Search Results

Efficacy of conservative treatment strategies for partial distal biceps tendon ruptures. A case-control study. Jansen, et al. (2025) Level of Evidence : 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Partial distal biceps tears - Management approaches This retrospective study assessed the effectiveness of conservative treatments for partial distal biceps tendon tears, comparing three approaches: wait-and-see, physiotherapy, and injection therapy. Over five years, a total of 78 participants (26 in each group) were included to assess treatment outcomes. The overall success rate across all methods was 47%, with no significant differences between the treatments at 3 and 6 months. Injection therapy yielded the fastest results when successful, but there were no meaningful distinctions in outcomes among the approaches. Importantly, conservative management did not appear to impair surgical outcomes for patients who eventually required surgery after failed nonoperative treatment. The study also found no progression of partial tears to complete ruptures regardless of treatment. Keep in mind that this was a small study without randomisation. Results at six months for each intervention. 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, for a partial distal biceps tendon tear, wait-and-see, physiotherapy, and injection therapy present with an overall 50% success rate across, without differences amongst treatments. Injection therapy showed potential for quicker results when effective, yet no significant differences were noted with other treatment approaches. If you want to know more about conservative management for distal biceps tendinopathy, have a look at this synopsis . Keep in mind that if conservative treatment fails, surgical options have a an overall positive outcome for distal biceps tears . URL : https://doi.org/10.1016/j.jse.2025.04.017 Abstract Background: Partial distal biceps tendon tears (PDBTs) are uncommon injuries that present with a range of symptoms, from mild pain to significant weakness. The optimal treatment approach for PDBTs remains debated, with a lack of consensus regarding the most effective nonoperative strategies. This study compares three nonoperative treatments: wait-and-see, physiotherapy, and injection therapy, to determine their efficacy and identify factors influencing treatment outcomes. Materials and methods: This retrospective study included 78 patients diagnosed with partial distal biceps tears from January 2017 to December 2024. Diagnosis was confirmed through clinical examination and magnetic resonance imaging. Patients were treated with one of three nonoperative strategies: a wait-and-see approach, standardized physiotherapy, or ultrasound-guided injection therapy. Functional and clinical assessments, including the Mayo Elbow Performance Score and visual analog scale for pain, were conducted at 3- and 6-months post-treatment. Results: The overall success rate for nonoperative treatment at 6 months was 47%, with no significant difference between the treatment groups (injection 50%, physiotherapy 46%, wait-and-see 46%). Injection therapy resulted in the fastest symptom relief, with most patients reporting improvement within one week. No patients progressed to complete ruptures, and those requiring surgery after treatment failure achieved full resolution. Multivariable analysis showed no significant impact of factors like inflammatory disease, diabetes, profession, smoking, grading of the tear and lesion origin (trauma vs. attrition) on treatment outcomes. Conclusion: Nonoperative treatment for PDBTs, including injection therapy, physiotherapy, and a wait-and-see approach, yields moderate success rates. Injection therapy offers the quickest relief with no detrimental effects. Surgery remains an effective option for treatment failures. 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

Physical therapies for delayed-onset muscle soreness: An umbrella and mapping systematic review with meta-meta-analysis. Wiecha, et al. (2025) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : DOMS - Interventions to reduce pain This umbrella review with meta analysis assessed the scientific evidence on various post-exercise physical therapy interventions for Delayed Onset of Muscle Soreness (DOMS). The research aimed to address inconsistencies in existing systematic reviews by analysing quantitative data from multiple meta-analyses, providing a comprehensive overview of therapeutic approaches. The study focused on therapies such as massage, stretching, vibration, photobiomodulation, compression, and heat/cold applications. More than 800 unique randomised controlled trials were included. A methodological quality assessment of the included evidence was conducted to evaluate the robustness of the scientific findings (Class I highest, class V lowest). The results showed that the majority of treatments you can think of, tend to reduce DOMS within 24 hrs. As you can see from the figure below, studies with the largest effect size also appear to be the ones with the smallest number of participants, which suggest the presence of some publication bias. Overall, you could probably say that any of the interventions presented have a small to moderate effect in reducing DOMS. Forest plot demonstrating the effectiveness of various therapies on pain intensity indices at specific timepoints post-exercise. Positive Hedges’ g and 95% confidence interval (CI) values indicate an improvement with therapy interventions over control groups. h hours, I2 heterogeneity, n studies number of studies in the meta-analysis, 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, massage, stretching, vibration, photobiomodulation, compression, and heat/cold applications have some effect, albeit small, in reducing Delayed Onset of Muscle Soreness (DOMS) following exercise . If you would like to know more about resistance training options for our patients, have a look at the entire database . URL : https://doi.org/10.1007/s40279-025-02187-5 Abstract Background: Delayed-onset muscle soreness commonly arises from intense and unaccustomed physical exercise, leading to reduced muscle strength, increased pain and inflammation. A number of systematic reviews evaluating physiotherapeutic treatments for delayed-onset muscle soreness have been published since the 1990s. However, these systematic reviews frequently yield conflicting findings, further impeding clinical practice. Objectives: The primary aim of this study was to summarise the effectiveness of physiotherapy interventions in alleviating delayed-onset muscle soreness through an umbrella review. Additionally, we evaluated the risk of bias in systematic reviews, synthesised their findings, and categorised the evidence strength to provide practical insights for clinicians and researchers. Methods: An umbrella review with a meta-meta-analysis was conducted. MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PEDro and Epistemonikos were searched from 1998 to February 2024. Systematic reviews of randomised controlled trials of any treatments used post-exercise by physiotherapists to reduce delayed-onset muscle soreness in healthy adults, regardless of their physical activity, were eligible. A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) was used to evaluate the methodological quality of the included systematic reviews. Corrected covered areas were calculated to address the overlap of primary trials in the included systematic reviews. An evidence map was created to categorise and visualise the effects of interventions using a multi-dimensional approach, based on the effect size and strength of evidence (Class I–V), i.e. the number of cases, Hedges’ g, p-value, heterogeneity, Egger’s test and excess of significance bias test. Results: Twenty-nine systematic reviews with 863 unique randomised controlled trials, addressing 24 distinct physiotherapeutic treatments, met the inclusion criteria. Seventeen systematic reviews were of critically low methodological quality, with only two rated as high quality. The evidence map suggests significant effects in pain reduction immediately post-exercise for contrast therapy (Class II), cooling therapy and cryostimulation (Class IV); 24 h: massage therapy (Class III) and cooling therapy, contrast therapy, electrical stimulation, cryostimulation, phototherapy, heat therapy (Class IV); 48 h: compression, contrast therapy, kinesiotaping and cryostimulation (Class III) and cooling therapy, massage, phototherapy, heat therapy (Class IV); 72 h: kinesiotaping (Class III) and contrast therapy, cooling therapy, massage, phototherapy, vibration (Class IV); 96 h: compression, phototherapy, and contrast therapy (Class IV). The effect sizes (Hedges’ g) ranged from 0.36 (95% confidence interval 0.46, 3.18) for cooling therapy to 1.82 (95% confidence interval 0.46, 3.18) for heat therapy indicating small and large effects, respectively. Conclusions: There is a large body of evidence from predominantly low-quality systematic reviews of randomised controlled trials evaluating the effectiveness of physiotherapeutic treatments for delayed-onset muscle soreness. There is some strong evidence to support the effectiveness of cooling therapy, cryostimulation, contrast therapy, massage, phototherapy and kinesiotaping at various follow-up intervals, whereas evidence for stretching, exercises and electrical stimulation is weak. Uncertainties, heterogeneity and weaknesses of the available evidence partially limit the applicability and generalisability of the findings. 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

Prevalence of hand arm vibration syndrome in mine workers of khewra salt mines. Tanveer, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Aetiologic/Preventative Topic : Hand vibration - Vascular effect This cross-sectional study assessed the prevalence of Hand Arm Vibration Syndrome (HAVS) among mine workers at the Khewara Salt Mines in Pakistan. This pathology (HAVS) presents with hand discoloration, tingling sensation in upper extremities, and reduced grip strength. A total of 140 mine workers were included in the study. The results indicated that HAVS prevalence was higher in the dominant hand, suggesting increased vulnerability due to prolonged vibration exposure. The study emphasised the need for targeted clinical interventions and workplace policies to mitigate vibration exposure and enhance occupational health. 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, Hand Arm Vibration Syndrome (HAVS) is associated with hand discoloration, tingling sensation, and reduced grip strength in the affected upper limb. It is likely that workplace policies aimed at reducing vibration exposure through ergonomics, education, and the use of protective equipment are they key. In addition, providing sufficient recovery periods is likely helpful in works exposed to intense vibrations. If you are interested in other vascular presentations of the hand and upper limb, have a look at the whole database . URL : https://doi.org/10.1016/j.jht.2024.11.002 Abstract Background: Hand-arm Vibration Syndrome (HAVS) is a disorder caused by prolonged exposure to hand-held vibrating instruments, commonly observed in industrial contexts such as mining, construction, and manufacturing. It involves symptoms affecting the musculoskeletal, neurological, and vascular systems of the arm and hand. Purpose: The main aim of this study is to determine the prevalence of HAVS among laborers working in the Khewra salt mines. Study Design: This study utilized a cross-sectional observational design. Methods: A total of 140 drill machine operators from the Khewra salts mines were selected through purposive sampling. Handgrip strength was assessed using the Camry-EH101 hand dynamometer and the data was collected through structured questionnaire focusing on neurological, vascular and musculoskeletal symptoms. The prevalence of HAVS was determined from the collected data and the severity of symptoms was as analyzed across different age groups and working conditions. Results: Out of the participants, n = 121 (86.4%) were found to be right-hand dominant, with average grip strength of 40.9 ± 3.1 kg, while n = 19 (13.6%) were left hand dominant, with average grip strength of 45.9 ± 2.6 kg. Compared to normative data, right-hand dominant workers showed a 15% reduction in grip strength, while left-hand dominant workers showed a 5% decreased. The most common reported neurological symptoms included prolonged hand vibration (52.9%), tingling sensation (60%) and numbness (46.4%). Vascular symptoms included discoloration of fingers (50%), felling cold (48.6%) and needle like sensations (45.7%). Musculoskeletal symptoms included reduced grip strength (51.4%), hand discomfort (46.4%) and hand cramping, tiredness or itching (46.4%). Conclusion: The high prevalence of HAVS among miners emphasizes the importance of targeted clinical interventions and workplace policies modifications to reduce vibration exposure and improve occupational health. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Changes in distal radioulnar joint stability with metaphyseal versus diaphyseal ulnar shortening osteotomies: A biomechanical investigation. Doermann, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Ulnar shortening osteotomy - Most DRUJ stability This cadaver study assessed the effects of different ulnar shortening osteotomy techniques on distal radioulnar joint (DRUJ) stability in the treatment of ulnar impaction syndrome. In particular, the study compared diaphyseal and metaphyseal osteotomies, focusing on their impact on DRUJ stability. A total of 12 cadavers were included and either underwent metaphyseal (n=6) or diaphyseal (n=6) osteotomy. The results showed that both techniques effectively reduce ulnar impaction, however, diaphyseal ulnar shortening osteotomy was associated with greater DRUJ stability compared to metaphyseal shortening. 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, diaphyseal or metaphyseal ulnar shortening osteotomy techniques reduce ulnar impaction at the wrist. However, metaphyseal osteotomies increase DRUJ laxity compared to diaphyseal approaches. If you are interested in the topic, have a look at other synopses on how to test for DRUJ laxity , whether we may be able to increase DRUJ stability conservatively , or whether the ulnar styloid requires repairing after distal radius fracture , the effect of widget splinting , and others . URL : https://doi.org/10.1016/j.jhsa.2025.03.015 Abstract Purpose: Diaphyseal ulnar shortening osteotomy (DUSO) is the gold standard operative treatment to address positive ulnar variance in the setting of ulnocarpal impaction syndrome. However, an alternative technique, the distal metaphyseal ulnar shortening osteotomy (DMUSO), has been described with good initial results. Previous biomechanical investigations have shown increased stiffness of the distal radioulnar (DRU) joint after DUSO, but the effect of DMUSO on DRU joint stiffness has not been studied. The primary aim of the study was to compare DRU joint motion after DMUSO compared to DUSO. The hypothesis was that there is no difference in stiffness of the DRU joint after DMUSO compared to DUSO. Methods: Twelve fresh frozen cadaveric specimens were used; six underwent DUSO, and six underwent DMUSO. A custom jig was designed and used to apply a volar and dorsal force to the distal ulnar shaft while stabilizing the carpus. Each specimen was tested before and after osteotomy in neutral rotation, 60° of forearm pronation, and 60° of forearm supination. DRU joint translation and stiffness were then compared between DUSO and DMUSO. Results:In neutral forearm rotation, there was a significant decrease in translation of the ulna after DUSO compared to DMUSO in both volar and dorsal directions. In supination, there was a significant decrease in translation of the ulna with a volar force after DUSO compared to DMUSO. No significant differences were seen in pronation. Conclusions: The results demonstrate that compared to DUSO, the DRU joints has more translation after DMUSO with the forearm in neutral and supination. Clinical relevance: The authors recommend consideration of using a DUSO if there is preoperative DRU joint laxity and, alternatively, a DMUSO if no instability exists. More studies may be helpful comparing the techniques, including in vivo applications. 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

Predicting surgical versus nonsurgical management of acute isolated distal radius fractures in patients under age 60 using a convolutional neural network. Hsu, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : AI - Distal radius fracture diagnosis This study explores the application of artificial intelligence (AI) and machine learning in the diagnosis, management, and monitoring of distal radius fractures. It highlights advancements in AI-driven diagnostic tools that improve accuracy and speed in identifying fractures from imaging data, including X-rays and CT scans. The research also delves into predictive models using clinical registry data to forecast treatment outcomes and complications, enabling personalised care strategies. The study underscores the potential of AI to enhance diagnostic precision, streamline treatment decisions, and improve patient outcomes in orthopedic care. 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 is possible that in the future, AI-driven tools will improve the accuracy and speed of diagnosing fractures requiring conservative or surgical management based on X-rays and CT scans. If you are interested in other uses of AI and machine learning in the field of hand therapy, have a look at the entire database . URL : https://doi.org/10.1016/j.jhsa.2025.04.015 Abstract Purpose: Distal radius fractures (DRFs) represent up to 20% of the fractures in the emergency department. Delays to surgery of more than 14 days are associated with poorer functional outcomes and increased health care utilization/costs. At our institution, the average time to surgery is more than 19 days because of the separation of surgical and nonsurgical care pathways and a lengthy referral process. To address this challenge, we aimed to create a convolutional neural network (CNN) capable of automating DRF x-ray analysis and triaging. We hypothesize that this model will accurately predict whether an acute isolated DRF fracture in a patient under the age of 60 years will be treated surgically or nonsurgically at our institution based on the radiographic input. Methods: We included 163 patients under the age of 60 years who presented to the emergency department between 2018 and 2023 with an acute isolated DRF and who were referred for clinical follow-up. Radiographs taken within 4 weeks of injury were collected in posterior-anterior and lateral views and then preprocessed for model training. The surgeons’ decision to treat surgically or nonsurgically at our institution was the reference standard for assessing the model prediction accuracy. Results: We included 723 radiographic posterior-anterior and lateral pairs (385 surgical and 338 nonsurgical) for model training. The best-performing model (seven CNN layers, one fully connected layer, an image input size of 256 × 256 pixels, and a 1.5× weighting for volarly displaced fractures) achieved 88% accuracy and 100% sensitivity. Values for true positive (100%), true negative (72.7%), false positive (27.3%), and false negative (0%) were calculated. Conclusions: After training based on institution-specific indications, a CNN-based algorithm can predict with 88% accuracy whether treatment of an acute isolated DRF in a patient under the age of 60 years will be treated surgically or nonsurgically. Clinical relevance: By promptly identifying patients who would benefit from expedited surgical treatment pathways, this model can reduce times for referral. 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

Education matters when it comes to pain: A cross-sectional study of self-reported pain competencies among physiotherapists. Hoegh, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Education - Pain management knowledge This cross sectional study assessed the effect of postgraduate studies on pain management knowledge, and critical thinking in healthcare professionals. A total of 369 physiotherapists completed the survey shared by the researchers. The results showed that educational level (Bachelor, Postgraduate, Advanced degrees) had the highest effect in determining physiotherapists pain mechanism and management knowledge. Experience had a smaller effect. The authors underscores the value of advanced degrees, like master’s programs, in fostering critical thinking and clinical competencies. Results from the post-hoc analysis with Bonferroni correction displaying the Interaction between the effects of education level and clinical experience on pain knowledge. PT-group have no formal education beyond the undergraduate physiotherapy-degree, PT+ have either clinical certificates or diplomas and PT++ have or are currently studying at MSc-level degree. Legend: EDPPQ-score refers to the total raw score, ) significantly higher than PT+, *) significantly higher than PT and PT+ 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, well-structured educational interventions enhance healthcare professionals' skills and patient outcomes. Further study and advance degrees appear to be essential for improving clinical decision-making, and an evidence based practice that ensures the application of most current and reliable evidence to patient care. This is relevant to hand therapists too and has been highlighted in previous research . URL : https://doi.org/10.1016/j.msksp.2025.103363 Abstract The increasing burden of chronic pain raises demands for improved competencies for physiotherapists. Research suggests that postgraduate training and improved prelicensure pain curriculum might enhance physiotherapists skills in the management of people with chronic pain. The aim of this cross-sectional study was to determine self-reported pain competences among physiotherapists, and to look for potential impact of experience and education. Competencies were evaluated using an online questionnaire based on The European Diploma in Pain Physiotherapy curriculum (EDPP) using the approach of Bloom's taxonomy. Questions reflected all sections of the curriculum for the EDPP. Total score of the EDPP-questionnaire was used as the primary outcome. Responses were grouped by years of professional experience (<2, 2–7, >7 years) and level of education (entry-level, professional courses, MSc-level or higher). The validity of the hypothesis was analyzed using a two-factor ANOVA. 369 physiotherapists were eligible for analysis. A large main effect of education was found, ω 2  = 0.149 (95 % CI: 0.085–0.215), p < 0.001. Additionally, a small, but significant main effect of experience was found as well, ω 2  = 0.018 (95 % CI: 0.00–0.050), p = 0.008. We conclude that physiotherapists with post-graduate education are more likely to report higher levels of pain competencies, independently of how long they have worked as physiotherapists. We speculate that this may relate to their scholarly achievements, e.g., critical thinking skills, rather than more pain education alone. 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

Outcomes of limited fasciectomy, needle fasciotomy and collagenase injection for dupuytren’s disease: A systematic review and meta-analysis of individual patient data. van den Berge, et al. (2025) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic : Dupuytren's - Treatments comparisons This systematic review compared three treatments for Dupuytren’s disease: Collagenase Clostridium Histolyticum (CCH), Limited Fasciectomy (LF), and Percutaneous Needle Fasciotomy (PNF). Using individual patient data from randomised controlled trials (RCTs) and cohort studies, the research evaluated outcomes such as postoperative contracture correction, complications, and recurrence rates. A total of 300 to 700 participants per outcome (e.g. contracture, subjective outcomes) were available. The results showed that CCH was associated with a higher risk of minor complications, but achieves comparable contracture correction to LF, which consistently outperformed PNF in long-term outcomes. LF demonstrates better long-term results with fewer recurrences compared to both CCH and PNF. 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, collagenase clostridium provides reasonable outcomes with a high number of minor complications. Open fasciectomy appeared to have longest duration without recurrence. Based on previous evidence, collagenase clostridium and needle fasciectomy are equally effective , however, based on this new information, collagenase clostridium is associated with a higher number of minor complications. Health professionals have an important role in counseling patients on what to choose based on whether they are interested in minimising invasiveness or ensuring sustained outcomes. If you are interested in further information on Dupuytren's, have a look at the whole database . URL : https://doi.org/10.1177/17531934251338349 Abstract This systematic review and meta-analysis of individual patient data evaluates the outcomes of treatment for Dupuytren's disease using limited fasciectomy (LF), percutaneous needle fasciotomy (PNF) and collagenase clostridium histolyticum (CCH) injection. A total of 1423 studies were identified, of which 15 met the eligibility criteria for meta-analysis. The postoperative total extension deficit was smaller after LF than after PNF or CCH, but the difference was not clinically relevant. Minor complications were more frequent after CCH than after LF and PNF. The risk of major complications did not differ between the treatments. Recurrence occurred earlier after PNF and CCH than after LF during 36 months of follow-up. Patient-reported outcome measures showed substantial heterogeneity, which precluded meta-analysis. Overall, the clinically relevant contracture correction was comparable between LF, PNF and CCH, but CCH had a higher risk of minor complications and LF had the longest time to recurrence. Treatment decisions should consider the trade-off between complications and recurrence risk. 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

Potential misinformation in large language model descriptions of upper extremity diseases. Sayegh, et al. (2025) Level of Evidence : 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : ChatGPT - Misinformation This study evaluated the reliability of ChatGPT in providing information on upper extremity conditions. A group of hand surgeon asked questions to ChatGPT and analysed the responses. The results suggested that 75% of initial responses contained potential misinformation, primarily reinforcing unhelpful thinking and misrepresenting pathophysiology. ChatGPT often confused palliative treatments with disease-modifying ones. The authors highlight the risks of relying on large language models for medical advice, noting their tendency to mention irrelevant symptom progression or severity. These findings stress the need for cautious interpretation of AI-generated information and emphasise the importance of clear communication from healthcare professionals to promote patient agency and positive mindsets. 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 are significant limitations in the reliability of ChatGPT when providing medical advice on upper extremity conditions. In particular, around 75% of responses contained potential misinformation, which poses a risk if relied upon for health decisions. ChatGPT may also suggest negative or ineffective treatment strategies, potentially affecting patient motivation and mindset. These findings are in line with previous research suggesting that large language models have some benefits , but do not have specialist knowledge at this stage . So while AI tools have potential, clinicians have an important role in guiding patients towards accurate resources. URL : https://doi.org/10.1177/17531934241268975 Abstract When a large language model was prompted to discuss upper extremity conditions and correct instances of misinformation in responses, there was notable persistent misinformation, reinforcement of unhelpful thinking and reduction of independent management of one’s health (agency). 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

Metabolic syndrome is associated with increased complications and healthcare costs after adhesive capsulitis surgery. Khela, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study : Prognostic Topic : Metabolic syndrome - Upper limb surgery This retrospective study investigates how metabolic syndrome affects surgical outcomes and healthcare costs in patients undergoing surgery for frozen shoulder. More than 22,000 participants were included. Around 11,000 were identified as having metabolic syndrome and an additional 11,000 were age and sex matched. The results showed that metabolic syndrome significantly increases the likelihood of postoperative complications, necessitating additional treatments, and the need for additional treatments/rehabilitation. The cost of care for people with metabolic syndrome was almost twice as much as for matched controls at two 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, metabolic syndrome has a significant impact on surgical outcomes following upper limb surgery. In particular, metabolic syndrome significantly increases the risk of postoperative complications, which can lead to prolonged recovery, longer hospital stays, and higher healthcare costs. These findings are not surprised as it appears that low grade inflammation has negative effects on general health and complications following surgery . URL : https://doi.org/10.1016/j.jse.2025.04.008 Abstract Background: Metabolic disturbances are increasingly recognized as contributing factors in the development of adhesive capsulitis (AC). While metabolic syndrome (MetS) has been established as a risk factor for poorer surgical outcomes, there exists limited data on its impact on postoperative outcomes following surgical treatment for AC. The purpose of this study was to investigate the effects of MetS on complications and costs after surgery for AC. Methods: A retrospective cohort analysis from 2011 to 2020 was conducted in the PearlDiver database. Patients with or without MetS who underwent arthroscopic capsular release and/or manipulation under anesthesia for AC were identified using International Classification of Disease and Current Procedural Terminology diagnosis codes. Patients with active records 1 year prior to and 2 years after the initial diagnosis of adhesive capsulitis were eligible. The MetS cohort was matched 1:1 to a control group without MetS based on age, sex, and Charlson Comorbidity Index. Total cost of care at various postoperative time points was compared between cohorts using Student’s t-test. Multivariable logistic regression was performed to assess the impact of MetS on 90-day complications and secondary treatment utilization two years after surgery. A Bonferroni correction was applied to univariable analyses and multivariable regressions. Results: The overall prevalence of MetS was 37.5% (n=16,081) in a cohort of 42,862 patients undergoing AC surgery. After matching, patients with metabolic syndrome were more likely to experience 90-day hospital readmissions (OR=1.89, p<0.001), emergency department visits (OR=1.55, p<0.001), and medical complications (OR=1.10, p<0.001), including acute kidney injury (OR=2.21, p<0.001), pulmonary embolism (OR=2.76, p<0.001), myocardial infarction (OR=1.99, p<0.001), urinary tract infection (OR=1.42, p<0.001), and cardiac arrhythmia (OR=1.51, p<0.001). MetS was also associated with higher secondary treatment utilization, including physical therapy (OR=1.19, p<0.001) and intra-articular injections (OR=1.16, p<0.001). Patients with MetS had higher mean costs of care at 60 days ($2,964.1 vs. $2,726.2, p<0.001), 90 days ($3,683.2 vs. $3,305.9, p<0.001), one year ($10,110.6 vs. $7,680.9, p<0.001), and two years ($19,013.2 vs. $13,577.4, p<0.001) after surgery. Conclusion: MetS is associated with increased postoperative complications, secondary treatment utilization, and healthcare costs following surgery for AC. Further prospective studies are required to understand why this relationship exists and to test if targeted management strategies, such as metabolic control and tailored rehabilitation protocols, for this high-risk population can reduce complications and improve 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

Evaluating the association between health literacy and patient-reported outcome measures after distal radius fracture. Miclau, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Aetiology Topic : Social determinants of health - Distal radius fracture This cross-sectional study assessed the role of health literacy in shaping healthcare outcomes and disparities following a distal radius fracture. A total of 65 participants who had had a distal radius fracture (DRF) or surgery for DRF within the previous six weeks were included in the study. Participants were asked to complete outcome measures including QuickDASH, and numerical rating scales for pain amongst several others. Other participants' characteristics like health literacy, income, preference to speak in a language other than English were also collected. The results showed that lower income and preference to speak in a language other than English were associated with higher pain and lower function whilst controlling for health literacy and lower levels of education. 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, greater social deprivation significantly impacts healthcare outcomes following a conservatively or surgically managed distal radius fracture. In particular, it appears that lower income levels and preference to speak in a language other than English were associated with worse pain and function. It therefore seems that tailored interventions are essential to address these inequities, especially for vulnerable groups. This article is an important reminder that social determinants of help have an important effect on pain and function in our patients. Have a look at the entire database for further information on the topic . URL : https://doi.org/10.1016/j.jhsa.2025.03.022 Abstract Purpose: Patient-reported outcome measures (PROMs) are used to assess patients’ outcomes during the treatment of distal radius fractures (DRFs). Limited health literacy is linked to poorer health outcomes. We asked whether limited health literacy is associated with PROM scores in patients with a DRF. Methods: This cross-sectional study enrolled adults ≥18 years of age with an isolated DRF from two urban hospitals within 6 weeks of injury or surgery. Participants completed a demographics survey, brief health literacy screen, and three PROMs: Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH); Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity v2.0 Short Form-7a (PROMIS-UE); and Numeric Rating Scale (NRS). Associations between social determinants of health (SDOH) factors (health literacy, income, education, and preferred language) and PROMs were assessed using multivariable linear regressions. Propensity score analyses to control for confounding and postmatching regressions were conducted. Results: Sixty-five patients participated in this study. In this sample, the mean age was 54 years, 65% were women, 26% had limited health literacy, 46% had public insurance, 18% completed at most a high school education, and 23% preferred a language other than English (PLOE). In multivariable analyses, limited health literacy and PLOE were associated with worse PROMIS-UE, and low income was associated with worse QuickDASH and NRS; associations between health literacy and QuickDASH and NRS were not statistically significant. Propensity score analyses indicated that all SDOH variables had confounding effects on associations between health literacy and PROMs. The postmatching regression analysis demonstrated that PLOE was associated with worse PROMIS-UE, and low income and PLOE with worse QuickDASH and NRS scores; limited health literacy was not significantly associated with any PROMs. Conclusions: Low income and PLOE were significant predictors of worse PROM scores. After adjusting for other SDOH variables, limited health literacy was not significantly associated with PROM scores. These findings underscore the importance of recognizing and addressing the multiple interconnected SDOH aspects associated with PROM scores. 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

Effectiveness of night splints for cubital tunnel syndrome: A systematic review. Bateman, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Cubital tunnel syndrome - Splints This systematic review assessed the effectiveness of night splints for cubital tunnel syndrome (CuTS) based on studies published in English over the last 30 years. The review included two randomised controlled trials and a few single arm trials. The main results of the review are based on a single RCT. In the RCTs, splinting was compared to advice alone. The review highlighted significant heterogeneity in outcome measures, splint types (custom-made vs. off-the-shelf), and treatment durations (6 weeks to 6 months). Overall, there was very low certainty of evidence suggesting that cubital tunnel splinting had a similar effect to advice only. 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, night splints for cubital tunnel syndrome (CuTS) have limited effectiveness. To console ourselves, another study assessed the effectiveness of splinting and injection for CuTS and showed that injections achieve an even lower positive outcomes compared to splinting . The main difference between this study and the previous review is that in the previous review all sorts of study designs were included whilst in this most recent review, more weighing was given to RCTs. URL : https://doi.org/10.1177/17589983251336157 Abstract Introduction: Cubital Tunnel Syndrome (CuTS) is a common condition of the elbow that is often treated with surgical decompression of the ulnar nerve but evidence for optimal management is unclear. A previous Cochrane review from 2016 identified very limited evidence to guide conservative management, in particular, night splints. The aim of this systematic review was to update the evidence related to the effectiveness of night splints in the treatment of CuTS. Methods: We conducted an electronic search on January 15th 2025 of the MEDLINE, Embase, Emcare and CINAHL databases from the last 30 years, using a pre-defined protocol. Risk of bias was assessed using the RoB2 and ROBINS-I tools, with certainty assessed using GRADE. Results: We identified only one randomised controlled trial (RCT), with high overall risk of bias, that compared night splints to a control arm of advice only. This under-powered trial with high loss to follow-up found no difference between groups. One additional RCT and three single-arm studies, all at high/serious/critical risk of bias, suggested the majority of patients with mild/moderate CuTS improve with night splinting but it is unclear whether the effect was due to treatment or time. Evidence certainty was very low. Discussion: We identified a paucity of evidence, of low quality, regarding night splinting. The evidence identified by this review is currently insufficient to determine whether night splints should be recommended for the treatment of CuTS and there is a need for a high-quality research trial comparing night splints to a control intervention. 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

Analysis of mechanoreceptors and free nerve endings in the lateral collateral ligament of the elbow using immunofluorescence and confocal microscopy. de Paula Costa, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : LUCL - Innervation This cadaver study investigated the lateral collateral ligament (LCL) of the elbow, focusing on its anatomical and functional aspects. Microscopic analysis reveals diverse mechanoreceptors within the LCL, including Ruffini-like receptors, free nerve endings, and blood vessels near nerve structures. The study also calculated nerve density, showing a 0.5% area fraction of nerve density in the LCL. The mechanoreceptors indentified included Ruffini (round, low threshold), Pacini (column/cone-shaped, rapidly adapting), Golgi tendon organs (spindle-shaped, connected to thicker fibers), and free nerve endings (non-myelinated, transmitting nociceptive signals). 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 lateral ulnar collateral ligament (LUCL) of the elbow contains several sensory receptors. These include Ruffini receptors detecting slow pressure changes, Pacini corpuscles responding to dynamic movements, Golgi tendon organs providing information on ligament tension. Overall, it appears that these sensory fibres make up 0.5% of the ligament tissue. Injuries or surgeries affecting the LUCL may disrupt sensory feedback, potentially contributing to persistent pain. If you are interested in knowing how to test the LUCL, have a look at this synopsis . URL : https://doi.org/10.1016/j.jse.2025.04.005 Abstract Background: The lateral collateral ligament (LCL) of the elbow is an essential static stabilizer against varus and posterolateral rotatory forces. It is hypothesized that injury to the LCL might impair elbow proprioception, although direct evidence for this impairment remains limited and warrants further investigation. This study aimed to describe the morphology and distribution of mechanoreceptors and free nerve endings within the LCL. Methods: Twenty ligaments were obtained from 10 fresh cadavers, in compliance with local legislation. Each ligament was measured, weighed, and sectioned. Histological integrity was confirmed using hematoxylin-eosin (HE) staining on 10 μm sections, while 50 μm sections underwent immunofluorescence with protein gene product (PGP) 9.5 as the primary antibody and Alexa Fluor 488 as the secondary antibody, followed by analysis with a confocal laser scanning microscope (Zeiss LMS 710). Results: The LCL was identified in 100% of dissections, with an average length of 36.2 ± 3.4 mm, width of 9.5 ± 2.24 mm, and weight of 0.8 ± 0.13 g. HE staining revealed dense, organized collagen fibers and vascular tissue. Type I (Ruffini-like) and type IV (free nerve endings) mechanoreceptors were identified, along with unclassified nerve endings. Conclusion: These findings suggest a potential additional role for the LCL in proprioception, highlighting the possible importance of neural structures preservation. However, further clinical studies are necessary to determine the actual functional impact beyond mechanical stabilization. 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