Search Results

Round table discussion. Neurogenic thoracic outlet syndrome. Chim, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic: Neurogenic thoracic outlet - Assessment and management This is an expert opinion on Neurogenic Thoracic Outlet Syndrome (NTOS) diagnosis and management. NTOS presents significant challenges in diagnosis as it often relies on clinical evaluation rather than definitive tests like blood tests or imaging scans. While imaging techniques such as MRI can aid in visualising nerve compression, they are not always conclusive. Management of NTOS involves a range of conservative and surgical approaches. Conservative treatments such as physical therapy and botulinum toxin injections are often implemented. Physical therapy focuses on muscle strengthening and flexibility of the upper limb. Botulinum Toxin Injections to the anterior scalene muscles are another conservative treatment option that aims at reducing this muscle activity and as a result compression on the brachial plexus. Surgical procedures include scalenectomy, and first rib resection. 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, Neurogenic Neurogenic Thoracic Outlet Syndrome (NTOS) can be managed either conservatively or surgically. Conservative exercise interventions will focus on maintaining and improving upper limb strength and flexibility as well as some light aerobic exercise. Other conservative interventions involve anterior scalene botulinum toxin injections, which aim at reducing anterior scalene contraction are also an option. Surgical intervention involve release of the anterior scalene or first/accessory rib removal. Scalenectomy seems to be quite effective, although in athletes it does not seem to be as effective. Finally remember that neurogenic thoracic outlet is a very good mimicker of carpal tunnel syndrome. Hence, if your carpal tunnel syndrome testing is negative, think about this as a differential diagnosis. Cervical myelopathy is another presentation that you need to keep in mind as it can mimic upper limb nerve entrapment. URL: https://doi.org/10.1177/17531934251361644 Abstract The diagnosis and treatment of neurogenic thoracic outlet syndrome (NTOS) remains an area of controversy. Criteria for diagnosis are not uniform. Advanced imaging modalities such as magnetic resonance imaging (MRI) may have varying utility based on institutional expertise, availability of equipment and familiarity with protocols. The use of diagnostic scalene blocks, or botulinum toxin injection is very dependent on surgeon experience and preference. Techniques for surgical management vary among surgeons, with biases between surgical subspecialities. In the field of hand surgery, outcomes following surgical treatment of NTOS are one of the most variable, with different surgeons achieving good outcomes with routine use of either rib sparing scalenectomy or first rib resection in primary management of supraclavicular NTOS. Further high-quality studies are needed to guide surgeons on best practices for management of NTOS. In this round table discussion, a group of expert surgeons from different surgical specialties discuss areas of consensus and controversy in NTOS. 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

National survey on antithrombotic management in minor hand surgery. Haas, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic. Topic: Aspirin - Perioperative suspension This survery explored how Canadian plastic surgeons manage anticoagulation therapy during minor hand surgeries, focusing on whether they discontinue or continue medications like warfarin and direct oral anticoagulants (DOACs). A total of 74 surgeons took part in the study. They were asked whether they would suspend or continue anticoagulation therapy in patients undergoing carpal tunnel/trigger finger release or soft tissue excision. The results showed significant variability in practices: while some discontinued anticoagulation preoperatively, others continued it. This is despite guidelines recommending continuation to minimise thromboembolic risks, many surgeons expressed concerns about perioperative bleeding. 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, antiplatelet monotherapy (e.g. aspirin) should be continued during low risk hand surgery procedures like carpal tunnel or trigger finger release. The risks of suspending the intervention include thromboembolic events, which far outweigh the risk of a small bleed/hematoma. URL: https://doi.org/10.1016/j.jhsa.2025.04.019 Abstract Purpose: Temporarily withholding antithrombotic medications for surgical procedures can increase thromboembolic risk. Many patients undergoing minor hand surgeries take these medications, requiring careful perioperative management by surgeons. Although general guidelines exist for periprocedural antithrombotic management, guideline adherence among surgeons performing minor hand procedures is unknown. This study aimed to assess current pre-procedural antithrombotic management strategies employed by hand surgeons for patients undergoing minor hand surgeries, specifically focusing on how closely these practices align with established clinical practice guidelines. Methods: A cross-sectional, descriptive study using an electronic survey was conducted among Canadian hand surgeons in 2024. Surgeons were queried on their general clinical practices and specifically about whether they would hold antithrombotic medications for theoretical cases describing soft tissue excision in the hand, trigger finger release, and carpal tunnel release. Results: Seventy-four surgeons participated. Although 93.7% of respondents considered the procedures to have a “low” bleeding risk, this perception varied with the type of antithrombotic medication to be managed. The perception of bleeding risk as “low” decreased to 71.2% for apixaban and 59.9% for warfarin. Additionally, 26.6% of respondents indicated they would hold aspirin, 37.8% would hold warfarin, and 47.7% would hold apixaban. Being a nonhand surgeon and requesting consultation from hematology specialists were significantly associated with holding antithrombotic medications. Conclusions: These findings highlight substantial variation in perioperative antithrombotic management, with many surgeons choosing to hold medications despite guidelines supporting continuation for low-risk procedures. Most surgeons consider minor hand procedures low-risk for bleeding, but this perception shifts with anticoagulant use. Clinical relevance: This study highlights practice variation in perioperative antithrombotic management for minor hand surgery, identifying a gap between current practice and guideline recommendations. Improved dissemination and adherence to evidence-based guidelines may help standardize care and optimize patient outcomes. 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

Minimal improvements in objective shoulder strength following shoulder arthroplasty: A systematic review. Pluta, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Shoulder strength - Shoulder replacement The systematic review and meta-analysis assessed clinical outcomes of anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA). A total of 11 studies were included in the review. More than 1,800 participants' data was available. The results showed that the most common average strength improvement was 1-2 kg compared to pre-surgery with exceptions showing an improvement of 5 kg strength. These improvements in strength were measured across shoulder flexion, external and internal rotation. 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, both anatomical and reverse shoulder replacements improve strength, albeit by 1-2 kg on average and 5 kg at the most. If you are interested to know more about shoulder assessment and management, have a look at the whole database. URL: https://doi.org/10.1016/j.jse.2025.06.020 Abstract Background: Patients with degenerative shoulder conditions indicated for shoulder arthroplasty frequently present with weakness due to disuse, pain, or their underlying pathology. However, it is unclear whether shoulder arthroplasty results in improvements in strength postoperatively. The purpose of this systematic review was to evaluate changes in objective strength following both anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA). Methods: A systematic review was conducted in April 2024 using the keywords 'shoulder arthroplasty,' 'outcomes,' and 'strength' in the PubMed, Web of Science, OVID, and EMBASE databases. Studies were included if they reported on patients who underwent aTSA or rTSA with preoperative and postoperative strength measurements (in lbs, kg, or N-m) assessed at a mean follow-up of two years postoperatively. Proximal humerus fractures, tendon transfers, revisions, axillary nerve injuries, level V evidence, reviews and biomechanical studies were excluded. Results: The search identified 2,070 studies, of which 11 met the inclusion criteria: 4 for aTSA, 5 for rTSA, and 2 for both. Among five studies evaluating rTSA abduction strength, improvements ranged from 0.4-4.9 kg, with each demonstrating objective strength gains, although two did not include statistical analysis of pre- and postoperative differences. Only one study assessed abduction strength in aTSA, also finding significant improvements. Two rTSA studies and three aTSA studies each also demonstrated significant improvements in supraspinatus or forward elevation strength, while one study showed significant improvement in forward flexion strength (3-6 N-m) for both rTSA and aTSA. Three of four studies reporting postoperative external rotation (ER) strength improvements following rTSA found significant increases, ranging from 1.0-1.8 kg. In aTSA, all three studies demonstrated significant improvements in ER strength. Three studies also assessed internal rotation (IR) strength post-aTSA, demonstrating improvement ranging from 1.4-2.5 kg, with two randomized clinical trials finding no significant strength difference between subscapularis peel and lesser tuberosity osteotomy or tenotomy. Conclusions: While shoulder arthroplasty leads to some degree of strength improvement across all planes of motion, the magnitude is modest and may not be perceptible to patients. Although these improvements may facilitate active shoulder range of motion, postoperative strength remains well below normative shoulder values. 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

Flexor tendon repair in zone ii of the hand: Evidence-based management. Douwes, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Zone II flexor tendon - Management strategies This systematic review provides a summary of the current understanding and management strategies for flexor tendon injuries in Zone II of the hand. A couple of take home messages are likely useful for hand therapist: - Start mobilising a few days after surgery. Early mobilisation is probably key independently of whether it is passive or active. - Higher incidence of adhesion is likely in degloving injuries, delayed surgery (more than 12 hrs), vascular injuries, and the involvement of multiple fingers. Prolonged immobilisation was consistently associated with worse outcomes. Splinting options varied but did not seem to have a large effect unless overall compliance with rehabilitation was affected. 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, moving (passively or actively) zone II flexor tendon repairs appears to be the most important factor for a good recovery. This appears to be in line with previous research comparing active vs passive rehabilitation approaches (Study 1 and Study 2). Younger, more socially deprived, and patients presenting with multiple fingers or thumb involvement, require greater care from hand therapists as they are at greater risk of developing adhesions or re-rupture their repair. URL: https://doi.org/10.1016/j.hansur.2025.102230 Abstract Introduction: Flexor tendon injuries require precise surgical repair followed by rehabilitation to ensure optimal recovery and reduce the risk of complications such as tendon rupture, scarring and adhesions. Zone II flexor tendon injuries, which are located between the flexor digitorum superficialis insertion and the A1 pulley, are particularly challenging due to the complex anatomy and the high risk of complication, earning it the nickname "no man's land". Material and methods: This systematic review was conducted in accordance with the principles of evidence- based medicine (EBM), which involve formulating a clinical question, searching for relevant studies, and critically appraising the quality of the evidence. This included evaluating study design, methods, sample size, and bias. Recommendations were made based on the strength of evidence and the impact of bias. This review addressed eight key questions concerning the diagnosis, repair, and rehabilitation of zone II flexor tendon injuries. Three review authors independently examined the titles and abstracts of the references retrieved from the searches, selecting all those that were potentially relevant. Results: Imaging still plays a limited role in diagnosis. Up to an unknown percentage of partial tears may be treated conservatively when comparable stringent rehabilitation principles are used. WALANT technique is not superior. Repair requires a four-strand or multi-strand core suture, with or without an epitendinous suture. Judicious pulley venting is safe and effective. The cornerstone of effective post-operative management in zone II flexor tendon injuries is early controlled mobilization, either passive or active, based on the strength of the repair and patient adherence. Combining this approach with structured therapy and vigilant follow-up is associated with improved range of motion, minimized adhesion formation and optimal functional outcomes in clinical practice. 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

Variation in interpretation of provocative tests for carpal tunnel syndrome. Davids, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: Carpal tunnel tests - What constitutes a positive test This study assessed how surgeons interpreted provocative tests (Phalen, Durkan, and Tinel tests) in people presenting with hand symptoms which may or may not indicate the presence of carpal tunnel syndrome. A total of 86 surgeons were asked to reflect on clinical vignettes and determine whether the response to carpal tunnel tests was positive or negative. The results showed that surgeons deemed the tests negative if they elicited pain rather than paresthesia or reproduced symptom in the whole hand/ring finger/little finger. 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 large majority of surgeons interpret Phalen, Durkan, and Tinel tests as positive when they reproduce paraesthesia in the anatomical nerve distribution of the median nerve. Conversely, when these tests elicit pain or involve non-median nerve symptoms distribution, they consider them negative. For a refresher of what tests are often utilised for carpal tunnel syndrome, have a look at this other synopsis. For a more comprehensive overview on carpal tunnel syndrome, have a look at the entire database on the topic. URL: https://doi.org/10.1016/j.jhsa.2024.07.004 Abstract Purpose: We studied variation in interpretation of specific symptoms during clinical tests for carpal tunnel syndrome to estimate the degree to which surgeons consider pain without paresthesia characteristic of median neuropathy. Methods: We invited all upper-extremity surgeon members of the Science of Variation Group to complete a scenario-based experiment. Surgeons read 5e10 clinical vignettes of patients with variation in patient demographics and random variation in symptoms and signs as fol- lows: primary symptoms (nighttime numbness and tingling, constant numbness and loss of sensibility, pain with activity), symptoms elicited by a provocative test (Phalen, Durkan, or Tinel) (tingling, pain), and location of symptoms elicited by the provocative test (index and middle fingers, thumb and index fingers, little and ring fingers, entire hand). Results: Patient factors associated with surgeon interpretation of provocative tests as negative included pain rather than paresthesia during the Phalen, Durkan, or Tinel test and location of symptoms in the entire hand rather than the median nerve distribution. Conclusions: Specialists do not consider pain without paresthesia or a noncharacteristic symptom distribution as characteristic of carpal tunnel syndrome. Clinical relevance Awareness that elicitation of pain with Phalen, Durkan, and Tinel tests is regarded by specialists as relatively uncharacteristic of median neuropathy can help limit the potential for both overdiagnosis and overtreatment of median neuropathy as well as under- diagnosis and undertreatment of mental and social health contributions to illness (notable correlates of the intensity and distribution of 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

Effects of forearm rotational movements on median nerve and carpal tunnel morphology: A magnetic resonance imaging study. Şencan, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic Topic: Carpal tunnel - Effect of pronation/supination This cross-sectional study assessed how the cross-sectional area (CSA) of the median nerve and carpal tunnel changed with pronation and supination of the forearm. A total of 177 participants undergoing MRI for ulnar-sided wrist pain, were included in the present study. Since MRI imaging was available in supination and pronation for all these patients, the research took advantage of the already existing data for this separate study. CSA of the carpal tunnel and median nerve was measured at four levels within the carpal tunnel in both supination and pronation. The results showed that the median nerve and carpal tunnel CSA was smaller in supination compared to pronation across all levels examined. 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, supination results in a smaller cross-sectional area of the median nerve and carpal tunnel compared to pronation. These findings could be even more pronounced in people who are genetically predisposed to develop carpal tunnel syndrome. Remember that one of the differential diagnoses for carpal tunnel syndrome is neurogenic thoracic outlet and be careful on how you interpret your objective tests. URL: https://doi.org/10.1016/j.jhsa.2025.06.008 Abstract Purpose: This study used magnetic resonance imaging (MRI) to investigate the effects of forearm pronation and supination on the morphology of the median nerve and carpal tunnel. Materials and Methods: The MRI images of 177 patients were analyzed. Median nerve cross-sectional area (CSA) and carpal tunnel dimensions (height and width) were measured at four levels in pronation and supination. Statistical analyses evaluated positional differences. Results: Median nerve CSA was significantly smaller, carpal tunnel height decreased, and width increased in supination compared with pronation. Pronation caused dorsoradial displacement of the median nerve, whereas supination led to ulnopalmar displacement and superficial positioning relative to flexor tendons. Conclusions: The median nerve and carpal tunnel undergo morphological changes during forearm pronation and supination, with supination causing positional shifts, reduced CSA, and increased ovality of the carpal tunnel. Clinical relevance Forearm supination significantly affects carpal tunnel anatomy and morphology, as demonstrated by MRI findings. These findings may serve as a reference for ultrasound-based evaluations and support future efforts to optimize diagnostic and interventional approaches in carpal tunnel syndrome. 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

Congenital mallet finger: A case report. de Oliveira, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic: Congenital mallet finger - Pediatric This case report describes a rare instance of congenital hypoplasia of the terminal extensor tendon in the fifth finger, presenting as a mallet finger-like deformity in a three-year-old girl. The patient exhibited a flexion deformity of the distal interphalangeal joint (dipj), hyperextension of the proximal interphalangeal joint (pipj) in a classic swan-neck deformity presentation. They also had subtle hypoplasia of the nail and distal phalanx. Conservative treatment with immobilisation failed to correct the deformity, leading to surgical intervention. The procedure involved resecting the hypoplastic, fibrotic segment of the extensor tendon and directly suturing the healthy proximal and distal tendon portions. The dipj was immobilised with a k-wire for 8 weeks, followed by hand therapy. At 12-month follow-up, the patient showed close to complete correction of the deformity (-15deg from full dipj extension) with full passive mobility, and no functional limitations. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, pediatric congenital mallet finger does not appear to respond to splinting approaches. Although it may be worth trialing, it seems that surgical treatment is more effective. Following surgery, the patient still needs to undergo a period of immobilisation followed by hand therapy. If you are interested in more surgeries for mallet finger or the new concentric circle method to assess surgical requirement for bony mallet presentations, head over to the database on the topic. URL: https://doi.org/10.1016/j.jhsg.2024.11.015 Abstract This study describes a rare case of congenital hypoplasia of the terminal extensor tendon in the fifth finger, resulting in a mallet finger-like deformity, and presents the surgical technique used to correct the deformity. The case involves a three-year-old girl with a flexion deformity of the distal interphalangeal joint of the left fifth finger. Initial conservative treatment was unsuccessful, leading to surgical intervention, which involved resecting the hypoplastic portion of the extensor tendon and directly suturing the healthy proximal and distal portions. The surgery was reinforced with a periosteal strip from the middle phalanx. Postoperative recovery was monitored with physical therapy, and the patient showed successful correction of the deformity after 12 months. There was no recurrence of the deformity or functional limitations. The surgical technique proved effective in resolving the deformity, restoring function, and providing an excellent cosmetic result. 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 Dupuytren’s disease following hand trauma: A systematic review. Novo, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Aetiology Topic: Dupuytren's onset - Trauma This systematic review assessed the relationship between trauma and Dupuytren’s disease onset. A total of 22 studies were included in this review, most of which were cross-sectional studies with a few prospective and retrospective ones. The results showed that both surgical and non-surgical hand trauma may contribute to disease onset, particularly in genetically predisposed individuals. In terms of non-surgical trauma, it appears that repetitive mechanical stress, vibration exposure, and sports-related injuries are potential risk factors. Evidence for surgical trauma was more inconsistent. The hypotheses provided for trauma onsetting Dupuytren's disease cascade include the onset of inflammation and fibrotic pathways, including TGF-β signalling, leading to myofibroblast activation and collagen deposition in susceptible individuals. 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, it appears that trauma to the hand can contribute to Dupuytren's disease onset in genetically predisposed individuals. Trauma may include repetitive mechanical stress, vibration exposure, and sports-related injuries. There is a growing body of evidence suggesting that connective tissue disease may cluster in patients genetically predisposed presenting with conditions like carpal tunnel syndrome and trigger finger. URL: https://doi.org/10.1177/17531934251360545 Abstract Trauma, particularly surgical trauma, has been suggested as a potential trigger for Dupuytren’s disease (DD). This systematic review examined the prevalence of DD after surgical and non-surgical hand trauma by conducting thorough searches of the PubMed, Embase, Cochrane and Scopus databases. Qualitative methods were used to synthesise the data and summarize the findings that were unsuitable for meta-analysis. The findings revealed an increased risk of DD associated with exposure to hand-transmitted vibration, sports-related trauma and distal radial fractures. Surgical procedures such as trigger finger release were also found to be associated with an increased risk, particularly in individuals who are predisposed to the condition. Key risk factors included age, male sex, diabetes and smoking. Hand trauma, particularly surgical trauma and repetitive mechanical stress, is associated with the onset of DD. These findings highlight the need to consider the risk of developing DD in patients undergoing surgery or sustaining an injury. Further research is needed to develop preventive strategies for at-risk populations. 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 spontaneous tear of the medial collateral ligament while batting: Results of nonoperative treatment: A case report. Hanna, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: MCL partial tear - Recovery This case reports on an elite high school baseball player who sustained a partial tear of the medial collateral ligament (MCL) in his dominant elbow whilst batting. The 14-year-old patient experienced acute pain and a popping sensation during a swing, with no prior history of elbow issues. Following 4 weeks of rest, he was unable to return to play due to persistent pain and weakness. Physical examination from an orthopaedic team revealed no valgus instability but a partial MCL tear on MRI. After four months of strict rest the MRI was repeated and the MCL had fully healed. Following this, the patient was gradually returned to batting and throwing. 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, elbow MCL injuries during batting, although rare, can occur in baseball players. Conservative management can be effective in cases of partial MCL tears, provided there is strict adherence to rest followed by a well-structured rehab program. If you are interested in elbow medial collateral injuries and training adaptations, have a look at the database on the topic. URL: https://doi.org/10.1016/j.jse.2024.11.040 No Abstract available 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

Prognostic value of the CURL classification system for proximal ulna fracture dislocations of the elbow. Bagga, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Coronoid and ligament lesions - Elbow complications This retrospective study evaluates the prognostic value of the Coronoid, Proximal Ulna, Radius, and Ligaments (CURL) classification system for proximal ulna fracture dislocations. Over a 10-year period, researchers analysed 182 patients to assess how the system predicts patient-reported outcomes and complication rates. The results showed a high complication rate of 40%, consistent with other studies. Key factors influencing prognosis included injuries involving the coronoid process and ligaments, which were significantly correlated with poorer outcomes, particularly when unrecognised or inadequately treated. 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 presence of non-reduced coronoid processes fractures alongside the lack of ligament reconstruction, was associated with worse outcomes. As expected higher complexity fractures and ligament lesions were associated with worse complications, explaining the 1 in 2 people occurrence of complications. Other strategies to assess who will require further surgery, especially for post-traumatic elbow stiffness are presented on this calculator, which you can have a look at! URL: https://doi.org/10.1016/j.jse.2024.11.026 Abstract Background: Proximal ulna fracture dislocations comprise a wide spectrum of injury. The Coronoid, proximal Ulna, Radius and Ligaments (CURL) classification is a simple framework designed to aid surgical decision-making by focusing attention on the key components of the injury and their relative severity. It has been demonstrated to have a high interobserver and intraobserver reliability. The aim of this study was to analyze the prognostic value of the CURL classification with respect to patient outcome. Methods: The CURL framework was applied retrospectively to 182 patients treated surgically for a proximal ulna fracture dislocation in a level 1 trauma center. Patient outcomes collected included complication rate, reoperations, patient satisfaction, and Oxford Elbow Score (OES). The CURL score overall and each individual component were assessed for the effect on outcome. Appropriateness of surgical fixation was also assessed and correlated with outcome. Results: Of 182 patients, 69 (37.9%) had at least 1 major or minor complication and the overall CURL score was associated with a higher rate of complications (r = 0.85, P = .02). The presence of a coronoid fracture as well as the radial head and ligament components was associated with increased complications (coronoid: r = 0.26, P < .01; radial head: r = 0.36, P < .01; ligament: r = 0.38, P < .01). The complication rate was higher as the CURL value increased for both coronoid and radial head components (coronoid score 0 = 30.9%, coronoid score 1 = 54.6%, coronoid score 2 = 69.2% and radial head score 0 = 26.1%, radial head score 1 = 50.0%, radial head score 2 = 73.3%). The median OES was 43, and the total CURL score was correlated with inferior OES (r = –0.89, P = .01) as were the coronoid, radial head, and ligament components (coronoid: r = –0.43, P < .01; radial head: r = –0.38, P < .01; ligament: r = –0.42, P < .01). The proximal ulna fracture severity was not correlated with increased complication rate or OES. Patients deemed to have inappropriate fixation (20.8%) had a significantly higher complication rate (65.8% vs. 30.5%, P ≤ .001), with the 9 patients with inadequate coronoid fixation demonstrating a 100.0% complication rate. Conclusion: Proximal ulna fracture dislocations have a high complication rate and are intolerant to inadequate fixation. The CURL system demonstrates prognostic value with the coronoid component most influential on outcome. 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

Traumatic loss of adduction of the little finger. Sato, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: Loss of finger adduction - Palmar interossei avulsion This is a case report on a traumatic abduction of the little finger in a 12-year-old girl who caught her finger in a hoop during gymnastics. At the first assessment, passive adduction was possible, but active adduction was impaired (see picture). MRI imaging revealed detachment of the third palmar interosseous muscle tendon from the proximal phalanx. Conservative treatment with buddy taping was trialed for three weeks without success. The surgical approach involved a zigzag incision between the metacarpal bones, identifying the detached muscle, and using an ulnar half-slip of the fourth flexor digitorum superficialis tendon for reconstruction of the interossei tendon. A bone tunnel was created at the proximal phalanx base, through which the tendon was threaded and sutured to the periosteum under tension. The little finger was temporarily fixed in 60 degrees adduction with a Kirshner wire, followed by functional exercises post-wire removal. One year post-surgery, the patient achieved active adduction, restored grip strength (26 kg), and resumed gymnastics without issues. 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, little finger abduction has been often described as the result of ulnar nerve involvement (Wartenberg's sign), however, in traumatic instances, this sign may be caused by avulsion/rupture of the third palmar interossei tendon. Advanced imaging may be required to identify the lesion. If you are interested about other subtle pathologies of the intrinsic muscles of the hand, have a look at "saddle syndrome". URL: https://doi.org/10.1177/17531934251363113 Abstract We report a case of traumatic abduction of the little finger. FRACTURE was useful for identifying avulsion of the third palmar interosseous muscle. Reconstruction using an ulnar half-slip of the fourth flexor digitorum superficialis tendon led to good functional outcomes. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Does a counterforce brace reduce common extensor tendon loading during a wrist extension task? An in vivo study. Magni, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Counterforce brace - Tendon loading This cross sectional study assessed the effect of a counterforce brace inflated to 80 mmHg on common extensor origin (CEO) loading during wrist and finger extension tasks. A total of 19 healthy participants were assessed across four levels of muscle contraction, namely 0%, 20%, 30%, and 40% of maximum voluntary contraction (MVC). Share wave velocity measurements collected via ultrasound imaging were utilised to measure tendon stiffness. The results showed no significant reduction in tendon stiffness when wearing the brace compared to no compression. However, tendon stiffness increased with higher muscle activation, aligning with expectations that greater tension on the tendon would stiffen it. 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, counterforce braces do not appear to reduce loading on the common extensor origin (CEO) during a wrist and finger extension task. This is in contrast with cadaver studies showing reduction in CEO when tension was applied distally to the wrist extensors tendons. This recent in vivo study appears to align with clinical studies showing that a counterforce brace does not provide a large treatment effect for people with CEO tendinopathies. URL: https://doi.org/10.1016/j.jbiomech.2025.112909 Abstract This study assessed the biomechanical effect of a counterforce brace on the common extensor origin (CEO) tendon at the elbow via the measurement of shear wave velocity (SWV) using ultrasound. The counterforce brace was hypothesised to reduce SWV, which is a proxy measure of tendon stiffness, whilst the wrist and finger extensors were contracting at different levels of maximum voluntary contraction (MVC). In this cross-sectional study, nineteen healthy participants (age±SD: 30±9) were included in the study. The counterforce brace was applied with either 0 or 80 mmHg pressure to the forearm. The SWV was measured under four different wrist extensors MVC levels: 0%, 20%, 30%, and 40%. The counterforce brace had no significant effect on CEO tendon SWV at rest (V-statistic = 86, p = 0.74), 20% (V-statistic = 105, p = 0.71), 30% (V-statistic = 87, p = 0.77), or 40% (V-statistic = 94, p = 0.98) of MVC. The Friedman test for repeated measures showed an increase in SWV with greater levels of wrist extension MVC (x2 = 7.9, p = 0.048). In conclusion, the counterforce brace does not appear to have a biomechanical effect on the CEO of the elbow during resting conditions or whilst the wrist extensors are contracting. The SWV of the CEO, a proxy for tendon stiffness, increases with greater levels of MVC. 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