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Osteosarcoma of the Trapezium. Ferrando, E., Navarro, J., Rojas, R., Mata, D., & Silvestre, A. (2020) Level of Evidence : 5 Follow recommendation : 👍 Type of study : Diagnostic Topic : What is the differential diagnosis? – Case study This is the answer for the last week case study. The patient was a 51 years old female with a three years history of painless palpable firm mass on the dorsal and radial aspect of the wrist. Subjectively, they reported swelling and pain in the last two months. The patient reported a history of hypertension. The x-ray that you see below revealed a calcification on the radial aspect of the wrist. An MRI was completed, which revealed a soft tissue mass. Surgery was performed to remove the mass and histological studies revealed that it was a low grade osteosarcoma. URL : https://www.jhandsurg.org/action/showPdf?pii=S0363-5023%2820%2930607-9 Available through EBSCO Health Databases for PNZ members. Abstract Osteogenic sarcoma is a malignant tumor that rarely affects the hand. When it does, it most often involves the phalanges or metacarpal heads. We present the case of a 51-year-old woman with a low-grade osteosarcoma affecting the trapezium bone of her left hand. A total trapeziectomy with partial removal of the first metatarsal, scaphoid, trapezoid, and capitate bones was performed, and no adjuvant therapy was administered. Six years after the intervention, the patient is disease-free, with excellent functionality and yearly imaging tests showing no signs of recurrence.

Functional outcomes of trigger finger release in non-diabetic and diabetic patients. Stirling, P. H. C., P. J. Jenkins, A. D. Duckworth, N. D. Clement and J. E. McEachan (2020) Level of Evidence : 2b Follow recommendation : 👍 👍 Type of study : Prognostic Topic : Trigger finger surgery - diabetes and functional recovery This retrospective study assessed the effect of diabetes on functional recovery following surgery for trigger finger (A1 pulley release). Functional recovery was measured through the QuickDASH questionnaire, and the presence of diabetes was self-reported by participants. A total of 192 participants were recruited at baseline and they were assessed pre-surgery and one year post-surgery. The results showed that 25% (n = 49) of the participants reported diabetes (no information was provided on number of participants with Type 1 or Type 2 diabetes). Participants' function at baseline was significantly worst in diabetic subjects (16 points worse). However, improvements in functional outcome following surgery were similar in both the diabetic (13 points improvement) and non-diabetic participants (9 points improvement). Clinical Take Home Message : Based on what we know today, clients affected by trigger finger and diabetes may have greater disability than clients without diabetes. It may be worth checking with the client if they are compliant with their diabetes medications (e.g. metformin) and if they have had a check up with their GP recently. The functional outcomes of A1 pulley release are similar between clients with and without diabetes. This synopsis is a nice addition to the one written on the effect of diabetes on functional recovery following distal radius fracture . URL : https://doi.org/10.1177/1753193420925027 Available through EBSCO Health Databases for PNZ members. Abstract We compared the functional outcomes, health-related quality of life, and satisfaction in diabetic and non-diabetic patients undergoing A1 pulley release for trigger finger in 192 patients. Preoperative and postoperative Quick Disabilities of the Arm, Shoulder and Hand questionnaire (Quick DASH), EuroQol-5 dimensions, and satisfaction scores were collected prospectively over a 6-year period. These patients had a mean follow-up of 14 months (range 11?40) after surgery. There were 143 patients (143 trigger fingers) without diabetes and 49 patients (49 trigger fingers) with diabetes. We found overall QuickDASH improvement was the same in both groups (-4.5 points). Patient satisfaction rates were comparable in both groups (90% versus 96%), and no significant difference in postoperative health-related quality of life was observed. No complications were reported in either group. We conclude from this study that A1 pulley release leads to similar functional improvement and high patient satisfaction at one year postoperatively in diabetic and non-diabetic patients.

Level of Evidence : 5 Follow recommendation : 👍 Type of study : Diagnostic Topic : What is the differential diagnosis? – Case study Have a think about this case study. Leave a diagnostic comment if you like. I will publish the diagnosis and treatment reported by the paper next week. The patient was a 51 years old female with a three years history of painless palpable firm mass on the dorsal and radial aspect of the wrist. Subjectively, they reported swelling and pain in the last two months. The patient reported a history of hypertension. X-ray images are shown below. What is it?

Trapeziometacarpal joint arthritis: A personal approach to its treatment. Davis, T. R. C. (2020) Level of Evidence : 5 Follow recommendation : 👍 Type of study : Therapeutic Topic : Thumb OA - Surgeon's point of view This is a surgeon's opinion on treatment of thumb osteoarthritis (OA). I particularly enjoyed the open minded approach that this surgeon has about thumb OA. They recognise the limitations of their own approach and they are ready to change their practice in light of new evidence, which will inevitably arise in the future. The approach suggested is to delay surgery (e.g. trapeziotomy) as much as possible. This is based on evidence suggesting that a limited proportion of the pain is correlated with radiographic findings and that a flare in pain may resolve within 6 months to a year. Furthermore, conservative treatments may help in the resolution or reduction of pain. More importantly, they recognise the significant impact of psychological factors in the exacerbation of pain (which is the driver for surgery) and the potential effect of other conservative interventions in the management of thumb OA. Cortisone injections are suggested as an additional treatment option. They report being happy to provide more than 3 injections if the benefits last for more than 6 months. A final point was made on the lack of evidence suggesting greater effectiveness of trapeziotomy alone vs trapeziotomy plus suspension arthroplasty. No differences have been identified between these approaches at short and long term in randomised controlled trials. 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, thumb OA should be initially treated conservatively. Conservative treatments should last between 6 to 12 months and consider other factors contributing to pain other than radiographic evidence of thumb OA. Psychological factors (e.g. anxiety, depression, pain catastrophising) have been shown to mediate pain/recovery and should be taken into account more than the degree of "degeneration" of the joint ( up to 75% of people with radiographic evidence of thumb OA do not have pain ). Have a look at conservative treatments for hand OA (e.g. manual therapy/exercise , illusory resizing , mental health component ) , we can make a difference! URL : https://journals.sagepub.com/doi/abs/10.1177/1753193420970343?journalCode=jhsc Available through EBSCO Health Databases for PNZ members. Abstract Many hand surgeons have fixed beliefs on how trapeziometcarpal (TMC) osteoarthritis should be treated. However, not all hand surgeons share the same fixed beliefs, so different factions of hand surgeons can hold contradictory beliefs. Many retain their fixed beliefs, rather than reconsidering them, when the best available evidence challenges them. The problem causing this heterogeneity of fixed beliefs is the lack of high-quality evidence that can withstand critical appraisal and cannot be ignored or simply dismissed by those with rigid contradictory beliefs. This article examines some of the dogmas surrounding the treatment of TMC osteoarthritis.

Factors affecting suboptimal outcomes in hand infections. Botma, N., McGuire, D., Koller, I., & Solomons, M. (2020) Level of Evidence : 4 Follow recommendation : 👍 👍 Type of study : Prognostic Topic : Revision surgery following infection – Diabetes This is a non-peer reviewed prospective study assessing the risk factors for the development of complications following a hand washout procedure. A total of 674 participants diagnosed with a hand infection were included in the study. The results showed that being diabetic increased the risk of a second infection by at least twofold. In people with diabetes, delayed presentation to ED (i.e. more than 1 week) increased the odds of amputation due to sepsis by 6 times. 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, diabetes is a risk factor for the development of a secondary infection following a washout procedure. A prompt referral to ED is warranted given the substantial risk of sepsis and potential amputation in clients with diabetes. This synopsis is a nice addition to a previous synopsis on risk factors for hand infection . URL : https://journals.sagepub.com/doi/full/10.1177/1753193420977791 Available through EBSCO Health Databases if you have access ( PNZ ) No abstract available.

The impact of type 2 diabetes on the development of tendinopathy. Cannata, F., Vadalà, G., Ambrosio, L., Napoli, N., Papalia, R., Denaro, V., & Pozzilli, P. (2020) Level of Evidence : 5 Follow recommendation : 👍 Type of study : Prognostic Topic : Lateral epicondylalgia – Risk factors This is a narrative review assessing the connection between type 2 diabetes and tendinopathy, and exploring the potential treatment pathways. Type 2 diabetes is associated with chronic hyperglycemia (high levels and significant fluctuations of glucose in the bloodstream - especially if not treated) and poses several risks for tendons. In particular, it reduces the loading threshold at which tendons enter a degenerative phase, and it reduces the ability of tendon to heal due to tenocytes oxidative stress and impairment of stem cells activity. This is not to mention the effect that hyperglycemia has on connective and vascular tissue. Thus, glycation of connective tissue makes it more stiff and less resilient to loading. Vascular impairments lead to a reduction of neoangiogenesis (formation of new vessels), which is fundamental for tendon healing. Management of people presenting with type 2 diabetes and tendinopathy includes both local treatment ( reduction in loading during the acute phase and gradual resistance training ) and other interventions aiming at weight-loss (i.e. exercise, diet, and pharmacological, +/- surgical). Interventions aiming at weight loss have shown to reduce symptoms in both weight-bearing and non-weight-bearing tissues. Finally, resistance training and aerobic exercises are fundamental interventions in the management of type 2 diabetes and should be undertaken under the supervision of a health professional. Clinical Take Home Message : Based on what we know today, clients with type 2 diabetes may be predisposed to develop lateral epicondylalgia. When assessing clients with Type 2 diabetes, hand therapists should investigate whether they are compliant with medications (e.g. metformin) and encourage clients to take part in supervised resistance and/or aerobic training exercises (as per international guidelines ) . This article is a nice addition to what we already know on the risk factors for lateral epicondylalgia . URL : https://doi.org/10.1002/dmrr.3417 Available through EBSCO Health Databases for PNZ members. Abstract Tendinopathy is a chronic and often painful condition affecting both professional athletes and sedentary subjects. It is a multi‐etiological disorder caused by the interplay among overload, ageing, smoking, obesity (OB) and type 2 diabetes (T2D). Several studies have identified a strong association between tendinopathy and T2D, with increased risk of tendon pain, rupture and worse outcomes after tendon repair in patients with T2D. Moreover, consequent immobilization due to tendon disorder has a strong impact on diabetes management by reducing physical activity and worsening the quality of life. Multiple investigations have been performed to analyse the causal role of the individual metabolic factors occurring in T2D on the development of tendinopathy. Chronic hyperglycaemia, advanced glycation end‐products, OB and insulin resistance have been shown to contribute to the development of diabetic tendinopathy. This review aims to explore the relationship between tendinopathy and T2D, in order to define the contribution of metabolic factors involved in the degenerative process and to discuss possible strategies for the clinical management of diabetic tendinopathy.

Corticosteroid or hyaluronic acid injections to the carpometacarpal joint of the thumb joint are associated with early complications after subsequent surgery. Giladi, A. M., Rahgozar, P., Zhong, L., & Chung, K. C. (2018) Level of Evidence : 4 Follow recommendation : 👍 👍 Type of study : Prognostic Topic : 1st cmcj OA injections - Are they safe? This is a retrospective study assessing post-surgical complications in clients who underwent injection therapy vs those who did not, prior to surgery for symptomatic 1st cmcj OA. The surgical procedure was trapeziotomy with or without suspension arthroplasty or fusion. A total of 16,268 participants, took part in this study. Of these, 4,462 (27%) and 252 (1.5%) received at least one cortisone or hyaluronic acid injection respectively prior to surgery. The average time between injection and surgery was 12 months. The results showed that one cortisone injection increased the odds of post surgical infection by 20% while three cortisone injections increased the odds of post surgical infection by 70%. Hyaluronic acid injections increased the risk of post surgical infection by 110%. Unfortunately, the absolute number of participants presenting with post-surgical infections was not provided ( I also contacted the authors but they were unable provide me with the numbers). It is therefore possible that the effect reported is overestimated and potentially not clinically relevant. Clinical Take Home Message : Based on what we know today, cortisone or hyaluronic injections for 1st cmcj OA may not be the best therapeutic options if clients are scheduled for a trapeziotomy in the near future. The risk of post-surgical complications may be higher and other therapeutic interventions may be as effective and less harmful . Considering that the effectiveness of cortisone injections for 1st cmcj OA is not superior to placebo , their use is questionable. The results from this study are not surprising considering that cortisone injections have shown to increase the risk of post surgical infections in other joint (e.g. hip ). URL : https://journals.sagepub.com/doi/10.1177/1753193418805391 Available through EBSCO Health Databases for PNZ members. Abstract Truven MarketScan® Databases were used to identify patients with thumb carpometacarpal arthritis who underwent surgical treatment. Pre-operative corticosteroid or hyaluronic acid injections were identified, as were post-operative complications. Multivariable regressions assessed the relationship between injections and complications. Of 16,268 patients, 4462 had steroid injections and 252 received hyaluronic acid injections. Twenty-one per cent (3381 patients) had post-operative complications. Diabetes and smoking increased the odds of complications in all models. Odds of any complication, most notably infectious complications, were increased 20% by corticosteroids (OR 1.2; 95% CI: 1.1 to 1.3). More than three injections increased the odds of a complication by 70% (OR 1.7; 95% CI: 1.3 to 2.1). Hyaluronic acid increased the odds of wound-healing complications by 110% (OR 2.1; 95% CI: 1.3 to 3.4). Corticosteroid and hyaluronic acid injections for thumb carpometacarpal arthritis increase the odds of post-operative complications.

Enigmatic and unusual cases of upper extremity pain: Mislabeling as malingerers. Bradburn, K. N., Beleckas, C. M., Peck, K. M., Kaplan, F. T., & Merrell, G. A. (2020) Level of Evidence : 5 Follow recommendation : 👍 Type of study : Diagnostic Topic : What is the differential diagnosis? – Case study This synopsis provides you with the answer! The patient was a 33 year old female with an insidious onset of pain at the base of the index finger for the last 3 months. Aggravating factors included playing tennis and increasing tennis frequency. In the last three months, they had been playing tennis more frequently. Objectively, there were no massess or skin changes. There was tenderness on palpation at the second metacarpal. There was no extensor digitorum subluxation at mcpj. Laboratory testing was negative for inflammatory conditions. X-rays revealed no bony abnormalities. MRI showed cortical thickening and bone edema of the second metacarpal shaft. The subjective history, the objective testing, and the MRI result suggested that the client presented with a stress fracture of the second metacarpal. The client was treated with rest for three months. No splinting was provided. A repeat MRI at three months showed stress fracture healing. Clinical take home message : Hand therapists may consider stress fractures of the upper limb as a differential diagnosis in athletes. Females appear to be at greater risk compared to males. The presence of eating disorders, menstrual cycle alterations, and osteopenia (female athlete triad) may increase the likelihood of this condition. URL : https://www.jhandsurg.org/article/S0363-5023(20)30189-1/fulltext Available through the Journal of Hand Surgery (American Volume) for HTNZ members. Available through EBSCO Health Databases for PNZ members.

Protective effect on mortality of active commuting to work: A systematic review and meta-analysis. Dutheil, F., Pélangeon, S., Duclos, M., Vorilhon, P., Mermillod, M., Baker, J. S., . . . Navel, V. (2020). Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 Type of study : Prognostic, Preventative, Therapeutic Topic : Mortality – Active commuting This is a systematic review and meta-analysis of prospective cohort studies assessing the effect of active commuting (e.g. walking, cycling) on mortality at 5-25 years follow up. Seventeen studies were included for a total of 829,098 participants. The results from this systematic review and meta-analysis were assessed through the Newcastle-Ottawa Quality Assessment Scale, which score from 0 (low quality) to 100 (High quality). The quality of evidence was moderate to high (average of 75 out of 100). Active commuting was defined as cycling or walking. The results showed that moderate to high intensity walking reduced mortality by 15% ( 95%CI : 2% to 28%) and 19% ( 95%CI : 8% to 30%) respectively. Cycling reduced mortality independently of intensity from 14% to 28%. It is necessary to keep in mind that the studies included were not randomised (as it would be unethical to randomise participants to 5-25 of sedentary behavior) and other systemic factors may contributed to the findings (e.g. less stressful lifestyle). Clinical Take Home Message : Based on what we know today, walking briskly or at a fast pace, or cycling to work, will reduce our clients' mortality risk in the next 5 to 25 years. As hand therapist we are privileged to be able to positively affect our clients' life and a simple advice on active commuting may provide them with longer healthspan and lifespan. We may also encourage our clients to be active outside of work as a greater number of daily steps , ability to do more than 10 push-ups (in middle aged males), and a greater grip strength have all been shown to predict mortality in previous studies. URL : https://link.springer.com/article/10.1007/s40279-020-01354-0 Available through EBSCO Health Databases for PNZ members. Abstract Background: Sedentary behaviour is a major risk of mortality. However, data are contradictory regarding the effects of active commuting on mortality. Objectives: To perform a systematic review and meta-analysis on the effects of active commuting on mortality. Methods: The PubMed, Cochrane Library, Embase, and Science Direct databases were searched for studies reporting mortality data and active commuting (walking or cycling) to or from work. We computed meta-analysis stratified on type of mortality, type of commuting, and level of commuting, each with two models (based on fully adjusted estimates of risks, and on crude or less adjusted estimates). Results: 17 studies representing 829,098 workers were included. Using the fully adjusted estimates of risks, active commuting decreased all-cause mortality by 9% (95% confidence intervals 3–15%), and cardiovascular mortality by 15% (3–27%) (p < 0.001). For stratification by type of commuting, walking decreased significantly all-cause mortality by 13% (1–25%), and cycling decreased significantly both all-cause mortality by 21% (11–31%) and cardiovascular mortality by 33% (10–55%) (p < 0.001). For stratification by level of active commuting, only high level decreased all-cause mortality by 11% (3–19%) and both intermediate and high level decreased cardiovascular mortality. Low level did not decrease any type of mortality. Cancer mortality did not decrease with walking or cycling, and the level of active commuting had no effect. Low level walking did not decrease any type of mortality, intermediate level of walking decreased only all-cause mortality by 15% (2–28%), and high level of walking decreased both all-cause and cardiovascular mortality by 19% (8–30%) and by 31% (9–52%), respectively. Both low, intermediate and high intensities of cycling decreased all-cause mortality. Meta-analysis based on crude or less fully adjusted estimates retrieved similar results, with also significant reductions of cancer mortality with cycling (23%, 5–42%), high level of active commuting (14%, 4–24%), and high level of active commuting by walking (16%, 0–32%). Conclusion: Active commuting decreases mainly all-cause and cardiovascular mortality, with a dose–response relationship, especially for walking. Preventive strategies should focus on the benefits of active commuting.

The reliability and validity of novel clinical strength measures of the upper body in older adults. Legg, H. S., Spindor, J., Dziendzielowski, R., Sharkey, S., Lanovaz, J. L., Farthing, J. P., & Arnold, C. M. (2020) Level of Evidence : 2b Follow recommendation : 👍 👍 Type of study : Diagnostic test Topic : Push off test – Validity and reliability as a strength measure This is a longitudinal study (two repeated measures over 48 hrs) assessing the validity and reliability of the push off test in comparison to hand held dynamometer strength testing of the upper limb. Seventeen healthy participants (11 females, 6 males), who were on average 71 years old, took part in the study. The push off test was completed by inverting the handle of a hand held dynamometer and positioning it on a table. Participants were then asked to put as much weight as possible through it with the elbow and shoulder in 10°-40° of flexion and extension respectively (See picture below from the article). The results from this test were repeated two times (to assess reliability after 48 hrs) and compared to strength measurements of shoulder extension, shoulder abduction, and elbow extension (assessed through a hand held dynamometer) to assess validity. The results showed that the push off test was reliable (meaning that the measurements taken at two different times were very similar) with intraclass correlation coefficient between 0.92 and 0.94 (the closer to 1 the better). The push off test was also valid (it was indeed measuring upper limb strength) with strong correlation with the other measures of upper limb strength ranging from 0.8 to 0.9 (the closer to 1 the better). On average, the push off test was 27kg, and the average weight of the participants was 77kg. This suggests that for healthy patients around the age of 70, they should be able to push off during the test 35% of their weight (27kg/77kg=0.35). Clinical Take Home Message : Based on what we know today, the push off test can be utilised to assess upper limb strength in older people. This test has been previously used to assess late stage TFCC recovery . Getting our clients to achieve 35% of their body weight during this test may be an appropriate goal for our treatment. If our clients are younger, a better test may be the maximum number of push up that they can do in a row without stopping ( Reaching 11 push-up may be an appropriate goal ). Open Access URL : https://journals.sagepub.com/doi/10.1177/1758998320957373 Abstract Introduction: Research investigating psychometric properties of multi-joint upper body strength assessment tools for older adults is limited. This study aimed to assess the test–retest reliability and concurrent validity of novel clinical strength measures assessing functional concentric and eccentric pushing activities compared to other more traditional upper limb strength measures. Methods: Seventeen participants (6 males and 11 females; 71 ± 10 years) were tested two days apart, performing three maximal repetitions of the novel measurements: vertical push-off test and dynamometer-controlled concentric and eccentric single-arm press. Three maximal repetitions of hand-grip dynamometry and isometric hand-held dynamometry for shoulder flexion, shoulder abduction and elbow extension were also collected. Results: For all measures, strong test–retest reliability was shown (all ICC > 0.90, p < 0.001), root-mean-squared coefficient of variation percentage: 5–13.6%; standard error of mean: 0.17–1.15 Kg; and minimal detectable change (90%): 2.1–9.9. There were good to high significant correlations between the novel and traditional strength measures (all r > 0.8, p < 0.001). Discussion: The push-off test and dynamometer-controlled concentric and eccentric single-arm press are reliable and valid strength measures feasible for testing multi-joint functional upper limb strength assessment in older adults. Higher precision error compared to traditional uni-planar measures warrants caution when completing comparative clinical assessments over time.

The clinical and cost effectiveness of splints for thumb base osteoarthritis: A randomized controlled clinical trial. Adams, J., Barratt, P., Rombach, I., Arden, N., Barbosa Bouças, S., Bradley, S., . . . Dziedzic, K. (2020) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 👍 Type of study : Therapeutic Topic : Thumb osteoarthritis - Real vs Sham thumb splint This is a randomised, multicentre, double-blind, placebo controlled trial assessing the effectiveness of thumb splinting on pain and function in participants with thumb osteoarthritis (OA). Participants (N = 292) were included if they presented with clinical signs of 1st cmcj OA (inclusion criteria available through their supplemental data ) and if they had moderate hand pain and disability. Importantly, participants were excluded if they had previously tried thumb splinting. Pain and function were assessed through the AUSCAN at baseline, 8 weeks, and 12 weeks. Participants and assessors were blinded to treatment allocation. Participants were randomised to either an 8 weeks self-management program which provided participants with a handout from Arthritis Research UK and a series of exercises to perform three times per week (n = 97), or the self-management program (advice + exercise) plus a true splint limiting 1st cmcj movement (n = 97), or the self-management treatment (advice + exercise) plus a placebo splint, which did not provide any support to the 1st cmcj (n = 102). Participants in all groups attended one hour session at baseline for the introduction to the program. They also had a follow-up at 4 weeks for 30 minutes where key concepts were reiterated. At the eight weeks mark, a final session reminded participants to continue doing their exercises three times per week and wear the splint for at least 6hrs/day (in the splinting groups). The results showed that participants in all groups improved at the 8 and 12 weeks follow up without differences between groups. The placebo and true splint increased the cost of care by at least £100 without providing any significant benefit. Clinical Take Home Message : Based on what we know today, splinting for thumb OA does not provide any additional benefit than education and simple exercises. Providing a splint is more pricey and the expense does not appear to be justified. Instead of providing a splint, it may be more useful to use those resources (money and time) for an additional session of hand therapy where we can encourage joint motion for lotion , promote joint movement for amusement , and suggest meditation for elation . If this is not enough and clients want something passive (no exercises) that has been shown to have some effect (compared to placebo), although small, look at supplements for osteoarthritis . Also remember: keep smiling , your clients' pain will decrease! Open access URL : https://doi.org/10.1093/rheumatology/keaa726 Abstract Objectives: To investigate the clinical effectiveness, efficacy and cost effectiveness of splints (orthoses) in people with symptomatic basal thumb joint OA (BTOA). Methods: A pragmatic, multicentre parallel group randomized controlled trial at 17 National Health Service (NHS) hospital departments recruited adults with symptomatic BTOA and at least moderate hand pain and dysfunction. We randomized participants (1:1:1) using a computer-based minimization system to one of three treatment groups: a therapist supported self-management programme (SSM), a therapist supported self-management programme plus a verum thumb splint (SSM+S), or a therapist supported self-management programme plus a placebo thumb splint (SSM+PS). Participants were blinded to group allocation, received 90 min therapy over 8 weeks and were followed up for 12 weeks from baseline. Australian/Canadian (AUSCAN) hand pain at 8 weeks was the primary outcome, using intention to treat analysis. We calculated costs of treatment. Results: We randomized 349 participants to SSM (n = 116), SSM+S (n = 116) or SSM+PS (n = 117) and 292 (84%) provided AUSCAN Osteoarthritis Hand Index hand pain scores at the primary end point (8 weeks). All groups improved, with no mean treatment difference between groups: SSM+S vs SSM −0.5 (95% CI: −1.4, 0.4), P = 0.255; SSM+PS vs SSM −0.1 (95% CI: −1.0, 0.8), P = 0.829; and SSM+S vs SSM+PS −0.4 (95% CI: −1.4, 0.5), P = 0.378. The average 12-week costs were: SSM £586; SSM+S £738; and SSM+PS £685. Conclusion: There was no additional benefit of adding a thumb splint to a high-quality evidence-based, supported self-management programme for thumb OA delivered by therapists.

Temporal trends in the handgrip strength of 2,592,714 adults from 14 countries between 1960 and 2017: A systematic analysis. Dufner, T. J., Fitzgerald, J. S., Lang, J. J., & Tomkinson, G. R. (2020) Level of Evidence : 2a Follow recommendation : 👍 👍 Type of study : Symptoms prevalence Topic : Grip strength – Changes in the last 57 years This is a systematic review assessing the change in grip strength in the last 57 years. Ten prospective studies were included for a total of 2,592,714 participants. The age of participants ranged between 20 and 90. Data were collected from high to moderate income countries. Hand grip strength was assessed through hand held dynamometers. The results showed that no significant change in grip strength was identified before 2000. However, between 2000 and 2017, there was a trend towards a decrease in grip strength. Clinical Take Home Message : Based on what we know today, grip strength has been declining in the last 20 years. This is unfortunate because grip strength is predictor of mortality at 10 years . It may be worth reminding our clients about the importance of general body strengthening and aerobic exercise to increase lifespan and more importantly health span. URL : https://link.springer.com/article/10.1007/s40279-020-01339-z Available through EBSCO Health Databases for PNZ members. Abstract Background: Handgrip strength (HGS) is an excellent marker of functional capability and health in adults, although little is known about temporal trends in adult HGS. Objectives: The aim of this study was to systematically analyze national (country-level) temporal trends in adult HGS, and to examine the relationships between national trends in adult HGS and national trends in health-related and socioeconomic/demographic indicators. Methods: Data were obtained from a systematic search of studies reporting temporal trends in HGS for adults (aged ≥ 20 years) and by examining national fitness datasets. Trends in mean HGS were estimated at the country–sex–age group level by best-fitting sample-weighted linear/polynomial regression models, with national and sub-regional (pooled data across geographically similar countries) trends estimated by a post-stratified population-weighting procedure. Pearson’s correlations quantified relationships between national trends in adult HGS and national trends in health-related and socioeconomic/demographic indicators. Results: Data from ten studies/datasets were extracted to estimate trends in mean HGS for 2,592,714 adults from 12 high- and 2 upper-middle-income countries (from Asia, Europe and North America) between 1960 and 2017. National trends were few, mixed and generally negligible pre-2000, whereas most countries (75% or 9/12) experienced negligible-to-small declines ranging from an effect size of 0.05 to 0.27, or 0.6 to 6.3%, per decade post-2000. Sex- and age-related temporal differences were negligible. National trends in adult HGS were not significantly related to national trends in health and socioeconomic/demographic indicators. Conclusions: While trends in adult HGS are currently limited to 14 high- and upper-middle-income countries from three continents, adult HGS appears to have declined since 2000 (at least among most of the countries in this analysis), which is suggestive of corresponding declines in functional capability and health.