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An uncomplicated and accurate approach to the measurement and reporting of Dupuytren’s contractures. du Plessis, et al. (2025) Level of Evidence : 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Dupuytren’s contractures - New measurement This expert opinion addressed the lack of standardised methods for measuring Dupuytren’s contractures, which has led to variable definitions and reporting terminology across studies. The authors propose a simple, reliable, and reproducible technique using a goniometer to measure the passive extension deficit (PED) at the metacarpophalangeal joint (mcpj) and proximal interphalangeal joint (pipj). Their method involves assessing the mcpj PED whilst in full passive pipj and dipj extension, accounting for the dynamism effect. For the pipj and the dipj the PED would be measured in full mcpj extension fist followed by mcpj flexion. This would allow for easy monitoring of disease progression and surgical outcomes. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, a new method for measuring Dupuytren's contractures on passive extension deficits (PED) at the mcpj, pipj, and dipj has been proprosed. This approach measures the passive mcpj extension whilst in full pipj and dipj extension. For the pipj and dipj the passive extension deficit is measures in full mcpj extension and flexion. This accounts for the differential contribution of the palmar lesions to the mcpj, pipj, and dipj contributions. If you would like to have a look at splinting options for Dupuytren's, have a look at this synopsis . URL : https://doi.org/10.1177/17531934251318896 Abstract There is currently no standardized method to measure Dupuytren’s contractures and the reported definitions are variable and often confusing. We present an uncomplicated and accurate measuring and reporting technique that considers the dynamism effect. 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-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: The liftmor randomized controlled trial. Watson, et al. (2018) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic : Bone mass density - Heavy lifting The study evaluates high-intensity resistance training vs low-intensity resistance training for postmenopausal women with low bone mass over 12 months. The primary objective was to assess differences on bone mineral density, muscle strength, physical function, and injuries resulting from the two training approaches. A total of 101 postmenopausal women were included in the study. The high intensity exercises trained twice a week and involved squatting, deadlifting, and shoulder pressing at 80% to 85% of their maximum capacity. In addition, people in this group underwent landing exercises from a height to expose the body to impact loading. The control group underwent resistance exercise twice a week withe resistance exercises performed at less than 60% of their maximum (e.g. lunges, calves raises). The results showed significant improvements in spine and hip bone mineral density, along with enhanced leg strength and physical performance in the high intensity resistance training group. Notably, the program was found to be both feasible and safe, with no injuries reported. 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, postmenopausal women, who are at elevated risk for osteoporosis, need to lift heavy weights (80% of their maximum) and load their bones (impact exercise) to improve their bone mass density in the spine and hip. Low intensity weight lifting (<60% of maximum), is not sufficient to improve bone mass density . Heavy lifting appears to be safe and the benefit of improving bone mass density is that it will reduce fracture risks. This research is in line with more recently published papers . Remember that as hand therapists, we should screen patients at higher risk of osteopenia/osteoporosis , especially if they had a low energy fracture . If you have a hand x-ray, you can already estimate your patient's bone mass density . URL : https://doi.org/10.1002/jbmr.3284 Abstract Optimal osteogenic mechanical loading requires the application of high-magnitude strains at high rates. High-intensity resistance and impact training (HiRIT) applies such loads but is not traditionally recommended for individuals with osteoporosis because of a perceived high risk of fracture. The purpose of the LIFTMOR trial was to determine the efficacy and to monitor adverse events of HiRIT to reduce parameters of risk for fracture in postmenopausal women with low bone mass. Postmenopausal women with low bone mass (T-score &lt; –1.0, screened for conditions and medications that influence bone and physical function) were recruited and randomized to either 8 months of twice-weekly, 30-minute, supervised HiRIT (5 sets of 5 repetitions, &gt;85% 1 repetition maximum) or a home-based, low-intensity exercise program (CON). Pre- and post-intervention testing included lumbar spine and proximal femur bone mineral density (BMD) and measures of functional performance (timed up-and-go, functional reach, 5 times sit-to-stand, back and leg strength). A total of 101 women (aged 65 ± 5 years, 161.8 ± 5.9 cm, 63.1 ± 10.4 kg) participated in the trial. HiRIT (n = 49) effects were superior to CON (n = 52) for lumbar spine (LS) BMD (2.9 ± 2.8% versus –1.2 ± 2.8%, p &lt; 0.001), femoral neck (FN) BMD (0.3 ± 2.6% versus –1.9 ± 2.6%, p = 0.004), FN cortical thickness (13.6 ± 16.6% versus 6.3 ± 16.6%, p = 0.014), height (0.2 ± 0.5 cm versus –0.2 ± 0.5 cm, p = 0.004), and all functional performance measures (p &lt; 0.001). Compliance was high (HiRIT 92 ± 11%; CON 85 ± 24%) in both groups, with only one adverse event reported (HiRIT: minor lower back spasm, 2/70 missed training sessions). Our novel, brief HiRIT program enhances indices of bone strength and functional performance in postmenopausal women with low bone mass. Contrary to current opinion, HiRIT was efficacious and induced no adverse events under highly supervised conditions for our sample of otherwise healthy postmenopausal women with low to very low bone mass. 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 association between the extent of sagittal band disruption and extensor tendon subluxation in different flexion angles: A cadaveric study. Vahabi, et al. (2025) Level of Evidence : 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Sagittal band lesions - Subluxations This anatomical study on cadavers, assessed the role of sagittal band integrity in maintaining extensor tendon stability at the metacarpophalangealjoint (mcpj). A total of nine cadaveric hands, the sagittal bands of the index, middle, ring, and little fingers were progressively sectioned either from the proximal or distal end in increments of 10%, 25%, 50%, 75%, 90%, and 100%. Tendon subluxation was measured at metacarpophalangeal joint positions of 0°, 45°, and 90° flexion. Even minimal (10%) sagittal band damage produced measurable subluxation, which increased progressively with greater disruption, reaching over 40% at complete sectioning. Proximal-to-distal sectioning caused greater tendon subluxation than distal-to-proximal sectioning. The little finger was resiliant to sagital band resection, with EDC subluxation occurring in only one of nine specimens. 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, even small amounts of sagittal bands lesion, especially if proximal, can induce some level of EDC subluxation. The only finger that appeared to avoid EDC instability with sagittal band lesions was the little finger. It seems like the little finger, similarly to the thumb, has different anatomical variations to the ring, middle, and index finger. It also seems that FDP can be hypoplastic in the little finger compared to other fingers . URL : https://doi.org/10.1016/j.jhsa.2025.04.026 Abstract Purpose: We aimed to quantitatively assess the relationship between the extent of sagittal band damage and tendon stability across different fingers and positions while also examining the effects of proximal versus distal damage. Methods: This was a cadaveric study conducted on the index, middle, ring, and little fingers of nine cadavers. Damage was induced through stepwise sectioning either from the proximal or distal end. Sectioning was performed in increments of 10%, 25%, 50%, 75%, 90%, and 100%. Photographs were taken to measure subluxation at metacarpophalangeal joint positions of 0°, 45° flexion, and 90° flexion. Data from the index, middle, and ring fingers were pooled, whereas data on the little finger were analyzed separately. Results: Subluxation was greater with proximal to distal sectioning at 25%, 75%, and 90% damage thresholds. Ten percent sectioning resulted in a mean subluxation of 5.1% (95% confidence interval [CI], 2.5–7.7); 25% sectioning led to a mean subluxation of 13.6% (95% CI, 7.9–19.3); 50% sectioning resulted in a mean subluxation of 15.3% (95% CI, 9.2–21.3); 75% sectioning resulted in a mean subluxation of 18.1% (95% CI, 12.2–23.9); 90% sectioning led to a mean subluxation of 24.1% (95% CI, 17.5–30.7); and 100% sectioning resulted in a mean subluxation of 41.6% (95% CI, 33.7–49.5). Regarding the little finger, complete dislocation occurred in only one of the nine fingers. Conclusions: Even minimal sagittal band damage results in measurable subluxation, but the presence of even 10% intact fibers confers some stability against subluxation. As the extent of sagittal band disruption increases, the extensor tendon progressively deviates from its native position. Damage to the proximal fibers has a more detrimental impact on tendon stability. Clinical relevance: The relationship between sagittal band integrity and tendon stability extends beyond a simple dislocation threshold. Both the extent of damage and location of the disrupted fibers are associated with the degree of subluxation. 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

Anatomical distribution and treatment of paediatric hand fractures: A multi-centre study of 749 patients in the netherlands. de Haas, et al. (2025) Level of Evidence : 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Pediatric fractures - Management This multicentre cross-sectional study investigated treatment variations for pediatric hand fractures in the Netherlands. A total of 749 pediatric, across multiple hospitals, were included in the study. The majority of the injuries were low energy trauma (90%) whilst a smaller number was the result of crush injuries (10%). Physeal fractures were the most common (20%) followed by volar plate avulsions. For an extensive description of the fractures included in the study, have a look at the figure below. The large majority of fractures were treated with immobilisation (circa 60%), followed by some gentle mobilisation (circa 40%). Less than 4% of all fractures underwent surgery. The fractures that were managed with surgery included phalangeal and metacarpal shaft fractures as well as intra-articular fractures. 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, clinicians can choose to either immobilise or initiate early motion in pediatric patients with hand/finger fractures in most cases. Shaft or intra-articular fractures present with a lower threshold for for surgical interventions as these may cause finger scissoring or intra-articular step deformities, which may required more invasive treatment. If you are interested in pediatric hand therapy care, have a look at the whole database on the topic . URL : https://doi.org/10.1177/17531934241258862 Abstract This study describes the anatomical distribution of paediatric metacarpal and phalangeal fractures and evaluates treatment methods for each fracture type. A multicentre study was conducted over a 3-month period in the Netherlands. A total of 749 consecutive patients, aged 0–17 years, with single metacarpal or phalangeal fractures were included. Physeal fractures of the proximal phalanx were most common ( n = 135, 17%), followed by proximal interphalangeal joint palmar plate avulsion fractures ( n = 81, 10%) and proximal phalanx shaft fractures ( n = 80, 10%). Treatment methods varied: 63 (47%) patients with proximal phalanx physeal fractures were allowed mobilisation of their fingers, while 70 (51%) were immobilised; 53 (65%) patients with proximal interphalangeal joint palmar plate avulsion fractures were allowed mobilisation, while 28 (35%) were immobilised; and 33 (41%) patients with proximal phalanx shaft fractures were allowed mobilisation, while 42 (52%) were immobilised. The study identified substantial treatment variability in common fractures, providing information and insights for future research directions. 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 risk of surgical site infection for hand trauma surgery performed outside main theatres: A systematic review and meta-analysis. Shafi, et al. (2025) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Simple hand surgeries - Outside main theatre This systematic review and meta-analysis assessed the risk of surgical site infections in hand trauma surgery performed outside the main theatre (OMT). A total of 1,635 participant across seven studies were included in the study. The Cochrane Risk of Bias Tool was utilised to assess the quality of the studies. The surgeries performed included fracture fixations with k-wires or plates and screws, as well as soft tissue repair (e.g. extensor or flexor tendon repair). The results showed that the risk of surgical site infections in OMT settings was low, with an estimated risk of 2.8% (CI 2.1–3.8%). Despite these findings, it is important to keep in mind that there was only one randomised controlled trial and that the other were cohort studies that presented with missing data. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the risk of surgical site infections in hand trauma surgery performed outside the main theatre (OMT) appears to be similar to what has been reported in main theatre . It is likely that we will be seeing more OMT surgeries as the ratio of theatres to population shrinks. It is also possible that in the future of hand therapy we will have some advanced scope practitioners performing some of simpler surgeries due to shortages of available specialists. URL : https://doi.org/10.1177/17531934251345358 Abstract Increasing pressure on healthcare systems and limited emergency operating capacity has reduced the availability of main theatres for hand trauma surgery. This has led to an increase in hand trauma surgery performed outside the main theatre (OMT). Data on the risk of surgical site infection (SSI) in the OMT setting for hand trauma are limited. This systematic review and meta-analysis summarize the risk of SSI for hand trauma surgery in this setting. We included seven studies involving 1635 patients. The meta-analysis suggests an SSI risk of 2.8%, which is a lower estimate than the overall risk of SSI in hand trauma surgery. Hand trauma surgery performed OMT is not associated with an increased risk of SSI compared with existing summary estimates. This supports recent guidelines from the British Society for Surgery of the Hand, and Getting It Right First Time programme. 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

Exercise for postmenopausal bone health: Can we raise the bar?. Kumar, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Bone health - Weight lifting and impact training This narrative review discussed the importance of high-intensity resistance and impact training (HiRIT) in promoting bone health, particularly among postmenopausal women with osteopenia or osteoporosis. Despite initial safety concerns, recent evidence demonstrated that HiRIT is effective in stimulating bone growth and improving musculoskeletal outcomes. The study also addresses the challenges of muscle and bone loss during weight-loss therapies, emphasising the role of resistance exercise in preserving lean muscle mass and bone density. While a wealth of research underscores the benefits of exercise for bone health, several unanswered questions remain, including how to sustain long-term osteogenic responses and the mechanisms underlying skeletal adaptations. The potential integration of exercise with pharmacotherapy offers promising avenues for more effective approaches to treating osteoporosis in aging populations. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, high-intensity resistance and impact training (HiRIT), which involves weight lifting and jumping/jogging, can reverse bone loss in postmenopausal women with osteopenia or osteoporosis. This seems to be in line with what previous evidence has suggested . This information is useful as we see lots of clients with fragility fractures (e.g. low energy distal radius fracture) who would benefit from this type of training. For a simple screening, you can even assess bone mass density from your clients' hand x-rays . URL : https://doi.org/10.1007/s11914-025-00912-7 Abstract Purpose of Review: This review summarises the latest evidence on effects of exercise on falls prevention, bone mineral density (BMD) and fragility fracture risk in postmenopausal women, explores hypotheses underpinning exercise-mediated effects on BMD and sheds light on innovative concepts to better understand and harness the skeletal benefits of exercise. Recent Findings: Multimodal exercise programs incorporating challenging balance exercises can prevent falls. Emerging clinical trial evidence indicates supervised progressive high-intensity resistance and impact training (HiRIT) is efficacious in increasing lumbar spine BMD and is safe and well-tolerated in postmenopausal women with osteoporosis/osteopenia. There remains uncertainty regarding durability of this load-induced osteogenic response and safety in patients with recent fractures. Muscle-derived myokines and small circulating extracellular vesicles have emerged as potential sources of exercise-induced muscle-bone crosstalk but require validation in postmenopausal women. Summary: Exercise has the potential for multi-modal skeletal benefits with i) HiRIT to build bone, and ii) challenging balance exercises to prevent falls, and ultimately fractures. The therapeutic effect of such exercise in combination with osteoporosis pharmacotherapy should be considered in future trials. 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

Thoracic outlet syndrome: A comprehensive review. Simpson, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Thoraci outlet syndrome - Upper limb entrapment mimicker This is an expert opinion on Thoracic Outlet Syndrome (TOS) and their clinical presentation. TOS is a multifactorial disorder caused by compression of the brachial plexus, subclavian artery, or subclavian vein within the thoracic outlet, a space bounded by the clavicle, first rib, and scalene muscles. The most common presentation is neurogenic TOS (≈90 % of cases), followed by venous, and arterial subtypes, each presenting with distinct neurologic, ischemic, or thrombotic symptoms that can mimic cervical radiculopathy, carpal tunnel syndrome, or cardiac embolic disease. Clinical diagnosis is difficult, and currently available tests include Adson, Roos, and Wright test. In terms of imaging, MRI, CT angiography (CTA), and dynamic ultrasound can be helpful, however, they have limitation under dynamic or subtle compressions. Anterior scalen blocks can be a useful diagnostic and short‑term therapeutic tool, with response rates predicting surgical benefit, especially in older patients. Management approaches include conservative physical‑therapy regimens to first‑rib resection with or without scalenectomy, depending on subtype. Venous TOS decompression yields 94 % clinical improvement, while arterial procedures achieve 85 % long‑term relief, though restenosis can occur. 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, thoracic outlet syndrome (TOS) is best approached as a multidisciplinary problem. Neurogenic TOS, which is the most common, often mimics cervical radiculopathy or carpal tunnel syndrome. This seems to be in line with previous research on upper limb entrapment neuropathies . A high index of suspicion and provocative tests (Adson, Roos, Wright) are first steps in making a diagnosis. If you are concerned about an arterial TOS, the use of a pulsoximeter during these tests may be useful. Keep in mind that a cervical/upper thoracic x-ray may be useful in excluding a cervical rib or long transverse processes that may contribute to the compression of these structures. Similarly, US imaging could be utilised to assess whether there is dynamic compression of the neurovascular bundles. Treatment wise, resection of the anterior and middle scalene seem to have a similar effect to 1st rib removal with lower complications . Unfortunately for younger athletes, surgery for neurogenic TOS does not seem to be as effective as for older and possibly less active individuals . URL : https://doi.org/10.1097/CRD.0000000000001023 Abstract Thoracic outlet syndrome (TOS) comprises a range of conditions characterized by compression of the brachial plexus, subclavian artery, or subclavian vein as these structures traverse the thoracic outlet. Although TOS was first documented in 1860 by Willshire, it remains a diagnostic and therapeutic challenge—particularly for cardiologists evaluating upper-extremity ischemia, suspected arm emboli, or unexplained swelling. This article provides a cardiology-focused overview of TOS, emphasizing the condition’s subtypes (neurogenic, venous, and arterial), key diagnostic approaches, comparative surgical outcomes, and considerations relevant to cardiovascular specialists. Literature pertaining to TOS pathophysiology, clinical diagnosis, imaging, and surgical management was reviewed. Where available, quantitative outcome data and success rates are highlighted to guide evidence-based decision-making. TOS is commonly categorized into neurogenic, venous, and arterial forms. Each subtype necessitates a distinct approach. Developments in imaging (magnetic resonance imaging, computed tomography angiography, and dynamic ultrasound) and refined surgical techniques have improved diagnostic accuracy and therapeutic success: yet questions remain regarding long-term efficacy and optimal procedural approaches. Prompt differentiation between TOS and intrinsic cardiac or major vascular etiologies is essential for preventing severe complications such as limb ischemia and permanent nerve damage. A multidisciplinary model integrating cardiologists, vascular surgeons, neurologists, and physical therapists offers the best outcomes. Further studies, particularly large-scale comparative trials, are needed to standardize diagnostic protocols and evaluate emerging surgical approaches. 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

Relative metacarpal shortening as a radiographic measure of fourth and fifth carpometacarpal fracture dislocation. Fones, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Cmcj fracture dislocations - Relative metacarpal length This retrospective study assessed whether an easily calculable radiographic metric called Relative Metacarpal Shortening, could improve detection of fourth and fifth carpometacarpal joints (cmcj) fracture‑dislocations hand x-rays. A total of 41 patients with confirmed cmcj injuries and 42 matched controls were included in the study. Three independent reviewers measured the perpendicular distance from each affected metacarpal head to a line tangent to the third metacarpal, dividing by the third metacarpal length to obtain RMS values (postero-anterior x-ray). Injured digits exhibited significantly greater shortening compared to the healthy controls. Inter‑observer agreement was excellent. Cut‑off thresholds to detect fracture-dislocations was 0.13 and 0.28 for the fourth and fifth digit respectively. Keep in mind that these thresholds were selected based on the best diagnostic accuracy of the sample available, however, they have not been validated on a separate sample. Have a look at the pictures below to get an understanding of these measurements. 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, relative metacarpal shortening (RMS) is a practical and simple measurement that can be added to the routine review of posteroanterior hand films in patients with 4th and/or 5th cmcj pain. It appears that if the fourth and/or fifth metacarpals are shortened by more than 1/10 and 1/3 of the third metacarpal, this may increase the probability of our patients having a cmcj fracture-dislocation. If you are interested in other cool ways to utilise x-ray for clinical decision making, have a look at this synopsis on bony mallets . URL : https://doi.org/10.1016/j.jhsa.2025.08.011 Abstract Purpose: Fourth and fifth carpometacarpal fracture dislocations may be missed on plain x-ray. The purpose of this study was to describe a radiographic measurement, the relative metacarpal shortening (RMS), to evaluate for fourth and fifth carpometacarpal fracture dislocations on posteroanterior radiographs. We hypothesize that the RMS will increase in patients with fourth and fifth carpometacarpal fracture dislocations relative to controls. Methods: A retrospective review identified posteroanterior hand radiographs of skeletally mature patients with fourth and/or fifth carpometacarpal fracture dislocations. Comparisons were made of normal radiographs identified from patients presenting to the outpatient orthopedic hand clinic for complaints other than fracture or dislocation. Three independent reviewers performed measurements, with two of these reviewers measuring the RMS for each patient radiograph. The fourth and fifth RMS were calculated by dividing the length from the fourth/fifth distal metacarpal head to a tangential line to the third metacarpal head by the third metacarpal length. Measures were compared between the two cohorts. Agreement was assessed by intraclass correlation coefficients between reviewers. Results: In total, 42 controls and 41 fractures were included. The fracture group included 18 patients (43.9%) with isolated fifth metacarpal involvement and 23 patients (56.1%) with both fourth and fifth metacarpal involvement. Fractures were more commonly right-sided, younger, and men relative to controls. The fourth and fifth RMS were higher for fractures (0.16 and 0.31) than for controls (0.12 and 0.26), respectively. The intraclass correlation coefficient agreement test was almost perfect for all measurements (range: 0.82–0.94). Conclusions: The RMS is a radiographic measurement with almost perfect agreement between reviewers and is increased in fourth and fifth carpometacarpal fracture dislocations. Fourth RMS >0.13 and fifth RMS >0.28 should increase the index of suspicion for carpometacarpal fracture dislocation in a patient with corresponding ulnar hand pain. 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

Cubital tunnel syndrome: Does a consensus exist for diagnosis?. Collins, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic Topic : Cubital tunnel syndrome - Physical tests This is a Delphi study that attemped to establish consensus on diagnostic criteria for cubital tunnel syndrome (CuTS) among 12 hand and upper limb surgeons. A 55‑item questionnaire covering history, physical exam, and provocative tests was distributed, and panelists ranked each item’s importance on a 1–10 scale. Internal consistency was assessed through Cronbach’s α. Items which were identified as very similar amongst each other were combined. The results showed that there was a high level of agreement amongst surgeons on what subjective and objective aspects were useful in making a diagnosis of cubital tunnel syndrome. The top three were: Paresthesias localised to the ulnar nerve distribution of the forearm/hand. Symptoms worsening with elbow flexion. A positive Tinel sign at the medial elbow. Other objective findings/history that they deemed important included atrophy/weakness of intrinsic hand muscles, loss of two‑point discrimination within the ulnar hand, and successful treatment of the contralateral limb with cubital tunnel release. 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, paraesthesia in the ulnar hand/forearm that worsen with sustained elbow flexion, and a positive Tinel's at the cubital tunnel seem to be useful in making a cubital tunnel diagnosis. In addition, a good neurological assessment including sensory and motor tests are useful in differentiating between a peripheral entrapment vs a more proximal compression. Don't forget to screen the rest of the upper limb, including the neck , as some presentations like thoracic outlet or cervical radiculopathy can mimic peripheral entrapment neuropathies. URL : https://doi.org/10.1016/j.jhsa.2023.05.014 Abstract Purpose: Cubital tunnel syndrome (CuTS) is the second most common compressive neuropathy of the upper extremity. We aimed to determine a consensus among experts using the Delphi method for clinical criteria that could be validated further for the diagnosis of CuTS. Methods: The Delphi method was used for establishing a consensus among a group of expert panelists, comprising 12 hand and upper-extremity surgeons, who ranked the diagnostic clinical importance of 55 items related to CuTS on a scale from 1 (least important) to 10 (most important). The average and SDs of each item were calculated, and Cronbach α was used to assess homogeneity among the panelist-ranked items. Results: All panelists answered the 55-item questionnaire. A Cronbach α value of 0.963 was obtained on the first iteration. The top criteria that were considered most clinically relevant to the diagnosis of CuTS among the group were determined based on the most highly ranked and correlated items among the expert panelist group. The criteria based on which there was agreement were as follows: (1) paresthesias in ulnar nerve distribution, (2) symptoms precipitated by increased elbow flexion/positive elbow flexion tests, (3) positive Tinel sign at the medial elbow, (4) atrophy/weakness/ late findings (eg, claw hand of the ring/small finger and Wartenberg or Froment sign) of ulnar nerve-innervated muscles of the hand, (5) loss of two-point discrimination in ulnar nerve distribution, and (6) similar symptoms on the involved side after successful treatment on the contralateral side. Conclusions: Our study demonstrated a consensus among an expert panelist group of hand and upper-extremity surgeons on potential diagnostic criteria for CuTS. This consensus on diagnostic criteria may help clinicians readily diagnose CuTS in a standardized form; however, further weighting and validation are necessary prior to the development of a formal diagnostic scale. Clinical relevance: This study is the first step in producing a consensus on how to diagnose CuTS. 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

Mental and physical health disparities in patients with carpal tunnel syndrome living with high levels of social deprivation. Wright, et al. (2019) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Social deprivation - Carpa tunnel outcomes This retrospective study assessed how neighborhood socioeconomic deprivation influences health outcomes in patients with carpal tunnel syndrome (CTS). A total of 367 patients with CTS were included in the present study. Area Deprivation Index, which ranks U.S. census tracts from most to least deprived, was included as a variable amongst patient‑reported outcomes were measuring physical function, pain interference, depression, and anxiety. Comorbidity burden and tobacco use were quantified by the Charlson Comorbidity Index and self‑report. The resultsh showed that patients residing in the most deprived areas reported significantly lower physical function and higher pain interference, depression, and anxiety compared with those in the least deprived areas. These results were maintained after adjusting for age, sex, employment type, and other covariates. 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, living in a highly deprived neighborhood is independently associated with worse physical function, greater pain interference, and higher depression and anxiety in patients with carpal tunnel syndrome. Even after controlling for age, sex, employment, comorbidities, and tobacco use, social deprivation remaines a significant predictor of poorer outcomes. These findings are in line with previous research showing that social deprivation is an importand social determinant of health in upper limb conditions . Clinicians should routinely assess patients’ socioeconomic context and integrate multidisciplinary resources (social work, mental‑health support, smoking‑cessation programs ) into treatment plans to address the broader determinants of health that hinder recovery and satisfaction. URL : https://doi.org/10.1016/j.jhsa.2018.05.019 Abstract Purpose: Social, mental, and physical health have a complex interrelationship with each influencing individuals’ overall health experience. Social circumstances have been shown to influence symptom intensity and magnitude of disability for a variety of medical conditions. We tested the null hypothesis that social deprivation would not impact Patient-Reported Outcomes: Measurement Information System (PROMIS) scores or objective health factors in patients presenting for treatment of carpal tunnel syndrome (CTS). Methods: This cross-sectional study analyzed data from 367 patients who presented for evaluation of CTS to 1 of 6 hand surgeons at a tertiary academic center between August 1, 2016, and June 30, 2017. Patients completed PROMIS Physical Function—v1.2, Pain Interference—v1.1, Depression—v1.0, and Anxiety—v1.0 Computer Adaptive Tests. The Area Deprivation Index was used to quantify social deprivation. Medical record review determined duration of symptoms, tobacco and opioid use, and the Charlson Comorbidity Index (CCI) for each patient. Sample demographics, PROMIS scores, and objective health measures were compared in groups defined by national quartiles of social deprivation. Results: Patients with CTS living in the most deprived quartile had worse mean scores across all 4 PROMIS domains compared with those living in the least deprived quartile. A higher proportion of individuals from the most deprived quartile had a heightened level of anxiety than those in the least deprived quartile (37.3% vs 12.6%). The mean CCI was higher in the most deprived quartile, as was the proportion of individuals using tobacco. There were no differences in opioid use or symptom duration between patients from each deprivation quartile. Conclusions: Social deprivation is associated with worse patient-reported health measures in patients with CTS. Compared with those from the least deprived areas, patients from the most deprived areas also have a greater comorbidity burden and higher rates of tobacco use at presentation to a hand surgeon. 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 management of double crush syndrome: Outcomes of cervical decompression with and without peripheral nerve release. Gullborg, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Double crush syndrome - Cervical and peripheral nerve release This retrospective study assessed the surgical management of double crush syndrome by comparing outcomes between patients undergoing anterior cervical discectomy and fusion (ACDF) alone versus those receiving both ACDF and subsequent peripheral nerve decompression. A total of130 patients were included, with 66 in the ACDF-alone group and 64 in the bimodal decompression group. The results showed that the bimodal decompression group experienced significant improvements in physical examination metrics, including recovery of two-point discrimination, which was not observed in the ACDF-alone group. The bimodal group also presented with greater reductions in neck and arm pain scores compared to those receiving only ACDF. 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, double crush syndromes appear to benefit the most from release of all compression sites. This appears to improve both neurological findings and subjective symptoms compared to a cervical discectomy alone. These findings appear to be in line with other conservative treatment approaches that not only include management of the area of peripheral entrapment but also more proximal areas of potential compression . URL : https://doi.org/10.1016/j.jhsg.2025.100770 Abstract Purpose: Double crush syndrome involves two distinct compressive lesions along a single peripheral nerve. Patients with compressive neuropathies at the wrist and elbow may experience exacerbated symptoms from cooccurring cervical radiculopathy. Surgical management aims to decompress at either or both proximal and distal sites. This study compares outcomes of anterior cervical discectomy and fusion (ACDF) alone versus ACDF with subsequent peripheral nerve decompression. Methods: This retrospective study evaluated patients with double crush lesions, diagnosed with magnetic resonance imaging-confirmed cervical radiculopathy and carpal or cubital tunnel syndrome via electrodiagnostic confirmation. Two cohorts were matched and analyzed: (1) ACDF alone and (2) those with ACDF with subsequent peripheral nerve decompression. All procedures were performed at a single institution between 2004 and 2020, with a minimum 1-year follow-up. Postoperative symptoms, examination findings, patient-reported outcomes, and reoperations were compared. Results: Among 130 patients (66 receiving ACDF alone, 64 with additional peripheral nerve decompression), those with both procedures had a significantly longer duration of preoperative radicular/peripheral symptoms (29.2 months vs 18.3 months). At the latest follow-up, patients receiving ACDF alone had significantly more persistent numbness (42.4% vs 17.2%), nerve irritability (21.2% vs 4.7%), and reduced 2-point discrimination (20.3% vs 12.1%) when compared with those who had bimodal decompression. Patients receiving both procedures reported significantly greater improvements in visual analog scale neck pain (−5.62 vs −3.63), visual analog scale arm pain (−4.73 vs −3.54), and neck disability index scores (−17.50 vs −6.80). Conclusions: Isolated cervical decompression may be insufficient for double crush neuropathies. Treatment of both proximal and distal sites can provide superior pain and symptom relief. Management of compressive pathology at both sites should be strongly considered by treating surgeons. 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 local tenderness at the lacertus fibrosus in healthy people. Fang, et al. (2025) Level of Evidence: 4 Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic/Symptoms Prevalence Study Topic : Lacertus fibrosus - Palpation This study assessed the incidence of tenderness over the lacertus fibrosus in healthy individuals and its implications for diagnosing lacertus syndrome. A total of 36 healthy adults (72 limbs) were included in the present study. Age ranged from 20 to 75 years old. Palpation of the lacertous fibrosus was defined as thumb pressure applied to this anatomical landmark for 5 seconds. The results showed that 14 limbs exhibited tenderness, with bilateral tenderness observed in two participants. There was also a higher incidence of tenderness among individuals over 60 years old compared to younger participants, though the small sample size limited definitive conclusions about age-related effects. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the incidence of tenderness over the lacertus fibrosus in healthy individuals is 20%. In addition, utilising the contralateral limb as a comparison may not be particularly useful. There is some evidence that these pathologies exist ( Lacertus fibrosus and pronator teres ), as well as a cadaver studies looking at how this structure can cause higher levels of compression . However, it appears that palpation of the median nerve at these areas can be tender in asymptomatic subjects. URL : https://doi.org/10.1177/17531934251346595 Abstract In 36 healthy adults (72 arms), we found tenderness at the lacertus fibrosus in 14 limbs. Local tenderness in the area of the lacertus fibrosus alone may have no diagnostic value, and using the contralateral arm for comparison may not be reliable. 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