Search Results

The natural history of paediatric trigger thumbs. A prospective cohort study. Chew, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic/Prognostic Topic : Paediatric trigger thumb - Prognosis This study assessed the rate of spontaneous resolution of paediatric trigger thumb over time and identified factors influencing its treatment. It found that approximately 37% of children resolved spontaneously within five years, with a higher rate observed by eight years. The interphalangeal joint (ipj) angle was identified as a significant predictor, with thumbs presenting at less than 30 degrees more likely to resolve conservatively. Economic analysis highlighted cost savings associated with conservative management compared to surgery. However, the study’s findings are limited to a cohort of children whose parents opted for non-surgical treatment initially, potentially skewing 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, pediatric trigger thumb resolves spontaneously in 40% of cases within five years. This number increases to 50% by eight years. A key predictor is the interphalangeal joint (ipj) angle: thumbs with an angle below 30 degrees are more likely to improve without surgery. This suggests that conservative management, such as observation and therapy, is a viable option for many children. Monitoring and conservative care are recommended for mild cases with low ipj angles. If there's no improvement after four years or if symptoms worsen, surgical intervention may be necessary. URL : https://doi.org/10.1177/17531934241295903 Abstract The aim of this study was to report the natural history of paediatric trigger thumbs, determining the rate and factors predictive of spontaneous resolution. A total of 62 patients presenting with 79 thumbs locked in flexion were observed for a mean of 4.2 years. The median age at presentation was 20.5 months. The spontaneous resolution rate was 37% at 5 years and 50% at 8 years of follow-up. Of the thumbs, 27% had undergone surgery at 5 years and 48% at 8 years. Thumbs that spontaneously resolved did so at a mean of 3.4 years. Thumbs presenting with an interphalangeal joint angle of less than 30° were likely to resolve spontaneously, with a sensitivity of 0.50 and specificity of 0.82. It is reasonable to offer observation alone for 4 to 5 years as the first line of management for paediatric trigger thumb. 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

Heterotopic ossification in patients with posttraumatic elbow stiffness: 3d analysis of regional distribution features and associated risk factors. Hua, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic/Prognostic Topic : Heterotopic ossification - Presentations This study investigates the development of heterotopic ossification (HO) following elbow injuries in 170 patients, analysing various clinical factors influencing its occurrence across different anatomical regions. The most common injuries included distal humerus fractures (34%), olecranon fractures (32%), and radial head fractures (31%). High-energy trauma was more prevalent (52%) than low-energy mechanisms, and operative treatment was the primary intervention in 85% of cases. Key findings from logistic regression analyses revealed that HO development varied significantly by region. HO in the anteromedial region was more common after elbow dislocation and longer time intervals (≥1 year). HO in the anterolateral region showed higher odds with high-energy trauma. HO in the posterior region was influenced by prolonged immobilisation (>2 weeks). Radial head fractures were strongly associated with proximal radioulnar joint (PRUJ) HO. 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, heterotopic ossification (HO) after elbow injuries varies across different anatomical regions. Notably, high-energy trauma elevates HO risk in specific areas. Prolonged immobilisation beyond two weeks significantly increases HO risk, particularly posteriorly. Additionally, radial head fractures are strong indicators of HO, especially affecting the proximal radioulnar regions. These findings are in line with previous evidence , and they highlight the importance of getting the elbow to move as soon as possible after injury. URL : https://doi.org/10.1016/j.jse.2025.03.020 Abstract Background: The development of heterotopic ossification (HO) is a common yet debilitating complication after elbow injuries and related surgical procedures. We intend to evaluate the regional distribution features of HO around the elbow joint in patients with posttraumatic elbow stiffness (PTES), and explore the independent risk factors for HO development in different regions. Materials and Methods: Patients who presented with PTES attributed to HO from January 2018 to December 2019 were consecutively enrolled. The pattern of HO distribution was analyzed using Mimics software and classified into 8 distinct regions: anteromedial (AM), anterolateral (AL), posteromedial (PM), posterolateral (PL), posterior (P), medial (M), lateral (L), and proximal radioulnar (PRU) regions. The initial injuries were further categorized based on the presence or absence of 5 fundamental injury types: distal humerus fracture, olecranon fracture, radial head fracture, coronoid fracture, and elbow dislocation. With the occurrence of HO in a specific region as the dependent variable and the initial injury patterns and baseline clinical data as independent variables, logistic regression analyses were conducted to identify the associated independent risk factors for HO development in different regions. Results: A total of 170 patients were included. We identified PM HO in 166 patients (97.6%), P HO in 135 patients (79.4%), PL HO in 128 patients (75.3%), AM HO in 92 patients (54.1%), AL HO in 57 patients (33.5%), PRU HO in 32 patients (18.2%), M HO in 12 patients (7.1%), and L HO in 11 patients (6.5%). The results of logistic regression analyses: (1) AM HO: time interval between the initial injury and this admission ≥1 year (OR=2.338), the presence of elbow dislocation (OR=3.193) and olecranon fracture (OR=0.305); (2) AL HO: high energy trauma (OR=2.073) and the presence of olecranon fracture (OR=0.367); (3) P HO: immobilization for more than 2 weeks after the initial injury or subsequent surgical procedures (OR=2.466); (4) PL HO: the presence of radial head fracture (OR=2.805); (5) PRU HO: the presence of radial head fracture (OR=8.186); (6) PM+P+PL HO: the presence of radial head fracture (OR=2.235). Conclusion: The regional distribution of HO in patients with PTES exhibits distinct features, and PM HO is observed in almost all patients. The type of initial injury and its subsequent management are closely related to the occurrence and development of HO in different regions. Our findings provide valuable insights and serve as a useful reference for the clinical assessment of HO in patients with PTES. 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

Incidence of extensor carpi ulnaris pathology in patients with triangular fibrocartilage complex foveal repairs. Jung, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic/Symptom prevalence Topic : ECU pathology - TFCC injury The study investigated the relationship between extensor carpi ulnaris (ECU) tenosynovitis and distal radioulnar joint (DRUJ) subluxation in patients with TFCC foveal tears compared to controls without ulnar wrist pain. Using MRI, researchers measured variables like ulnar groove dimensions and DRUJ subluxation ratios, but found no significant differences between groups. ECU tenosynovitis and subluxation grades were identified as significant factors in multivariate analysis, with tenosynovitis strongly associated with TFCC foveal tears. The study highlights that ECU tenosynovitis is more prevalent in patients and likely linked to DRUJ instability caused by TFCC tears. Limitations included underpowering for some analyses, static MRI assessment, and the several univariate analyses, which increase the odds of returning significant findings. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, there is a significant association between ECU tenosynovitis and TFCC foveal tears. This may suggest that ECU inflammation could be the result of DRUJ instability or is a common pathology alongside these presentations. Keep in mind that despite people with TFCC injuries have a higher likelihood of ECU tenosynovitis, there are many asymptomatic people with MRI changes in the wrists . Have a look at the whole database on ulnar wrist pain if you are interested in the topic. URL : https://doi.org/10.1177/17531934251335104 Abstract We analysed the association between extensor carpi ulnaris pathology and triangular fibrocartilage complex foveal tears. In total, 178 patients (58 patients and 120 controls) were retrospectively recruited. The patient group comprised individuals with foveal tears. Extensor carpi ulnaris pathology was defined as the presence of tenosynovitis, tendinosis and high-grade tendon subluxation in magnetic resonance images. Tenosynovitis and a high grade of subluxation were more prevalent in patients than in controls (43 vs. 23% and 26 vs. 14%, respectively) whereas the incidence of tendinosis did not significantly differ. In a multivariate regression model, only tenosynovitis was associated with foveal tears (odds ratio 2.56; 95% CI 1.29 to 5.08; p =  0.007). Overall, the prevalence of tenosynovitis was higher in the patient group than that in the control group. Extensor carpi ulnaris tenosynovitis detected on magnetic resonance images is highly associated with triangular fibrocartilage complex foveal tears. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Clinical irrelevance of the Martin–Gruber communication: A study in proximal ulnar and median nerve lesions. Sporer, et al. (2025) Level of Evidence: 3b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Median-ulnar anastomosis - Martin-Gruber The study examined the clinical relevance of the median-to-ulnar nerve motor fibre communication (Martin-Gruber communication - MGC) in individuals with ulnar or median nerve injuries. Researchers assessed patients to determine if this anatomical connection could compensate for lost thumb adduction or little finger abduction functions, particularly in cases where one nerve is affected. Through clinical testing and intraoperative electrical stimulation, the study found no evidence of a significant motor fibre exchange between the two nerves. Patients with ulnar nerve injuries exhibited severely reduced key-pinch strength, indicating that the MGC does not effectively compensate for lost function. Conversely, those with median nerve injuries retained full thumb adduction and related functions. The researchers concluded that the clinical significance of the MGC has been overstated, suggesting it may be more relevant anatomically than functionally. 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, Martin-Gruber communication (MGC) is not sufficient to compensated for isolated nerve lesions of the ulnar/median nerve. This shift emphasises the need for early surgical options in cases where nerve injuries are severe or incomplete. There is now clinical evidence confuting the previously held notion that Martin-Grouber anastomosis could help in proximal ulnar or median nerve lesions . URL : https://doi.org/10.1177/17531934251330989 Abstract The Martin–Gruber communication is a median-to-ulnar motor fibre exchange. However, no clinical evidence of its potential compensatory function was found in 54 patients with complete proximal lesions of either the ulnar or median nerves, suggesting that its significance is largely anecdotal. 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

Results of a 6-week treatment with 10 mg prednisolone in patients with hand osteoarthritis (HOPE): A double-blind, randomised, placebo-controlled trial Kroon, et al. (2019) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Hand OA - Prednisone This double blind placebo trial evaluated the efficacy of a six-week course of 10 mg prednisolone daily compared to placebo in 92 patients with painful hand osteoarthritis and synovial inflammation. Results showed significant improvements in pain, functional limitation, and joint tenderness favoring prednisolone. Around 70% of people in the experimental and 30% of people in the placebo group obtained clinically relevant changes. While short-term use was effective, prolonged prednisolone use was discouraged due to risks like glucocorticoid-induced osteoporosis. 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 six-week course of prednisone is likely to reduce pain hand osteoarthritis by reducing synovial inflammation. This seems to be in line with another study looking at topical NSAIDs, which reduced synovitis within two weeks of application . URL : https://doi.org/10.1016/S0140-6736(19)32489-4 Abstract Background: Hand osteoarthritis is a prevalent joint condition that has a high burden of disease and an unmet medical need for effective therapeutic options. Since local inflammation is recognised as contributing to osteoarthritic complaints, the Hand Osteoarthritis Prednisolone Efficacy (HOPE) study aimed to investigate the efficacy and safety of short-term prednisolone in patients with painful hand osteoarthritis and synovial inflammation. Methods: The HOPE study is a double-blind, randomised, placebo-controlled trial. We recruited eligible adults from rheumatology outpatient clinics at two sites in the Netherlands. Patients were considered eligible if they had symptomatic hand osteoarthritis and signs of inflammation in their distal and proximal interphalangeal (DIP/PIP) joints. For inclusion, patients were required to have four or more DIP/PIP joints with osteoarthritic nodes; at least one DIP/PIP joint with soft swelling or erythema; at least one DIP/PIP joint with a positive power Doppler signal or synovial thickening of at least grade 2 on ultrasound; and finger pain of at least 30 mm on a 100-mm visual analogue scale (VAS) that flared up during a 48-h non-steroidal anti-inflammatory drug (NSAID) washout (defined as worsening of finger pain by at least 20 mm on the VAS). Eligible patients were randomly assigned (1:1) to receive 10 mg prednisolone or placebo orally once daily for 6 weeks, followed by a 2-week tapering scheme, and a 6-week follow-up without study medication. The patients and study team were masked to treatment assignment. The primary endpoint was finger pain, assessed on a VAS, at 6 weeks in participants who had been randomly assigned to groups and attended the baseline visit. This study is registered with the Netherlands Trial Registry, number NTR5263. Findings: We screened patients for enrolment between Dec 3, 2015, and May 31, 2018. Patients completed baseline visits and started treatment between Dec 14, 2015, and July 2, 2018, and the last study visit of the last patient was Oct 4, 2018. Of 149 patients assessed for eligibility, 57 (38%) patients were excluded (predominantly because they did not meet one or several inclusion criteria, most often because of an absence of synovial inflammation or of flare-ups after NSAID washout) and 92 (62%) patients were eligible for inclusion. We randomly assigned 46 (50%) patients to receive prednisolone and 46 (50%) patients to receive placebo, all of whom were included in the modified intention-to-treat analysis of the primary endpoint. 42 (91%) patients in the prednisolone group and 42 (91%) in the placebo group completed the 14-week study. The mean change between baseline and week 6 on VAS-reported finger pain was −21·5 (SD 21·7) in the prednisolone group and −5·2 (24·3) in the placebo group, with a mean between-group difference (of prednisolone vs placebo) of −16·5 (95% CI −26·1 to −6·9; p=0·0007). The number of non-serious adverse events was similar between the groups. Five serious adverse events were reported during our study: one serious adverse event in the prednisolone group (a myocardial infarction) and four serious adverse events in the placebo group (an infected traumatic leg haematoma that required surgery, bowel surgery, atrial fibrillation that required a pacemaker implantation, and symptomatic uterine myomas that required a hysterectomy). Four (4%) patients discontinued the study because of an adverse event: one (2%) patient receiving prednisolone (for a myocardial infarction) and three (7%) patients receiving placebo (for surgery of the bowel and for an infected leg haematoma and for Lyme disease arthritis of the knee). Interpretation: Treatment with 10 mg prednisolone for 6 weeks is efficacious and safe for the treatment of patients with painful hand osteoarthritis and signs of inflammation. The results of our study provide clinicians with a new short-term treatment option for patients with hand osteoarthritis who report a flare-up of their disease. 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

Topical diclofenac reduces joint synovitis in hand osteoarthritis: A pilot investigation using fluorescent optical imaging. Mantantzis, et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Hand OA - Topical NSAIDs This pilot study investigated the effectiveness of topical diclofenac in reducing synovitis, a marker of inflammation in hand osteoarthritis (OA), using fluorescence optical imaging (FOI). The research employed a quantitative approach to analyse FOI images, demonstrating a 42.4% reduction in synovitis after two weeks of treatment compared to baseline. This reduction was consistent with semi-quantitative analyses and subjective improvements in pain perception. While the study highlights the potential of topical diclofenac to alleviate inflammation in HOA, it is limited by its small sample size (10 patients) and open-label design without a placebo control. It is possible that improvements in synovitis could be part of a larger cycle of synovitis and remission independent of the NSAIDs. 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, this pilot study explores the potential benefits of topical diclofenac in managing inflammation in hand osteoarthritis through its ability to reduce synovitis. The reduction in synovitis after two weeks of treatment aligned with subjective improvements in pain perception. The findings from this paper seem to be in line with previous evidence suggesting that in presence of synovitis, prednisone had a clinically relevant improvement in pain . Since we cannot prescribe prednisone, topical NSAIDs may be a useful alternative. URL : https://doi.org/10.2147/JPR.S463633 Abstract Purpose: Synovitis, the inflammation of joint synovia, is a prominent feature of osteoarthritis (OA) manifested by enhanced synovial vascularity, endothelial leakage, and perivascular oedema. In this pilot study, we assessed the effect of topical diclofenac in hand OA (HOA) using the established semi-quantitative methods Magnetic Resonance Imaging (MRI) and Ultrasonography (US), and compared them with Fluorescent Optical Imaging (FOI), an emerging imaging modality. Patients and Methods: Ten patients with symptomatic and diagnosed HOA used topical diclofenac for 14 days, with FOI, MRI, US, and subjective pain assessed at Baseline and after 7 (Day 8), and 14 (Day 15) days of treatment. Changes in synovitis were assessed for all 10 joints of the hand (via sum scores), and separately for the two joints most affected by synovitis. A new, fully quantitative approach for objective synovitis assessment based on the FOI images was also developed and applied. Results: The semi-quantitative analysis of the sum scores showed a small decrease in synovitis throughout the treatment duration across the different imaging modalities. The effect of the treatment was more prominent on the two most affected joints, with a synovitis reduction vs Baseline of 21.1% and 34.2% on Day 8 and Day 15, respectively, in the FOI. The quantitative FOI pixel analysis further strengthened the evidence for this effect, with observed reduction of 17.8% and 42.4% for Days 8 and 15, respectively. A similar trend was observed for subjective pain perception, with a reduction of 7.2 and 13.3 mm on Days 8 and 15. Conclusion: This pilot study evidenced the effect of topical diclofenac on reducing synovitis in hand OA in semi- and fully quantitative analyses, with the effect being stronger in the most affected joints. Further, supporting studies are needed to probe the accuracy of the quantitative pixel analysis of FOI images. 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

Preoperative malnutrition is associated with increased risk of 90-day major medical complications and increased 2-year revision rates following total shoulder arthroplasty. Lawand, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Malnutrition - Post-surgical recovery This retrospective study assessed the impact of preoperative malnutrition on postoperative complications in patients undergoing Total Shoulder Arthroplasty (TSA). By analysing data from a multi-institutional database, researchers identified malnutrition using surrogate markers such as low serum albumin, transferrin, and total leukocyte count. The findings revealed that patients with preoperative malnutrition experienced significantly higher rates of myocardial infarction, sepsis, and readmissions within 90 days post-surgery. Additionally, these individuals demonstrated increased risks of periprosthetic joint infections and the need for revision shoulder arthroplasty within two years postoperatively. The study underscores the importance of routine preoperative nutritional screening and optimisation to mitigate complications and improve surgical outcomes in TSA patients. 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, preoperative nutritional status is a strong contributor of post-surgical outcomes following upper limb surgery. The identification of malnutrition through surrogate markers such as low serum albumin, transferrin, and total leukocyte count is a practical approach that can be easily incorporated into pre-operative screening. This study reinforces the importance of routine preoperative nutritional screening and optimisation in patients undergoing TSA. Malnutrition should be addressed as part of a comprehensive prehabilitation strategy to improve surgical outcomes and reduce postoperative risks. These issues could be flagged during our pre-surgical appointment, which is also useful in setting surgical expectations . URL : https://doi.org/10.1016/j.jse.2025.03.005 Abstract Introduction: Preoperative malnutrition is a known risk factor for poor short-term outcomes after Total Shoulder Arthroplasty (TSA), but the relationship between preoperative malnutrition and implant complications remains unclear. This study aims to evaluate the association between preoperative malnutrition lab markers with the risk of 90-day postoperative complications and 2-year revision rates in TSA patients. Methods: This retrospective cohort study used the TriNetX database to assess TSA patients with and without preoperative malnutrition markers (albumin <3.5g/dL, transferrin <204mg/dL, total leukocyte count <1,500 cells/mm3) from 2004 to 2022, with a minimum of two years of follow-up. Propensity matching (1:1) balanced malnourished and non-malnourished groups by demographics (age, race, ethnicity) and comorbidities (diabetes, hypertension, liver disease, tobacco use, chronic kidney disease, obesity, and osteoporosis). Ninety-day outcomes included infection, blood transfusion, sepsis, pulmonary embolism, myocardial infarction, stroke, readmission, pneumonia, and renal failure. Two-year outcomes assessed revision arthroplasty, periprosthetic joint infection (PJI), mechanical loosening, and prosthetic dislocation. Associations were measured with relative risks (RR), confidence intervals (CI), and p-values. Results: A total of 1,936 patients per group were analyzed after matching. Malnourished patients had significantly higher risks of 90-day major complications, including sepsis (RR 2.400, p = 0.016), myocardial infarction (RR 3.4, p < 0.001), readmission (RR 1.6, p = 0.003), pneumonia (RR 1.667, p = 0.018), renal failure (RR 1.806, p = 0.003), and blood transfusion (RR 5.1, p < 0.001). Within two years postoperatively, these patients were at increased risk of PJI (RR 2.0, p = 0.009), and revision TSA (RR 1.8, p = 0.001). No significant differences in pulmonary embolism, stroke, and mechanical loosening were reported. Conclusion: Preoperative malnutrition is associated with a higher rate of 90-day complications, including sepsis and myocardial infarction following shoulder replacement and a higher two-year risk of PJI and revision TSA. 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

Trapeziometacarpal osteoarthritis: Do not forget other disorders. Druel, et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Hidden disorders - 1st cmcj OA A retrospective study was conducted on patients with 1st cmcj OA to evaluate the prevalence of other hand disorders. The study involved 193 patients over a decade; 49% had additional hand disorders, and 35% underwent concurrent surgery. The most prevalent associated conditions were scaphotrapezotrapezoid (STT) osteoarthritis, median nerve compression, and tenosynovitis. Metacarpophalangeal hyperextension of the thumb, often linked to 1st cmcj OA, was found in 18% of cases. This research emphasises the necessity of a comprehensive hand examination before surgery, as associated disorders could impact surgical outcomes. Differences in prevalence rates of associated conditions and concurrent surgeries were noted compared to previous studies, possibly due to variations in diagnostic criteria. 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, 1st cmcj OA is frequently associated with STT osteoarthritis, carpal tunnel syndrome, and FCR tenosynovitis. This study appears to be in line with a previous meta-analysis showing that carpal tunnel syndrome is two times more likely in people with hand OA . Additionally, biopsychosocial factors play a role in exacerbating symptoms of osteoarthritis , and employing a multidisciplinary approach could be beneficial. URL : https://doi.org/10.1177/17531934231220644 Abstract A retrospective study of patients with symptomatic trapeziometacarpal osteoarthritis was conducted to assess the prevalence of other disorders of the hand. Another disorder of the hand was associated in 49% of cases. A systematic clinical examination of the whole hand must be performed preoperatively. 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

Ruhigstellungstechniken der oberen extremität bei kindern. Kaiser, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Children's fractures - Conservative treatment This expert opinion discusses conservative treatment methods for stable fractures in the upper extremities of children, emphasising non-operative techniques as the gold standard. Indications for these methods include undisplaced and displaced fractures which underwent reduction of the hand, forearm, and elbow. The use of forearm and long arm splints or casts, along with intrinsic plus splints for certain finger and metacarpal injuries, is highlighted. Immobilisation aims primarily at pain relief, with suggested durations varying based on the patient's age and fracture stability. Clinical and radiographic monitoring is recommended, especially for reduced or spontaneously corrected fractures. The article underscores that while these methods are cost-effective and devoid of surgery-related risks, there are potential complications like secondary displacement, pressure sores, and compartment syndrome. 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, conservative treatment remains the gold standard for managing stable fractures of the upper extremity in children. Correct application of immobilisation techniques, such as forearm and long-arm casting, can effectively stabilise fractures and promote healing with a good cost-benefit ratio. Fracture stability should be reassessed following 1 week, especially in those fractures that have been reduced. A repeat x-ray in one week is supported by other research showing that within the first week there is the highest probability of displacement . The results of this study are supported by additional research in torus fractures (see guidelines ), and osteochondritis dissecans . URL : https://doi.org/10.1007/s00064-025-00896-8 Abstract Objective: Conservative treatment of stable fractures of the upper extremity in children. Indications: Undisplaced and age-tolerable displaced fractures of the hand, forearm, and elbow. Contraindications: Open fractures. Treatment options: Forearm splint/forearm cast for stable injuries to the radius or ulna. Long arm splint/long arm cast for injuries to the radius and ulna and after reduction of the forearm, as well as for stable, undisplaced injuries to the elbow. Intrinsic plus splint for injuries to the four fingers (excluding the thumb) and metacarpus. Further treatment: For stable injuries, immobilization for analgesia for 3-4 weeks. Clinical check after treatment. In the case of repositioned fractures or fractures displaced within the spontaneous correction limits, clinical-radiological control (if necessary, with cast wedging) after 1 week. Immobilization for 4 weeks (prepubertal children) or 5 weeks (pubertal children). Results: Conservative treatment of fractures of the upper extremity is still the gold standard today. In pediatric patients in particular, but also in adult patients, correct healing of the fracture with good analgesia can be achieved with manageable effort and a good cost-benefit ratio through correct cast immobilization. A measurable parameter for monitoring a good cast is the cast index. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

A prospective, randomized, blinded study on the efficacy of using corticosteroids in hydrodilatation as a treatment for adhesive capsulitis of the shoulder. Gebellí-Jové, et al. (2024) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Hydrodilatation - Frozen shoulder This randomised controlled study investigated the efficacy of hydrodilatation with or without corticosteroids in treating shoulder adhesive capsulitis. A total of 82 participants, the study assessed pain relief and functionality using various metrics over a year. The hydrodilatation group receiving corticosteroids (HDC) demonstrated significantly better outcomes in pain reduction and shoulder function compared to the group without corticosteroids (HDA). Assessments including the Visual Analog Scale, Shoulder Pain and Disability Index, Simple Shoulder Test, and Subjective Shoulder Value were used to gauge effectiveness. Differences in these metrics were evident as early as 48 hours post-treatment and persisted through the one-year follow-up. It is unclear whether these differences were clinically relevant. 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, hydrodilatation with corticosteroids is effective, however, the addition cortisone may provide marginal improvements in pain and function. The effectiveness of hydrodilatation for frozen shoulder seems to be in line with previous evidence showing that this intervention provides improvements in pain and range of movement . URL : https://doi.org/10.1177/17585732241239030 Abstract Background: This study aimed to compare hydrodilatation with or without corticosteroid administration on the outcomes of patients with shoulder adhesive capsulitis. Methods: This was a prospective, randomized, blinded study of 82 patients with adhesive capsulitis treated with hydrodilatation with corticosteroids (HDC) or without corticosteroids (HDA). Assessments were performed at 48 h and 1, 3, 6, and 12 months. Results: Pain in HDC patients was significantly lower after 48 h of treatment than that of HDA, and the functional scales were better after the first month. These differences were maintained after 1 year. (visual analog scale: 0.8 vs. 1.6, p = 0.018; shoulder pain and disability index: 4.8 vs. 9.8, p = 0.003; simple shoulder test: 11.4 vs. 8.7, p = 0.008; subjective shoulder value: 96.6 vs. 90.1, p = 0.024). Conclusion: We found that hydrodilatation with corticosteroids improved pain levels, shoulder function, and subjective perception of shoulder status compared to hydrodilatation without corticosteroids. 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

High radial nerve entrapment neuropathy: An anatomical cadaver study and case report. Tada, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Aetiologic Topic : Radial nerve - High entrapment This paper explores the pathophysiology of high radial nerve entrapment neuropathy through an anatomical study of 22 cadaveric limbs and a case report. The radial nerve, which passes through the fibrous tunnel formed by the lateral head of the triceps brachii and the lateral intermuscular septum, is susceptible to entrapment neuropathy due to the complex structure. This study highlights the critical role played by the lateral head of the triceps brachii-lateral intermuscular septum complex in nerve compression. It also emphasises the rarity yet significant impact of such neuropathy on patients. 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, high radial nerve entrapment neuropathy arises from fibrous tunnels formed by the structures at the lateral head of the triceps brachii and the lateral intermuscular septum. This condition can lead to significant nerve compression. It is possible that radial tunnel syndrome unresponsive to localised treatment may be due to a more proximal compression site. Have a look at these synopses if you are interested in how common radial tunnel syndrome is or how effective injections are . URL : https://doi.org/10.1016/j.jse.2025.02.060 Abstract Background: The pathogenetic mechanism of high radial nerve entrapment neuropathy involves the fibrous arch of the lateral head of the triceps brachii and lateral intermuscular septum. However, the details of these anatomical structures remain unknown. We described the anatomical course of the radial nerve in the upper arm and its relationship with the lateral head of the triceps brachii and lateral intermuscular septum. Methods: Eleven freshly frozen cadavers (22 limbs, 7 females, and mean age: 87.3 years) were used. The elbow joint was placed at 90° flexion, and a lateral incision was made. Specifically, the tendons of the lateral head of the triceps brachii, deep fascia, and lateral intermuscular septum are continuous at the attachment and form a complex. The radial nerve runs obliquely through the fibrous tunnel formed by this complex, and the entry and exit portions form fibrous arches. Additionally, the distance from the lateral humeral epicondyle to the entrance (X1) and exit (X2) of the fibrous tunnel and fibrous tunnel length were measured. The tunnel was incised, and the radial nerve was exposed. Specifically, the radial nerve was observed from the lateral aspect of the humerus. R1, R2, and R3 were defined as the points where the radial nerve crosses the posterior aspect, lateral center, and anterior aspect of the humeral shaft, respectively. Their distances from the lateral humeral epicondyle were also measured. Results: The distance from the lateral humeral epicondyle to X1 and X2 was 145±15 (121–185) and 91±14 (72–122) mm, respectively, while the fibrous tunnel length was 55±12 (28–83) mm. Additionally, the distances from the lateral epicondyle to R1, R2, and R3 were 143±18 (103–177), 107±13 (75–142), and 79±14 (59–105) mm, respectively. No significant correlation was found between the humeral and tunnel lengths. Conclusion: The lateral head of the triceps brachii and lateral intermuscular septum form a complex that creates a fibrous tunnel. Additionally, the radial nerve traverses obliquely within this fibrous tunnel on the humerus, forming fibrous arches at both its entrance and exit. The lateral head of the triceps brachii-lateral intermuscular septum complex can be a source of compression in cases of high radial nerve entrapment neuropathy. Such neuropathy may result from a plane of compression. Therefore, we advocate for surgery in high radial nerve entrapment neuropathy cases that are resistant to conservative treatment. Dissecting the entire length of the fibrous tunnel is also important during 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

Surgical treatment of lateral epicondylitis: A prospective, randomized, double-blinded, placebo-controlled clinical trial. Kroslak, et al. (2018) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Tennis elbow - surgery vs sham The study conducted by Martin Kroslak and George A.C. Murrell compared the effectiveness of surgical excision versus placebo surgery for treating chronic tennis elbow, or lateral epicondylitis. The trial, conducted at St George Hospital in Sydney, Australia, involved 26 patients divided into two groups: one undergoing surgery to remove degenerative tissue from the extensor carpi radialis brevis (ECRB), and the other receiving a placebo involving a skin incision without tissue removal. Results showed significant improvements in pain and function in both groups over 6 months to 2.5 years, with no significant differences between surgical and placebo groups. Despite patient improvements, the study concluded that ECRB excision offered no additional benefits over placebo surgery. Limited by small sample size, a post hoc analysis suggested over 6,500 participants per group would be required to demonstrate significant differences. The study highlights the challenges in demonstrating the efficacy of surgical interventions for chronic tennis 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, surgical excision of the CEO offers no additional benefit over placebo surgery. The findings emphasise that tennis elbow is often a self-limiting condition, where both surgical and sham interventions can lead to significant improvement without being significantly different from each other in outcome. These findings are supported by additional research comparing surgery to PRP and PRP to saline injections . URL : https://doi.org/10.1177/0363546517753385 Abstract Background: A number of surgical techniques for managing tennis elbow have been described. One of the most frequently performed involves excising the affected portion of the extensor carpi radialis brevis (ECRB). The results of this technique, as well as most other described surgical techniques for this condition, have been reported as excellent, yet none have been compared with placebo surgery. Hypothesis: The surgical excision of the degenerative portion of the ECRB offers no additional benefit over and above placebo surgery for the management of chronic tennis elbow. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: This study investigated surgical excision of the macroscopically degenerated portion of the ECRB (surgery; n = 13) as compared with skin incision and exposure of the ECRB alone (sham; n = 13) to treat patients who had tennis elbow for >6 months and had failed at least 2 nonsurgical modalities. The primary outcome measure was defined as patient-rated frequency of elbow pain with activity at 6 months after surgery. Secondary outcome measures included patient-rated pain and functional outcomes, range of motion, epicondyle tenderness, and strength at 6 months and 2.5 years. All outcome measures up to and including the 6-month follow-up were measured in person; the longer-term questionnaire was conducted in person or over the phone. Results: The 2 groups, surgery and sham, were similar for age, sex, hand dominance, and duration of symptoms. Both procedures improved patient-rated pain frequency and severity, elbow stiffness, difficulty with picking up objects, difficulty with twisting motions, and overall elbow rating >6 months and at 2.5 years ( P < .01). Both procedures also improved epicondyle tenderness, pronation-supination range, grip strength, and modified Orthopaedic Research Institute–Tennis Elbow Testing System at 6 months ( P < .05). No significant difference was observed between the groups in any parameter at any stage. No side effects or complications were reported. The study was stopped before the calculated number of patients were enrolled (40 per group); yet, a post hoc futility analysis was conducted that showed, based on the magnitude of the differences between the groups, >6500 patients would need to be recruited per group to see a significant difference between the groups at 26 weeks in the primary outcome (patient-rated frequency of elbow pain with activity). Conclusion: With the number of available participants, this study failed to show additional benefit of the surgical excision of the degenerative portion of the ECRB over placebo surgery for the management of chronic tennis elbow. 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