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The effect of exercise training on blood lipids: A systematic review and meta-analysis. Smart, et al. (2025) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : Lipids - Resistance training This systematic review and meta-analysis assessed the effects of exercise training on lipid profiles in individuals with dyslipidemia. A total of 148 randomised controlled trials for more than 8,000 participants were assessed. Exercise was divided into resistance training, aerobic conditioning, and a combination of the two. The results showed that combined aerobic and resistance training was optimal for improving lipid outcomes, while resistance training alone showing limited effectiveness (see figure below). The combined effect reduced low density lipoprotein (LDL) by 7 mg/dL with 95% confidence intervals being between 9 and 5 mg/dL. 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 combination of aerobic and resistance training exercise appears to improve "bad" cholesterol by a significant albeit small level. It is important to remember that the improvements obtained with statins tend to be much higher (17 mg/dL to 68 mg/dL) , hence, if patients decide that they want to "self manage" with exercise it may be beneficial to point this out. Remember that in your patients utilising statins, the risk of developing tendinopathies appears to be higher in the first year of use . URL : https://doi.org/10.1007/s40279-024-02115-z Abstract Background: Dyslipidemia is a primary risk factor for cardiovascular disease (CVD). Exercise training (EXTr) improves some lipid markers but not others; the literature is dated and analyses may be underpowered. Objectives: To clarify which lipid markers are altered with ExTr and establish if information size had yet reached futility. Methods: We conducted a systematic review/meta-analysis, with meta-regression, to establish expected effect size in lipid profile with aerobic (AT), resistance (RT) and combined (CT = AT + RT) ExTr. We conducted trial sequence analysis (TSA) to control for type I and II error and establish if information size had reached futility. Results: We included 148 relevant randomized controlled trials (RCTs) of ExTr, with 227 intervention groups, total 8673 participants; exercise 5273, sedentary control 3400. Total cholesterol (TC) MD – 5.90 mg/dL (95% confidence interval (CI) – 8.14, – 3.65), high-density lipoprotein cholesterol (HDL) 2.11 (95% CI 1.43, 2.79), low-density lipoprotein cholesterol (LDL) – 7.22 (95% CI – 9.08, – 5.35), triglycerides – 8.01 (95% CI – 10.45, – 5.58) and very low-density lipoprotein cholesterol (VLDL) – 3.85 (95% CI – 5.49, – 2.22) all showed significant but modest 3.5–11.7%, improvements following ExTr. TSA indicated all analyses exceeded minimum information size to reach futility. CT was optimal for dyslipidemia management. Meta-regression showed every extra weekly aerobic session reduced TC – 7.68 mg/dL and for every extra week of training by – 0.5 mg/dL. Each minute of session time produced an additional 2.11 mg/dL HDL increase. Conclusion: TSA analysis revealed sufficient data exist to confirm ExTr will improve all five lipid outcomes. CT is optimal for lipid management. The modest effect observed may moderate dyslipidemia medication for primary prevention. Prediction intervals suggest TC, HDL, LDL and TGD are only improved in one-quarter of studies. 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

Stabilization of the distal radioulnar joint with or without triangular fibrocartilage complex tear by an external wrist band brace: A cadaveric study. Shin, et al. (2022) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic : DRUJ brace - Stability effect This study assessed the effect of an wrist band brace on distal radioulnar joint (DRUJ) stability in cadavers, both with and without a triangular-fibrocartilage TFCC lesion. A total of seven cadavers were included in this study. A circumferential brace that could be tightened with a dial was utilised and tightened to achieve a torque that appeared reasonable in clinical practice (1 kg x cm - I have tried it and it felt like a gentle squeeze). Radius translation on a fixed ulna was assessed through motion capture. The trial was completed with and without the brace as well as under the same conditions with a TFCC excised from the ulnar styloid. The results showed that the brace significantly reduced DRUJ translation under all conditions except for full pronaiton. With the brace, near-normal stability in TFCC-detached wrists was achieved. 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 brace significantly reduced DRUJ translation in both intact and TFCC excised wrists . It is possible that these biomechanical findings may translate to clinical practice. Currently, it appears that wrist extension loading in people with ulnar side wrist pain may benefit from these sorts of braces . It is also possible that these braces may benefit a subgroup of people undergoing ulnar shortening osteotomies. However, symptoms response to this braces wearing should not be utilised for diagnostic purposes as it does not appear to be useful for that scope . URL : https://doi.org/10.3390/healthcare10050828 Abstract The purpose of this study was to investigate whether a watch-shaped external wrist band brace improves distal radioulnar joint (DRUJ) stability. Seven fresh cadaveric arms were used. Using a customized testing system, volar and dorsal translation forces were applied to the radius externally while the ulna was fixed. The test was performed with the forearm in neutral, 60° pronated, and 60° supinated positions, once without the brace and once with the brace applied. In each condition, the amount of translation was measured. Then, the triangular fibrocartilage complex (TFCC) was detached from the ulnar styloid process and the fovea ulnaris, and the same tests were performed again. Detachment of the TFCC significantly increased volar and dorsal translations in all forearm rotations compared to the intact condition (p < 0.05), except for the pronated dorsal translation of the radius (p = 0.091). Brace application significantly reduced volar and dorsal translations in all forearm rotations both in intact specimens and in TFCC-detached specimens (p < 0.05), except for pronated volar and dorsal translations in TFCC-detached specimens (p = 0.101 and p = 0.131, respectively). With the brace applied, the TFCC-detached specimens showed no significant difference in volar or dorsal translation in all forearm rotations compared to the intact specimens (p > 0.05). The external wrist band brace improved DRUJ stability in both normal and TFCC-torn wrists and reduced the DRUJ instability caused by TFCC tear to a near-normal level. 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

Revision rates between obese and non-obese total shoulder arthroplasty patients: An australian registry data study. Onggo, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Revision rate - Reverse shoulder replacement for fractures This retrospective study assessed the cumulative percent revision rates of shoulder replacement surgeries across different levels of Body Mass Index (BMI). More than 25,000 people were included in the study. People wither underwent anatomical or reverse shoulder replacements depending on the nature of their presentation. Long term complications were collected for all patients. The results showed that revision rates for anatomical replacements remained consistently low across all BMI groups, with no significant differences between normal weight, overweight, or obese patients. For reverse shoulder replacements, the results differed based on primary diagnosis and BMI category. In cases of rotator cuff arthropathy, revisions were initially similar across BMI categories but increase slightly over time among obese patients. When the primary diagnosis was a fracture, only severe obesity (BMI ≥40) significantly elevates revision risk. 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, all causes revisions following reverse shoulder replacement for fractures are higher in people with a BMI greater than 40 compared to people with a lower BMI. This rule does not appear to hold when the shoulder replacement is completed for osteoarthritis or cuff atrhopathy. It is possible that obese people undergoing shoulder replacement for fractures, may present with a more complex surgery due to higher levels of comminution due to greater trauma impact and potentially a lower rotator cuff quality. If your polytrauma patient has had a reverse shoulder replacement for a humeral fracture, keep a closer eye on them. URL : https://doi.org/10.1016/j.jse.2025.05.036 Abstract Background: Obesity is an epidemic more apparent in many developed countries, like Australia. The effect on total shoulder replacement (TSA) is not clear, with different studies reporting varying conclusions. This registry-based study offers a large-scale analysis of the effects of obesity on the risk of revision in anatomic TSA (aTSA) and reverse TSA (rTSA) for various indications. Methods: This is an observational cohort analysis of data from a national arthroplasty registry. Primary aTSA for osteoarthritis and primary rTSA for cuff arthropathy or fracture performed between January 2015 and December 2022 in Australia were included. Procedures were stratified by body mass index (BMI) groups and the cumulative percentage of revision was compared between groups. The analyses were undertaken using Kaplan-Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazards models. Results: There were 9,549 primary aTSAs for osteoarthritis, 13,920 primary rTSAs for cuff arthropathy, and 4,685 primary rTSAs for fractures. In rTSA indicated for fracture, obese class III had an increased all-cause revision risk compared with normal-BMI patients (HR 1.87, 95% CI 1.13-3.10, P = .014) throughout the entire follow-up period. In contrast, all-cause revision rates for aTSA for osteoarthritis and rTSA for rotator cuff arthropathy across BMI categories were not significantly different. There was an increased risk of revision for instability or dislocation in BMI class III compared with normal-BMI patients after rTSA for fracture (HR 2.84, 95% CI 1.43-5.63, P = .002). Obese class 1 and obese class 2 patients receiving aTSA for osteoarthritis had a higher rate of revision for cuff insufficiency compared with normal-BMI patients (entire period HR 2.30, 95% CI 1.17-4.55, P = .016, and entire period HR 2.10, 95% CI 1.00-4.40, P = .049, respectively). Conclusion: Obesity has an increased risk of all-cause revisions and revision for instability or dislocation in patients receiving rTSA indicated for fractures. BMI was not associated with an increased risk of revision in primary aTSA indicated for osteoarthritis, nor for primary rTSA indicated for rotator cuff arthropathy. We recommend BMI class III patients undergoing rTSA for fracture to be counseled on their complication risks during the informed consenting process. 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

Identifying clinically meaningful changes and predictors of improvement for patient- reported outcome measures in patients who undergo arthroscopic arthrolysis of Post-traumatic elbow stiffness. Ben et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Elbow stiffness - Arthroscopic surgery This retrospective study aimed at identifying the effectiveness of arthroscopic elbow arthrolysis for people with post-traumatic stiffness. A total of 65 participants were included in the study. Statistical as well as patient reported subjective improvements were utilised to assess the effectiveness of surgery at one-year follow up. The outcomes assessed included Visual Analog Scale (VAS), elbow function, and range of motion improvements. The results showed that all the patients presented with statistically relevant improvements. However, very few patients were satisfied with pain and function compared to pre-surgery. Predictors for achieving favorable outcomes included younger age, lower body mass index, and shorter symptom duration. 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, one year after arthroscopic surgery for post-traumatic elbow stiffness, most patients are still not fully satisfied with their elbow function and pain. This has both physical and mental health negative repercussions . As previous research has shown, pre-surgical predictors of favorable outcomes include lower BMI, shorter symptom duration, and pre-existing elbow pathology . Given all these findings, it is important to counsel our patients to the estimated recovery times, which often can extend beyond one year. URL : https://doi.org/10.1016/j.jse.2025.05.042 Abstract Background: Clinically meaningful outcome thresholds, including patient acceptable symptom state (PASS), minimal clinically important difference (MCID), and substantial clinical benefit (SCB), have rarely been evaluated after arthroscopic arthrolysis for post-traumatic elbow stiffness. This study therefore aimed to determine PASS, MCID, and SCB values for the pain visual analog scale (pVAS), Single Assessment Numeric Evaluation (SANE), Mayo Elbow Performance Score (MEPS), and range of motion difference (ROMD) after arthroscopic elbow arthrolysis. Methods: Sixty-five patients who underwent arthroscopic elbow arthrolysis were evaluated at a minimum of 1 year postoperatively using anchor-based methods for PASS and SCB, and a distribution-based method for MCID. Anchor questions were used to define clinically meaningful thresholds. Univariate and multivariate logistic regression analyses were performed to determine predictors of improvement for surgical outcomes. Results: All four measures demonstrated acceptable discriminative ability (area under the curve >0.70) for PASS and SCB. The PASS, MCID, and SCB thresholds were 2.5, 1.2, and 2.5 for pVAS; 65.0, 11.9, and 12.5 for SANE; 87.5, 9.5, and 17.5 for MEPS; and 113, 15, and 58 for ROMD. Lower preoperative scores were associated with significantly higher odds ratios (ORs) for achieving all thresholds. Longer symptom duration and the presence of ulnar nerve symptoms were associated with significantly lower ORs for achieving PASS for SANE. Younger age was significantly associated with achieving higher ORs for PASS for MEPS. For ROMD, younger age, shorter symptom duration, lower BMI, and the presence of preoperative ulnar nerve symptoms were associated with significantly higher ORs for achieving PASS. Conclusion: After arthroscopic elbow arthrolysis, reliable PASS, MCID, and SCB thresholds were identified for pVAS, SANE, MEPS, and ROMD. Favorable outcomes were more likely in patients with poorer preoperative scores, younger age, lower BMI, and shorter symptom duration, while preoperative ulnar nerve symptoms were negatively associated with achieving PASS. 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

Intra-articular corticosteroid injection versus suprascapular nerve block for adhesive capsulitis: A systematic review and meta-analysis of level I randomized controlled trials. Harley et al. (2025) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Nerve block - Frozen shoulder This systematic review and meta-analysis assessed the effectiveness of suprascapular nerve blocks (SSNB) vs intra-articular corticosteroid injections (CSI) for treating frozen shoulder. Eight randomised controlled trials for a total of 452 participants were included in the study. Pain relief, shoulder function, and range of movement were assessed at 3-4 weeks, 6-7 weeks, and 12 weeks. The individual studies were scored according to the Cochrane risk of bias criteria and the overall quality of the evidence was scored through the GRADE system. The results showed that low quality evidence supports the use of SSNB compared to CSI for potentially clinical relevant improvement in pain, and clinically relevant improvements in function (8 points difference on SPADI) and range of movement (14deg difference). 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, suprascapular nerve blocks are likely superior for pain relief, shoulder function, and active abduction by 12 weeks compared to intra-articular cortisone injections. Interestingly, hydrodalitation also appears to be superior to cortisone injections alone . The addition of cortisone to hydrodilatation appears to provide marginal improvements . Remember that to avoid higher shoulder disability in our patients with multiple upper limb trauma, wrist immobilisation should be kept to a minimum . URL : https://doi.org/10.1016/j.jse.2025.05.037 Abstract Background: Intra-articular corticosteroid injection and suprascapular nerve block are both options for nonoperative management of adhesive capsulitis. While numerous studies support the benefits of steroid injections, the use of suprascapular nerve blocks is less established. Published randomized trials comparing steroid injections and suprascapular nerve blocks for managing adhesive capsulitis have reported mixed results. This study aimed to perform a systematic review and meta-analysis of published level I studies to compare outcomes for patients with adhesive capsulitis following intra-articular corticosteroid injection or suprascapular nerve block. Methods: The study was performed according to the preferred reporting items for systematic reviews and meta-analysis. Three databases were searched for randomized controlled trials comparing an intra-articular steroid injection to a suprascapular nerve block in patients with adhesive capsulitis. Trials were excluded if either group received another procedure or included patients with concomitant ipsilateral shoulder pathology. Outcomes were patient-reported pain intensity and shoulder function, range of motion, and time to symptom resolution. Meta-analysis was performed for pain, shoulder function, and range of motion using random-effects models. Results: Eight studies with a total of 452 patients were included. Pain was assessed using the Shoulder Pain and Disability Index (SPADI) pain subscale and the visual analog scale. Functional outcomes were assessed using the SPADI and Constant-Murley Score. Range of motion assessments included active and passive movements in abduction, forward flexion, external rotation, and internal rotation. Random-effects comparisons at baseline, 3-4 weeks, 6-7 weeks, and 12 weeks were performed for pain and SPADI scores, and at baseline and 12 weeks for active abduction. Suprascapular nerve blocks were superior to steroid injections for pain at 3-4 weeks (standardized mean difference [SMD]: 0.63, 95% CI: 0.06-1.19, P = .03), 6-7 weeks (SMD: 0.49, 95% CI: 0.01-0.96, P = .046), and 12 weeks postintervention (SMD: 1.68, 95% CI: 0.30-3.06, P = .017). Nerve blocks were superior to steroid injections in reducing SPADI scores at 12 weeks postintervention (MD = 8.94, 95% CI: 1.44-16.44, P = .020). Nerve blocks were superior to steroid injections for active abduction at 12 weeks postintervention (MD = 14.44°, 95% CI: 11.05°-17.83°, P < .001). Heterogeneity was considerable for all meta-analyses. There were no other significant differences between groups at any time point. Conclusions: In patients with adhesive capsulitis, suprascapular nerve blocks provide greater pain relief at 3-4, 6-7, and 12 weeks, greater improvements in shoulder function at 12 weeks, and greater active abduction at 12 weeks, compared to intra-articular corticosteroid injections. 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

Total joint arthroplasty versus trapeziectomy for trapeziometacarpal joint arthritis: 5-year follow-up of a randomized controlled trial. Bonhof-Jansen, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Thumb OA - Trapeziectomy vs joint replacement This is a secondary analysis of a randomised controlled trial comparing total joint replacement and trapeziectomy for 1st cmcj OA. A total of 54 participants were included in the analysis. Severel ouctomes including hand function (primary outcome), grip, tip to tip, key pinch strength, and satisfaction were measured at 5-year follow-up. The results showed no significant difference between groups except for key pinch strength and satisfaction, suggesting that there is 12% probability that these significant cases were due to chance. 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, total joint replacement and trapeziectomy, for thumb OA both showed similar results in terms of function, grip, and tip to tip pinch strength . However, trapeziectomy still remains the procedure with the least number of complications compared to other surgical approaches for thumb OA . If you are interested in early motion following trapeziectomy and return to work timeframes , have a look at the linked synopses. URL : https://doi.org/10.1177/17531934251357456 Abstract This study presents 5-year results of a randomized controlled trial comparing total joint arthroplasty (TJA) with the Maïa prosthesis and trapeziectomy for trapeziometacarpal joint osteoarthritis. Sixty-two women aged 40 and older scheduled for surgery were randomized. The primary outcome was daily hand function using the Michigan Hand Outcomes Questionnaire (MHOQ). Secondary outcomes included MHOQ subscales, range of motion, strength, satisfaction, complications and survival. Follow-up data were available for 28 TJA and 26 trapeziectomy patients. At 5-years, TJA did not show superior patient reported outcomes on the MHOQ compared with trapeziectomy. Grip and tip pinch strength differences were not statistically significant or clinically relevant. However, key pinch strength, satisfaction and willingness to undergo the same treatment again favoured TJA. There was no statistically significant difference in revision rates between the groups. Five-year survival was 73% for trapeziectomy and 93% for TJA. 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 presentation of periprosthetic joint infection after primary metacarpophalangeal and proximal interphalangeal arthroplasty. Schluttenhofer, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic/Prognostic Topic : Pipj or mcpj replacement - Peri-prosthetic risk This retrospective study assessed the number of peri-prosthetic joint infections following proximal interphalangeal and metacarpophalangeal joint replacements. A total of 642 participants underwent 1418 replacements (average of two replacements per patient). The results showed that only 6 fingers developed a peri-prosthetic infection, which is 0.4% of the whole number of surgeries completed. The most frequent timeframe for periprosthetic infection was within 3 months from surgery, however, one person had one a 3.5 years after surgery. It was not possible to identify surgical or patient's factors associated with the risk of peri-phrostetic joint infections. This is most likely due to the low number of people in the infection group. Smith & Nephew pyrocarbon joint replacement 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, peri-prosthetic joint infections following pipj or mcpj replacement happen in 1 out of 200 or 300 people most often within the first three months after surgery. Very rarely, these infections can occur 3-4 years after surgery. In contrast, superficial infections occur in 5-10% of people after hand surgery surgery . Peri-prosthetic infections of the pipj and mcpj are so rare that it is difficult to identify risk factors for them. However, post-surgical infections seem to be more common in smokers , as well as in immunocompromised people or those with diabetes . Also remember that cortisone injections in close proximity to the surgical have the potential to increase the risk of infection if delivered within 3 months prior to surgery. This is not the case if the injection is delivered to other distant joints . URL : https://doi.org/10.1016/j.jhsa.2024.12.008 Abstract Purpose: Periprosthetic joint infection (PJI) is a devastating complication that has been extensively investigated in large joint arthroplasty. However, this has been inconsistently reported after metacarpophalangeal (MCP) and proximal interphalangeal (PIP) arthroplasty. The objective of the study was to report the presentation and treatment of patients with PJI after MCP or PIP joint arthroplasty. Methods: We performed a retrospective review of 1418 primary MCP or PIP arthroplasties in 642 patients with a minimum of 180 days of follow-up (mean 9.0 years) at a single institution from 1991 to 2020. We also analyzed the association of patient (body mass index, smoking, diabetes, and immunocompromised status) and surgical (digit, implant, operative time, and reoperation) factors with infection. Results: There were six joints, all in separate patients, that developed PJI (0.4%). The median time to PJI was 91.5 days. Of the six patients with PJI, five had no systemic symptoms and a normal leukocyte count. The most common cultured organism was Staphylococcus aureus. PJI was most commonly treated with hardware removal and antibiotics. Conclusions: PJI is uncommon after MCP or PIP arthroplasties. It commonly presents without systemic symptoms or leukocyte count and is most frequently caused by Staphylococcus aureus. More studies are needed to identify the optimal diagnostic criteria, treatment, and preventive strategies of PJI of the MCP and PIP joints. 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

Preoperative hand therapy instructions do not improve short-term outcomes in carpal tunnel and trigger finger surgery. Kalimian, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Pre-surgical instructions - Carpal tunnel and trigger finger release This non-registered, not blinded randomised controlled study assessed whether structured preoperative instructions from a hand therapist improved short-term outcomes after carpal tunnel (CT) and trigger finger (TF) release surgeries. A total of 87 patients were randomly assigned to either receive detailed preoperative guidance from a hand therapist or brief verbal instructions from the surgeon prior to their procedure. The preoperative instructions included edema management, exercises, pain control strategies, and expectations of recovery. Assessments were completed pre-surgery, and 2 and 6 weeks post-surgery. The primary outcome was Quick DASH at 6 weeks, however, there were other outcomes including pain, pinch and grip strength. The results showed no significant differences between groups on both objective and subjective measures. 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, structured preoperative instructions from hand therapists do not significantly improve short-term recovery outcomes after carpal tunnel or trigger finger release surgeries. It is possible that different types of surgery, that have lower satisfaction rates for patients, may benefit from pre-surgical consultations . URL : https://doi.org/10.1177/17531934251313763 Abstract The impact of preoperative structured instructions by a hand therapist on recovery after carpal tunnel and trigger finger releases was assessed in 87 patients. No significant differences in recovery, satisfaction, or outcomes were found, suggesting limited benefit. 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

Secondary metacarpal fracture after malunion of the little metacarpal. Zhang, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : 5th metacarpals - Secondary fractures This retrospective study assessed the likelihood of same location secondary metacarpal fractures in the little finger. A total of 19 patients with secondary fractures of the little finger metacarpal were included in the study. Of these, 9 patients had had a metacarpal neck fracture and 10 a shaft fracture. The results showed that an additional fracture of the 5th metacarpal occurred on average at 6 years after the first fracture. The majority (80%) of people who had a previous 5th metacarpal neck fracture fractured another area of the 5th metacarpal. In contrast, those people with a 5th metacarpal shaft fracture re-fractures the same area (80%). a) Secondary injury occurred at the original fracture site of the little metacarpal shaft. (b) Malunion of the little metacarpal neck fracture with a secondary fracture at the base of the little metacarpus. (c) Malunion of the little metacarpal shaft with a secondary fracture of the ring metacarpal neck. (d) Secondary fractures are likely at initial sites if the force direction is parallel to the long axis of the metacarpus. (e) Secondary fractures owing to shearing force occur at distinct sites when the force direction is not parallel to the long axis of the metacarpus and (f) the angular malunion of the little metacarpal fractures results in shortening, concentrating stress on the middle and ring metacarpals. 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, 5th metacarpal shaft fractures are more likely to re-fracture at the same location compared to neck fractures. It appears that bowing stress due to shaft angulation is the most likely biomechanical factor responsible for this finding. Most of the 5th metacarpal neck fractures can be managed conservatively with buddy strapping or splinting , however, shaft fractures require more careful consideration considering due to the potential for same site re-injury. URL : https://doi.org/10.1177/17531934251313978 Abstract Nineteen patients presenting with a secondary metacarpal fracture after a previously fractured little metacarpal were retrospectively reviewed. The new injury was more likely to be at the original fracture site in patients with shaft fractures than those with neck fractures. 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

Long-term survival of acumed anatomical radial head implant for mason type iii-iv fractures: A 15-year follow-up. Tarallo, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Radial head replacement - Survival expectations This retrospective study assessed the survival and complications following radial heal replacement. A total of 149 patients comprising 73 women and 76 men were included in the study. All patients had undergone radial replacements for Mason III and IV fractures (comminuted and displaced fractures) from 2005 to 2020. Post-surgery the average range of motion was elbow e/f of 10/130 degrees with supination/pronation of 80/80 degrees with good functional outcomes overall. Heterotopic ossification was observed in 50% of patients. In terms of complications, 10% presented with stiffness and 5% had implant loosening. Of those that required implant removal, this occured, on average at 1.5 years from surgery. Kaplan-Meier survival curve showed 95% implant survival at 15 years. 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 head replacements for comminuted and/or displaced fractures have a positive outlook with 95% survival at 15 years from surgery. The most common complication was stiffness (10%) followed by implant loosening (5%). In contrast to radial head replacements, total elbow replacement or hemiatroplasty have worse outcomes with significant lifting limitations. For further stories and fun facts on elbow replacements, have a look at the entire database on the topic . URL : https://doi.org/10.1016/j.jse.2025.05.038 Abstract Background: Radial head fractures account for 1.7% to 5.4% of all skeletal fractures and approximately one-third of elbow fractures. These injuries are often associated with other concurrent injuries, such as fractures of the coronoid, ligamentous injuries of the elbow, or trauma to other regions of the upper limb. Intra-articular fractures, especially Mason type III and IV, often require anatomical reduction to restore the articular surface, but such procedures can yield suboptimal results, highlighting the role of radial head implants in complex cases. Materials and methods: This retrospective study evaluated patients treated with Acumed Anatomical Radial Head implant from 2008 to 2023, specifically those with Mason type III and IV fractures. A total of 149 patients were included, with an average follow-up of 7 years. Results: Clinical outcomes, assessed using the Mayo Elbow Performance Score, showed an average score of 90, with an average range of motion of 130° in flexion and 78° in pronation and supination. Implant survival at 15 years exceeded 95%, confirming the long-term effectiveness of anatomical radial head implants. The most common complications included: heterotopic ossification with reduced joint mobility (35%), postoperative stiffness with functional limitations (9.4%), and implant loosening (4.7%). Conclusions: Radial head implants offer a reliable treatment for complex Mason type III and IV fractures, with good functional and survival outcomes and a low incidence of complications. However, careful implant sizing is crucial to avoid complications such as premature loosening, joint stiffness, and 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

Tendon impingement of the extensor digiti minimi: Clinical cases series and cadaveric study. Yoo, et al. (2012) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic/Anatomical Topic : EDM impingement - Ulnar sided pain This article reports on two cases of extensor digiti minimi (EDM) tendon impingement and one on EDM tenosinovitis due to anatomical variations. The two traumatic cases had wrist hyperflexion in a full fist position as a mechanism of injury. Through surgical exploration, the EDM bifurcation was found to be impinging at the entry of the sheet (see surgical and anatomical picture below). Through dissections of 49 cadavers, the authors showed that 40% of people had an EDM bifurcation very close to the synovial septum (asterisk in surgical picture), which caused impingement during full little finger flexion. 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, patients reporting pain in the dorsal ulnar aspect of the hand, who have had a wrist hyperflexion injury whilst holding a full fist, may be presenting with extensor digiti minimi (EDM) impingement or traumatic tenosynovitis. This is because some people have EDM bifurcations very close to the synovial septum (see pictures above). The large majority of people present with EDM, hence this pathology has the potential to occur in a good chunk of our patients given the right mechanism of injury. It is much less likely for extensor digitorum communis (EDC) to present with this pathology as the majority of people do not have a slip going to the little finger . URL : https://doi.org/10.1002/ca.22017 Abstract The authors describe two unique clinical cases of closed extensor digiti minimi (EDM) tendon injuries after hyperflexion of the wrist with full finger flexion and one case of chronic tenosynovitis around the EDM tendon. All three cases were thought to be related to the bifurcation of the EDM tendon and synovial septum. Subsequently, variations in EDM tendons were investigated in 49 cadaveric hands with a focus on patterns of tendon bifurcation and their relationships with the surrounding synovial sheath. The EDM tendon was found to be bifurcated in 74% (n = 36) of hands and all of these hands contained a synovial septum. In 9 (25%) hands, the EDM tendon bifurcated proximal to the retinaculum, in 15 (42%), it bifurcated distal to the retinaculum, and in the other 12 hands (33%), the tendon bifurcated at the retinacular level. In 6 of the 15 hands with an infraretinacular bifurcation, the tendon was found to impinge on the synovial septum during passive flexion of the wrist with full finger flexion, and the mean distance between the synovial septum and the bifurcation point in these specimens was 0.6 cm (range, 0.4–0.7 cm), which was differed significantly from hands not showing impingement (P = 0.01). This study shows that distal bifurcation of the EDM tendon may lead to tendon impingement on the septum and suggests that this is a potential etiology of chronic tenosynovitis of the fifth compartment and of acute closed tendon injuries. 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

Ulnar-sided wrist pain: Systematic clinical approach and principles of treatment. Satria, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Ulnar wrist pain - Objective tests This is an expert opinion on ulnar sided wrist pain. The authors highlight how ulnar wrist pain can be a diagnostic challenge due to its anatomy and symptoms presentation. A comprehensive approach involving detailed medical history, physical examination, and imaging is reported as being fundamental for accurate diagnosis. Common diagnoses include ECU tendinopathy, TFCC sprains, ulnar impaction syndrome, as well as more severe traumatic presentations like DRUJ laxity, lunotriquetral ligament injuries or fractures, hook of hamate fractures and non-union, with potential progression to DRUJ and pisotriquetral osteoarthritis. Other differential diagnoses include nerve-related issues, such as Guyon’s canal syndrome, and vascular problems like hypothenar hammer syndrome. Last but not least this article describes the DRUJ compression test, which is performed by asking the patient to perform pronation-supination whilst the clinician indirectly applies compressive forces to the DRUJ at the mid-distal forearm (see picture below). The DRUJ compression test is also the first test that is shown in the video below. Also, if you would like to see a positive DRUJ ballottement test, go to the minute 1:38 of the video. 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 DRUJ compression test could be utilised to assess whether approximation of the radius and ulna contribute to symptoms during pronation/supination in our patients. Keep in mind that often there is more that one pathology involved with ulnar wrist pain and that ECU tendinopathy can be often present with TFCC tears . In addition to the most common musculoskeletal conditions of the ulnar wrist described above, it is important to exclude less common differential diagnoses, such as nerve-related issues (e.g., Guyon’s canal syndrome) or vascular problems (e.g., hypothenar hammer syndrome). In the next few months you will see a case study on vascular problems coming through on HandyEvidence. On a final note, make sure you always test the contralateral limb of patients as I have seen bilateral positive DRUJ ballotement , which was not associated with trauma/symptoms. If you are interested in ulnar sided wrist stories and information, have a look at the whole dataset . URL : https://doi.org/10.2147/ORR.S506374 Abstract The source of ulnar-sided wrist pain is difficult to determine because the history and physical examination findings of various illnesses frequently coincide, and are multifactorial. Pain on the ulnar side of the wrist can be identified on the basis of the tissue from which it arises. Knowledge of the anatomy of the ulnar side of the wrist is required for correct diagnosis, as in numerous diagnostic tests. Given the complex nature of disease diagnosis, various methods have been proposed. This article discusses systematic methods for obtaining a patient’s medical history, physical examination, and treatment principles to assist surgeons in determining the source of common ulnar-sided wrist 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