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A 20-year national decline in wrist fractures: Unraveling trends and persistent challenges. Dinh, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study : Aetiological Topic : Wrist fractures - Incidence This retrospective study assessed wrist fracture trends over two decades in the USA. A total 106,929 wrist fractures were identified by utilising the National Electronic Injury Surveillance System (NEISS) and USA census data. Amongst all, young males experienced higher rates of sports-related fractures, particularly from activities like biking, American football, and skateboarding. Sporting injuries accounted for 48% of all cases. Conversely, older women over 65 years old had the highest risk for non-athletic fractures, often resulting from falls at home, contributing to 52% of the non-athletic fractures. Overall, the incidence of fractures in the past 20 years had been declining, suggesting a positive trend. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, there has been a decline in overall incidence of wrist fractures since 2004. This patter is specifically true for younger athletes, however, incidence is unchanged for older people. We know that heavy resistance training and osteoporosis screening can reduce the future risk of frailty fractures, the only thing we need to know is implementing this knowledge into our daily practice. Remember that by simply looking at a hand x-ray, you can estimate people's bone mass density , use it! URL : https://doi.org/10.1016/j.hansur.2025.102151 Abstract Background: Wrist fractures are among the most common upper extremity injuries. Despite their prevalence and significant societal and healthcare costs, long–term epidemiological data on national wrist fracture trends remain limited. Methods: This retrospective study analyzed data from the National Electronic Injury Surveillance System (NEISS) and U.S. Census data to evaluate national trends in wrist fractures from 2004 to 2023. Utilizing weighted sampling techniques, incidence rates were calculated, and demographic patterns, causes, and differences between athletic and non–athletic injuries were assessed. Statistical analyses included regression models, chi–square tests, and injury proportion ratios (IPR). Results: Over the twenty-year study period, there were a reported 106,929 wrist fractures, representing 4,040,516 cases nationwide (95% CI: 3,414,316–4,666,716). The incidence declined significantly over the study period from 78.04 per 100,000 person–years in 2004 to 60.27 in 2023 (p < 0.05), representing a 22.7% decrease in overall wrist fracture incidence rates. Males aged 5–14 years showed the highest fracture rate (238.2 per 100,000), primarily driven by sports–related injuries such as bicycling, football, and skateboarding. Conversely, females aged ≥65 years had the highest risk of non–athletic fractures, often due to falls on stairs or floors. Nearly half (47.96%) of all wrist fractures were sports–related, with males three times more likely than females to sustain such injuries (OR: 3.05, p < 0.001). Conclusion: This comprehensive analysis of wrist fracture trends over two decades reveals a significant decline in overall incidence, with notable demographic patterns. These findings underscore the importance of targeted prevention strategies, such as improving safety measures in youth sports and enhancing fall prevention programs for older adults, while highlighting the need for continued research to inform effective prevention and treatment 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

Post-burn carpal tunnel syndrome: A systematic review. Albert, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Aetiologic/Prognostic Topic : Burns - Carpal tunnel syndrome A 23 yrs old left-handed man suffered a 63,000 volt electric arc burn. They had 30% second degree and 10% first degree burns. At five months from injury, they started developing tingling in the thumb, index, and middle finger of the left hand. Grip strength on the right was 20kg and 5kg on the affected side. Two-point discrimination in the left hand was 6 mm. Eleven months from injury, a nerve conduction study (NCS) was completed, revealing median nerve impairments. Ultrasound imaging was completed excluding the presence of anatomical variations responsible for the carpal tunnel syndrome (e.g. persistent median nerve artery). Carpal tunnel release was completed. Six months after surgery, night paraesthesia had resolved, however, day paresthesia was still present. Two point discrimination improved to 3 mm alongside grip strength (R: 20 kg; L: 15 kg). Sensory NCS had improved, but motor conduction had not. Improvements in self reported upper limb function had been marginal and clinically irrelevant. The authors also completed a systematic review to assess the relationship between burn injuries and peripheral nerve damage, particularly focusing on carpal tunnel syndrome (CTS). A total of 31 studies were included, most of which (70%) were restrospective cohorts. The results showed that the burns description was poor with a mix of electrical, thermal, and chemical burns. The most common neuropathy reported was carpal tunnel syndrome. An important finding was the delayed in treatment of the neuropathy due to burns management requiring priority. Below you can find a flowchart to monitor nerve function in post-burn patients. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, burn are often associated with peripheral nerve damage, which often involves the median nerve. Early neurological assessments are crucial post-burn to identify potential nerve issues like carpal tunnel syndrome. Factors which may predispose patients to this presentation include space invading lesions or persistent median nerve artery amongst others. URL : https://doi.org/10.1016/j.hansur.2025.102134 Abstract Objectives: Post-burn neuropathy is a little-known pathology. However, the nerve is the most sensitive organ to burns, especially electrical burns. Carpal tunnel syndrome is the most common mononeuropathy worldwide and the most common post-burn neuropathy. The aim of this study is to evaluate, through a review of the literature, the specificities of the management of mononeuropathy of the median nerve at the wrist occurring at a distance from the burn injury. Methods: A comprehensive search of the literature was conducted using the Cochrane Library, PubMed, and EMBASE. We included all articles that mentioned nerve injury associated with burns and excluded those that did not address the median nerve or in which the median nerve was the subject of early release. For each study, we compared diagnostic methods and patient management elements. We propose to associate to this review the case of a 23-year-old male victim of an electrical burn who developed a carpal tunnel at a distance from his burn. The patient underwent surgery and was evaluated 1 mo and 6 mo after surgery using grip strength, Weber’s two-point discrimination test, QuickDASH, and BCTSQ questionnaires. An electromyogram was performed preoperatively and 6 mo postoperatively. Results: Thirteen articles met the inclusion criteria and were reviewed. The majority of these involved electrical and thermal burns, with TBSA ranging from 2% to 65%. The affected population was young (36.7 years) and predominantly male. The mean hospital stay was 59.1 days, compared with 137.5 days for diagnosis delay. Diagnostic electromyography was not always performed. No study used ultrasound or MRI to look for an etiology other than burns in the development of carpal tunnel syndrome. All studies that reported symptom improvement after treatment did not use a functional score. In our case, grip strength on the operated side improved moderately. Discriminative sensation was restored. QuickDASH and BCTSQ scores were initially poor and improved very modestly after surgery. Electromyography showed recovery of sensory conduction but no recovery of motor conduction. Conclusion: Carpal tunnel syndrome can have significant functional consequences in burn patients because it is often overlooked and treated late. Early clinical and electromyographic diagnosis is essential to ensure surgical management before irreversible intra-neural injury occurs. Ultrasound could be useful for the early detection of signs of median nerve injury at the wrist when electromyography is not possible, and to verify the absence of another associated etiology in the development of carpal tunnel syndrome after burns. We propose a decision algorithm for the management of carpal tunnel syndrome associated with burns. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Clinical and functional outcomes of distal biceps tendon repair using all-suture anchors. Hayta, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Distal biceps repair - Sutures with bone anchor This retrospective study assessed the outcomes of distal biceps tendon repair using suture anchors only. A total of 40 patients were included in the study. The injury mechanisms varied, including lifting (38%), sports activities (15%), and falls (8%). Surgical technique involved a ventral approach to expose the radial tuberosity, where two suture with bony anchors inserted at a 45 deg angle were applied. Postoperative results showed normal elbow flexion (140 deg) and extension (0 deg) with minimal differences between operated and contralateral sides. Elbow flexion and supination strength measured 97% and 85% of the unaffected side respectively. Patient-reported outcomes indicated low pain levels and high functional recovery. Re-ruptures were 2.5% of all cases. 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, distal biceps tendon repair using sutures with bone anchors and no bony tunnels for endobutton is a feasible option. Thus, it provides good elbow range of movement a strength outcomes. Self-reported functional and pain outcomes were also good with a low number of complications. This repair option may become widespread in the future as the more widespread endobutton approach appear to have higher number of post-surgical complications . URL : https://doi.org/10.1016/j.jse.2025.06.005 Abstract Background: Various surgical approaches and fixation methods are available for distal biceps tendon repair. Although all-suture anchors offer theoretical advantages and are widely used in orthopedic surgery, clinical data on their use in distal biceps tendon repairs remain limited. This study aims to evaluate the clinical and functional outcomes of distal biceps tendon repair using two all-suture anchors via a single-incision approach. We hypothesized that this technique would result in effective restoration of supination strength, excellent patient-reported outcomes, and a low re-rupture rate. Methods: A retrospective analysis was conducted on patients who underwent distal biceps tendon repair using all-suture anchors between September 2016 and September 2022. A total of 40 patients were included. At clinical follow-up, range of motion (ROM), elbow flexion, and forearm supination strength were measured and compared to the contralateral side. Subjective outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Subjective Elbow Value (SEV), Mayo Elbow Performance Score (MEPS), American Shoulder and Elbow Surgeons Standardized Elbow Assessment Questionnaire (pASES-e), and visual analog scale (VAS) for pain. Complications were recorded. Results: The mean age at the time of injury was 51.9 ± 9.2 years. The mean follow-up duration was 4.8 ± 2 years, and the mean time between injury and surgery was 14.2 ± 11.9 days. Median DASH, SEV, MEPS, and pASES-e scores were 2.3 (range, 0–31.8), 100 (range, 50–100), 100 (range, 70–100), and 98 (range, 53–100), respectively. The median pain level on the VAS was 0 (range, 0–7), with only one patient reporting pain at rest. Mean relative elbow flexion strength compared to the uninjured side was 99.5 ± 23.3%, and forearm supination strength was 88.7 ± 28.2%. The re-rupture rate was 2.5%, with one case occurring within the first postoperative week. All patients returned to work after an average of 8.7 ± 8.4 weeks, and 96.9% (31/32) returned to sports, with 81.3% (26/32) returning to >90% of their pre-injury activity level. Conclusions: Our findings demonstrate that distal biceps tendon repair using two all-suture anchors via a single-incision approach yields excellent patient-reported outcomes. With a low re-rupture rate as well as high return-to-work and return-to-sport rates, this technique appears to be a reliable treatment option. However, the observed reduction of forearm supination strength underscores the need for further research to optimize anatomical footprint coverage. 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

Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) A 23 yrs old left-handed man suffered a 63,000 volt electric arc burn. They had 30% second degree and 10% first degree burns. At five months from injury, they started developing tingling in the thumb, index, and middle finger of the left hand. Grip strength on the right hand was 20kg and 5kg on the affected side. Two-point discrimination in the left hand was 6 mm. What is it and what tests would you do?

Dynamometer elbow strength and endurance testing after distal biceps reconstruction with allograft. McGee, et al. (2015) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Distal biceps repair - Allograft tendon This study assessed the strength and functional outcomes of distal biceps reconstruction using allograft tissue. A total of 10 patients with a mean age of 48 years underwent surgery with Achilles tendon (90%) and tibilialis anterior/gracilis (10%) allograft. Patients underwent elbow flexion and supination strength/endurance test at 13 to 81 months after surgery. Patients underwent isokinetic dynamometer testing at 60°/s for strength and 240°/s for endurance, as well as isometric strength testing for elbow flexion and forearm supination. Results showed that the operative limb achieved near-normal strength, with peak torque in flexion (92%) and supination (93%) of the unaffected side. Fatigue indices were comparable between limbs, indicating similar endurance performance. 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, reconstructing the distal biceps using allograft tissue is a safe and effective approach. Strength deficit was less than 10% compared to the unaffected side , which is much better compared to the strength deficit you would have without a repair (25% to 30% deficit) . These findings are in line with previous research suggesting that distal biceps repair for full tears are usually beneficial in active people . URL : https://doi.org/10.1177/2325967115S00166 Abstract Objectives: The purpose of the current study is to investigate the functional strength outcomes of late distal biceps reconstruction using allograft tissue. Methods: Patients who underwent distal biceps reconstruction with allograft tissue between May 2007 and May 2013 were identified. Charts were retrospectively reviewed for post-operative complications, gross flexion and supination strength, and range of motion (ROM). Isokinetic strength and endurance in elbow flexion and forearm supination were measured in both arms. Tests were conducted using a dynamometer at 60o per second for isokinetic strength and 240o per second for endurance. Isometric strength testing was also measured for elbow flexion and forearm supination. Paired t tests were used for statistical analysis. Results: Ten patients with a mean age of 48 years (range 42 - 61 years) were included in the study. Distal biceps reconstruction was performed using an Achilles tendon allograft in 9 patients and a combination of tibialis anterior allograft and gracilis allograft in 1 patient. Of the reconstructions, 50% involved the dominant arm. Full ROM was observed in all patients at the time of their final follow up assessment. The mean follow- up for dynamometer strength testing was 34 months (range 13-81 months). No statistical differences were noted between data obtained from operative and contralateral extremities. The average peak torque of the operative limb (38.5± 5.9 Nm) was 91.7% of that of the contralateral limb (41.8±4.9 Nm) in flexion and 93.4% (operative, 5.7±1.3 Nm; contralateral, 6.1± 1.0 Nm) in supination. No significant differences were found in fatigue index between operative or contralateral limbs for flexion (operative, 34.1±17.1%; contralateral, 30.8±17.1%; p = 0.29) or supination (operative, 38.2±16.5%; contralateral, 42.1±11.9%; p = 0.65). . The only complication observed was a transient PIN palsy in one patient which resolved by 3 months post-operatively. All patients reported postoperative cosmetic deformity but found their gross appearance acceptable. Conclusion: Late reconstruction for chronic distal biceps rupture using allograft tissue is a safe and effective solution for symptomatic patients with functional demands in forearm supination and elbow flexion. Dynamometer testing shows near normal return of strength and endurance of both elbow flexion and supination following the procedure. 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

Augmented anterior capsular plication for Type II atraumatic anterior sternoclavicular joint instability refractory to non-operative treatment based on structural anatomic MRI findings. Tytherleigh, et al. (2025) Level of Evidence : 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : SCJ - Stabilisation This retrospective study assessed the outcomes following surgical stabilisation of the anterior sternoclavicular joint (SCJ). A total of 13 participants with atraumatic presentation of SCJ instability confirmed by MRI were included. Age ranged from 16 to 25 years old and the majority were female (9 participants). All participants had trialled a conservative management approach first. A capsular splitting and plication augmented with suture anchors was utilised in all the patients. The results showed that QuickDASH reduced from an average of 32 to 1 out of 100 at six months post-surgery. 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, capsular plication with augmentation may be useful in those patients reporting collar bone instability at the sternum. Participants numbers in this study were however small and surgical risks of affecting lungs or important vessels should be disclosed. Overall, this study offers a new surgical option for rare cases of atraumatic SCJ instability. If you are interested in other shoulder presentations that you might come across working in hand and upper limb rehabilitation, have a look at the entire collection! URL : https://doi.org/10.1016/j.jse.2025.06.003 Abstract Background: Atraumatic anterior sternoclavicular joint (SCJ) instability is attributable to a component of capsular laxity (Type II) and muscle sequencing (Type III). The majority of patients can be successfully treated by a specialist physiotherapy protocol. However, a small number of patients, despite adequate treatment, remain symptomatic due to a residual Type II capsular laxity component. We have undertaken an augmented anterior capsular plication (ACP) procedure for patients with residual Type II atraumatic SCJ instability, confirmed by MRI, refractory to adequate non-operative treatment. Materials & Methods: Between 2015 and 2021 all patients that underwent an ACP for atraumatic SCJ instability with no evidence of a ligamentous capsular injury on MRI scan and were refractory to adequate non-operative treatment were reviewed. Exclusion criteria were patients that had not undergone adequate non-operative treatment, with a ligamentous injury on MRI scan or had undergone previous surgery. The procedure was a modification of a previously described augmented capsular repair for traumatic anterior SCJ instability. It consisted of a suture plication of the anterior capsule protected by an InternalBrace (Arthrex, Naples, FL, USA) between the medial clavicle and sternum. Patient-reported outcomes were assessed at 6 months, 12 months and at final follow-up by the following scores: Rockwood SCJ, Oxford Shoulder Instability Score (OSIS) and Single Assessment Numeric Evaluation (SANE). Optional questions were asked about the patients’ preoperative and postoperative participation in extracurricular activities and sport. Survivorship was defined as no clinical failure, such as instability or recurrent dislocation, and no revision surgery. Results: A total of 13 patients who underwent an ACP and were available at final follow-up were included. The mean age at surgery was 20.5 years (16-25) and the mean follow-up was 46.5 months (25-75). At final follow-up the mean Quick-DASH score had dropped from 32.2 (22.7 – 40.9) to 0.9 (4.5 – 0), the mean Rockwood score had risen from 7.5 (6 – 9) to 15 and the mean OSIS score had risen from 24.8 (18 – 31) to 47.5 (46 – 48). These all reached statistical significance. The mean SANE score at final follow-up was 95.5 (89 – 100). With regards to return to sport and extracurricular activities all of the patients considered their SCJ to be either “normal” (11 Patients) or to have “minor difficulties”. The repair/construct survivorship was 100%. Conclusion: Undertaking an augmented capsular plication on patients with symptomatic atraumatic SCJ instability confirmed by MRI imaging that have failed appropriate non-operative treatment provides a satisfactory result with regards to clinical outcomes and joint stability. 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

Is the anconeus epitrochlearis muscle a predictor for ulnar nerve compression?. Debras, et al. (2025) Level of Evidence : 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Aetiologic/Prognostic Topic : Anconeous epitrochlearis - Cubital tunnel syndrome. This retrospective study assessed the prevalence of the anconeus epitrochlearis (AE) muscle and its impact on cubital tunnel syndrome. A total of 1,240 participants who had undergone elbow MRI, were included in the study. A further 344 participants who had undergone ulnar nerve surgery were included. The results showed that AE was present in 5.9% of people undergoing an MRI. The presence of AE was not associated with an increased risk of ulnar nerve compression or subluxation, nor did it influence surgical outcomes or recovery time. Both groups, with and without AE, demonstrated similar rates of symptom resolution postoperatively. However, the study noted that preoperative nerve status, particularly hypoesthesia compared to paresthesia, was a significant predictor of surgical success. The findings suggest that the AE does not predispose individuals to cubital tunnel syndrome or negatively impact treatment outcomes. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, anconeus epitrochlearis (AE) is present in 6% of individuals or roughly in 1 out of 20 people we see. The presence of the AE is not associated with an increased risk of ulnar nerve compression or subluxation. Following cubital tunnel release, those with and without AE experienced similar rates of symptom resolution postoperatively. These findings appear to be in contrast with a previous study showing a higher prevalence of AE (1 in 10 people with cubital tunnel syndrome), although their sample size was 60% of the current study . URL : https://doi.org/10.1016/j.jse.2024.09.039 Abstract Background: The role of the anconeus epitrochlearis (AE) in cubital tunnel syndrome, either as protector or potential compressor of the ulnar nerve, as well as its prevalence in both symptomatic and asymptomatic patients is still unclear. This study aimed to assess the prevalence of the AE in a large cohort using 3-dimensional imaging and to investigate any association of the AE with preoperative or postoperative features of patients undergoing cubital tunnel surgery. Methods: From a database of 1240 elbow magnetic resonance imagings, all patients with an AE were retrospectively screened for major criteria of cubital tunnel syndrome. A matching cohort without AE was then similarly assessed to deduct the prevalence of AE and evaluate potential correlations. Next, 344 ulnar nerve surgeries were reviewed. Data including pre- and postoperative physical exam findings, electromyographic study results, reason for compression or (sub)luxation, presence of AE, time to improvement, and need for reoperations were collected. The prevalence of AE in the symptomatic population was determined and possible associations were explored. Results: The overall prevalence of AE in the population, based on magnetic resonance imaging data, was 5.9%, which closely matched the 5.8% prevalence observed in the operative population. Among the AE group of 13 patients, all were treated with myotomy and in situ decompression during surgery. No higher reoperation rate was seen in the AE group compared to the non-AE group. Conclusion: The contribution of the AE to the compression neuropathy or protection of the ulnar nerve could not be discerned for the standard population. Therefore, in the routine practice, the AE should be considered as a rare and nonpathological anatomical variant, devoid of any surgical implications. 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

Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow: A Systematic Review. Fares, et al. (2022) Level of Evidence: 3a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : LUCL reconstruction - Success This systematic review assessed outcomes following lateral ulnar collateral ligament (LUCL) reconstruction for postero-lateral rotatory instability of the elbow (PLRI). Eleven case series for a total of 148 participants were included in the review. The results showed that LUCL reconstruction consistently achieves lateral elbow stability and reduces pain, with most patients achieving postoperative stability (90%) and a mean Mayo Elbow Performance Score (MEPS - 0 to 100 with higher score representing better outcomes) of 89.7 at long-term follow-up. Graft selection varies, with the palmaris longus tendon being the most frequently used (45%), followed by triceps tendon (24%) and synthetic grafts (7%). Complications include persistent moderate to severe pain in 11% of patients and recurrent instability leading to reoperation in 2.7%. Picture from Rotaman et al. (2023) - https://www.handyevidence.com/post/how-much-does-the-posterolateral-ligament-of-the-elbow-contribute-to-stability 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 : Base on what we know today, 9 out of 10 people achieved elbow stability and good functional recovery following LUCL repair. Complications include persistent pain (1 in 10 people) and reoperations (3%). This suggests that despite this surgery being succesful, we should counsel patients on potential postoperative complications . LUCL reconstruction appears to be beneficial for young, active individuals requiring high elbow stability. If you want to know more about the important anatomy of the LUCL, have a look at the entire database . URL : https://doi.org/10.1177/1558944720917763 Abstract Background: Posterolateral rotatory instability (PLRI) is a common form of recurrent elbow instability. The aim of this systematic review is to present the outcomes and complications of lateral ulnar collateral ligament (LUCL) reconstruction surgery for PLRI. Methods: A literature search of LUCL reconstructions was performed, identifying 99 potential papers; 11 of which met inclusion/exclusion criteria, accounting for 148 patients. Papers were included if they reviewed cases of PLRI from 1976 to 2016 with reported outcome measures. Data were pooled and analyzed focusing on patient demographics as well as subjective and objective patient outcomes and complications. Results: The average age of patients was 34 years with a mean follow-up time of 49.8 months. The most common mechanism of injury was a traumatic elbow dislocation (66%), followed by cubitus varus deformity (7%), and unknown mechanisms (7%). Overall, 90% of patients achieved elbow stability and 2.7% experienced a failed reconstruction that necessitated an additional surgery. Furthermore, 93% were satisfied with the outcome of the reconstruction, and 83% reported good to excellent outcomes with 11% reporting moderate to severe persistent pain. Nearly half (45%) of reconstructions were done using a palmaris longus tendon graft, 24% with a triceps tendon graft, and 7% with a synthetic graft. Conclusions: Outcomes following LUCL reconstruction for PLRI are excellent and revision rates are low. LUCL reconstruction is a safe and reliable procedure. 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

Patient perception of a community - based thumb osteoarthritis group: A qualitative service evaluation. Bamford, et al. (2025) Level of Evidence : 3a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Thumb OA - Community based group This service evaluation qualitative study assessed the value and reported experiences of people attending a community-based group for thumb osteoarthritis (OA). Two focus groups were completed to collect data. Participants highlighted the benefits of face to face interactions, practical advice on exercises, self-management strategies, and the social support provided by peers. They appreciated the biopsychosocial approach to managing their condition, acknowledging its complexity. However, challenges such as travel barriers, unclear referral pathways, and potential language inequities were noted. The study suggests that while the group intervention is well-received, improvements in access and equity are essential. Image from Duong et al. (2021) - https://www.handyevidence.com/post/is-mcpj-hyperextension-during-pinching-associated-with-greater-pain-in-thumb-oa 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, community groups for thumb OA are well received, particularly due to their holistic biopsychosocial approach. Participants valued face-to-face interactions and peer support. However, challenges such as travel barriers, unclear referral pathways, and language inequities can be problematic. If we were to implement this idea, we should integrate international guidelines alongside more recent evidence on the effectiveness of exercises and splinting , similarly to what the authors of this study have done. If you are interested in additional option for thumb OA such as resistance training or surgery, have a look at the database on the topic . URL : https://doi.org/10.1177/17589983251356917 Abstract Introduction: Base of thumb osteoarthritis (OA) is a common degenerative condition, causing pain, stiffness, weakness and functional limitations. Most patients initially present to their GP. It is important that patients have timely access to therapy interventions. A base of thumb OA group was established within a U.K. inner-city location, as part of a community musculoskeletal therapy service. The group aligned with international clinical guidelines, providing a treatment package including exercise, educational advice and behaviour change strategies. Methods: A prospective qualitative service evaluation was undertaken, with an aim of understanding patients’ experiences and views about the base of thumb OA group. Focus groups were undertaken with six patient participants and were recorded, transcribed and analysed thematically. Results: Participants were positive about the impact of the group on self-management of their condition. Participants recognised the complex nature of base of thumb OA and felt that the group provided holistic support. Participants expressed a need for long term support. From a practical perspective participants described some lack of clarity regarding the clinical pathway and referral routes and a lack of support during the waiting period. Participants expressed a preference for face-to-face care delivery. Discussion: Participants appeared supportive of the base of thumb OA group. It appears that such groups can be delivered in a community setting. Some practical service design and delivery lessons were learned. Further research would expand this relatively small scale, pragmatic service evaluation. 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

Assessing long-term outcomes after operative management of elbow stiffness secondary to heterotopic ossification. Liu, et al. (2025) Level of Evidence : 3a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Heterotopic ossification - Excision This retrospective study assessed the long-term outcomes of elbow heterotopic ossification (HO) excision. A total of 48 participants were included in the present study. Pre-surgical range of movement for elbow in e/f and supination/pronation was 50 deg (range 10-75) and 80 deg (range 10-135) respectively. Following surgery, elbow e/f and supination/pronation reached 110 deg (range 95-130 deg) and 170 deg (range 105-180 deg) respectively. There was therefore a 60 deg arc of motion improvement for e/f and 90 deg arc of motion improvement for supination/pronation. Pain post surgery (Visual Analog Scale - VAS) ranged from 0 to 4 with a median of 2/10. Complications occurred in 15 patients (28%), including 5 people requiring a total elbow arthroplasty and others requiring additional surgery for elbow instability, stiffness, or ulnar nerve entrapment. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, heterotopic ossification excision improves range of motion and functional outcomes for most patients. On average the arc of motion improvement is 60 deg for extension/flexion and 90 deg for supination/pronation. It is important to remind patients that it is unlikely they will regain full range of motion and that there is a potential for complications requiring further surgery or even a total elbow replacement . Further education is also important on what to expect if people present with cubital tunnel syndrome and require a release . URL : https://doi.org/10.1016/j.jse.2024.11.019 Abstract Background: Heterotopic ossification (HO) of the elbow resulting in limited motion is a relatively uncommon condition often caused by burns, trauma, and central nervous system injuries. This retrospective study presents the long-term outcomes of 51 cases of elbow HO treated with surgical excision and regimented postoperative rehabilitation protocol. Methods: A retrospective case series was conducted on 48 patients (51 elbows) who underwent surgical excision of elbow HO. All procedures were performed in the inpatient setting at an Academic Level I Trauma Center between September 1999 and August 2022 by fellowship-trained upper extremity surgeons. Patient demographics and case characteristics such as age, gender, mechanism of injury, and comorbidities were collected for comparison. Long-term follow-up examinations were elbow flexion-extension arcs, prono-supination arcs, Visual Analog Scale pain scores, and Mayo Elbow Performance Score. Results: Patients were followed for a minimum of 2 years with an average follow-up of 8 years (range, 2-24 years). The median flexion-extension arc at final follow-up was 110° (95°-130°), which was maintained at 85% of the intraoperative arc achieved. Prono-supination arc at final follow-up was 170° (105°-180°), which was maintained at 97% of intraoperative levels. The median reported Mayo Elbow Performance Score and Visual Analog Scale score were 80 (70-93) and 2 (0-4), respectively. Although it was not statistically significant, patients diagnosed with type II diabetes had the worst flexion-extension arcs at final follow-up and highest complication rates compared to other risk factors. Conclusion: Surgical excision coupled with HO prophylaxis and a regimented rehabilitation program resulted in a lasting improvement in functional outcomes for patients with elbow dysfunction secondary to HO at long-term follow-up. Overall, patients maintained substantial reductions in pain, improvement in elbow range of motion, and increased overall elbow function. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Biomechanical evaluation of physical examination tests for rotator cuff tears: A computer simulation study. Menze, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Rotator cuff tears - Objective tests This biomechanical simulation study assessed diagnostic shoulder tests for detecting rotator cuff (RC) tears using musculoskeletal modeling. The analysis identifies variations in biomechanical sensitivity among tests, with the Lift-off test being more sensitive than the Bear Hug test for anterior RC tears due its heavy reliance on subscapularis muscle. Conversely, the Jobe and Full-can tests show low sensitivity for detecting superior RC tears, as deltoid is the main muscle involved. The Hornblower test emerged as more effective test for assessing teres minor integrity in posterosuperior RC tears. 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 lift-off test and the Hornblower test are useful in detecting subscapularis and teres minor lesion respectively. Have a look at a previous case study to see how you can differentiate rotator cuff tears from other hand pathologies in your patients . Make sure that you screen your patients who have had an upper limb trauma for these pathologies! URL : https://doi.org/10.1016/j.jse.2024.09.050 Abstract Background: Numerous physical diagnostic shoulder tests have been established to determine the presence of rotator cuff tears and to identify the affected muscles. However, reported sensitivities and specificities of these tests vary strongly. The aim of this study was to identify diagnostic postures that are biomechanically most sensitive in identifying rotator cuff lesions and compensation mechanisms. Methods: A musculoskeletal modeling study investigating muscle activity in healthy shoulders as well as in shoulders with anterior, superior, and posterosuperior rotator cuff tear patterns, was conducted. Muscle moment arms and muscle synergism for the Lift-off and Bear Hug tests, Jobe and Full-can tests, and Infraspinatus and Hornblower tests were compared for healthy and pathological models. Results: In a healthy model the Lift-off test showed significantly higher subscapularis activity compared to the Bear Hug test (P < .001). Teres minor and infraspinatus activity were threefold and twofold higher, in the Hornblower than the Infraspinatus test, respectively. In superior tests, supraspinatus activity was more than twofold lower than lateral deltoid activity and synergistic activity increase was smallest (Δ 1%-3% in deltoid). Activity increase was highest in posterosuperior tests for the teres minor with 66.4% activity increase in the Infraspinatus test (P < .001) and 81.3% increase in the Hornblower test (P < .001). Conclusions: The Lift-off test was significantly more sensitive in detecting subscapularis tears and the Hornblower test was more effective in assessing teres minor integrity in posterosuperior tears. Both, Jobe and Full-can tests demonstrated low biomechanical sensitivity in the detection of superior rotator cuff tears. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Time to recovery of radial nerve palsy after surgically treated humeral shaft fractures. Gomez, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Wrist drop - Natural recovery This retrospective study assessed the outcomes of radial nerve palsy in surgically treated humeral shaft fractures. A total of 471 participants underwent open reduction internal fixation for humeral shaft fractures, of these, 58 patients presented with radial nerve palsy. The first signs of motor recovery happened on average at 4 months from injury. By 9 months, 50% of people had fully motor recovery. By 12 to 18 months, 80% to 90% of people respectively had recovered full motor function. 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, radial nerve palsy following humeral shaft fractures surgery recovers in the large majority of people (8 to 9 people out of 10) within 12 to 18 months. One in 2 people have full motor recovery by 9 months. The first signs of motor recovery tend to appear around the fourth month from injury. Similar recovery times have been reported following radial nerve grafting . If you are looking for a cool splint to improve function during recovery, have a look at this one . If you want to know more about radial nerve pathology in general, have a look at the whole database on the topic ! URL : https://doi.org/10.1016/j.jhsa.2024.11.024 Abstract Purpose: The purpose of this study was to report a timeframe for neurologic recovery of complete radial nerve palsies in patients with humeral shaft fractures treated with internal fixation. Methods: We retrospectively analyzed the data of patients who underwent surgical treatment of a humeral shaft fracture between 2016 and 2021 at a level I trauma center. Patients with complete sensory and motor radial nerve palsy were identified. The time elapsed until detection of the first clinical signs of neurologic recovery, and then until full function (M5 according British Medical Research Council scale) was measured. Results: Of 32 radial nerve palsies in 471 surgically treated humeral shaft fractures (6.8%), 17 were recorded at the time of injury and 15 were noted after surgery. Median patient age was 31.5 years (range, 19–58 years). Thirty patients recovered full motor function at a median time of 36 weeks (range, 6–83 weeks). Kaplan-Meier analyses showed that 90.6% of patients presented the first signs of nerve recovery in the initial 6 months of observation. At 12 and 18 months of follow-up, 84.3% and 94% of patients, respectively, had recovered full function of the hand and wrist. Conclusions: Surgically treated humeral shaft fractures associated with radial nerve palsies are expected to show signs of neurologic recovery during the first 6 months and should recover completely after 12 months of follow-up in almost all cases. 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