Search Results

Management of stable proximal interphalangeal joint volar plate injuries with figure-of-8 orthoses: A parallel-group randomized controlled trial. Grange, M., Carra, K., Barrett, S. and McKinstry, C. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Therapeutic Topic: Pipj volar plate injury - Figure eight splint This randomised controlled trial compared the effectiveness of figure-of-8 orthoses and dorsal blocking orthoses in managing stable proximal interphalangeal joint volar plate injuries. A total of 30 participants were included in the study. Participants were randomised to either a dorsal blocking splint or a figure 8 splint which maintained the pipj in 20 deg of flexion. Both splints were worn for four weeks. The results showed that both types of splinting provided similar outcomes in terms of pain, function, and range of movement. However, the group using the figure-of-8 orthosis required fewer therapy appointments on average than the group using the dorsal blocking orthosis. 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 figure 8 and dorsal blocking splints are effective in managing stable volar plate injuries of the pipj. Early mobilisation with a figure 8 splint in 15-20 degrees of flexion can be beneficial in the initial management stages following the injury. If you are interested in reading more research about pipj, have a look at the database for splinting options. URL: https://doi.org/10.1016/j.jht.2023.11.001 Abstract Background: Volar plate injuries of the proximal interphalangeal (PIP) finger joint are common. Conservative treatment involves orthoses to limit hyperextension at the PIP joint yet allow movement of the joints to prevent joint stiffness and deformity. Custom-made dorsal blocking orthoses are recommended treatments. Previous research also supports the use of a figure-of-8 orthosis, although the comparative effectiveness of these orthoses is not currently known. Purpose: This study aimed to compare the figure-of-8 orthosis and dorsal blocking orthosis for changes in the range of movement, pain, and function following stable volar plate PIP joint injuries and to compare the number of hand therapy appointments required. Study Design: A parallel-group pilot randomized controlled trial. This trial was registered with the Australian and New Zealand Clinical Trials Registry (Trial ID: CTRN12619000449134). Methods: Participants aged 13-65 years were recruited from an outpatient hand therapy service and randomly assigned to experimental or control groups. The experimental group of 20 participants received a custom-made thermoplastic figure-of-8 orthosis limiting the extension to 15-20 degrees. The control group of 22 participants had a dorsal blocking orthosis, which was serially extended by 10 degrees weekly starting at 30 degrees flexion. Participants were blinded to their group allocation. Outcome measures included range of movement, edema, pain, function, and number of hand therapy appointments. Data collection was completed by the treating therapist who was not blinded to group assignment. Data analysis included a series of mixed-model analyses of variance to examine changes over time. Results: Forty-two participants were recruited and had their data analyzed. No significant between-group differences were observed for DIP flexion, PIP flexion, pain, and function from baseline to follow-up. Both groups exhibited significant improvements in these outcomes over time (p < 0.001); effect sizes ranged from small to large (0.28-0.79). On average, the intervention group required 4 (±1.5) appointments compared to 6 (±1.5) in the control group over the same period representing a significant difference (p < 0.001). Conclusions: Both dorsal blocking and figure-of-8 orthoses provide similar outcomes. The use of a figure-of-8 orthosis, or a dorsal block orthosis fabricated in maximal comfortable extension depending on severity, could reduce the number of appointments and increase convenience for patients. 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

Depression, anxiety, and post-traumatic stress disorder following upper versus lower extremity fractures. Chen, K., Hynes, K. K., Dirschl, D., Wolf, J. M. and Strelzow, J. A. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Symptoms prevalence Topic: Mental health after injury - Upper vs lower limb The study investigated the prevalence of depression, anxiety, and PTSD following upper extremity fractures (UEF) compared to lower extremity fractures (LEF) using a national insurance claims database. A total of 310,000 UEF and 360,000 LEF participants were included. These participants were compared to a group of people undergoing carpal tunnel release (600,000) for the upper limb and knee arthroscopy (1,145,000) for the lower limb. Both UEF and LEF participants showed higher rates of psychiatric diagnoses compared to the controls, with isolated UEF associated with all three psychiatric diagnoses (depression, anxiety, post-traumatic stress disorders - see adjusted odds ratios forest plots below). The study emphasized the importance of normalizing psychiatric care, early intervention, and stigma reduction. Factors such as injury location, trauma severity, and pre-injury psychiatric history were identified as key variables affecting psychiatric pathology. 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, psychiatric pathology is prevalent following orthopaedic trauma, particularly in patients with upper extremity fractures. It is crucial for us to be aware of the increased risk of major depressive disorder (MDD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD) in these patients. Normalising psychiatric care, early intervention, and reducing stigma around mental health are essential aspects of orthopaedic trauma management. Screening for psychiatric symptoms and providing support for mental health concerns alongside physical rehabilitation can enhance overall patient well-being and recovery. This study is part of a growing body of evidence showing that mental health is an important aspect of people affected by hand and upper limb conditions. URL: https://doi.org/10.1016/j.injury.2023.111242 Abstract Introduction: Orthopaedic trauma has been linked to major depressive disorder (MDD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD). Post-injury rates of psychiatric diagnoses and their relationship to various injury characteristics are not well characterized. We aimed to determine the association between orthopaedic trauma and MDD, GAD, and PTSD diagnoses at 5-year follow-up. Methods: A national insurance claims database was used to create upper extremity fracture (UEF) and lower extremity fracture (LEF) cohorts, with further stratification by isolated versus multiple fractures. Patient undergoing elective upper or lower extremity orthopaedic procedures served as controls. Rates of post-injury psychiatric diagnoses were calculated. Univariate logistic regression was conducted after matching in a 1:1 ratio based on relevant comorbidities such as psychiatric history. All significant variables were included in multivariate analysis. Results: A total of 308,578 UEF patients and 360,510 LEF patients were identified. Within the UEF cohort, the diagnosis rates following either isolated or multiple fractures were identified: MDD (25% to 30%), GAD (10% to 11%), and PTSD (4%). LEF cohort rates were as follows: MDD (30% to 38%), GAD (11% to 14%), and PTSD (4% to 7%). Compared to non-injured controls, both the UEF and LEF cohorts were associated with higher rates of all psychiatric diagnoses. In comparing UEF and LEF cohorts, isolated UEF was associated with MDD, GAD, and PTSD; however, multiple UEF was associated with MDD and GAD, whereas multiple LEF was associated with PTSD. Conclusion: Psychiatric pathology is prevalent following orthopaedic trauma. Even after controlling for psychiatric history, orthopaedic trauma is independently associated with post-injury psychiatric diagnoses and may be more predictive of PTSD and GAD than of MDD. Upper extremity fractures may portend higher psychiatric risk. With negative stigma surrounding mental health and the early role of orthopaedic surgeons in providing care, it is imperative to normalize psychiatric care with patients and discuss warning symptoms that may indicate the onset of psychiatric disorders. 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: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic/Therapeutic This is the answer to last week's Sherlock Handy. A 29-year-old healthy woman had been experiencing insidious onset of wrist pain for two years, after which they developed paraesthesias in the median nerve distribution at the hand. On objective examination there were no range of movement restrictions or abnormal findings on special tests, however, carpal tunnel tests were positive. Magnetic resonance imaging (MRI) was completed and one of the images is reported below. What is it?

Clinical outcomes following surgical management of post-traumatic elbow contractures in the pediatric age group: A meta-analysis and systematic review. Onggo, J. R., Chua, N. S. H., Onggo, J. D., Wang, K. K. and Ek, E. T. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Therapeutic Topic: Pediatric post-traumatic elbow stiffness - effect of surgery This systematic review and meta-analysis assessed the effect of surgical management of post-traumatic elbow contractures in pediatric patients under 18 years old. A total of 13 papers were included in the present review. The results showed that overall surgical interventions were effective in improving range of motion. On average there was an improvement of 50deg in elbow e/f and 20def for supination/pronation. The results also highlighted that older children, those with radial head fractures, and individuals undergoing open releases tended to experience greater improvements in motion. 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, surgical management of pediatric elbow contractures has shown to be effective in improving range of motion in both flexion-extension and prono-supination by an average of 50 and 20 deg on average. It appears that older children, those with radial head fractures, and patients undergoing open releases are more likely to experience greater improvements post-operatively. Such improvements in elbow range of movement are very important because we have evidence suggesting that elbow stiffness is associated with greater mental health burden in our patients. If you are interested in determining which other factors contribute to improvement in elbow ROM post surgery for post-traumatic stiffness, have a look at this synopsis. URL: https://doi.org/10.1016/j.jhsa.2024.01.010 Abstract Purpose: Post-traumatic elbow stiffness is a common occurrence resulting in potentially substantial functional limitations in both daily activities and recreational endeavors. In children, this can be particularly difficult given the early stages of childhood and development and the challenges of rehabilitation. Several studies have reported favorable results of elbow contracture releases in children, resulting in improvements in outcomes. This meta-analysis aimed to determine the efficacy and safety of elbow contracture releases in the pediatric population (<18 years), along with subgroup analyses comparing age groups, operative approach, and post-traumatic versus nontraumatic etiologies. Methods: Meta-analysis was performed with a multidatabase search (PubMed, OVID, EMBASE, and Medline) according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines on September 25, 2020. Data from all published literature meeting inclusion criteria were extracted and analyzed. Results: Seven studies were included, comprising 114 post-traumatic elbow contractures. Mean age was 13.7 years. Contracture releases of the elbow led to improvements in flexion-extension arc of motion by 48º, and pronosupination arc of motion by 22º. Subgroup analysis comparing age groups of <10, 10–14 and 15–18 years showed greater improvements in flexion-extension arc in the older age group, whereas subgroup analysis comparing injury patterns revealed a larger improvement in pronosupination motion for radial head fractures. Comparing open and arthroscopic procedures, open releases had greater improvement in both flexion-extension and pronosupination motion by 18º and 21º, respectively, although there were limited patients in the arthroscopy group. Conclusion: Operative management of pediatric elbow contractures is effective. Older children, children with radial head fractures, and those receiving open contracture releases may be more likely to have greater 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

In-house 3D-printed custom splints for non-operative treatment of distal radial fractures: A randomized controlled trial. Guebeli, A., Thieringer, F., Honigmann, P. and Keller, M. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Distal radius fracture – 3D-printed splints This randomised controlled trial compared patient satisfaction and effectiveness of 3D-printed custom splints to conventional fiberglass casts in treating distal radial fractures. A total of 39 participants were included. To be suitable for inclusion, participants had to present with a minimally displaced distal radius fracture. Participants were randomised to either 3D-printed splints, created using digital light processing technology, or traditional fiberglass casting. Participants in both groups were immobilisation for 6 weeks. The study showed that 3D-printed splints were well tolerated and effective, although complications (e.g. pressure sores, temporary paraesthesias) were twice as likely compared to fiberglass casting. These new 3D-printed splints may be useful for young and active patients. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, 3D-printed splints may present a safe alternative to conventional fiber glass casts, especially for non-operative treatment of distal radial fractures in young, active patients. However, it is important to keep in mind that at this point in time, they are more likely to be associated with pressure sores and transient numbness/P&N/Tingling. If you are interested in knowing what other complications may be associated with distal radius fractures, especially when ORIFed, have a look at this synopsis. URL: https://doi.org/10.1177/17531934231187554 Abstract We compared patient satisfaction and clinical effectiveness of 3D-printed splints made of photopolymer resin to conventional fibre glass casts in treating distal radial fractures. A total of 39 patients with minimally displaced distal radius fractures were included and randomized. Of them, 20 were immobilized in a fibre glass cast and 19 in a 3D-printed forearm splint. The 3D-printed splints were custom-designed based on forearm surface scanning with a handheld device and printed in-house using digital light processing printing technology. Patient satisfaction and clinical effectiveness were assessed with questionnaires 1 and 6 weeks after the initiation of immobilization. Fracture healing, pain, range of motion, grip strength and the DASH and PRWE scores were assessed up to 1-year follow-up. 3D-printed splints proved to be equally well tolerated by the patients and equally clinically effective as conventional fibre glass casts although there was a higher rate of minor complications. 3D-printed splints present a safe alternative, especially in young, active patients, for non-operative treatment of distal radial fractures. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Four-corner fusion versus proximal row carpectomy for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist: A systematic review and meta-analysis. Hones, K. M., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 👍 (4/4 thumbs up) Type of study: Therapeutic Topic: SLAC and SNAC wrist – 4CF vs proximal row carpectomy This systematic review and meta-analysis compared Proximal Row Carpectomy and Four-Corner Fusion (4CF) in treating scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists. A total of 61 studies were included. Amongst these studies, only three were randomised controlled trials. The resultsh showed that Proximal Row Carpectomy showed significantly better postoperative outcomes in terms of extension, ulnar deviation, pain scores, and lower complication rates compared to 4CF. 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, Proximal Row Carpectormy demonstrated superior outcomes in terms of range of movement, pain, and number of complications compared to 4CF for SNAC and SLAC wrists. These results appear to be similar to what has been shown when trapeziectomy vs other interventions have been compared for the treatment of thumb OA. Other interventions available for SLAC and SNAC wrist include denervation. You can find more about this topic in this snopsis. URL: https://doi.org/10.1016/j.jhsa.2024.01.011 Abstract Purpose: Although proximal row carpectomy (PRC) has increasingly been shown to have superior features to four-corner fusion (4CF), individual surgeons may remain convinced of the superiority of one procedure based on personal experience and individual biases. Hence, we sought to perform an updated meta-analysis with some of the largest studies to date to compare outcomes and complications between these procedures in the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists. Methods: A systematic review and meta-analysis was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane were queried for articles on PRC and 4CF performed for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist. Primary outcomes included wrist range of motion; grip strength; outcome measures, including Disabilities of Arm, Shoulder, and Hand and Quick Disabilities of Arm, Shoulder, and Hand scores, Patient-Rated Wrist and Hand Evaluation, and visual analog scale pain scores; and surgical complications. Results: Sixty-one studies reported on 3,174 wrists, of which 54% were treated with PRC and 46% were treated with 4CF. The weighted mean follow-up was 61 months (range, 12–216 months). Meta-analysis comparing PRC and 4CF demonstrated that PRC had significantly greater postoperative extension; ulnar deviation; postoperative improvement in extension, flexion, ulnar deviation; and visual analog scale score. No comparisons showed significant differences in grip strength. The percentage of wrists requiring arthrodesis was 5.2% for PRC and 11% for 4CF. There was an 8.9% (57/640 wrists) 4CF nonunion rate and 2.2% (17/789) hardware removal rate after 4CF. Conclusions: In the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists, PRC results in better outcomes and a lower complication rate compared to 4CF. 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

Reliability and validity analysis of the distal radioulnar joint ballottement test. Nagashima, M., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: DRUJ Ballottement test - Validity and reliability This diagnostic study assessed the reliability and validity of the Distal Radioulnar Joint (DRUJ) Ballottement Test, used to assess DRUJ instability caused by TFCC injuries. The research aimed to evaluate the test's accuracy and reliability. A total of 25 healthy participants and 8 participants with TFCC injuries were included. The test was validated against a device that tracked DRUJ volar and dorsal movement. The results showed that the test was reliability, and valid when assessing DRUJ instability. It is important to remember that in this study there was no mention to the blinding of surgeons completing the test. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, the DRUJ Ballottement Test, particularly with the holding technique, has been shown to have good reliability and validity for the assessment of TFCC injuries. This test can effectively quantify DRUJ movement and identify mild to moderate instability. It's great to see that there is more research assessing diagnostic tests for the hand and upper limb as we have had a paucity of them up until this point in time. URL: https://doi.org/10.1016/j.jhsa.2023.10.006 Abstract Purpose: Triangular fibrocartilage complex injuries can cause distal radioulnar joint (DRUJ) instability, which can be evaluated clinically with the DRUJ ballottement test. However, the reliability and validity of the test are unclear. This study aimed to analyze the reliability and validity of the test using a tracking device on healthy participants and patients with triangular fibrocartilage complex injuries. Methods: In this cross-sectional study, three orthopedic hand surgeons performed the DRUJ ballottement test using a technique of holding the carpal bones to the radius on 25 healthy participants (50 hands; 10 men and 15 women; mean age, 33 years; range, 20–51 years) and eight patients with triangular fibrocartilage complex injuries (16 hands; six men and two women; mean age, 43 years; range, 27–59 years). We used a three-dimensional electromagnetic tracking device to quantify the movement of the DRUJ and verify the reliability and validity of the test. Results: The intrarater and interrater intraclass correlation coefficients for DRUJ movement were 0.77 and 0.61, respectively, and the kappa coefficient for grading of DRUJ instability was 0.79. The correlation coefficient between DRUJ movement measured using the tracking device and instability judged clinically was 0.77. A comparison of healthy participants and the patients showed significantly greater DRUJ movement in the patients. Conclusions: The test showed substantial intrarater and interrater reliability for assessing DRUJ movement and instability. The significant positive correlation between DRUJ movement and instability indicates the concurrent validity of the test. Moreover, the test showed discriminative validity in identifying mild or moderate DRUJ instability. Clinical relevance: The DRUJ ballottement test using the holding technique has a relatively high diagnostic accuracy and can be used to assess DRUJ instability. 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

Treatment of trigger finger with metacarpophalangeal joint blocking orthosis vs relative motion extension orthosis: A randomized clinical trial. Yendi, B., Atilgan, E., Namaldi, S. and Kuru, C. A. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Trigger finger conservative treatment - mcpj vs RME splint This randomised trial assessed the effectiveness of two orthoses, mcpj blocking splint and Relative Motion Extension (RME) splint, in the treatment of trigger finger. A total of 30 participants were included in the study. Participants were asked to wear the splint for 6 weeks. The results showed that participants in each group reported clinically relevant improvements in pain and function. There were some statistically significant differences between groups, however, they were not clinically relevant. 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, mcpj block and RME splints are both effective for the treatment of trigger finger. Considering that both interventions had similar outcomes, patient preferences, occupation, and specific characteristics, such as which splint is the most comfortable and appears to reduce triggering the most, can be considered. If you would like to read more about trigger finger, have a look at the database on this topic. URL: https://doi.org/10.1016/j.jht.2023.10.008 Abstract Background: The metacarpophalangeal joint blocking orthosis (MCPJ-BO) is one of the first-line orthotic treatment for patients with trigger finger (TF). Relative motion extension orthosis (RME-O) has recently emerged as a treatment option for various hand disorders involving TF. Purpose: The primary objective of this study was to compare the effectiveness of 6 weeks of orthotic treatment with the MCPJ-BO and the RME-O for pain relief. Function and satisfaction with the orthosis were assessed as secondary objectives. Study design Randomized clinical study. Methods: Thirty patients with an average age of 50 years with Froimson stage 1-3 A1 pulley triggering participated in the study. They were randomly assigned to either the MCPJ-BO (n = 15; 10 females, five males) or the RME-O group (n = 15; 12 females, three males). The orthoses were worn full time for 6 weeks. All patients received patient education, activity modification, and flexor tendon gliding exercises as part of the rehabilitation program. Pre- and post-assessments included Numeric Pain Rating Scale, Disability of the Arm, Shoulder, and Hand questionnaire, and Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire. The Mann-Whitney U test was conducted to analyze the difference between the two groups. Results: There were no significant differences between the two groups in pain and function before treatment (p < 0.05). Within-group comparisons indicated that both orthoses relieved pain, but the MCPJ-BO group achieved greater pain relief (p = 0.001). There was a significant improvement in function in the MCPJ-BO group, with a mean change of 12.7 (p = 0.0001). The overall success rates for the MCPJ-BO group and RME-O group were 60% and 27%, respectively. Patients in both groups had high satisfaction with the orthosis. Conclusions: MCPJ-BO and RME-O could be used for pain relief in the treatment of TF. The MCPJ-BO appears to be more effective than the RME-O in improving function. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Recommendations for radiographic assessment of hand wounds. Druel, T., Jalaguier, T., Gaillard, C. and Gazarian, A. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic: Hand infections – x-ray This retrospective analysis of 945 hand patients focused on the importance of using radiographic assessment in selected cases of hand wounds. The study found that 34% of the cases reviews presented with radiopaque foreign bodies, which were not visible during objective examination. Different mechanisms of injury were categorized, with higher rates of positive radiographic findings seen in cases of high-energy trauma, crushing, avulsion, and falls. Furthermore, x-ray assessment may be required in those patients who had a puncture/laceration obtained through objects that are likely to fragment (e.g. kina/sea urchins). A combined approach with ultrasound has also been suggested to help with the diagnosis. 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, 34% of hand wound cases may present with radiopaque foreign bodies, especially when high-energy trauma, crushing injuries, avulsions, and falls were the mechanism of injury. This article is in line with previous expert opinions suggesting that X-rays and US are the primary investigations to be utilised if suspecting an infection. If you would like to have a look at a case study on the topic, read this synopsis. URL: https://doi.org/10.1177/17531934231211566 Abstract A retrospective study of 945 hand patients was conducted to determine the relevance of systematic radiographic assessment. An osteoarticular lesion or a radiopaque foreign body was found in 34% of cases. The indications for radiographic assessment should be related to the mechanism of injury. 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 eccentric strengthening in the treatment of lateral elbow tendinopathy: A systematic review with meta-analysis Chen, Z., & Baker, N. A. (2020) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍(4/4 Thumbs up) Type of study: Therapeutic Topic: Lateral epicondylalgia - Eccentric resistance training This is a systematic review and meta-analysis assessing the effectiveness of eccentric training vs other exercise interventions on pain, function, and strength in people with lateral epicondylalgia. Eight studies were included for a total of 504 participants. The eccentric training involved graded wrist extensors progressions, which lasted on average 4 weeks. The participants trained on average 6 times per week, performing 13 reps for 3 sets with one minute rest in between sets. The comparison groups performed mixed concentric-eccentric or concentric exercises without further training information being provided by the authors. Outcomes were measured before and after the training. The results showed that the eccentric training group improved to a statistically and clinically meaningful level compared to the group doing other forms of strength training on pain (Mean difference in pain: 2.7 points out of 10; 95% CI: 0 to 5.4 - Calculation based on Tyler et. al. 2010 standard deviation). The confidence intervals were large, suggesting that the analgesic response to eccentric exercises may be quite variable. No notable differences were noted in terms of function and strength between groups. 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, eccentric training exercises may be useful for patients with lateral epicondylalgia. Eccentric strengthening may provide greater pain relief compared to other forms of resistance training. Strengthening regimes involving concentric or a combination of eccentric-concentric contractions appear to be equally useful in improving strength and function. URL: https://doi.org/10.1016/j.jht.2020.02.002 Abstract Study Design: Meta-analysis. Introduction: Lateral elbow tendinopathy is a common condition with an annual incidence of up to 3% of the population. Eccentric strengthening has shown promise as a method to treat lateral elbow tendinopathy, but is unclear if it is superior to other forms of treatment. Purpose of the Study: The purpose of this study was to investigate the effectiveness of eccentric strengthening compared with other forms of strengthening and pain-relieving modalities on pain, strength, and function in people with lateral elbow tendinopathy. Methods: Five electronic databases were searched. Reference lists of selected articles were hand-searched. Outcomes were defined a priori. Meta-analyses were performed using a random effects model with standardized mean differences, test of heterogeneity, and sensitivity analyses. Results: Eight articles were included in this review. When comparing eccentric strengthening to other forms of strengthening and pain-relieving modalities, there were significant large effect size of 1.12 (CI: 0.31-1.93) and 1.22 (CI: 0.25-2.18) in reducing pain and improving function in the short-term, respectively. In long-term, results were inconclusive on all outcomes. Discussion: A treatment program using eccentric strengthening of adequate intensity and duration seemed to be most effective for treating lateral elbow tendinopathy. Conclusions: The state of science of best care for lateral elbow tendinopathy is still in its infancy. Large, high-quality randomized controlled trials with clearly defined strengthening regime are needed to determine optimal dosage to maximize treatment effects. Recommendations were provided based on careful synthesis of findings from this review and current evidence in literature. 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

Pre-operative hand therapy management of Dupuytren’s disease: A systematic review. Fernando, J. J., et al. (2024) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Dupuytren – Splinting and other interventions This systematic review focused on the non-surgical treatments for Dupuytren's Disease, including extracorporeal shockwave therapy, corticosteroid injection, splinting, massage, stretching, ultrasound therapy, and temperature controlled high energy adjustable laser. A total of 17 studies were included in the present study. For splinting, three studies were included, one of which was an RCT and the others were case studies. Overall, there was a positive effect of conservative treatments for pain, range of motion, grip strength, and Disabilities of the Arm Shoulder Hand scores in individuals with Dupuytren's Disease. Splinting for three months appeared to improve range of movement of the pipj between 10 and 25 degrees. 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, non-surgical interventions can improve ROM and function in patients with Dupuytren's disease. These interventions include splinting and they may need to be applied for three months to see significant improvements. More invasive interventions include surgery or needle fasciectomy. URL: https://doi.org/10.1177/17589983241227162 Abstract Introduction: Dupuytren’s Disease is a fibroproliferative disorder of the hand, with a heterogenous pathogenesis, ranging from early-stage nodule development to late-stage digital contractures. Hand therapy intervention is not routinely provided pre-operatively. The objective of this systematic review was to explore the efficacy of hand therapy interventions provided for pre-operative Dupuytren’s Disease. Methods: A systematic review was undertaken of the databases CENTRAL, CINAHL, OVID Medline and OVID EMBASE, PubMed, BNI, Web of Science, with grey literature and reference searches conducted from database inception to April 2022, and confirmed in August 2023. Included studies required non-surgical intervention and outcome data on individuals with Dupuytren’s Disease who have not had surgical intervention. Two reviewers conducted the searches, independently assessed eligibility and completed methodological quality assessments. Data were summarised narratively. Results: Seventeen studies were selected for final inclusion. Interventions included Extracorporeal Shockwave Therapy (ESWT), Corticosteroid Injection (CSI), Splinting, Massage and Stretching, Ultrasound Therapy (US), Temperature Controlled High Energy Adjustable Laser (THEAL). ESWT positively maintained or improved pain, active range of motion (AROM), Disabilities of the Arm Shoulder, and Hand (DASH) scores, and grip strength. US positively maintained or improved ROM and grip. Splinting positively maintained or improved ROM, CSI positively improved nodule size. Cross Frictional Massage positively impacted AROM and THEAL improved pain and DASH scores. Conclusions: Outcomes from therapeutic interventions for pre-operative management of Dupuytren’s Disease were largely positive. However, there is a need for further high-quality research into these interventions to understand their full potential for the management of Dupuytren’s Disease. 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

Trapezium tunnel syndrome. Afshar, A., Tabrizi, A. and Shariyate, M. J. (2024) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic: Trapezium Tunnel Syndrome - Diagnosis and treatment This expert opinion discusses trapezium tunnel syndrome, a condition involving flexor carpi radialis tendinopathy and peritendinitis leading to complications like tendon rupture and ganglion cyst formation in the wrist. It emphasizes the anatomical relationship of the trapezium bone and the flexor carpi radialis tendon within a fibro-osseous tunnel. Intrinsic and extrinsic factors contribute to the syndrome, which is often overlooked due to other causes of radial side wrist pain. Detection and diagnosis are vital to prevent complications, and various imaging techniques such as US and MRI can be utilised. Treatment options range from non-surgical interventions like immobilisation and corticosteroid injections to surgical decompression, though the latter poses risks such as damaging the palmar cutaneous branch of the median nerve. 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, trapezium tunnel syndrome may coexist with other wrist pathologies, such as carpal tunnel syndrome and/or 1st cmcj OA, and it should be part of our differential diagnosis. Conservative interventions, such as immobilisation followed by gradual loading could be trialed followed by CSI or surgery if these are ineffective. US imaging and x-rays may be useful in differentiating between trapezium tunnel syndrome, carpal tunnel syndrome, and 1st cmcj OA. URL: https://doi.org/10.1016/j.jhsa.2023.10.014 Abstract The trapezium tunnel is situated on the lateral side of the carpal tunnel, lined with synovial tissue, and accommodates the flexor carpi radialis tendon. Trapezium tunnel syndrome is characterized by flexor carpi radialis tendinitis/peritendinitis and may lead to complicated clinical scenarios, such as flexor carpi radialis tendon rupture and the formation of primary or recurrent ganglion cysts on the volar radial side of the wrist and thenar area. Notably, the simultaneous presence of trapezium tunnel syndrome might contribute to unsuccessful outcomes in carpal tunnel surgeries. Trapezium tunnel syndrome may arise from either intrinsic or extrinsic factors. The entity of trapezium tunnel syndrome has attracted a low index of clinical suspicion because the other causes of radial side wrist pain that are more prevalent and frequent. We present a narrative review of this condition in an endeavor to heighten awareness and clinical suspicion of trapezium tunnel syndrome. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings