Cubital tunnel revision after transposition: A single center experience. King, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Cubital tunnel - Revision surgery This retrospective study assessed the number of revision surgeris completed after cubital tunnel releases with transposition. After excluding traumatic and post‑traumatic cases, 216 primary transpositions remained. Twenty patients (3% of all releases and 9% of the transposition surgeries) required revision surgery. Revision surgery occurred on average 16 months from the primary surgery. The results showed no significant difference in revision rates among subcutaneous, subfascial, or submuscular transpositions. 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, 9% of cubital tunnel releases with transposition require further revision, with the average time to revision being 16 months. It is important to set expectations in people undergoing this surgery as it appears that patients present with low satisfaction as it does not always resolve their symptoms. It is nevertheless an important surgery as people who wait longer, tend to present with worse neurological function. URL: https://doi.org/10.1016/j.jhsg.2025.100815 Abstract Purpose: The purpose of this study was to assess the rates of revision after cubital tunnel release with transposition among three different transposition techniques in a single institution. Methods: A retrospective chart review of all cubital tunnel surgeries over a 5-year period was performed via a query of the billing records of three different surgeons who typically perform three different types of transposition. This yielded 937 records. After eliminating records with incomplete clinical information (141 records), a total of 796 records were evaluated, with 540 representing in situ releases and 255 transpositions. The transposition cohort was further evaluated, and 39 records were eliminated as the operation was performed for traumatic or post-traumatic indications, leaving 216 transpositions performed between December 1, 2016, and December 1, 2021. Results: In the 216 cubital tunnel releases with transposition performed, 82 (38%) were subcutaneous transpositions, 71 (33%) were subfascial transpositions, and 63 (29%) were submuscular transpositions. Twenty of the 216 cubital tunnel releases with transpositions that were performed in this study period represented revision surgeries. Eleven were revisions after an in situ release, and eight were revisions after a transposition. One is unknown as the index operation was performed by an outside physician whose operative note was not available. Of the revision surgeries performed, 10 represented revisions of index cases performed by our institution with six being revisions for an in situ release and four revisions after a transposition. Of those four revisions after a transposition, one was performed for a subcutaneous transposition, two were following subfascial transpositions, and one was following a submuscular transposition. The average time from index operation to revision after a transposition was 16.3 months. Conclusions: The rate of revision surgery following cubital tunnel release with transposition is quite low, and there do not appear to be major differences in the rate of revision among the different types of surgical transposition, indicating that a true subcutaneous transposition may be adequate. 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

Biomechanical comparison of volar plate repair versus volar plate repair with suture tape augmentation at the finger proximal interphalangeal joint. Wright, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Volar plates - Repair augmentation This cadaveric study assessed whether adding suture tape augmentation to volar plate repair enhanced biomechanical stability in proximal interphalangeal joint laxity. Ten matched finger pairs from five cadavers underwent extension‑laxity testing at 5 and 10 N·cm, followed by a standardised volar‑plate release and 30° hyperextension injury. Each side of a pair was repaired either with a single suture anchor (volar plate repair alone) or with the same anchor plus a 1.3 mm suture tape bridged through a second anchor (suture‑tape augmentation). Cyclic loading (2–5 N·cm, 30 cycles) and subsequent load‑to‑failure testing were performed. Both repairs reduced extension laxity relative to injury, but the augmented construct displayed significantly greater stiffness at 10, 20, and 30 cycles, higher yield load (16.7 vs 12.4 N·cm), greater ultimate load (25.9 vs 19.1 N·cm), and absorbed more energy at failure. 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, suture tape augmentation significantly improves the volar‑plate repair resilience. We know that pipj volar plate repairs work, if you have an athlete that needs to return to sport quickly, maybe you could suggest this approach to the surgeon! If they do not want surgery, you can provide them with an oval 8, and remember, they don't need to be placed in pipj flexion for the volar plate to heal. URL: https://doi.org/10.1016/j.jhsa.2024.11.005 Abstract Purpose: The purpose of this study was to perform a biomechanical comparison of volar plate repair alone versus volar plate repair with suture tape augmentation in a hyperextension laxity injury model at the proximal interphalangeal (PIP) joint. Methods: Ten matched cadaveric fingers were obtained from five cadavers (average age, 59 ± 7 years). The specimens underwent 5 and 10 N·cm of extension load at the PIP joint to measure the laxity of the intact joint. Next, an injury model was created by incising the proximal volar plate and loading the specimen on a testing machine to 30° of hyperextension; laxity testing was repeated. Within each matched pair, one side was used for volar plate repair, and the contralateral side was used for volar plate repair with suture tape augmentation. Laxity measurements were repeated. The specimens were then loaded from 2 to 5 N·cm for 30 cycles, and then loaded to failure. Results: In both groups, extension angle significantly increased following PIP joint injury. Both repair groups significantly decreased extension angle compared with injury. Specimens that underwent volar plate repair with suture tape augmentation demonstrated significantly increased stiffness at 10, 20, and 30 cycles compared with volar plate repair alone (3.4, 3.5, and 3.6 N·cm/° vs 2.5, 2.5, and 2.6 N·cm/°, respectively), a higher yield load (16.7 vs 12.4 N·cm), and ultimate load (25.9 vs 19.1 N·cm) and absorbed more energy at ultimate load (4.1 vs 2.6 N·cm). Conclusions: Suture tape augmentation increased construct stiffness, yield load, load to failure, and ultimate load in this biomechanical study and may offer additional support in volar plate repair for chronic PIP joint hyperextension laxity. Clinical relevance: This finding lends support to using suture tape as an augment to produce a stronger PIP joint repair, potentially leading to an expedited recovery and earlier return to activities. 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

Nonoperative versus operative treatment for displaced finger metacarpal shaft fractures. Peyronson, et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic, Economic and Decision Analyses Topic: Displaced metacarpal #s - Return to work This randomised controlled trial compared nonoperative versus operative management of displaced finger metacarpal shaft fractures in 42 adults (22 treated nonoperatively and 20 operatively) and evaluated outcomes at 12 months. The primary outcome, hand grip strength, showed no significant difference between groups. Secondary outcomes including DASH scores, pain, patient satisfaction, and range of motion were also comparable, while the nonoperative group experienced markedly less metacarpal shortening and a significantly shorter duration of sick leave. Operative treatment incurred higher costs and a 15 % complication rate, versus no complications in the nonoperative cohort. 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, nonoperative treatment of displaced metacarpal shaft fractures gives grip strength, DASH scores, pain, and ROM comparable to surgery at 12 months, while reducing shortening, sick‑leave duration, costs, and complications. If you want to provide something supportive for their return to work, a clam shell splint over rigid casting could be useful. We can also reassure patients that functional outcomes are not compromised and that the are likely to have similar outcomes to a surgical approach. These findings are in line with previous research suggesting that a hand based cast/splint are sufficient. URL: https://doi.org/10.2106/JBJS.22.00573 Abstract Background: Finger metacarpal fractures represent up to 31% of all hand fractures, and most can be treated nonoperatively. Whether operative treatment is superior to nonoperative treatment for oblique and/or spiral finger metacarpal shaft fractures (MSFs) is unknown. Methods: Forty-two patients with displaced oblique and/or spiral finger MSFs were randomized to either nonoperative treatment with unrestricted mobilization or operative treatment with screw fixation. The primary outcome was grip strength in the injured hand compared with the uninjured hand at the 1-year follow-up. Secondary outcomes were the Disabilities of the Arm, Shoulder and Hand score, range of motion, metacarpal shortening, complications, sick leave duration, patient satisfaction, and costs. Results: All patients attended the 1-year follow-up. Mean grip strength relative to that in the contralateral hand was 104% (95% confidence interval [CI], 89% to 120%) in the nonoperative group and 96% (95% CI, 89% to 103%) in the operative group (p = 0.34). Mean metacarpal shortening was 5.3 mm (95% CI, 4.2 to 6.4 mm) in the nonoperative group and 2.3 mm (95% CI, 0.8 to 3.9 mm) in the operative group. In the nonoperative group, 1 minor complication was observed; in the operative group, there were 4 minor complications and 3 reoperations. The costs were estimated at 1,347 U.S. dollars (USD) for nonoperative treatment compared with 3,834 USD for operative treatment. Sick leave duration was significantly shorter in the nonoperative group (12 days [95% CI, 5 to 21 days] versus 35 days [95% CI, 20 to 54 days]) (p = 0.008). Conclusions: When treated with unrestricted mobilization, patients with a single displaced spiral and/or oblique finger MSF have outcomes comparable to those treated operatively, despite metacarpal shortening. Costs are substantially higher (2.8 times) and sick leave is significantly higher in the operative group. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Postoperative treatment of proximal humerus fractures with an early active motion protocol: A prospective randomized controlled trail. Crepaz-Eger, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Early mobilisation - Proximal humerus ORIF This randomised controlled trial assessed whether an early active‑motion protocol was non‑inferior to a conventional sling‑based regimen after locking‑plate fixation of proximal humerus fractures. A total of 40 were randomised to either a 4‑week immobilization group (CG) or an unrestricted movement group (EXP). All participants received the same surgical technique (an ORIF with plate) and were followed for 24 months. Primary outcomes were the Disabilities of the Arm, Shoulder and Hand (DASH) score, while secondary measures including pain (VAS), and patient satisfaction. Results showed no significant differences between groups on the DASH 16 vs. 14. Pain and satisfaction scores were comparable, and complication rates were 30% for CG and 15% for EXP. 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, proximal humerus fractures ORIF can safely commence an unrestricted, early active‑motion program without compromising functional recovery compared with the traditional 4‑week sling‑based approach. Over a 24‑month follow‑up, both groups achieved comparable functional and symptoms outcomes. Keep in mind that in patients over 60, you can conservatively manage this fractures without surgery and the outcome are equivalent. Remember to always screen patients for reduced bone mass density and refer them on for treatment if they are osteopenic. URL: https://doi.org/10.1016/j.jse.2025.01.042 Abstract Background: Proximal humerus fractures are common injuries in elderly patients. Although a majority of fractures can be treated conservatively, open reduction and internal fixation (ORIF) with locking plates is still the most commonly used operative treatment modality. Regarding postoperative treatment, there is currently no consensus in the literature. A restrictive rehabilitation regimen, which can lead to a prolonged and effortful rehabilitation process, may not make full use of the possibilities that modern angular stable implants in combination with adequate patient selection and improved operative techniques have to offer. Therefore, this study aimed to investigate the functional results of a novel early active motion rehabilitation protocol for postoperative treatment of proximal humerus fractures treated with a locking plate. Methods: From March 1, 2016, to February 29, 2023, patients were prospectively screened for inclusion. In the conventional group (CG), patients underwent a strict postoperative protocol with immobilization in a shoulder-arm sling for 4 weeks, which should be worn day and night. In the early functional group (EFG), no restrictions regarding movement and force were given. In both groups, no heavy lifting, no exhausting physical activity, and no blunt force on the arm was performed for 3 months postoperatively. Within a follow-up of 24 months, primary and secondary outcome parameters were collected. Results: No significant difference was found in the Disabilities of the Arm, Shoulder and Hand (DASH) score, Constant score (CS), and relative CS for the injured shoulder at any point of observation. After 24 months, the CS showed a mean of 81.3 (standard deviation [SD] 11.6) points in the CG and 78.4 (SD 14.0) points in the EFG. Relative CS was 89.8% of the uninjured side in both groups, respectively. DASH score showed a mean of 15.9 (SD 15.8) in the CG and 13.9 (SD 15.2) in the EFG. There was also no significant difference in visual analog pain scale score, patient satisfaction, and EuroQol–5 Dimensions visual analog scale score in between the groups. Conclusion: It could be demonstrated that early active motion rehabilitation for postoperative treatment after locking plate fixation of proximal humerus fractures was not inferior to a restrictive treatment protocol after a follow-up period of 24 months, even in a slightly older and more comorbid patient population. Further studies investigating postoperative rehabilitation after ORIF of proximal humerus fractures should be conducted. 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

Nonsurgical treatment versus surgical treatment in displaced metacarpal spiral fractures: Extended 4.5-year follow-up of a previously randomized controlled trial. Peyronson, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Displaced metacarpal spiral fracture - Non surgical approach This is a secondary analysis of a randomised controlled trial assessing assessing long term outcomes of conservative vs surgical management of displaced metacarpal spiral fracture without scissoring. Outcomes were measured at 4.5‑year after randomisation in 34 patients. Participants were included if they had a single displaced spiral or oblique metacarpal shaft fracture of the 2nd, 3rd, 4th, or 5th metacarpal. The outcome of interest was grip strength and the non-inferiority margin was 15% of the unaffected side. Secondary outcome measures included the DASH score, range of motion, rotational deformity, and pain. The results showed that conservative treatment was non-inferior to surgical management. There was no difference between the groups in the secondary outcomes. The blue bar represents two-sided 95% CI for grip strength percentage in the nonsurgical group versus noninferiority margin (
15% represented by the dotted yellow line). The green bar represents two-sided 95% CI for grip strength percentage in the nonsurgical group adjusted for hand dominance. 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, at long term follow up (4.5 years) there is no difference in grip strength/function/pain in people who were managed conservatively or surgically after a single‑ray displaced metacarpal spiral fracture without scissoring. This is additional evidence suggesting that metacarpal fractures can be managed conservatively in most cases. Such approach can be extended to proximal phalanx unstable fractures, especially if the patient is not keen to undergo surgery. More information on the conservative management of single‑ray displaced metacarpal spiral fracture without scissoring next week! URL: https://doi.org/10.1016/j.jhsa.2025.06.018 Abstract Purpose: Spiral or oblique fractures of the metacarpals of rays II−V are common and often managed nonsurgically. Surgery is typically recommended for fractures with displacement or rotational deformity. In a recent randomized controlled trial of displaced fractures, nonsurgical treatment with early unrestricted mobilization was found to be noninferior to surgical treatment at the 1-year follow-up. However, long-term outcomes comparing these approaches have not been reported. This study evaluated whether treatment differences emerge at the midterm follow-up, hypothesizing that nonsurgical treatment will remain noninferior. Methods: Of 42 patients with displaced spiral/oblique metacarpal shaft fractures enrolled in our previous randomized controlled trial, 34 were analyzed at a mean of 4.5 years postinjury (range: 3.1–6.6 years). The primary outcome was grip strength of the injured hand relative to the uninjured hand, with and without adjustment for hand dominance. Secondary outcomes included the Disabilities of the Arm, Shoulder, and Hand score, range of motion, rotational deformity, complications, and patient-rated pain. Results: Nonsurgical treatment remained noninferior within the predefined margin. The mean grip strength was 95% of the uninjured hand in the nonsurgical group and 95% in the surgical group. After adjusting for hand dominance, the mean grip strength was 103% of the uninjured hand in the nonsurgical group and 96% in the surgical group. Secondary outcomes were similar between the groups. Conclusions: Nonsurgical treatment with early unrestricted mobilization remains noninferior to surgical treatment at the midterm follow-up. These findings support the viability of this treatment option for displaced single spiral or oblique metacarpal shaft fractures of rays II–V in patients who prefer nonsurgical treatment. 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

Childhood trauma, ptsd/cptsd and chronic pain: A systematic review. Karimov-Zwienenberg, et al. (2024) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic, Prognostic Topic: Childhood trauma - Adulthood persistent pain This systematic review examined the interplay between childhood trauma, PTSD, and chronic pain in adults. Thirteen studies were included in the review. The results showed that neglect and emotional abuse were significant risk factors for chronic pain conditions, particularly fibromyalgia. Higher cumulative childhood maltreatment was associated with dose‑responsive increases in PTSD symptoms, re‑traumatisation, and perceived distress in later life, underscoring the long‑term burden of early adverse experiences. Neurophysiological findings showed altered pain modulation in patients with PTSD, suggesting differential hypo‑ and hyper‑responsivity. 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 happy childhood is protective for persistent pain in adulthood. Childhood trauma can both dampen and amplify nociceptive signalling leading to allodynia and hyperalgesia. As we know, pain is a brain output that is not only influenced by nociceptive inputs but also by peripheral and central factors that carry a history with them rather than being deterministically. If you get a chance, read Behave by Robert Sapolsky. It will boost your understanding of patients. URL: https://doi.org/10.1371/journal.pone.0309332 Abstract Background: Despite the growing body of literature on posttraumatic stress disorder (PTSD) and chronic pain comorbidity, studies taking into account the role of childhood exposure to traumatic and adverse events remains minimal. Additionally, it has been well established that survivors of childhood trauma may develop more complex reactions that extend beyond those observed in PTSD, typically categorized as complex trauma or CPTSD. Given the recent introduction of CPTSD within diagnostic nomenclature, the aim of the present study is to describe associations between childhood trauma in relation to PTSD/CPTSD and pain outcomes in adults with chronic pain. Methods: Following PRSIMA guidelines, a systematic review was performed using the databases Pubmed, PsychInfo, Psychology and Behavioral Sciences Collection, and Web of Science. Articles in English or French that reported on childhood trauma, PTSD/CPTSD and pain outcomes in individuals with chronic pain were included. Titles and abstracts were screened by two authors independently and full texts were consequently evaluated and assessed on methodological quality using JBI checklist tools. Study design and sample characteristics, childhood trauma, PTSD/CPTSD, pain outcomes as well as author’s recommendations for scientific research and clinical practice were extracted for analyses. Results: Of the initial 295 search records, 13 studies were included in this review. Only four studies explicitly assessed links between trauma factors and pain symptoms in individuals with chronic pain. Findings highlight the long-term and complex impact of cumulative childhood maltreatment (e.g., abuse and neglect) on both PTSD/CPTSD and chronic pain outcomes in adulthood. Conclusion: This review contributes to current conceptual models of PTSD and chronic pain comorbidity, while adding to the role of childhood trauma and CPTSD. The need for clinical and translational pain research is emphasized to further support specialized PTSD/CPTSD treatment as well as trauma-informed pain management in routine care. 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

Digital doses: Virtual reality use for perioperative pain and anxiety in patients undergoing hand surgery. Xiao, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: VR - Hand surgery This was a randomised controlled trial assessing whether immersive virtual reality (VR) could serve as a non‑pharmacologic adjunct during minor hand surgery performed under local anaesthesia. A total of 40 patients scheduled for elective hand procedures (e.g. carpal tunnel/trigger finger release) were randomised to standard monitored anesthesia care (MAC) alone or to MAC plus a VR headset providing immersive environments. Pain and anxiety were measured with numeric rating and anxiety scales, while intra‑operative medication usage and vital signs were recorded. Although VR did not produce statistically significant differences in self‑reported pain or anxiety at any time point, patients receiving VR required significantly less intra‑operative midazolam and fentanyl, and a multivariable analysis confirmed VR as a significant predictor of reduced anxiolytic use. Physiologic parameters remained comparable between groups, and VR recipients reported high satisfaction and relaxation, with 85 % believing the technology improved their surgical experience. 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, immersive virtual reality worn during hand surgery under local anesthesia markedly lowers intra‑operative sedative and opioid consumption. Patients also report high satisfaction and a perception that the experience improved their surgical experience. There is growing evidence that virtual reality is useful for upper limb rehab and it may become more widespread once the costs abate. URL: https://doi.org/10.1016/j.jhsg.2025.100830 Abstract Purpose: Virtual reality (VR) is increasingly recognized as a complementary tool to address pain and anxiety. We conducted a randomized controlled trial to evaluate the effectiveness of VR for the management of pain and anxiety in patients undergoing minor hand surgery. Methods: Patients undergoing outpatient hand surgery were randomized to VR or control groups. In addition to the standard anesthetic protocol, the VR group received a VR experience as part of their preoperative care. Patient anxiety and pain scores were collected using the Numerical Visual Analog Anxiety Scale and Numerical Rating Scale, respectively. In addition, we recorded changes in patient hemodynamics and any additional medication doses required to manage pain or anxiety. Results: Forty-one patients (21 VR and 20 control) were enrolled. There were no differences in reported pain or anxiety scores before, during, or after surgery. There was no difference in vital signs or recovery times. Patients in the VR groups received less additional midazolam (0.4 mg vs 1.2 mg) and fentanyl (10 mcg vs 27.4 mcg) compared with patients in the control group. In a multivariable model, VR use remained the only significant predictor for no required midazolam. Eighty-five percent of patients believed that the use of VR positively impacted their surgical experience. As a result of the VR experience, 78% believed that their anxiety decreased and 61.1% believed that their pain decreased. Conclusions: Although patient pain and anxiety levels between the VR and non-VR groups were similar, the VR group required significantly less midazolam and fentanyl. Moreover, VR use was the only predictor of not requiring midazolam administration during surgery. Patient satisfaction was high with VR usage. VR implementation during minor hand surgery is a viable option to improve patient experience. 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

Comparative clinical outcomes and patient satisfaction in primary vs. Revision total elbow arthroplasty. Ryu, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Symptoms prevalence Topic: Elbow revision arthroplasty - Are patients still happy? This retrospective cohort study assessed outcomes and satisfaction of people undergoing primary total elbow arthroplasty (TEA) and revision arthroplasty. A total of 51 participants, 33 TEA and 18 revisions with a minimum follow up of 2 years, were included in the present study. Outcomes measured included the Mayo Elbow Performance Score (MEPS), Disability of the Arm, Shoulder and Hand (DASH) questionnaire, and flexion‑extension range of motion. The revision group presented with clinically significant lower levels of function (e.g. DASH 54 vs 33), worse ROM (108° vs 86°). Interestingly, patient satisfaction scores did not differ between TEA and revision groups. Representative case of a patient with aseptic loosening. (A) A 71-year-old female patient presented with early humeral component loosening 1.5 years after primary TEA surgery. A cortical thinning balloon-like expansion was observed on X-ray. component loosening 1.5 years after primary TEA surgery. A cortical thinning balloon-like expansion was observed on X-ray. 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, despite revision total elbow arthroplasties achieving worse functional and range of movement outcomes (compared to first time arthroplasty), patients' overall satisfaction is high. This suggests that patients adjust their expectations after a failed primary procedure and their satisfaction may reflect relief from uncertainty/some improvement rather than absolute function. For us clinicians, it is a good reminder that absolute metrics can be independent from patients' priorities. In a similar fashion, surgeries which are extremely helpful in preventing further neurological impairment in people, can be perceived as providing little satisfaction in the patients' eyes (e.g. cubital tunnel release). Good communication on expectations and reasons for intervention are extremely important. URL: https://doi.org/10.1016/j.jse.2025.01.036 Abstract Background: Total elbow arthroplasty has become a common surgical procedure. However, a certain percentage of patients may require revision due to unsatisfactory outcomes or complications. This study aimed to compare the clinical outcomes and patient satisfaction between primary and revision total elbow arthroplasty (TEA), considering factors such as etiology and causes for revision. Methods: The study utilized a retrospective analysis of medical records from a cohort of 33 and 18 cases of primary and revision TEA, respectively, with a minimum follow-up of 2 years from the primary procedure. Clinical outcomes were assessed by measuring the Mayo Elbow Performance Score, Disabilities of the Arm, Shoulder and Hand score, range of motion, numeric rating scale, the Single Assessment Numeric Evaluation questionnaire, and patient satisfaction. Results: Significant differences were observed between primary and revision groups in the Mayo Elbow Performance Score (79.5 vs. 65.0), Disabilities of the Arm, Shoulder and Hand scores (32.6 vs. 53.7), and elbow range of motion (107.6° vs. 85.8°). The patients' subjective assessment via the numeric rating scale score, Single Assessment Numeric Evaluation score, and satisfaction did not show significant differences. The average numeric rating scale score was 1.6 for both groups; however, the Single Assessment Numeric Evaluation score (63 vs. 54) and patient satisfaction (4.0 vs. 4.1) were not significantly different between groups. Conclusion: The clinical outcomes of primary vs. revision TEA were significantly worse in the revision group. Patient satisfaction scores were not different between the primary and revision groups despite differences in outcome scores, suggesting that revision patients may be satisfied with their outcomes despite lower clinical scores. These findings underscore the importance of considering both patient-reported outcomes and satisfaction levels in addition to objective clinical measures when evaluating the success of primary vs. revision TEA 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

Complex regional pain syndrome: advances in epidemiology, pathophysiology, diagnosis, and treatment. Ferraro, et al. (2024) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic/Therapeutic Topic: CRPS - Immunotherapy This is a systematic review on Complex Regional Pain Syndrome (CRPS). Current evidence indicates that while many patients experience rapid improvement within the first six months, a substantial proportion (15-30%) continue to meet diagnostic criteria beyond 12–18 months, with persistent pain, sensory disturbances, and functional impairment being common. Return‑to‑work rates are low, underscoring the substantial socioeconomic burden. Pathophysiological investigations suggest that immune dysregulation, autoantibodies, and inflammatory cytokines may play key roles, yet definitive therapeutic targets are lacking. Diagnostic criteria are still debated, and the clinical heterogeneity hampers treatment selection. Existing interventions from pharmacological agents such as low‑dose naltrexone and vitamin C to multimodal rehabilitation and neuromodulation have uncertain efficacy and safety profiles. Future research priorities include accurate epidemiological estimates, validation of risk prediction models, exploration of immune mechanisms, refinement of diagnostic coding, and development of tailored, mechanism‑based therapies that incorporate patient preferences throughout the research cycle. 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, complex regional pain syndrome (CRPS) has a high probability of improvement within the first six months from injury. However, 15-30% of people continue to suffer pain, sensory changes, and functional loss beyond a year. Prevention of CRPS is the best option at this stage and we know that making sure that a cast/splint is comfortable, limit the imobilisation period to what is absolutely necessary, strongly encourage patients to take their painkillers, and consider vitamin C supplementation are all simple and effective approaches in reducing the incidence of CRPS. Unfortunately, some people are genetically predisposed (30% of people with CRSP) and they are probably more likely to develop CRPS despite these preventative measures. If despite our preventative measures and rehab people still develop CRPS, byphosponate infusion at 4 months from onset may be useful. This could also help prevent future fractures in this group of people as shown by the effect of infrequent zelodronate infusions, a synopsis will cover this in the near future. URL: https://doi.org/10.1016/s1474-4422(24)00076-0 Abstract Complex regional pain syndrome (CRPS) is a rare pain disorder that usually occurs in a limb after trauma. The features of this disorder include severe pain and sensory, autonomic, motor, and trophic abnormalities. Research from the past decade has offered new insights into CRPS epidemiology, pathophysiology, diagnosis, and treatment. Early identification of individuals at high risk of CRPS is improving, with several risk factors established and some others identified in prospective studies during the past 5 years. Better understanding of the pathophysiological mechanisms of CRPS has led to its classification as a chronic primary pain disorder, and subtypes of CRPS have been updated. Procedures for diagnosis have also been clarified. Although effective treatment of CRPS remains a challenge, evidence-based integrated management approaches provide new opportunities to improve patient care. Further advances in diagnosis and treatment of CRPS will require coordinated, international multicentre initiatives. 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

Effects of different protocols of high intensity interval training for vo2max improvements in adults: A meta-analysis of randomised controlled trials. Wen, et al. (2019) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Short and to the point - Hearth exercise This meta‑analysis of randomised controlled trials assessed the effect of high‑intensity interval training (HIIT) on maximal oxygen uptake (VO₂max) in healthy, overweight/obese, and athletic adults. Fifty-three studies for more than 1,500 participants were included in the review. Across all examined protocols, HIIT produced significant gains when compared to no training, conventional exercise, or moderate‑intensity continuous training. Importantly, even brief work intervals (≤30 s), low training volumes (≤5 min per session), and short intervention periods (≤4 weeks) yielded meaningful improvements, offering practical and time‑efficient options for the general population. More pronounced benefits were observed with longer work bouts (≥2 min), higher overall volumes (≥15 min per session), and extended training durations (≥4–12 weeks), particularly for healthy and overweight/obese participants. In contrast, athletic individuals displayed smaller responses, likely reflecting ceiling effects of their already high baseline VO₂max and limited relative improvements. 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‑intensity interval training (HIIT) consistently boosts maximal oxygen uptake in sedentary, overweight, and athletic adults. Even very short protocols ≤30‑second bouts, ≤5‑minute sessions, or ≤4‑week programs produce clinically relevant VO₂max gains, making HIIT ideal for patients limited by time or motivation. This is great news as it is similar to what has been shown for resistance training where 80% of benefit is achieved with 20% of the effort. Also, skip stretching as it is irrelevant if you are doing resistance training through range. In other words, you or your patients don't need to live at the gym to improve VO2max and gain strength. URL: https://doi.org/10.1016/j.jsams.2019.01.013 Abstract Objectives: To examine the effects of different protocols of high-intensity interval training (HIIT) on VO2max improvements in healthy, overweight/obese and athletic adults, based on the classifications of work intervals, session volumes and training periods. Design: Systematic review and meta-analysis. Methods: PubMed, Scopus, Medline, and Web of Science databases were searched up to April 2018. Inclusion criteria were randomised controlled trials; healthy, overweight/obese or athletic adults; examined pre- and post-training VO2max/peak; HIIT in comparison to control or moderate intensity continuous training (MICT) groups. Results: Fifty-three studies met the eligibility criteria. Overall, the degree of change in VO2max induced by HIIT varied by populations (SMD=0.41–1.81, p<0.05). When compared to control groups, even short-intervals (≤30s), low-volume (≤5min) and short-term HIIT (≤4weeks) elicited clear beneficial effects (SMD=0.79–1.65, p<0.05) on VO2max/peak. However, long-interval (≥2min), high-volume (≥15min) and moderate to long-term (≥4–12weeks) HIIT displayed significantly larger effects on VO2max (SMD=0.50–2.48, p<0.05). When compared to MICT, only long-interval (≥2min), high-volume (≥15min) and moderate to long-term (≥4–12weeks) HIIT showed beneficial effects (SMD=0.65–1.07, p<0.05). Conclusions: Short-intervals (≤30s), low-volume (≤5min) and short-term (≤4weeks) HIIT represent effective and time-efficient strategies for developing VO2max, especially for the general population. To maximize the training effects on VO2max, long-interval (≥2min), high-volume (≥15min) and moderate to long-term (≥4–12weeks) HIIT are recommended. 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

Does dynamic extension splinting or early active motion provide better outcomes post extensor pollicis longus repair? A systematic review. Brent, et al. (2025) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: EPL repair/transfer - Early Active Motion vs dynamic extension splinting This systematic review compared outcomes of Early Active Motion (EAM) versus dynamic extension splinting (DES) after extensor pollicis longus tendon repair/transfer. A total of six studies were included in the review for a total of 206 participants. Both interventions yielded comparable results in terms of range of motion, grip strength, and pinch strength, with no significant difference in adverse events. EAM was noted for its potential cost-effectiveness and reduced splint complexity, which may enhance patient satisfaction. Furthermore, while EAM does not offer superior functional outcomes or fewer adverse events, it may be a viable alternative to DES for suitable patients. Limitations included a small number of studies, mostly low-quality evidence, and uneven participant distribution between interventions (155 in DES vs. 31 in EAM). 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, extensor pollicis longus tendon repair/transfer can be managed with early active motion (EAM) or dynamic extension splinting (DES). Both splinting approaches appear to be safe. Hand therapist may therefore weigh factors like patient preference, and splinting design complexity when choosing between EAM and DES. If you want to dig deeper into extensor pollicis longus pathologies/impairments, have a look at this list of synopses. URL: https://doi.org/10.1177/17589983251372843 Abstract Introduction: Limited research exists on the post-operative treatment of extensor pollicis longus (EPL) repair (tendon transfer and direct repair). Early active motion (EAM) and dynamic extension splinting (DES) are becoming more common compared to static casting. The aim of this systematic review was to determine whether EAM was superior to DES post EPL direct repair or tendon transfer. Outcomes of interest included range of motion, strength, and adverse events. Methods: A systematic search of AMED, EBSCO health database (CINAHL, MEDLINE, and SPORTDiscus), and Scopus was completed. Randomised control trials or cohort studies were included if they followed either an EAM or DES rehabilitation protocol and assessed total active motion, grip strength, pinch strength, or range of motion post EPL surgical repairs. Data extracted included the surgical procedure, rehabilitation protocols, and results. The Downs and Black checklist for clinical trial quality assessment was utilised to assess the methodological quality. Results: Six studies met the inclusion criteria. Five studies included DES and two studies included EAM. Both interventions resulted in improvements in ROM, grip strength and pinch strength with neither intervention being superior. There was no increase in adverse outcomes by using EAM or DES. The risk of bias following assessment of methodological quality of included studies ranged from good to poor. Discussion: The use of EAM should be considered post EPL repair or tendon transfer. EAM does not result in superior outcomes post EPL repair compared to DES, equally EAM does not appear to be inferior compared to DES. 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 incidence of aseptic loosening and the potential impact of strut allografts in revision total elbow arthroplasty. Shim, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Total elbow arthroplasty revision - Allograft reinforcement This retrospective study assessed the benefit of adding a bone allograft in patients who underwent revision total elbow arthroplasty (TEA). A total of 18 participants were included in the present study, of which one group had a strut allograft (n = 9) and one had no allograft (n = 9). All surgeries were executed by a single surgeon, and cortical thinning was defined radiographically as a reduction of overall cortical thickness to less than 50% of the contralateral side or a localised thinning of at least 50%. At the time of revision surgery, 61% of patients exhibited cortical thinning. The results showed that aseptic loosening following revision surgery occurred in 11% in the strut allograft group versus 33% in the nongraft group. However, this difference was not statistically significant. Pain, Quick‑DASH scores, and range of motion were comparable between groups. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, cortical thinning is common in patients needing revision total elbow arthroplasty (60% presenting with it). Adding a structural bone allograft to the revision implant may reduce aseptic loosening events (11 % vs 33 %). Pain, function, and range of motion did not differ. Considering that aseptic loosening is the most common complication following total elbow arthroplasty, we may see more of these approaches in the future. If you want to dive more into total elbow replacements, have a look at the full database on the topic. URL: https://doi.org/10.1016/j.jse.2025.01.043 Abstract Hypothesis and background: Revision total elbow arthroplasty (TEA) is challenging because of poor bone stock. We hypothesized that strut allografts providing structural reinforcement would reduce occurrence of aseptic loosening after revision TEA. Methods: We retrospectively analyzed patients who underwent revision TEA at our hospital between 2005 and 2022. Patients were excluded from the study if the bone loss was too severe and required allograft-prosthetic composite reconstruction, if the implant stem was not replaced, or if the follow-up period was <2 years. Cortical thinning was defined as follows: (1) the overall cortical thickness was <50% compared to the contralateral side or (2) the cortex was locally thinner than the surrounding area by <50% on the radiograph. Implant stability and aseptic loosening were analyzed on the final radiograph. The patients were divided into a strut allograft group (n = 9) and a nongraft group (n = 9) for comparison. Results: Eighteen patients were analyzed during the study period. There were 8 males and 10 females with an average age of 66 years (range, 39-82 years). The average follow-up period was 61 months (range, 24-183). Cortical thinning was observed in 11 patients (61%) at the time of revision TEA. There were no differences in pain visual analog scale, Quick Disabilities of the Arm, Shoulder, and Hand score, and range of motion between the 2 groups. Aseptic loosening occurred in 1 patient (11%) in the strut allograft group and in 3 patients (33%) in the nongraft group; however, this difference was not statistically significant. In nongraft group, 3 patients developed aseptic loosening and subsequently underwent rerevision arthroplasty. In strut allograft group, 1 patient had aseptic loosening; however, the patient remained asymptomatic and observed without revision. Conclusion: Cortical thinning occurred in 61% of the patients undergoing revision TEA. Aseptic loosening is the most common complication of revision TEA, observed in 22% of the cases. The use of strut allografts did not show a significant association with a lower incidence of aseptic loosening. However, it may still have clinical value. 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