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Improving patient care and streamlining follow-up: Compliance with national institute for health and care excellence (NICE) guidelines for pediatric distal radius buckle fractures. Ali, F., et al. (2024) Level of Evidence: 3a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Torus fracture - Guidelines alignment This audit assessed the adherence to NICE guidelines for treating pediatric distal radius buckle fractures (Torus fractures) at Queen's Hospital (UK). Initially, 65 children were assessed, with 95% receiving full plaster casts rather than the recommended removable splints. Following the baseline assessment, which included hospital staff education and improved splint availability, a second audit of 87 patients showed notable progress. Thus, splint use increased from 5% to 53%, and first-visit discharge rose from 8% to 45%. 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, providing clinicians with education about torus fractures and having pediatric splints available for treatment has the potential to increase alignment with the NICE guidelines for the management of this condition. The use of splints instead of casting is not only in line with the NICE guidelines but also allows early return to function without increased risk of complications . Another distal radius pediatric injury that we need to be aware of is growth plate injury, which can stun bone growth . URL : https://doi.org/10.7759/cureus.73624 Abstract INTRODUCTION: Torus fractures, also known as buckle fractures, are among the most common types of fractures seen in children who present to the emergency department (ED). These injuries usually occur when a child falls onto an outstretched hand, resulting in the compression and buckling of the dorsal cortex of the radius while the volar cortex remains intact. These fractures generally have a good prognosis and heal well with simple immobilization with a low risk of complications. However, current treatment practices often involve using a rigid cast and scheduling multiple follow-up clinic visits, which increases the hospital's financial strain. MATERIALS AND METHODS: We conducted an initial audit that reviewed the practice in our unit between August and October 2017 at Queen's Hospital, Burton Upon Trent, United Kingdom. It included all children below the age of 16 who had radiograph images confirming distal radius buckle fractures and have been referred to the fracture clinic. Patient demographics, clinic visits, treating doctor grade/specialty, radiographs, initial and final treatment outcomes, and cast application were collected. After the initial audit, compliance with National Institute for Health and Care Excellence (NICE) guidelines was promoted through the education of healthcare providers. A second audit was performed within 12 months to reassess the compliance. RESULTS: This study looked at the management of pediatric distal radius buckle fractures in a cohort of 152 patients, of which 65 and 87 children were included in audit cycles I and II, respectively. In the ED, splint usage increased from 0% in the first cycle (all children initially treated in a back slab) to 20% following new recommendations. In the fracture clinic, there was a notable improvement in the use of splints over full plaster casts between the first and second cycles. Initially, in the first cycle, only 5% of patients were treated in a splint, with 95% receiving full plaster casts. Following recommendations, splint use increased significantly in the second cycle, rising to 53%, while cast use decreased to 47%. In the first audit, only 7.7% (five patients) were discharged at the first visit, compared to 44.8% (39 patients) in the second audit. In the first audit, 86.2% (56 patients) required a second visit, whereas in the second audit, this decreased to 55.2% (48 patients). Four individuals received a cast owing to splint size difficulties or patient preferences. CONCLUSION: Despite the improvement seen regarding compliance with NICE guidelines, work is still needed to further enhance compliance. Staff education and optimizing splint availability will be a priority to reduce the burden on fracture clinic resources by unnecessary follow-up appointments. 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 manual therapy to the cervical spine on clinical outcomes and electrodiagnostic tests in people with carpal tunnel syndrome: A randomized controlled trial. Zarrin, et al. (2024) Level of Evidence: 1b- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Cervical intervention - Carpal tunnel syndrome This randomised controlled study investigated the effectiveness of incorporating cervical spine manual therapy (CMT) in conjunction with traditional physical therapy (PT) on patients with carpal tunnel syndrome (CTS). Forty-eight individuals with CTS were randomly assigned to receive either conventional PT alone or PT combined with CMT. Over ten sessions, the CMT group also received specific neck mobilisations. Clinical outcomes such as pain intensity, functional status, and nerve electrophysiology were evaluated before, immediately after, and six months post-treatment. Results indicated greater improvements in the CMT group across multiple measures, including pain reduction, functional ability, and nerve conduction metrics, both immediately post-intervention and in the longer term. It is important to remember that this was a small studies and larger RCTs would be required to exclude this being a false positive finding. 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, incorporating cervical spine manual therapy into the standard physical therapy regimen for carpal tunnel syndrome may provide benefits in reducing pain and improving functional status . It is more likely that such interventions would benefit people who have a neck contribution to their symptoms based on additional subjective and objective information that you can gather . Currently, the suggested interventions for an isolated carpal tunnel syndrome include night splinting and exercise for mild to moderate entrapment with cortisone and/or carpal tunnel release for severe median nerve neuropathies . URL : https://doi.org/10.1016/j.jbmt.2024.04.020 Abstract Objective: To determine if cervical spine manual therapy (CMT) plus conventional physical therapy (PT) optimizes clinical objective and self-reported outcomes, compared to PT alone, in people with carpal tunnel syndrome (CTS). Method: Forty-eight patients with the diagnosis of CTS were randomly divided into conventional PT (control group) and conventional PT plus cervical spine manual therapy (intervention group). All patients received 10 sessions of supervised conventional physical therapy (wrist splint, electrotherapy and wrist joint mobilization). Patients in the cervical spine manual therapy group also had manual therapies techniques given to their neck. Visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), the disabilities of the arm, shoulder, and hand (DASH) questionnaire, median nerve motor distal latency (mMDL), and median sensory nerve conduction velocity (mSNCV) were assessed at three points: baseline, post-intervention, and six months later. Results: The cervical spine manual therapy group showed significantly greater improvement in VAS, DASH score, mMDL, and mSNCV in post-intervention and follow-up compared to the conventional group. There was no significant difference in two subscales of BCTQ at post-intervention for two groups, whereas these two subscales showed a significant difference in favor of the cervical manual therapy group at follow-up. Conclusion: The analysis of results showed that conventional CMT combined with PT could be more effective in improving the clinical outcomes and electrodiagnostic findings of patients with CTS compared to conventional PT only in the long term. Therefore, it can be suggested as a proper therapeutic method in CTS. 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

Premature closure of the distal radial physis without evident history of trauma. Tomori, et al. (2020) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Distal radius growth plate - Premature closure This case study described the clinical presentation of a 14-year-old girl, who presented with wrist pain, deformity, and functional impairment since the age of 5. Subjectively, there was no history of trauma. They reported significant pain, which limited the patient's daily and sports activities. There were close to no range of movement limitations in the wrist compared to the unaffected side. On x-ray there was significant radioulnar length discrepancy, as you can see from the x-ray shown below. The orthopedic team diagnosed the presentation as idiopathic premature closure of the distal radial physis. The corrective surgical intervention involved an opening wedge osteotomy of the distal radius using an iliac bone graft and a subsequent shortening osteotomy of the ulna. Post-operatively, the patient achieved full painless wrist mobility. 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, premature closure of the distal radial physis can occur in rare instances without a trauma history. In this cases, corrective osteotomy combined with bone grafting and ulnar shortening may be a useful management options to reduce symptoms and correct the deformity. Despite this presentation being much more common as a result of trauma, it remains a rare injury. Thus, torus fractures are the most common presentations of distal radius fracture in children and teenagers . URL : http://dx.doi.org/10.1097/MD.0000000000021515 Abstract Rationale: The distal radius is the region of the body with the highest incidence of physeal injury. However, it is uncommon for the distal radius to undergo growth arrest without a history of trauma. We present a case of premature closure of the distal radial physis without evident history of trauma in a girl. Patient concerns: A 14-year-old girl presented with chronic progressive deformity and painful functional limitation of her right forearm. The right wrist pain had begun when the patient was 5 years old. There was no evident history of trauma. The deformity and persistent right wrist pain had prevented her from performing sports activities and activities of daily living. Diagnoses: Radiography and computed tomography showed a volarly angulated distal radius and dorsally protruding distal ulna with a length discrepancy between the distal radius and ulna due to premature physeal closure of the right distal radius. Interventions: To eliminate the deformity and achieve painless functional recovery of the wrist, an opening wedge osteotomy of the distal radius with an iliac bone graft was performed, followed by a shortening osteotomy of the distal ulna. Outcomes: Radiography at final follow-up 1 year and 9 months postoperatively showed good alignment of the distal radioulnar joint without length discrepancy between the two forearm bones. The range of motion of the left wrist had reached 100% of the contralateral wrist without any pain, and the right grasp strength was 18 kg, which was 82% compared with the dominant left wrist. Lessons: Premature closure of the distal radial physis impairs the growth potential of the physis and leads to wrist dysfunction due to deformities. In the present case, a satisfactory outcome was achieved via corrective osteotomy of the distal radius with an iliac bone graft combined with ulnar shortening osteotomy. 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

Prospective study on splinting for first carpometacarpal joint: A comparison of conventional and three-dimensional printed splint. Inaba, N., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Thumb OA - Splinting This study assess the effectiveness of three-dimensional (3D) printed splints (including or not the mcpj) compared to conventional splints for first carpometacarpal osteoarthritis (no mcpj involved - see picture below). A total of 12 hands from nine patients were splinted. The study assessed pain, function, use time, satisfaction, and discomfort over two-week periods for each type of splint: conventional, short-type 3D-printed, and long-type 3D-printed. The results showed that there was no difference across splinting types except that the 3D-printed versions resulted in significantly less discomfort whilst wearing them. 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 use of 3D-printed splints for first carpometacarpal joint osteoarthritis offers comparable pain relief to conventional splints, with the added benefit of reduced discomfort. Despite this added benefit, it seems unlikely that the added cost of the machinery and time required currently outperform the traditional custom made thermoplastics. It is also important to remember that splinting for thumb OA may have limited effectiveness and hence a cheaper option (thermoplastic) may be sufficient if the patient would like to try it. URL : https://doi.org/10.3390/jcm13237043 Abstract Background: Patient compliance is a major concern of hand orthosis in first carpometacarpal osteoarthritis. To address this issue, we established a method for creating a custom-made three-dimensional printed splint based on computed tomography. This prospective study evaluates the usefulness of the three-dimensional printed splint compared with the conventional splint. Methods: A total of 12 hands in nine patients were included. The mean age of the patients was 69 years (range: 58–84). Conventional orthoses were made by prosthetists using molds. Three-dimensional printed orthoses (long and short types) were digitally designed from computed tomography data and created using Fused Deposition Modeling. Subjects were instructed to use three types of orthoses for 2 weeks each. They completed questionnaires that indicated pain, function, percentage of daytime spent using the orthosis, satisfaction score, and discomfort caused by wearing orthoses. Results: The pain on motion showed an improvement of approximately 20% for all orthoses. There was no significant difference in pain scale, function, percentages of daytime spent using each orthosis, and satisfaction score among the three types of orthoses. Discomfort caused by wearing orthosis was more frequent in conventional orthosis than in 3D-printed orthosis, and there was a significant difference between the conventional type and the long-type 3D-printed orthosis. Conclusions: This study suggests that 3D-printed splints provide comparable pain relief to conventional splints with reduced discomfort. However, limitations such as small sample size, short follow-up, and reliance on CT imaging highlight the need for further research. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic This case study described the clinical presentation of a 14-year-old girl, who presented with wrist pain, deformity, and functional impairment since the age of 5. Subjectively, there was no history of trauma. They reported significant pain, which limited the patient's daily and sports activities. There were close to no range of movement limitations in the wrist compared to the unaffected side. On x-ray there was significant radioulnar length discrepancy, as you can see from the x-ray shown below. What is it?

Outcomes and performance following posteromedial elbow débridement in major league baseball players. Wollenman, et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic : Elbow debridement/osteophites resection - Surgical interventions This retrospective study assessed the outcomes of posteromedial elbow debridement or osteophyte resection in Major League Baseball (MLB) players, particularly focusing on return to play (RTP), performance (ball velocity - pitchers), and the need for further surgeries, such as ulnar collateral ligament (UCL) reconstruction. The study included 39 players who underwent the procedure between 2008 and 2021. The results showed a high RTP rate of 82% in MLB games, with pitchers specifically showing a 77% RTP rate. Pitching performance metrics were mostly unchanged in the short term, except for a significant decrease in fastball velocity over three years (1.5 km/hr, which may not be clinically significant). The rate of subsequent UCL reconstruction was 19% among pitchers, aligning with baseline rates for MLB pitchers. However, concerns remain over long-term outcomes, as 39% of pitchers returned to the injured list within three seasons post-surgery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, players in the Major League Baseball can expect an 80% return-to-play following elbow debridement or osteophytes removal. Following such surgery there is no higher risk of subsequent ulnar collateral ligament (UCL) reconstruction compared to other players not having undergone surgery. Nevertheless, amongst those pitchers who had surgery, 40% are classified as re-injured at three years post injury. This study is a nice addition to the already existing research on the management of athletes with hands and wrist injuries requiring surgery . URL : https://doi.org/10.1016/j.jse.2024.05.035 Abstract Background: Overhead athletes are particularly susceptible to elbow valgus extension overload syndrome and development of pathologic changes in the posteromedial elbow. Though arthroscopic débridement/osteophyte resection is frequently performed, few studies have analyzed the outcomes of this procedure and none have specifically addressed professional level athletes. Hypothesis: We hypothesized that following posteromedial elbow débridement, Major League Baseball (MLB) pitchers would exhibit a higher rate of ulnar collateral ligament (UCL) reconstruction than baseline incidence in the existing literature, along with a decline in pitching performance. Methods: Using publicly accessible websites, MLB athletes undergoing posteromedial elbow débridement from 2007 to 2022 were identified. Demographic information, procedure details, return to play (RTP) information, return to the disabled/injured list (DL/IL), subsequent UCL reconstruction, and pitching statistics were analyzed. Pitching performance metrics included earned runs average, walks plus hits per innings pitched, innings pitched, and fastball velocity. Results: A total of 39 MLB players, including 26 pitchers, were included. Within the first three seasons after surgery, 82.1% (n = 32) of players returned to play at the MLB level at a mean time of 176.1 ± 69 days. Pitchers exhibited a RTP rate of 76.9% (n = 20) at 175.8 ± 16 days. A total of 38.5% (n = 10) of pitchers returned to the DL/IL for elbow-related issues within three seasons. Subsequent UCL reconstruction was seen only in pitchers, with a frequency of 19.2% (n = 5). No statistically significant differences between single season preoperative/postoperative pitching metrics were identified. A small but significant (P < .05) decrease in fastball velocity (94.4 vs. 92.84; P = .02) was observed over a three-season comparison. Conclusion: Contrary to our hypothesis, this study demonstrates that posteromedial elbow débridement is a viable surgery in MLB athletes, with RTP rate of 82.1% and no increase in rate of UCL reconstruction. Furthermore, there was no significant difference in single season preoperative and postoperative statistical pitching performance. However, over three years postoperatively, there was a 38.5% rate of return to the DL/IL for ongoing elbow ailment and a significant decrease in pitch velocity, raising some concern over the longevity of postoperative improvements. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

A randomized controlled trial on the effectiveness of mirror therapy in improving strength, range of movement and muscle activity, in people with carpal tunnel syndrome. Muñoz-Gómez, E., et al. (2024). Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Carpal tunnel syndrome - Conservative treatment This randomised controlled trial, compared the efficacy of mirror therapy (MT) versus traditional therapeutic exercises (TE) performed on the unaffected side only in patients with unilateral Carpal Tunnel Syndrome (CTS). A total of 39 participants were included in the present study, and they were randomised to MT or TE groups. The MT group performed exercises with the unaffected hand, which was reflected in a mirror, while the TE group executed the same exercises without a mirror and the CTS hand hidden below the table. The results that MT significantly improved wrist flexion-extension range of motion (ROM) and handgrip strength compared to the TE group. Both groups reported decreased pain, however, only the MT showed a clinically significant improvement (see graph below). 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, mirror therapy for carpal tunnel syndrome appears to provide better outcomes compared to exercises on the unaffected hand with the affected side out of sight. It is possible that part of the effectiveness of mirror therapy is due to increase attention towards the affected limb compared to an invitation to disregard the affected side when performing the exercises on the healthy hand. If you are interested in carpal tunnel syndrome assessment and management, have a look at the whole database . URL : https://doi.org/10.1016/j.jht.2024.02.007 Abstract Background: There is little information on the potential effects of mirror therapy (MT) on motor recovery in individuals with Carpal Tunnel Syndrome (CTS). Purpose: To compare the effectiveness of a MT protocol versus a therapeutic exercise (TE) protocol, in improving strength, range of motion (ROM), muscle activity, pain, and functionality in patients with CTS. Study design: Randomized clinical trial. Methods: Thirty-nine participants with unilateral CTS were divided into two groups: (i) MT group (n = 20) that followed an exercise protocol applied to the unaffected hand reflected in a mirror, and (ii) TE group (n = 19) that followed the same exercise protocol using the unaffected hand but without a mirror. Strength, wrist ROM, muscle activity, pain and functionality, were assessed at baseline (T0), after treatment (T1) and one month after treatment (T2). Results: At T1, the MT group showed significantly higher wrist flexion-extension ROM compared to TE (p = 0.04, d = 0.8), maintained at T2 (p = 0.02, d = 0.8). No significant changes were observed in ulnar-radius deviation, pronosupination, or fatigue following either MT or TE (p > 0.05). MT exhibited enhanced handgrip strength at T1 (p = 0.001, d = 0.7), as well as an increase in the extensor carpi radialis (ECR) and flexor carpi radialis (FCR) maximum muscle activity (p = 0.04, d = 1.0; p = 0.03, d = 0.4). At T1, both groups decreased pain (p = 0.002, d = 1.1; p = 0.02, d = 0.7), and improved functionality (p < 0.001, d = 0.8; p = 0.01, d = 0.5) (MT and TE respectively). Discussion: MT led to enhancements in wrist flexion-extension movement, handgrip strength and functionality unlike TE. MT notably increased muscle activity, particularly in the ECR and FCR muscles. Conclusions: MT is a favorable strategy to improve wrist flexion-extension ROM, handgrip strength, ECR and FCR muscle activity, and functionality in people with unilateral CTS. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

A review of the New Zealand National Joint Registry to evaluate the survivorship and revision rates of Nexel and Coonrad-Morrey total elbow arthroplasty. Wengle, L., Frampton, C. and Poon, P. C. (2024) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Total elbow replacement - Revision rate This retrospective study assessed the survivorship and revision rates of the Nexel and Coonrad-Morrey total elbow arthroplasty implants in New Zealand, using data from the National Joint Registry. Prior research criticised the Nexel TEA for high failure rates. The results showed a 7% revision rate for Nexel at five years compared to 5% for the Coonrad-Morrey, with average times to revision being 3 years for Nexel and 5 years for Coonrad-Morrey. Component loosening was a primary reason for revisions in both groups. There was a trend for the Nexel implant having worse outcomes, however, the incidence of revision/complication was lower compared to what has been previously reported in the literature (34% to 60% of revisions and complications respectively). 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, in New Zealand, the survivorship of both the Nexel and Coonrad-Morrey total elbow arthroplasty implants appear to be acceptable. Total elbow replacement is therefore a viable option for people with osteoarthritis who have not responded to conservative treatment . URL : https://doi.org/10.1016/j.jse.2024.03.029 Abstract Background: Total elbow arthroplasty (TEA) is an appropriate surgical treatment option for a variety of conditions ranging from inflammatory arthritis to trauma. Due to a high complication profile, implant companies have attempted to improve patient outcomes with evolving design mechanics and philosophy. However, the Nexel TEA prosthesis has been criticized for its unacceptably high revision rate by other research groups in the literature. The purpose of this study was to evaluate the survivorship and revision rates of the Nexel and Coonrad-Morrey total elbow arthroplasty implant systems in New Zealand. Methods: Prospectively collected national joint registry data was used to compare the survival rates of these prostheses. Underlying diagnoses, reasons for revision, and patient demographics were all recorded. Statistical analysis included survival analysis using Kaplan-Meier curves and comparison between groups using independent t-tests. Results: Over the 23-year study interval, the Nexel and Coonrad-Morrey prostheses showed similar survivorship and revision rates. The revision rates at 5 years were 7.3% for ZN and 4.5% for the Coonrad-Morrey cohorts. The average time to revision for those who are revised was 3.13 ± 1.74 years in the Nexel group and 4.93 ± 4.13 years in the Coonrad-Morrey population. Conclusion: Our study confirms a lower revision rate of the Nexel TEA compared to other studies in the literature. Additionally, the Nexel TEA implant performs comparably to its predecessor, the Coonrad-Morrey prosthesis in New Zealand. While it is difficult to explain the discrepancy in results with the study by Morrey et. al, future studies should focus on investigating postoperative radiographs and a deep analysis of the specific surgical technique used for this implant. 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

Orthotic interventions for restoring proximal interphalangeal joint motion for patients with hand injuries or conditions: A systematic review and meta-analysis. Yates, S. E., Glinsky, J. V., Hirth, M. J. and Fuller, J. T. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic : Splinting for pipj - Traumatic vs Dupuytren's flexion deformities This systematic review and meta-analysis assessed the effectiveness of splinting interventions in restoring pipj motion for patients with hand injuries or conditions, focusing on Dupuytren's contracture and fixed flexion deformities following traumatic injury/surgery. Twelve RCTs were included, with findings suggesting that splinting interventions do not offer additional benefits for pipj extension compared to hand therapy alone in postoperative Dupuytren's contracture. In contrast, for pipj flexion deformities, splinting significantly improved extension more than hand therapy alone. No studies assessed splinting interventions aimed at improving pipj 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, splinting for pipj injuries has a clinically important benefit in reducing fixed flexion deformities. However, splinting options to improve pipj impairments following Dupuytren's surgery do not appear to have an important effect. These findings appear to be in line with previous evidence showing that prolonged low level tension on healing tissues may help improving flexibility and that chronic presentations are less likely to benefit from splinting interventions . URL : https://doi.org/10.1016/j.jht.2023.12.018 Abstract Background: Limitations to proximal interphalangeal joint (PIPJ) motion can result in significant functional impairment for people with hand injuries and conditions. The role of orthotic intervention to improve PIPJ motion has been studied; however, high-quality systematic reviews and meta-analyses are lacking. Purpose: This study aimed to determine the effectiveness of orthotic intervention for restoring PIPJ extension/flexion following hand injuries or conditions. Study design: Systematic review. Methods: A comprehensive literature search was completed in MEDLINE, CINAHL, Embase, Cochrane Central, and PEDro using terms related to orthoses, finger PIPJ range of motion, and randomized controlled trial design. Methodological quality was assessed using the PEDro score, study outcomes were pooled wherever possible using random effects meta-analysis, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation. Results: Twelve trials were included (PEDro score: 4-7/10). The addition of orthotic intervention was not more effective than hand therapy alone following Dupuytren’s release for improving total active extension (mean difference [MD] −2.8°, 95% confidence interval [CI]: −9.6° to 4.0°, p = 0.84), total active flexion (MD −5.8°, 95% CI: −12.7° to 1.2°, p = 0.70), Disability of the Arm, Shoulder and Hand scores (MD 0.4, 95% CI: −2.7 to 3.6, p = 0.79), or patient satisfaction (standardized MD 0.20, 95% CI: −0.49 to 0.09, p = 0.17). Orthotic intervention was more effective than hand therapy alone for improving PIPJ extension for fixed flexion deformities following traumatic finger injury or surgery (MD −16.7°, 95% CI: −20.1° to −13.3°, p < 0.001). No studies evaluated orthotic intervention to improve PIPJ flexion. Conclusion: The addition of an extension orthosis following procedures to manage Dupuytren’s contracture is no better than hand therapy alone for improving PIPJ extension. In contrast, the addition of a PIPJ extension orthosis in the presence of traumatic PIPJ fixed flexion deformities is more effective for improving PIPJ extension than hand therapy alone. Future studies are needed to evaluate the role of orthotic intervention for improving PIPJ flexion. 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

Self-reported improvement after carpal tunnel release in patients with motor axonal loss. Livingston, N., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Carpal tunnel surgery - positive vs negative NCS This retrospective study assessed the effect of sensory and motor axonal loss (AL) on outcomes after carpal tunnel release (CTR). Sensory and motor AL were assessed through electrodiagnostic studies in the whole sample of 175 patients. Patient-reported outcomes were analysed before and three months after surgery. There was no difference in postoperative improvement between patients with and without sensory AL. However, those with motor AL experienced greater improvements in pain and QuickDASH outcomes. These findings suggest that despite severe CTS, surgery can significantly improve outcomes. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, patients with motor axonal loss due to carpal tunnel syndrome may experience greater postoperative improvements in function and pain relief compared to those without motor loss. In line with previous research, surgical intervention is therefore recommended for people with severe carpal tunnel syndrome. For those patients with mild to moderate symptoms, monitoring sensory and motor presentation and treating them with a night wrist splint appear to be an effective treatment approach. In particular, a splint blocking mcpj flexion appears to be more effective than a normal wrist splint . URL : https://doi.org/10.1016/j.jhsa.2024.10.010 Abstract Purpose: Electrodiagnostic studies can identify evidence of sensory and motor axonal loss (AL) in carpal tunnel syndrome (CTS) patients. However, the impact of sensory and motor AL on outcomes following carpal tunnel release (CTR) remains unclear. We hypothesize that patients with no evidence of sensory and motor AL will experience greater improvement following CTR compared to those with evidence of AL. Methods: Patients undergoing open and endoscopic CTR by four fellowship-trained orthopedic hand surgeons were identified. Sensory and motor AL were identified using preoperative electromyography and nerve conduction studies. Patients completed the following before surgery and 3-month postoperative patient-reported outcomes: Patient-Reported Outcomes Measurement Information System Upper Extremity (UE) and Pain Interference (PI) as well as Disabilities of the Arm, Shoulder, and Hand (QuickDASH [QD]). Preoperative and postoperative scores, changes in scores, and rates of achieving the minimally clinically important difference (MCID) were compared between patients with and without sensory and motor AL. Results: One hundred and seventy-five patients were included. Of these, 91 exhibited sensory AL and 98 exhibited motor AL. Demographic matched analysis of patients with and without sensory AL showed no differences in before surgery, after surgery, difference, or proportion meeting MCID for UE, PI, or QD. Matched analysis revealed no difference in preoperative PROMs between patients with and without motor AL. Patients with motor AL had increased postoperative UE (better function), decreased postoperative PI (less PI) and QD (less disability), increased changes in PI and QD, as well as a greater proportion meeting MCID for QD compared to those without motor AL. Conclusions: There was no difference in post-CTR improvement between patients with and without sensory AL. However, contrary to our hypothesis, motor AL patients experienced greater postoperative improvement according to QD. These findings suggest surgery should be recommended for severe CTS patients with evidence of AL. These results can better inform physicians and patients as they discuss expectations of CTR 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

Arthrodesis versus ligament reconstruction and tendon interposition for thumb carpometacarpal joint arthritis: A systematic review and meta-analysis. Kim, C.-H., Lee, D.-H., Lee, J.-S. and Jung, H.-S. (2024) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Suspension plasty vs arthrodesis - 1st cmcj OA This systematic review and meta-analysis compared arthrodesis and ligament reconstruction with tendon interposition (LRTI) for 1st cmcj OA. Data from six studies involving 285 thumbs showed no significant differences between the two procedures regarding pain levels (visual analog scale), functional outcomes (QuickDASH), and grip strength. However, arthrodesis patients exhibited higher key pinch strength. Despite this advantage, arthrodesis was linked to increased reoperation and postoperative complication rates compared to LRTI. These findings suggest that LRTI may be a less risky choice, particularly for older patients or those at higher risk of complications, while arthrodesis might be reserved for younger or more active patients. Below you can find the forest plot of re-operation rate (A) and post-surgical complications (B) for the two approaches. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, both arthrodesis and ligament reconstruction with tendon interposition (LRTI) for 1st cmcj OAmay be useful interventions. While arthrodesis enhances key pinch strength, it also associated with a higher risk of reoperation and postoperative complications compared to LRTI. Currently, the safest surgical approach for 1st cmcj OA appears to be trapeziectomy. URL : https://doi.org/10.1016/j.jhsa.2024.10.018 Abstract Purpose: Arthrodesis and ligament reconstruction and tendon interposition (LRTI) are commonly performed procedures for treatment of thumb carpometacarpal (CMC) osteoarthritis. Although LRTI is the most common surgical treatment, CMC arthrodesis has been performed because of its reported advantages. This systematic review and meta-analysis compared the differences between CMC arthrodesis and LRTI to better inform surgeons and patients when they are making treatment decisions. Methods: We searched MEDLINE, Embase, and the Cochrane Library for studies published up to 27 August 2023 that directly compared arthrodesis with LRTI for thumb CMC joint arthritis. The pooled analysis compared the visual analog scale; Quick Disabilities of the Arm, Shoulder, and Hand scores; grip strength; key pinch strength; reoperation rates; and postoperative complication rates. Results: Six studies describing 285 thumbs, including 141 and 155 thumbs that underwent arthrodesis and LRTI, respectively, were included. Visual analog scale (standard mean difference [SMD], −0.05; 95% CI, −0.40 to 0.30; P = .78), Quick Disabilities of the Arm, Shoulder, and Hand score (SMD, 0.53; 95% CI, −1.12 to 2.17; P = .53), and grip strength (SMD, −0.67; 95% CI, −1.85 to 0.51; P = .27) showed no difference between the two groups. The arthrodesis group showed significantly higher key pinch strength (SMD, 0.61; 95% CI, 0.32–0.90), reoperation rate (odds ratio, 8.02; 95% CI, 2.00–32.16), and postoperative complication rate (odds ratio, 2.08; 95% CI, 1.11–3.91; I2 = 0%) compared with the LRTI group. Conclusions: Carpometacarpal arthrodesis is associated with a better key pinch strength than LRTI. Nevertheless, no significant differences were observed in functional scores and grip strength. Patients who undergo arthrodesis have higher reoperation rates and incidence of postoperative complications than those who undergo LRTI. Thus, although arthrodesis may be a better operation for patients who require high pinch strength, surgeons should also consider the higher complication compared with LRTI. 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

Investigating the effect of triamcinolone local injection on clinical outcomes of patients with radial tunnel syndrome: A placebo-controlled clinical trial. Estaji, F., Daliri, M., Hashemi, S. and Moradi, A. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Radial tunnel syndrome - Cortisone vs placebo injections This randomised double-blind control trial compared the efficacy of cortisone vs saline injections for radial tunnel syndrome (RTS). A total of 42 participants characterised by pain exacerbated by activity, maximal tenderness 3 to 5 cm distal from lateral epicondyle, irradiation of pain to the dorsal aspect of the forearm, and pain with middle finger extension were included. The placebo/experimental injection was provided by a senior hand surgeon, without ultrasound guidance. Confirmation of the injection being delivered to the radial tunnel was provided by a short term duration (15-30 minutes) of wrist drop. Participants were assessed using the QuickDASH, VAS for pain, and the Oxford Elbow Score at baseline, two weeks, and three months post-injection. The results revealed no significant differences between the treatment and placebo groups regarding improvement across all measures. However, both groups showed clinically significant improvements over time. These results highlight the potential non-specific therapeutic effects of the injection process. 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, corticosteroid injections do not appear to be superior to saline injection (placebo) in radial tunnel syndrome. However, both injections provide clinically relevant improvements in pain and function over time. These findings are similar to previous research assessing the effectiveness of PRP and placebo injections for lateral epicondylalgia . URL : https://doi.org/10.1016/j.jhsa.2024.09.023 Abstract Purpose: The role of corticosteroid injection for radial tunnel syndrome (RTS) has not been studied in a placebo-controlled clinical trial. The present clinical trial aimed to evaluate the effect of local triamcinolone injection on pain intensity, upper-extremity disability, and elbow function of patients with RTS. Methods: Forty-nine patients clinically diagnosed with RTS were randomized into the intervention and placebo groups. The diagnosis of RTS was made based on the following criteria: activity-related pain, maximal tenderness 3 to 5 cm distal to the lateral epicondyle, pain that worsens with forearm supination, pain radiating to the dorsoradial aspect of the forearm, and a positive Lister test. To confirm RTS, patients needed to exhibit at least four of these five criteria, with the requirement that one of the criteria be the tenderness located 3–5 cm distal to the lateral epicondyle. Patients in the intervention group received local injection of a single dose of corticosteroid (0.25 mL lidocaine 1% and 1 mL triamcinolone 40 mg/mL), and the placebo group received injection of single dose of normal saline (0.25 mL lidocaine 1% and 1 mL normal saline). The clinical outcomes, including Quick DASH (Disabilities of the Arm, Shoulder, and Hand), visual analog scale for pain, and Oxford Elbow Score, were evaluated before treatment, as well as 2 weeks and 3 months after the injection. Results: Visual analog scale pain score, Quick DASH score, and Oxford Elbow Scores were similar between the intervention and placebo groups at 2 weeks and 3 months of follow-up. However, reduction in visual analog scale pain, Quick DASH score, and Oxford Elbow Scores were statistically significant over time among both groups. Conclusions: Triamcinolone injection does not have any superior effect on the clinical outcomes of patients with RTS, compared with placebo. 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