patients) had patients who underwent open stabilization, 11 studies (152 patients) had patients who underwent arthroscopic stabilization, and 6 studies (129 patients) had patients who underwent arthroscopic–assisted stabilization. The pooled rate of return to any level of sport was 97.6% (95% CI 94.8–99.5%, I2 = 32%). In addition, the pooled rate of return to the preinjury level was 79.1% (95% CI 70–87.1%, I2 = 78%). Moreover, the pooled rate of return to sport rate at the competitive level was 86.9% (95% CI 77.3–94.5%, I2 = 64.3%), and the return to sport for overhead athletes was 89.4% (95% CI 82.5–95.1%, I2 = 59%). The overall return to sport after an arthroscopic procedure was 96.4% (95% CI 91.3–99.6%, I2 = 1%) and for an open procedure was 97.8% (95% CI 93.7–99.9%, I2 = 46%). All functional outcome scores showed improvement postoperatively and the most common complication was revision surgery for loose body removal (19 patients). Conclusion: Surgical management of osteochondritis dissecans of the elbow resulted in a high rate of return to sport, including in competitive and overhead athletes. Similar rates of return to sport were noted across both open and arthroscopic procedures. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings