Search Results

Evaluating the impact of trauma on carpal tunnel syndrome onset and postsurgical recovery: A retrospective study in orthopedic practice. Ellingwood, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic Topic: CTS - Traumatic onset This retrospective study assessed outcomes in patients with carpal tunnel syndrome (CTS), focusing on the impact of trauma history, workers' compensation status, and other demographic and clinical factors. A total of 478 participants were included who had undergone CTS surgery. Pain levels (measured via visual analog scale) between patients with traumatically induced CTS and those without a trauma history were assessed. The results showed that individuals with a trauma-related diagnosis presented with higher initial and final pain scores, however, these were not clinically relevant (less than 1 point out of 10 more). Additionally, there was a trend for workers' compensation status predicting increased pain levels and prolonged length of care, suggesting that psychological or economic stress related to claims may contribute to poorer outcomes. Comparing estimated adjusted geometric means and 95% CI for the interaction between upper extremity diagnosis and workers’ compensation regarding length of care(in weeks). Light blue bars represent no workers’ compensation, whereas dark blue represents workers’ compensation. “*” indicates a statistically significant difference between thetwo means, with a P value < .05. For the upper extremity diagnosis, 0 ¼ No Additional Upper Extremity Diagnosis, 1 ¼ An Additional Upper Extremity Diagnosis on one side(Unilateral), and 2 ¼ Additional Upper Extremity Diagnoses on both sides (Bilateral). 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, carpal tunnel syndrome can be cause by trauma and that with this onset, pain levels can be slightly higher compared to insidious onsets. Workers' compensation status also appears to be associated with higher symptoms and longer recovery time. Remember that making a carpal tunnel diagnosis should rely on orthopaedic tests reproducing symptoms in the median nerve sensory distribution/identify sensory loss rather than only reproduce patients' symptoms. Also remember that the extend of biological changes to the nerve do not predict how much of an improvement we get following carpal tunnel release. This should be kept in mind when discussing expectations prior to surgery with patients. URL: https://doi.org/10.1016/j.jhsg.2025.100774 Abstract Purpose: The purpose of this study was to investigate the relationship between previous trauma to upper extremities and the subsequent development of carpal tunnel syndrome (CTS). By comparing cases of traumatically induced CTS with idiopathic CTS, the study aims to evaluate differences in symptom severity and postsurgical treatment outcomes. Additionally, the study explores other factors associated with higher pain scores and longer lengths of care. Methods: A retrospective study was conducted on patients who underwent carpal tunnel release surgery by a single hand surgeon from January 1, 2014 to October 1, 2020. Pre- and postoperative care duration and pain levels, assessed using a visual analog scale, were the primary outcomes. To analyze the predictors of pain levels and recovery time, unadjusted means were generated, followed by the development of a model to account for potential correlations and contributions. Results: The study included 478 patients (324 women and 154 men) with a mean age of 53.2 years, all of whom underwent carpal tunnel release surgery. Patients with traumatic injuries had higher initial and final pain scores compared with those with nontraumatic causes. Notably, trauma was not a significant factor in the length of care model, despite its association with pain scores. Meanwhile, worker’s compensation was a factor associated with prolonged length of care. Conclusions: This study demonstrates that traumatic injuries and other factors, such as worker’s compensation, gender, and race/ethnicity, significantly influence both pain levels and length of care in patients undergoing carpal tunnel release surgery. These findings emphasize that CTS can develop after trauma and is not exclusively idiopathic. Addressing various clinical and socioeconomic factors is essential for enhancing treatment effectiveness and managing expectations following surgery. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Exploring health and financial literacy in patients with peripheral nerve injury: A cross-sectional analysis of patients treated surgically. Goldfarb, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Economic Topic: Financial literacy - Patients with peripheral nerve injury This cross-sectional study assessed health and financial literacy among patients with peripheral nerve injuries. A total of 21 participants were included in the study. Validated scales were utilised to assess participants' ability to navigate healthcare and understand financial systems. The results showed that patients demonstrated high health literacy across nine domains, comparable to other patient groups such as those with psoriasis or heart failure. However, financial literacy scores were moderate, with patients answering 70% of questions correctly on average, indicating variability in their understanding of financial concepts. 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, peripheral nerve injury patients exhibit strong health literacy but only moderate financial literacy (~70%). This may be quite problematic due to them being potentially not prepared for the direct (e.g. medical/surgical) or indirect (e.g. being off work) cost. It may therefore be relevant for us to integrate financial education into our patient management to address challenges such as budgeting and insurance navigation. This would make sense especially considering that more socially deprived patients tend to have on average worse outcome across all presentation. Furthermore, in our pre-surgical consultations, it may be useful to indicate the time off work and the rehabilitation process, to avoid breaching their expectations, which in turns drives their satisfaction with the care provided. URL: https://doi.org/10.1016/j.jhsg.2025.100787 Abstract Purpose: Health literacy influences patient outcomes and recovery in musculoskeletal conditions. Although financial distress is common after orthopedic injuries, the role of financial literacy in these patients is unknown. We aimed to evaluate health and financial literacy in patients recovering from peripheral nerve injuries (PNI). Methods: After obtaining institutional review board approval, this cross-sectional study surveyed 21 patients with either PNI or brachial plexus injuries via phone. Two validated instruments were administered: the Health Literacy Questionnaire, comprising 44 items across nine independent domains, and a 23-item Financial Literacy Questionnaire assessing a range of financial literacy concepts. Descriptive statistics summarized scores on both surveys. Results: Participants had a mean age of 52.3 ± 15.8 years; 38% were women. The Health Literacy Questionnaire results demonstrated uniformly high health literacy across all domains, with the highest scores observed in domains related to active engagement with health care providers, understanding health information, and social support. In contrast, financial literacy, measured by the overall percentage of correct responses on the Financial Literacy Questionnaire, averaged 70% ± 20% (range: 21.7% to 91.3%), indicating moderate financial literacy with substantial interpatient variability. Conclusions: Patients recovering from PNI possess high levels of health literacy across nine different domains, comparable with populations with chronic conditions such as psoriasis, heart failure, and those undergoing dialysis. However, moderate and variable financial literacy suggests that despite effective health care system navigation, many patients may be less equipped for the financial challenges associated with their injury. These findings highlight the potential benefit of integrating targeted financial education into the perioperative management of PNI patients. 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

Integrating point-of-care ultrasound in hand clinic: A systematic review and meta-analysis. Perlmutter, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic: US imaging - Hand fractures This systematic review assess the usefulness of point-of-care ultrasound (POCUS) in diagnosing common hand pathologies such as fractures, tendinopathies, and nail injuries. Fifteen studies for a total of 1,217 participants were included in the review. The results showed that POCUS exhibits high diagnostic accuracy, particularly for hand and wrist fractures, with a pooled sensitivity of 82% and specificity of 89%. Trigger fingers and tendon lacerations were also easily identified via US imaging. For nail pathologies, POCUS achieves 97% sensitivity and 95% specificity in detecting subungual hematomas. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, US imaging in the clinic may be particularly useful in identifying hand/wrist fractures as well as tendon lacerations and pathologies. The main issue is that diagnostic ability is operator dependent. As you are probably aware, there is a series of additional uses for US imaging in clinic, which include the assessment of carpal tunnel syndrome, cubital tunnel syndrome, and the presence of intra-articular swelling at the elbow (suggestive of fractures). If you want to know more about US imaging for hand and upper limb therapy, have a look at the whole database. URL: https://doi.org/10.1016/j.jhsg.2025.100775 Abstract Purpose: Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable adjunct to physical examination in various clinical settings. Despite this, integration into the routine clinical practice of hand surgeons remains limited. This systematic review and meta-analysis aims to evaluate the diagnostic and clinical utility of POCUS in hand clinics for the assessment and management of common hand pathologies. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, MEDLINE and Embase were searched. Prospective studies evaluating POCUS use in hand pathologies were included. Two reviewers independently screened, extracted, and assessed data. Meta-analysis of diagnostic performance measures was conducted using a bivariate random effects model when appropriate. Results: Fifteen prospective studies involving 1,217 patients were included. POCUS was most commonly used to assess fractures (76.3%) and tendinous pathologies (20%). For hand fractures, pooled sensitivity and specificity were 81.95% (95% confidence interval [CI]: 78.03% to 85.31%) and 89.39% (95% CI: 87.12% to 91.30%), respectively. Among tendinous pathologies, POCUS demonstrated 100% sensitivity for trigger digits in three of four included studies. Limited evidence also supported high diagnostic performance for nail bed injuries (sensitivity: 97%, specificity: 95%). Conclusions: POCUS demonstrates high diagnostic accuracy for evaluating hand fractures and tendinous injuries while showing promise in the evaluation of nail bed trauma. Heterogeneity in study design, operator expertise, and reference standards was noted. Clinical relevance: The incorporation of POCUS into the clinical practice of hand surgeons, supported by formal training and technological advancements such as artificial intelligence integration, may improve diagnostic efficiency, guide management, and enhance care delivery. 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 and risk factors for soft tissue hand and wrist conditions in pregnancy and postpartum. Smith, et al. (2025) Level of Evidence: 3b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic: Pregnancy - Hand conditions This retrospective study assessed the incidence of hand conditions, namely De Quervain’s Tenosynovitis (DQT), Trigger Finger (TF), and Carpal Tunnel Syndrome (CTS) in pregnant and postpartum women. A total of 715,337 women were included in the paper. The sample was subdivided by pregnancy, diabetes, and gestational diabetes. The results showed that pregnancy was associated with an increased risk of DQT, but not, by itself, with an increased risk of CTS or TF. However, if gestational diabetes was present, this increased all hand conditions risk (DQT, CTS, and TF). 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, De Quervain’s Tenosynovitis is more likely in pregnant compared to non pregnant women and it occurs on average in 1 in 100 pregnant women. If pregnancy is associated with gestational diabetes, the odds of developing Trigger Finger and Carpal Tunnel Syndrome also increase. You could therefore suggest your pregnant clients to be physically active as that is a way of keeping gestational diabetes under control, alongside a healthy diet rich in fibres. Additionally, following the WHO guidelines for physical activity could be a population based intervention to prevent the risk of developing trigger finger and carpal tunnel syndrome during pregnancy. If you want to know more about De Quervain, Trigger Finger, or Carpal Tunnel Syndrome, you have a ton of synopses to look at :) URL: https://doi.org/10.1016/j.jhsg.2025.100778 Abstract Purpose: This study aimed to identify the incidence of and risk factors associated with soft tissue hand conditions in pregnancy and postpartum. We hypothesized that the incidence of de Quervain tenosynovitis (DQT) and possibly carpal tunnel syndrome (CTS) and trigger finger would be higher in pregnancy and postpartum and that gestational diabetes would be a risk factor for these conditions. Methods: Using the PearlDiver administrative claims database, we identified pregnant females undergoing vaginal or Cesarean delivery from 2011 to 2022. This cohort was propensity score matched based on age and Elixhauser comorbidity index to females who were not pregnant. We identified pregnant females with a diagnosis of gestational diabetes. Multivariate regression models were used to assess the risk of developing a hand condition within the first year postpartum, adjusting for age, geographical region, insurance plan, comorbidity index, and inflammatory arthritis or diabetes diagnosis. We applied these models to evaluate the risk of developing a hand condition in gestational diabetes patients. Results: We identified a cohort of 357,534 postpartum patients and 357,803 control patients. We observed a 1.5% incidence of hand conditions postpartum compared to 1.3% in the control population (P < .001). Pregnancy was associated with an increased risk of diagnosis with DQT (odds ratio [OR], 5.11; 95% confidence interval [CI], 4.47–5.85; P < .001). Gestational diabetes was also associated with an increased risk of a hand condition diagnosis (OR, 1.34; 95% CI, 1.26–1.42; P < .001), specifically increased odds of CTS (OR, 1.40; 95% CI, 1.29–1.51; P < .001) and DQT (OR, 1.23; 95% CI, 1.12–1.34; P < .001). Conclusions: Pregnancy is a significant risk factor for hand conditions and was associated with increased odds of DQT. Gestational diabetes is a significant risk factor for CTS and DQT. Our findings can inform screening and patient education efforts for high-risk pregnant patients. 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

Determining risk factors and rate of surgery after collagenase injections for dupuytren contracture. Cha, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Alcohol & Smoking - Dupuytren recurrence This retrospective study assessed the recurrence of Dupuytren contracture following collagenase treatment and identified risk factors associated with subsequent surgical intervention. A total of 14,805 patients were included in the study. Out of the whole sample,10% of patients underwent surgical intervention within five years. Patients who were smokers were more likely (13%) to undergo open surgery compared to non smokers. In addition, of the patients with alcohol use disorder (avoid use the term alcoholic as it is stigmatising) 16% had to undergo surgery. Other factors, such as diabetes, epilepsy, and vascular disease, did not seem to affect surgical intervention rates. Incidence rates (%) of surgical correction within 5 years among patients with Dupuytren contracture, categorized by the presence or absence of specific risk factors. 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, Dupuytren contracture recurrence after collagenase is significantly higher in people who smoke or those with an alcohol use disorder. It is therefore important to counsel our patients and help them living a healthier lifestyle. Helping our clients to stop smoking and drinking is therefore part of our role in our aim to prevent the need for further surgery for Dupuytren. Considering that smoking comes with a plethora of complications for our patients, including higher risk of tendon repair failure, infections, and ongoing symptoms, it is worth our time investment. URL: https://doi.org/10.1016/j.jhsg.2025.100768 Abstract Purpose: Collagenase injections are a nonsurgical treatment for Dupuytren contracture, but their long-term effectiveness in preventing surgery remains unclear. This study aimed to evaluate the rate of surgical intervention following collagenase treatment and identify whether specific risk factors increase the likelihood of future surgical correction. Methods: This retrospective cohort study utilized the TriNetX US Collaborative network to identify patients diagnosed with Dupuytren contracture between January 2007 and September 2024. Patients initially treated with collagenase injections were identified using relevant current procedural terminology codes. Procedure-specific current procedural terminology codes were then used to determine which patients underwent a subsequent fasciectomy or fasciotomy within 5 years of their initial injection. Risk factors, including smoking, diabetes, alcohol abuse, epilepsy, and vascular disease, were identified by International Classification of Diseases, 10th Edition codes. Statistical analysis was performed to evaluate the association between these risk factors and the likelihood of undergoing surgery. Results: Among 6,917 patients identified to have been treated with collagenase, 715 (10.2%) underwent surgery within 5 years of the injection. Tobacco use was associated with a significantly higher rate of surgery (12.98%, P = .03) compared with nonsmokers (10.1%). Similarly, patients with alcohol use disorder had a higher surgical correction rate (16.3%, P < .001) compared with those without (9.8%). Conclusions: Approximately 10% of patients treated with collagenase injections for Dupuytren contracture underwent surgery within 5 years. Smoking and alcohol use significantly increased the likelihood of surgery, representing a potential correlation. Further research is warranted to explore mechanisms underlying progression to surgery and prevention strategies. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

A meta-analysis of technology use and cognitive aging. Benge, et al. (2025) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Technology use - Cognitive preservation This systematic review and meta-analysis assessed the association between natural (not imposes) digital technology use (e.g., computers, phones, tablets) and cognitive decline in older adults. A total of 411,430 middle-age to older participants were included from cross-sectional and longitudinal studies. The results showed that higher levels of technology use were linked to a reduced risk of cognitive decline or dementia in both cross-sectional and longitudinal studies. Meta-regressions and sensitivity analyses (correction for certain variables) showed that study design, socioeconomic status, education, comorbidities, or social support did not blunt the positive effect of technology use (see picture below, which is showing the reduced odds - below 1 - of cognitive decline whilst controlling for several factors). 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, technology use is protective against cognitive decline/dementia in older adults independently of comorbidities, socioeconomic status, educational level, or social support. Considering that the negative influence of technology on the musculoskeletal system has been debunked in the hand and neck, we should encourage our middle age/older patient to be involved in the use of technology. If you combine use of technology with a bit of gaming and physical activity, you are likely to improve their mental health alongside their upper limb musculoskeletal pain/syndromes. URL: https://doi.org/10.1038/s41562-025-02159-9 Abstract The first generation who engaged with digital technologies has reached the age where risks of dementia emerge. Has technological exposure helped or harmed cognition in digital pioneers? The digital dementia hypothesis predicts that a lifetime of technology exposure worsens cognitive abilities. An alternative hypothesis is that such exposures lead to technological reserve, wherein digital technologies promote behaviours that preserve cognition. We tested these hypotheses in a meta-analysis and systematic review of studies published in Medline, PsycInfo, CINAHL, Science Direct, Scopus, Cochrane Library, ProQuest and Web of Science. Studies were included if they were observational or cohort studies focused on general digital technology use in older adults (over age 50) and included either a cognitive or dementia diagnosis outcome. We identified 136 papers that met inclusion criteria, of which 57 were compatible with odds ratio or hazard ratio meta-analysis. These studies included 411,430 adults (baseline age M = 68.7 years; 53.5% female) from cross-sectional and longitudinal observational studies (range: 1–18 years, M = 6.2 years). Use of digital technologies was associated with reduced risk of cognitive impairment (OR = 0.42, 95% CI 0.35–0.52) and reduced time-dependent rates of cognitive decline (HR = 0.74, 95% CI 0.66–0.84). Effects remained significant when accounting for demographic, socioeconomic, health and cognitive reserve proxies. All studies were evaluated for quality on the basis of a standardized checklist; the primary outcomes replicated when limiting analyses to the highest-quality studies. Additional work is needed to test bidirectional causal interpretations, understand mechanisms that underpin technological reserve, and identify how types and timings of technology exposures influence cognitive health. 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 connection between resistance training, climbing performance, and injury prevention. Saeterbakken, et al. (2024) Level of Evidence: 3a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic/Preventative Topic: Resistance training - Climbing injuries This systematic review assessed the role of resistance training (RT) in improving climbing performance and injury prevention. Climbing-specific RT programs have shown benefits for lower- and mid-level climbers, but their effectiveness for elite climbers remains unclear. The paper emphasises that brief, structured high-intensity RT sessions targeting finger flexors, shoulders, and back muscles are more feasible for climbers compared to long, high-volume sessions. It also underscores the need for gradual progression in RT intensity, sets, and frequency to minimise fatigue and maximise training quality. Injury prevention is a key focus, with fingers and shoulders being the most common injury sites. The review suggests that RT can reduce overall injury risk when implemented progressively. Additionally, body composition and eating patterns are discussed, revealing that climbers tend to be lean but not necessarily at disordered levels. The study highlights the importance of monitoring BMI, amenorrhea, and disordered eating in female climbers, as these factors may influence injury risk and performance. Finally, the paper advocates for a balanced approach to RT within climbing training programs. 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, biweekly resistance training (RT) is beneficial for lower- and mid-level climbers. This would include high-intensity, brief (low volume) RT sessions targeting finger flexors, shoulders, and back muscles via finger board training. This approach may be beneficial in preventing pulley or lumbricals injuries as well as progressively rehabbing them. For more on climbing hand presentations, look at the database. URL: https://doi.org/10.1186/s40798-024-00677-w Abstract Background: Climbing is an intricate sport composed of various disciplines, holds, styles, distances between holds, and levels of difficulty. In highly skilled climbers the potential for further strength-specific adaptations to increase performance may be marginal in elite climbers. With an eye on the upcoming 2024 Paris Olympics, more climbers are trying to maximize performance and improve training strategies. The relationships between muscular strength and climbing performance, as well as the role of strength in injury prevention, remain to be fully elucidated. This narrative review seeks to discuss the current literature regarding the effect of resistance training in improving maximal strength, muscle hypertrophy, muscular power, and local muscular endurance on climbing performance, and as a strategy to prevent injuries. Main Body: Since sport climbing requires exerting forces against gravity to maintain grip and move the body along the route, it is generally accepted that a climber`s absolute and relative muscular strength are important for climbing performance. Performance characteristics of forearm flexor muscles (hang-time on ledge, force output, rate of force development, and oxidative capacity) discriminate between climbing performance level, climbing styles, and between climbers and non-climbers. Strength of the hand and wrist flexors, shoulders and upper limbs has gained much attention in the scientific literature, and it has been suggested that both general and specific strength training should be part of a climber`s training program. Furthermore, the ability to generate sub-maximal force in different work-rest ratios has proved useful, in examining finger flexor endurance capacity while trying to mimic real-world climbing demands. Importantly, fingers and shoulders are the most frequent injury locations in climbing. Due to the high mechanical stress and load on the finger flexors, fingerboard and campus board training should be limited in lower-graded climbers. Coaches should address, acknowledge, and screen for amenorrhea and disordered eating in climbers. Conclusion: Structured low-volume high-resistance training, twice per week hanging from small ledges or a fingerboard, is a feasible approach for climbers. The current injury prevention training aims to increase the level of performance through building tolerance to performance-relevant load exposure and promoting this approach in the climbing field. 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

Osteoarthritis progression, pain, and function in early carpometacarpal osteoarthritis: A six-year longitudinal study. Ajayi, et al. (2025) Level of Evidence: 1b- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Hand OA x-rays - Symptoms and strength This prospective longitudinal study assessed the 6-year progression of radiographic severity, pain, and functional measures in early 1st cmcj OA, comparing healthy controls with individuals classified as having stable or progressing OA. A total of 86 participants with hand OA and 22 healthy controls were included in the study. Variables were measured at baseline, 1.5, 3.0, 4.5, and six years. Outcomes included x-ray changes (Eaton classification), self-reported pain and functional scores (PRWHE and AUSCAN questionnaires), grip and pinch strength. The result showed that whilst subgroup of hand OA progression were identifiable, minimal differences between these groups were present in terms of function and grip/pinch strength. Symptoms and objective measurements did not strongly correlate with radiographic changes. Longitudinal trajectories of PRWHE pain scores A and AUSCAN pain scores B over 6 years of follow-up, categorized by controls (green diamonds), stable OA (blue tri-angles), and progressing OA (red squares). Both panels show that control participants maintain consistently low pain scores, whereas the progressing OA group displays higher painscores over time. The stable OA group shows intermediate pain levels. Error bars represent 95% CIs around group means, highlighting the divergence in pain progression betweenthe groups across follow-up periods. C and S denote significant differences between controls and stable OA 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, radiographic changes can differentiate between stable and progressing OA. In contrast, self-reported pain and functional measures showed minimal differences between OA groups, indicating that disease progression may outpace symptom worsening. While objective measures like pinch and grip strength showed minor declines in the progressing group compared to controls, these changes did not strongly correlate with x-rays. These findings are in line with previous evidence suggesting that pain catastrophising is a more relevant factor in pain perception than radiological findings. URL: https://doi.org/10.1016/j.jhsg.2025.100795 Abstract Purpose: The purpose of this study was to examine the 6-year progression of modified Eaton staging, pain scores, and hand strength in patients with early carpometacarpal osteoarthritis (OA) and healthy controls, illustrating the differences between OA groups and controls. Osteoarthritis patients were stratified into stable and progressing groups using three-dimensional computed tomography imaging to identify clinical and radiographic markers differentiating progressing OA from stable disease and healthy controls. Methods: Data were collected from 86 early carpometacarpal OA patients, classified as stable or progressing OA based on trapezial osteophyte volume (progression defined as >150 mm3 at any visit or a growth rate >14.6 mm3/y), and from 22 healthy controls. Osteoarthritis patients were assessed at baseline and at 1.5-year intervals up to 6 years, whereas controls were evaluated at baseline and year 6. We analyzed modified Eaton stage, patient-rated wrist/hand evaluation, Australian/Canadian OA hand index pain and function scores, and key pinch and grip strengths across groups over 6 years. Tukey honestly significant difference tests evaluated intergroup differences, and fixed effects models assessed the effects of time and OA progression on outcomes, with statistical significance set at P < .05. Results: Progressing OA demonstrated an increase in modified Eaton score, with clear progression by year 6. Patient-rated wrist/hand evaluation and Australian/Canadian OA hand index pain scores were elevated in both stable and progressing OA groups at baseline and year 6 compared with controls (P < .05), although minimal differences existed between stable and progressing OA. Functional scores were similarly higher in OA groups, whereas key pinch and grip strength showed little trend over time, with minor differences between stable and progressing OA. Conclusions: Marked radiographic differences in modified Eaton score distinguish progressing from stable OA, indicating that structural progression is a key marker of disease advancement. Minimal differences in pain, functional scores, and hand strength between OA groups suggest that radiographic changes are more distinct indicators of OA progression than subjective or objective functional measures. These findings emphasize radiographic monitoring as the major parameter for OA progression. 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

Evaluating the relationship between patients diagnosed with anxiety and depression and rates of postoperative opioid use in five of the most common hand surgeries. Megalla, et al. (2025) Level of Evidence: 3b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic/Prognostic Topic: Anxiety/Depression - Opioid use This retrospective study investigated the relationship between preoperative diagnoses of anxiety, depression, or both, and postoperative opioid prescription rates in patients undergoing five common hand procedures: carpal tunnel release, trigger finger release, cubital tunnel release, lateral epicondylalgia surgery, and medial epicondylalgia surgery. Using a large national database of more than 4,000,000 people, information regarding the presence of anxiety and depression was pooled across all surgical procedures, alongside the use of opioids following surgery. The results showed that people with anxiety or depression were twice as likely to file opioid prescriptions within 30 days after surgery. Despite the significant increase in odds, the absolute number was relative low with 2% of people with mental health problems filing the prescription compared to 1% of patients without mental health conditions. It is also important to note that while the study highlights a correlation between mental health and opioid use, it does not establish causation. 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, postoperative opioid use following common hand surgeries such as carpal tunnel release, trigger finger release, cubital tunnel release, lateral epicondylalgia surgery, and medial epicondylalgia surgery is higher in people with mental health conditions. These findings are similar to what has been shown in terms of opioid use following upper limb fractures. Ultimately aiming to reduce reliance on opioids and enhance holistic care approaches seems the way to go. URL: https://doi.org/10.1016/j.jhsg.2025.100743 Abstract Purpose: This study compared postoperative opioid utilization between patients with and without preoperative diagnoses of anxiety and/or depression undergoing elective upper-extremity surgery. We hypothesized that patients with these diagnoses would fill more opioid prescriptions within 30 days of surgery than those without. Methods: We conducted a retrospective analysis using the PearlDiver Mariner Patient Claims Database (2010–2021). Patients undergoing carpal tunnel release, cubital tunnel release, trigger finger release, and epicondylitis surgeries were identified via Current Procedural Technology and International Classification of Diseases-Ninth and Tenth Revision codes. Patients were categorized by diagnosis of depression only, anxiety only, both anxiety and depression, and control. The primary outcome was opioid prescriptions filled within 30 days postsurgery. Descriptive statistics and chi-square tests were employed. Results: Among 4,166,706 carpal tunnel release patients, 22.4% with a diagnosis of anxiety and/or depression had a higher opioid fill rate (1.85%) than the control group (1.38%). For 1,409,802 trigger finger release patients, 20.7% with a diagnosis of anxiety and/or depression had a higher fill rate (1.62% vs 1.19%). In 913,929 cubital tunnel release patients, 23.0% with a diagnosis of anxiety and/or depression had a higher fill rate (2.41% vs 1.25%). Among 1,645,767 lateral epicondylitis surgeries, 22.2% with a diagnosis of anxiety and/or depression had a higher fill rate (1.04% vs 0.71%). For 397,916 medial epicondylitis patients, 22.2% with a diagnosis of anxiety and/or depression had a higher fill rate (0.92% vs 0.66%). Conclusions: Preoperative depression and/or anxiety were linked to higher postoperative opioid prescriptions across all surgeries, emphasizing the need to consider these diagnoses in opioid prescribing. 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 resistance training volume on physical function, lean body mass and lower-body muscle hypertrophy and strength in older adults: A systematic review and network meta-analysis of 151 randomised trials. Radaelli, et al. (2025) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic/Preventative Topic: Lowe limb resistance - Low volume effect This study is a systematic review and network meta-analysis examining the effects of resistance training volume on physical function, muscle strength, and lean mass in older adults. It analysed 151 randomised controlled trials involving 6306 participants aged ≥60 years, comparing low-, moderate-, and high-volume resistance training programs. The results were based on very low to low certaintly evidence, suggesting that reality may be different from what has been suggested by the results. It appears that low-volume resistance training (approximately ~30 full-body sets weekly or ~12 lower-limb sets) is effective for enhancing physical function, lean mass, and muscle size in both the short term (<20 weeks) and medium-to-long term (≥20 weeks). While higher volumes may offer additional benefits for specific strength measures like isometric torque, low volume remains sufficient for overall 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, low-volume resistance training appears to improve physical function, muscle strength, and lean mass among older adults. Approximately 30 full-body or lower limb sets per week seem to be sufficient. This seems to be in line with other studies suggesting that with 20% effort you get 80% of the benefits. Previous evidence has shown diminishing returns with higher levels of physical activity and it is important to keep in mind that people will cope with different volumes of exercise. Good new is that even low levels of exercise have a positive effect suggesting that the minimum effective dose is very achievable. URL: https://doi.org/10.1007/s40279-024-02123-z Abstract Background: The optimal prescription and precise recommendations of resistance training volume for older adults is unclear in the current literature. In addition, the interactions between resistance training volume and program duration as well as physical health status remain to be determined when assessing physical function, muscle size and hypertrophy and muscle strength adaptations in older adults. Objectives: This study aimed to determine which resistance training volume is the most effective in improving physical function, lean body mass, lower-limb muscle hypertrophy and strength in older adults. Additionally, we examined whether effects were moderated by intervention duration (i.e. short term, < 20 weeks; medium-to-long term, ≥ 20 weeks) and physical health status (i.e. physically healthy, physically impaired, mixed physically healthy and physically impaired; PROSPERO identifier: CRD42023413209). Methods: CINAHL, Embase, LILACS, PubMed, Scielo, SPORTDiscus and Web of Science databases were searched up to April 2023. Eligible randomised trials examined the effects of supervised resistance training in older adults (i.e. ≥ 60 years). Resistance training programs were categorised as low (LVRT), moderate (MVRT) and high volume (HVRT) on the basis of terciles of prescribed weekly resistance training volume (i.e. product of frequency, number of exercises and number of sets) for full- and lower-body training. The primary outcomes for this review were physical function measured by fast walking speed, timed up and go and 6-min walking tests; lean body mass and lower-body muscle hypertrophy; and lower-body muscle strength measured by knee extension and leg press one-repetition maximum (1-RM), isometric muscle strength and isokinetic torque. A random-effects network meta-analysis was undertaken to examine the effects of different resistance training volumes on the outcomes of interest. Results: We included a total of 161 articles describing 151 trials (n = 6306). LVRT was the most effective for improving timed up and go [− 1.20 standardised mean difference (SMD), 95% confidence interval (95% CI): − 1.57 to − 0.82], 6-min walk test (1.03 SMD, 95% CI: 0.33–1.73), lean body mass (0.25 SMD, 95% CI: 0.10–0.40) and muscle hypertrophy (0.40 SMD, 95% CI: 0.25–0.54). Both MVRT and HVRT were the most effective for improving lower-limb strength, while only HVRT was effective in increasing fast walking speed (0.40 SMD, 95% CI: − 0.57 to 0.14). Regarding the moderators, our results were independent of program duration and mainly observed for healthy older adults, while evidence was limited for those who were physically impaired. Conclusions: A low resistance training volume can substantially improve healthy older adults’ physical function and benefits lean mass and muscle size independently of program duration, while a higher volume seems to be necessary for achieving greater improvements in muscle strength. A low volume of resistance training should be recommended in future exercise guidelines, particularly for physically healthy older adults targeting healthy ageing. 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

Associations of preoperative ultrasonography, nerve conduction studies, and CTS-6 to boston carpal tunnel questionnaires up to one year following carpal tunnel release. Dvorsky, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Nerve factors - Symptomatic relief This retrospective study assess whether pre-surgical objective tests for carpal tunnel syndrome (CTS) can predict subjective recovery outcomes after surgery. A total of 106 patients were included. Pre-surgical objective tests included ultrasound to measure median nerve size, nerve conduction studies (NCS), and the CTS-6 questionnaire to estimate paraesthesia alongside objective tests (e.g. Phalen's test). Subjective recovery was assessed via changes in the Boston Carpal Tunnel Questionnaire (BCTQ) up to one year post surgery. The results showed that none of the pre-surgical objective tests reliably predicted subjective recovery. Breakdown of patients who were clinically diagnosed with CTS based on A number of positive preoperative tests and B specific combination of positive preoperative tests. 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, median nerve morphological changes (ultrasound imaging), nerve conduction studies (NCS), and the CTS-6 questionnaire (mainly relying on objective testing) do not appear to be relevant predictors of symptoms improvement following CT release. Diagnostic tests that are cheap and easy should therefore be utilised. Have a look at what constitutes a positive test for carpal tunnel syndrome so you don't get fooled by patients' symptoms. Also, keep in mind that mental health plays an important role in subjective recovery following carpal tunnel syndrome and this may partially explain this study findings. URL: https://doi.org/10.1016/j.jhsg.2025.100767 Abstract Purpose: The purpose of this study was to evaluate the association between preoperative ultrasound, nerve conduction studies (NCS), and/or carpal tunnel syndrome-6 (CTS-6) scores and the postoperative courses of patients undergoing carpal tunnel release (CTR). Methods: This was a retrospective study of all patients indicated for CTR at a single institution between October 2014 and August 2021. Preoperative data, including age, sex, body mass index, and laterality of the involved hand(s), were collected. Ultrasound was performed with a median nerve cross-sectional area (CSA) of ≥10 mm2 considered positive for CTS. Nerve conduction studies evaluated the distal sensory and motor latencies of the median nerve. Carpal tunnel syndrome-6 scores ≥12 were considered positive for CTS. The primary outcome measurement was the Boston Carpal Tunnel Questionnaire (BCTQ). Statistical analysis was performed to assess the correlation of preoperative studies to predict changes in postoperative BCTQ scores following CTR. Statistical significance was set to P < .05. Results: In total, 106 patients were included in the analysis, of which 69 patients were positive for CTS on US with an average median nerve CSA of 15.2 ± 4.4 mm2, whereas 37 patients were negative with an average CSA of 9.0 ± 1.3 mm2 (P < .001). Female sex, height, and weight were significantly different between the CTS-positive and -negative cohorts (P = .01, P = .02, and P = .01). Preoperative US, NCS, and CTS-6 were not associated with the ability to achieve minimal clinically important difference in change in BCTQ scores after surgery. Conclusions: Although helpful in establishing a diagnosis of CTS, positive findings on preoperative US, NCS, and CTS-6 alone are not associated with clinically significant changes in BCTQ symptom or function scores up to 1 year after surgery following CTR. 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

Failed ulnar nerve surgery due to persistent unrecognized snapping triceps from cubitus varus due to a distal humeral malunion in an adult: Illustrative case. O’Driscoll, et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: Distal humeral fracture - Snapping triceps The case study describes a 32-year-old man with a history of a distal humeral fracture following arm wrestling, which healed in varus malunion. Initially presenting with ulnar neuropathy and elbow snapping, he underwent ulnar nerve transposition within 12 months from injury. Symptoms improved but never fully resolved. About eight years after the fracture,, the patient returned with worsening of medial elbow pain and snapping, leading to a diagnosis of snapping medial triceps caused by the altered line of pull due to cubitus varus. Due to the potential repercussions and complications of corrective osteotomy, the patient elected non-operatative management. Based on the literature review completed by the authors, triceps snapping is not unusual following a distal humerus fracture. 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 distal humeral fracture with cubitus varus deformity can contribute to cubital tunnel syndrome as well as medial triceps subluxation during elbow flexion/extension. Medial triceps subluxation can be easily mistaken for a subluxating ulnar nerve and a closer look is always worth it in the objective examination. If you want to learn more about the ulnar nerve, have a look at the whole database. URL: https://doi.org/10.3171/CASE24596 Abstract BACKGROUND: Snapping triceps is a dynamic condition in which a portion of the medial head of the triceps dislocates over the medial epicondyle during flexion or extension. Pushed by the triceps, the ulnar nerve typically also dislocates over the medial epicondyle, causing neuropathy. Posttraumatic cubitus varus deformities resulting from pediatric supracondylar fractures have been associated with snapping triceps. This is the first case of snapping triceps associated with cubitus varus due to distal humeral malunion, which occurred in an adult. OBSERVATIONS: A 23-year-old man sustained a left distal humeral fracture from arm wrestling, which was treated nonoperatively, healing in a varus malunion. Within several months, he developed ulnar neuropathy and snapping at the medial elbow, which was diagnosed as a dislocating ulnar nerve and was treated with ulnar nerve transposition. He presented 8 years later with continued ulnar neuritis symptoms and snapping and was found to have snapping medial triceps. He chose nonoperative treatment. LESSONS: Snapping triceps, presenting as snapping at the elbow with ulnar nerve symptoms, can be incorrectly diagnosed as isolated ulnar nerve dislocation. Unrecognized snapping triceps leads to persistent symptoms after ulnar nerve transposition. The patient in this case demonstrated that an altered triceps line of pull can cause snapping triceps regardless of how the cubitus varus originated. 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