Search Results

Do surgeons accurately predict level of activity in patients with distal radius fractures? Harper, C. M., Model, Z., Xiong, G., Hegermiller, K. and Rozental, T. D. (2023) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Symptoms prevalence Topic: Physical activity - Are we good at gaging it? This prospective study investigated the ability of surgeons to correctly differentiate between patient involved in low, moderate, high levels of physical activity level in patients presenting with a distal radius fractures. A total of 97 participants were included in the study. Results showed only "fair" agreement between patient and surgeon assessments, with surgeons accurately identifying 73% of "high activity" patients but failing to correctly identify more than 41% of patients rated as "moderate activity" or "low activity". The odds of receiving surgical treatment were higher with higher surgeon-perceived activity level, but not with patient-reported activity level. The study concluded that surgeon assessment of patient activity level does not have strong agreement with patients' independent assessment of their physical level. 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 is a discrepancy between what level of physical activity patients engage with and surgeon's perception of their patients' physical activity. It appears that surgeons tend to overestimate patients' activity level. There are several repercussions associated with this finding. The first is that surgery may be offered to those people who the surgeon deems physically active, but not to others who may be equally active but don't give that impression (e.g. ORIF for distal radius fracture, distal biceps repair). The second is that as hand therapist we may not advise people who are inactive to increase their physical activity level and viceversa. As a result, we may need to question our patients more on this topic or utilise forms such as the International Physical Activity Questionnaire (IPAQ) to make better informed therapeutic decisions. If you want to gage an understanding on the importance of physical activity for our patients, have a look at the whole database. URL: https://doi.org/10.1016/j.jhsa.2023.07.007 Abstract Purpose: One factor influencing the management of distal radius fractures is the functional status of the patient. The purpose of this study was to assess the agreement between patient and surgeon assessments of patient activity level in patients sustaining a distal radius fracture. Methods: Ninety-seven patients were included, with a mean age of 58.5 years (range, 18–92 years). Patients completed the International Physical Activity Questionnaire, a validated survey that provides a score of low, moderate, or high activity levels. Treating surgeons provided an independent assessment using the same scale. Agreement between patient and surgeon assessments was evaluated using a weighted kappa-statistic, with a secondary analysis using logistic regression models to assess odds of surgical treatment. Results: Interrater agreement between surgeons and patients demonstrated only “fair” agreement, with a kappa-statistic of 0.33. Predictive models showed that surgeons accurately identified 73% of “high activity” patients but failed to correctly identify more than 41% of patients rated as “moderate activity” or “low activity.” There was a correlation between surgical intervention and increasing physical activity status as assessed by the surgeon; however, the magnitude of this effect was unclear (odds ratio, 2.14; 95% confidence interval, 1.07–4.30). This relationship was no longer significant after adjusting for age, Charlson comorbidity index, and fracture class. There was no association between surgical intervention and physical activity status when using the status provided by the patient. Conclusions: Surgeon assessment of patient activity level does not have strong agreement with patients’ independent assessment. Surgeons are most accurate at identifying “high activity level” patients but lack the ability to identify “moderate activity level” or “low activity level” patients. Clinical relevance: Recognition of surgeon assessment of patient activity level as flawed can stimulate improved dialog between patients and physicians, ultimately improving the shared decision-making process. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Effect of extension of the ulnar fingers on force control and muscle activity of the hand during a precision pinch. Date, S., et al. (2023) Level of Evidence: 4 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic test Topic: Pinch testing – Effect of positional variations This study investigated the effect of extending the ulnar fingers on force control and muscle activity during a precision tip to tip pinch task. A total of 27 healthy volunteers with a mean age of 22 years were recruited to participate in the study. Their maximum pinch strength was measured both whilst keeping the fingers flexed and extended. In addition, their ability to reach a certain level of force and the time to reach that level were measured in a submaximal task. The results showed that there was no difference in maximum pinch strength (4 kg) when keeping the fingers extended or flexed. In addition, extending the ulnar fingers when pinching resulted in quicker attainment of the target force level. 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, extending the ulnar fingers when pinching an object does not affect force output, but it can lead to a faster force production. As a result, it's probably not necessary to force patients to keep a certain position when testing their pinch strength. What may be important is to follow the same strategy every time that we assess it for reliability reasons. If you are interested in other variations of strength measures, have a look at the second interosseous pinch test and an update on devices to measure grip strength. URL: https://doi.org/10.1177/17531934231211254 Abstract Some individuals extend the three ulnar fingers when performing a precision pinch. The aim of the present study was to investigate the mechanisms and effect of the extension of the ulnar fingers during a pinch. When performing a pulp pinch task with the ulnar fingers in two positions (extension and flexion), 27 participants maintained 5% of their maximum force. The mean pinch force, force variability and time taken to reach the targeted force (reaching time) were calculated. Muscle activity was simultaneously measured, using surface electromyography, for nine muscles: the flexor pollicis brevis; abductor pollicis brevis; flexor pollicis longus; first lumbrical; first dorsal interosseous; flexor digitorum superficialis of the index finger; extensor indicis; and extensor digitorum of the index and ring fingers. No significant differences in the mean pinch force or force variability were found. However, the reaching time was significantly shorter (approximately 20% reduction) in the extension position and the activities in the flexor pollicis brevis, first lumbrical, extensor indicis and extensor digitorum of the ring finger were significantly higher. These findings suggest that extending the ulnar fingers during pinching enhances the activity of key muscles involved in the movement and allows for more rapid force exertion. 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

The impact of temperament on functional and symptomatic relief and satisfaction after carpal tunnel release. Karaduman, M., Bilgin, S. S. and Armangil, M. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Symptoms prevalence study Topic: Carpal tunnel syndrome - satisfaction with surgery This study examined the impact of different personality traits on the outcomes of surgery for carpal tunnel syndrome (CTS). A total of 171 patients with CTS were included and completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A), the Boston Carpal Tunnel Questionnaire (BCTQ), and satisfaction using the Patient Evaluation Measure (PEM) at baseline. The results showed that symptoms improved across all personality types, however, patients who presented with a depressive or anxious personality had the lowest postoperative satisfaction. 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, patient temperament should be taken into consideration when treating carpal tunnel syndrome or setting treatment expectations. In particular, it appears that some patients presenting with depressive or anxiety tracts will still be dissatisfied with treatment despite improvements in symptoms or their overall condition. I have noticed this happening in clinical practice across a series of hand and upper limb conditions. People may be improving from an objective point of view (e.g. pain-free grip strength in LE) or even subjectively on QuickDASH, but they are still not happy with such improvements. This shows how other factors including psychological and social aspects of the patient determine their happiness with our treatment. There is a growing amount of evidence suggesting that these factors have a significant impact on recovery. URL: https://doi.org/10.1177/17531934231173101 Abstract The aim of this study was to compare the symptomatic, functional and satisfaction outcomes of patients with different temperaments undergoing carpal tunnel surgery by a single surgeon. Dominant temperaments of 171 patients with carpal tunnel syndrome were determined using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A). Patients were divided into six temperament groups, and the impact of their respective group measured against preoperative and postoperative symptom severity and functional capacity using the Boston Carpal Tunnel Questionnaire (BCTQ] and satisfaction using the Patient Evaluation Measure (PEM). Patients in the depressive group had the largest improvement in symptoms (BCTQ score change, -2.2) as well as a significant improvement in function (BCTQ score change, -2.1), yet had the lowest postoperative satisfaction (mean PEM score 9). Determination of patient temperament before surgery for carpal tunnel syndrome (CTS) may be useful as an ancillary technique to help predict postoperative satisfaction, which may in turn help guide preoperative communication and expectation setting. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Patient perspectives on cognitive behavioral therapy for thumb, hand, or wrist pain and function: A survey of 98 patients. Imbergamo, C. M., Durant, N. F., Giladi, A. M. and Means, K. R., Jr. (2023). Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Hand pathology - Cognitive behavioral therapy This survey investigated the use of Cognitive Behavioral Therapy (CBT) to help manage thumb, hand, or wrist pain or dysfunction. Of the 327 patients surveyed, 98 responded, with 17% (17/98) reporting they had participated in CBT. Of this group, 15/17 felt that CBT had been helpful for them, while 75% (60/81) of those who had not used CBT were neutral. The findings suggest that increased CBT utilisation in this setting could positively affect patient outcomes, set realistic expectations, and ultimately improve satisfaction with 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, there is an opportunity to increase awareness and recommendations of Cognitive Behavioral Therapy (CBT) as a non-medication option to help manage thumb, hand, or wrist pain. Patients who have used CBT reported favorable results, and those without direct experience were open to considering it. Increasing utilization of CBT in this setting could positively affect patient outcomes, set realistic expectations, and ultimately improve satisfaction with care. URL: https://doi.org/10.1016/j.jhsa.2023.08.002 Abstract Purpose: Cognitive behavioral therapy (CBT) is an established option to improve pain and function for many orthopedic conditions. Our purpose was to obtain patient perspectives regarding CBT for thumb, hand, or wrist pain and function. Methods: Between March and April 2022, we distributed an electronic survey via email to patients in our institution’s health system with a diagnosis of arthritic or non-specific thumb, hand, or wrist pain. The survey included the opening statement “Cognitive Behavioral Therapy (CBT) is a non-medication option to help manage pain and improve function” and up to 13 questions pertaining to patients’ experiences and perceptions regarding CBT. The survey was anonymous and did not collect protected health information. We used descriptive statistics for the findings. Results: We distributed the survey to 327 patients, yielding a 30% response rate (98/327). Of the respondents, 17 reported already using CBT to specifically help with pain/function. Of these, 15 felt it was helpful and agreed it could help others. Of the subset that used CBT for arthritis, all felt it was helpful. Of the 75 respondents with no CBT experience, 42 indicated “I’ve never heard of it,” 28 responded “I never had it recommended as an option,” and 16 marked “I don’t know enough about it.” Small subsets noted potential personal barriers to CBT implementation, such as cost, time involved, or perceived lack of potential efficacy for themselves. Conclusions: A small proportion of patients from our institution with thumb, hand, or wrist pain are utilizing CBT, and the majority finds it helpful. Clinical relevance: While some patients are already substantially benefiting from CBT to improve their thumb, hand, or wrist pain or function, there is a notable opportunity for providers to increase awareness and recommendations for this option. 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

Type 2 diabetes and fasting glycemic are causal factors of frozen shoulder: A two-sample mendelian randomization analysis. Xu, T., Xia, Q., Zhang, L., Yang, X. and Fu, W. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Aetiologic, Therapeutic Topic: Frozen shoulder - Diabetes This is a retrospective analysis of existing genetic data assessing whether there is a causal relationship between type 2 diabetes, glycemic traits (fasting glucose, fasting insulin, glycated hemoglobin, and 2-hour postprandial glucose) and frozen shoulder. A total of 48,286 people with frozen shoulder and 250,671 controls were included in the study. The results showed a genetic causal relationship between type 2 diabetes, fasting glucose and frozen shoulder, but no evidence for a causal correlation between fasting insulin, glycated hemoglobin, 2-hour postprandial glucose and frozen shoulder. 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, diabetes and fasting glucose levels may be causal factors of frozen shoulder. Controlling glucose levels may be a potential avenue for the prevention and mitigation of frozen shoulder. This may be relevant in our clients who have had a FOOSH, have shoulder pain, and also present with type 2 diabetes. Thus, they may be more likely to develop a frozen shoulder. URL: https://doi-org.ezproxy.aut.ac.nz/10.1016/j.jse.2023.08.006 Abstract Background: The causal relationship between type 2 diabetes (T2D) and frozen shoulder (FS) is unclear. This study aims to explore the genetic causal association between type 2 diabetes (T2D) and glycemic traits (fasting glucose [FG], fasting insulin [FI], glycated hemoglobin [HbA1c] and 2hGlu [2-hour postprandial glucose]) on FS. Methods: Using two-sample Mendelian randomization (MR), we analyzed non-confounded estimates of the effects of T2D and glycemic traits on FS. Single nucleotide polymorphisms (SNPs) strongly associated (p<5×10-8) with exposures from genome-wide association studies (GWAS) were identified. We employed fixed effect mode inverse variance weighting (IVW-FE), random effect mode IVW (IVW-MRE), MR-Egger, weighted median to assess the association of exposures and outcome. Sensitivity analysis was conducted to test for heterogeneity and multi-directionality bias in MR. Results: We found a significant genetic causal correlation between T2D (IVW-MRE P = 0.00697, odds ratio [OR] (95% confidence interval [CI]) = 1.093 (1.03-1.16)), FG (IVW-FE p = 0.000351, OR (95% CI) = 1.455 [1.173-1.806]) and FS, but no evidence for causal correlation between FI, HbA1c, 2hGlu and FS. Although there was certain heterogeneity, sensitivity analysis reveals no deviation from the MR assumptions. Conclusion: This study supports a genetic causal relationship between T2D, FG and FS. 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

Upper limb neurodynamic mobilization disperses intraneural fluid in cervical nerve roots: A human cadaveric investigation. Burgess, N. E., et al. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Median nerve mobilisation - cervical radiculopathy This study examined the effects of median nerve-biased neurodynamic mobilisation on intraneural fluid dispersion in the C5, C6, and C7 cervical nerve roots of cadavers. A total of eight cadavers were included in the study. Dye was injected into C5-C6 roots. A period of time with no upper limb movement was utilised to act as a control for dye dispersion. The experimental intervention consistend in five minutes of median nerve tensioner exercise with the movement occurring at the elbow only (2 seconds for elbow extension and return to flexion). Results showed that neurodynamic mobilisation resulted in significant intraneural longitudinal dye spread at C5, C6, C7 nerve roots, with the most movement occurring at C6. 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, median nerve-biased neurodynamic mobilization (NDM) may reduce nerve root swelling in people with cervical radiculopathy involving C6. Previous research has shown that neurodynamic exercises are helpful for people with radiculopathy, however, they do not appear to be more effective than other form of exercise. It is possible that most form of exercise are effective in reducing intraneural swelling and they may not need to be very specific. If you are interested in reading more about cervical radiculopathies, have a look at the whole database. URL: https://doi.org/10.1016/j.msksp.2023.102876 Abstract Background: Cervical radiculopathy is a common cause of neck pain with resultant intraneural edema and impaired nerve function. One strategy to treat radiculopathy is neurodynamic mobilization (NDM); however, little is known about the effect of this treatment on nerve tissue fluid dynamics. Objective Investigate the impact of upper limb, median nerve-biased NDM on longitudinal intraneural fluid dispersion in the C5,C6,C7 nerve roots in un-embalmed cadavers. Design In situ repeated measures. Methods: Human cadavers (n = 8) were dissected to expose and inject C5,C6,C7 cervical nerve roots with a dying agent. Initial longitudinal dye spread was recorded after dye spread stabilization. Cadavers were taken through 150 repetitions of upper limb, median nerve-biased NDM followed by dye spread re-measurement. Paired-samples t-tests with Bonferroni correction (α = 0.017) were used to compare pre-vs post-NDM dye spread measurements at C5,C6,C7 nerve roots; a one-way repeated measures ANOVA (α = 0.05) was used to examine differences between change scores for C5,C6,C7 nerve roots. Results: Median nerve-biased NDM resulted in significant intraneural longitudinal dye spread at C5 and C6 nerve roots of 0.6 ± 0.6 mm and 3.4 ± 3.9 mm, respectively (p < 0.014). Dye spread was not significant at C7 nerve root (0.4 ± 0.7 mm). There was no between root difference in change of longitudinal dye spread between C5, C6, and C7 nerve roots. Conclusions: The results of this study show median nerve-biased NDM produced internal fluid movement within C5 and C6 cervical nerve roots. Results provide insight regarding possible mechanism of action and feasibility of NDM in treatment of patients with cervical radiculopathy. 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

Where does blood flow restriction fit in the toolbox of athletic development? A narrative review of the proposed mechanisms and potential applications. Davids, C. J., et al. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Blood flow restriction training - Athletes This is a narrative review on Blood Flow Restriction (BFR) training for the application in athletes. Blood flow restriction training is a novel model of exercise which has been shown to improve aerobic capacity and muscular endurance performance. It has been suggested that BFR may be used to target either type I fibres when compared with conventional high-load resistance training. For athletes, BFR may reduce the risk of injury, reduce the time needed to reach a certain level of fitness, and be used to target specific physiological adaptations. Blood flow restriction can be used to supplement or de-load from traditional high-intensity training, or to accelerate recovery from musculoskeletal injury. It can also be used to improve sport-specific tasks, such as sprinting, change of direction, and agility. Blood flow restriction has been shown to induce robust activation of skeletal muscle stem cells and improve oxidative capacity and local muscular endurance. Blood flow restriction is recommended to be used to maintain muscle mass rather than increase it, and should be carefully considered in sports due to the potential for muscle damage and prolonged stress. 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, Blood Flow Restriction (BFR) training is a promising strategy to accelerate the regeneration of musculoskeletal injuries, such as muscle strains. It can also be used to increment the effect of light resistance training when increasing loading is not possible due to pain or surgical restrictions. I currently use in some case presenting with common extensor origin tendinopathy and in those patients that want to have an expedite recovery following distal biceps repair but cannot load their biceps beyond light weight. The feasibility of blood flow restriction training has also been trialled in symptomatic hand OA and has shown some good success. URL: https://doi.org/10.1007/s40279-023-01900-6 Abstract Blood flow-restricted exercise is currently used as a low-intensity time-efficient approach to reap many of the benefits of typical high-intensity training. Evidence continues to lend support to the notion that even highly trained individuals, such as athletes, still benefit from this mode of training. Both resistance and endurance exercise may be combined with blood flow restriction to provide a spectrum of adaptations in skeletal muscle, spanning from myofibrillar to mitochondrial adjustments. Such diverse adaptations would benefit both muscular strength and endurance qualities concurrently, which are demanded in athletic performance, most notably in team sports. Moreover, recent work indicates that when traditional high-load resistance training is supplemented with low-load, blood flow-restricted exercise, either in the same session or as a separate training block in a periodised programme, a synergistic and complementary effect on training adaptations may occur. Transient reductions in mechanical loading of tissues afforded by low-load, blood flow-restricted exercise may also serve a purpose during de-loading, tapering or rehabilitation of musculoskeletal injury. This narrative review aims to expand on the current scientific and practical understanding of how blood flow restriction methods may be applied by coaches and practitioners to enhance current athletic development models. 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

Surgical site infection following surgery for hand trauma: A systematic review and meta-analysis. Wormald, J. C., et al. (2023) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Symptoms prevalence Topic: Hand surgery – Infection rate This systematic review and meta-analysis assessed the incidence of infections following surgery for hand trauma. A total of 201 study, which included RCTs, prospective cohort, retrospective, and case studies, were included. A total of 315,618 participants were included across all the studies. The results showed that the overall risk of surgical site infection was 5%, with RCTs showing a 10% risk of infection. The reason for this disparity is likely due to poorly reported records analysed by retrospective studies compared to RCTs. Subgroup analysis by clinical factors showed that the risk of surgical site infections varied according to type of intervention, with ORIF having the lowest risk of all surgical interventions. 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 site infection is a rare complication of hand trauma surgery, with an overall risk of 5-10%. The risk of post-surgical infection may double in those patients who are smokers/diabetics and/or who work in high-risk environments (e.g. fisherman, aquarist). If you have an open hand fracture, you can calculate the risk of developing an infection through the criteria in this synopsis. If you suspect an infection, x-rays and US are useful investigations to request. URL: https://doi.org/10.1177/17531934231193336 Abstract Surgical site infection is the most common healthcare-associated infection. Surgical site infection after surgery for hand trauma is associated with increased antibiotic prescribing, re-operation, hospital readmission and delayed rehabilitation, and in severe cases may lead to amputation. As the risk of surgical site infection after surgery for hand trauma remains unclear, we performed a systematic review and meta-analysis of all primary studies of hand trauma surgery, including randomized controlled trials, cohort studies, case-control studies and case series. A total of 8836 abstracts were screened, and 201 full studies with 315,618 patients included. The meta-analysis showed a 10% risk of surgical site infection in randomized control trials, with an overall risk of 5% when all studies were included. These summary statistics can be used clinically for informed consent and shared decision making, and for power calculations for future clinical trials of antimicrobial interventions in hand trauma. 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 systematic review of the effectiveness of wrist manipulative therapy in patients with lateral epicondylitis. Eapen, C., Rosita, R., Sohani, M. S. and Patel, V. D. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Lateral epicondylalgia – Wrist manipulations This is a systematic review assessing the effectiveness of wrist manipulation in the treatment of lateral epicondylitis. A total of four randomised controlled trials were included in the review. The manipulation was described as a repetition of forced passive extension of the wrist or extension of the wrist against resistance (20 repetitions). The duration of each intervention was 15 to 20 minutes. This wrist manipulation group was compared to ultrasound, laser, friction massage, MWMs, or resistance exercises. The results showed that wrist manipulations provided some sort term reduction in pain compared to other treatments, however, it is not clear whether the difference was clinically relevant. There was no consisten effect on grip strength or ROM. Given the lack of significant pain changes and the inexistence of an explanation for such findings, wrist manipulations do not appear to have a large effect compared to other interventions. 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, wrist joint manipulations may be beneficial in reducing pain in lateral epicondylitis, however, they are unlikely to provide larger effect sizes compared to other interventions. Other conservative interventions that may provide temporary relief for lateral epicondylalgia include MWMs. If you are interested in lateral epicondylalgia, have a look at the full database. URL: https://doi.org/10.1016/j.jht.2022.10.002 Abstract Study design: Systematic review. Introduction: Several treatment methods treat lateral epicondylitis, but there is no consensus regarding the most effective method. Research has suggested that joint mobilizations may help recover patients with lateral epicondylitis. Purpose of the study: To determine if wrist joint manipulations effectively improve pain, grip strength, ROM, and functional outcome in adults with lateral epicondylitis. Methods: Searches were performed in 6 databases to identify relevant clinical trials. Three reviewers independently extracted data and assessed the methodological quality using the PEDro scale. Standard data were extracted and summarized. Results: A total of 4 studies met the inclusion criteria. A best-evidence synthesis was used to summarize the results. The included studies found effectiveness in favor of wrist manipulations given for at least 3 weeks to reduce pain in lateral epicondylitis against comparison groups comprising ultrasound, laser, friction massage, and exercises. Functional outcomes varied considerably among studies. Grip strength showed varied results, and no effect was seen on wrist ROM. Conclusion: The evidence is convincing that wrist joint manipulations positively affect pain in the short term, compared to comparison groups in the management of lateral epicondylitis. Future high-quality studies are recommended. 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

Mechanisms linking physical activity with psychiatric symptoms across the lifespan: A systematic review. Ho, P. T. N., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Depression and anxiety - Hoe does exercise help? This is a systematic review assessing scientific evidence on the mechanisms through which physical activity might reduce psychiatric symptoms. A total of 22 studies, which included both experimental and observational articles were included. The results showed that physical activity has a small-to-moderate effect on mental health. It appears that self-esteem, self-concept, and self-efficacy were the only consistent mechanism through which physical activity appears to influences psychiatric symptoms (specifically depressive and anxiety symptoms). There were insufficient studies to determine the role of neurobiological mechanisms. 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, physical activity has a small-to-moderate effect on anxiety and depression. Self-esteem, self-concept, and self-efficacy are the only consistent pathways through which physical activity appears to influence psychiatric symptoms. Reminding our patients with depression and anxiety about the importance of being active may therefore be beneficial. Have a look at the entire database on the benefits of physical activity for our patients with hand and upper limb conditions. URL: https://doi.org/10.1007%2Fs40279-023-01895-0 Abstract Background: Physical activity has been suggested as a protective factor against psychiatric symptoms. While numerous studies have focused on the magnitude of physical activity’s effect on psychiatric symptoms, few have examined the potential mechanisms. Objective: The current review aimed to synthesize scientific evidence of the mechanisms through which physical activity might reduce psychiatric symptoms across the lifespan. Methods: We included articles that were published before March 2022 from five electronic databases (MEDLINE, Web of Science, PsycINFO, Embase, and Cochrane). A qualitative synthesis of studies was conducted. The risk of bias assessment was performed using The Joanna Briggs Institute Critical Appraisal Tool for Systematic Reviews. Studies were included if they explored the possible mechanisms through which physical activity influences psychiatric symptoms (i.e., internalizing and externalizing symptoms) across the lifespan. Results: A total of 22 articles were included (three randomized controlled trials, four non-randomized controlled trials, three prospective longitudinal studies, and 12 cross-sectional studies). Overall, most of the studies focused on children, adolescents, and young adults. Our findings showed that self-esteem, self-concept, and self-efficacy were the only consistent paths through which physical activity influences psychiatric symptoms (specifically depressive and anxiety symptoms) across the lifespan. There were insufficient studies to determine the role of neurobiological mechanisms. Conclusions: Overall, future physical activity interventions with the purpose of improving mental health should consider these mechanisms (self-esteem, self-concept, self-efficacy) to develop more effective interventions. 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

Case report illustrating use of serial elastic tension digital neoprene orthoses (ETDNO) protocol in the treatment of proximal interphalangeal joint flexion contracture. Punsola-Izard, V., et al. (2022) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Pipj flexion deformity - Neoprene splint This case study presents the use of a serial elastic tension digital neoprene orthosis protocol to treat a patient with a 45º proximal interphalangeal joint (pipj) flexion contracture caused by a finger crush injury. After seven days of orthosis use, the pipj extension improved 20º of passive pipj extension and after 15 weeks, the patient achieved 0º of passive pipj extension. After this time, the patient was able to maintain the 0º of passive pipj extension without the use of the orthosis. This research provides some evidence that custom, circumferential, neoprene-based orthoses may improve flexion contractures of the pipj. This neoprene orthosis maybe utilised as an alternative to static progressive or dynamic splinting. 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, custom, circumferential, neoprene-based splints can be an effective treatment for pipj flexion deformities. These findings are in line with previous research showing that pipj felxion deformity can improve with splinting. It is important to remember that no specific splint appears to provide better outcomes and that splint wearing for a maximum of 11 hrs/day seems to be enough to obtain positive outcomes. Improvements in pipj flexion deformity are usually achieved if patient are treated early post-injury. URL: https://doi.org/10.1016/j.jht.2022.06.003 Abstract Introduction: This case report details the application of a treatment regimen using a serial elastic tension digital neoprene orthosis (ETDNO) protocol for a patient with an eight-month-old finger crush injury who experienced recurrence of a 45 ºproximal interphalangeal joint (PIPJ) flexion contracture two months after arthrolysis. Purpose of the Study: To illustrate how the application strategy of ETDNO can increase the daily total end range time (TERT) and modify finger stiffness. Results: The patient reached full extension following 15 weeks of ETDNO treatment. The six-month follow-up evaluation revealed that the PIPJ was stable with full flexion and extension. The joint did not require continued orthosis use. Discussion: The literature describes orthosis application as the treatment of choice for PIPJ flexion con- tracture, but no study has described an ideal program for use nor the full and stable resolution of the flexion contracture. The current literature describes a maximum daily total end range time (TERT) of 12 hours a per day. The serial ETDNO protocol that this study described increased the daily TERT to nearly 24 hour per day and demonstrated an excellent result in the treatment of PIPJ flexion contracture Conclusion: This outcome suggests that clinicians will want to consider this new orthosis design and management protocol as a novel option for the treatment of PIPJ flexion contracture. We need future research to better define the optimum number of hours of daily TERT for the effective treatment of PIPJ flexion contracture. In addition, we will also benefit from the exploration of the optimum orthosis design to enable the highest amount of TERT. 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

Diagnosis of ulnar neuropathy at the elbow using ultrasound: A comparison to electrophysiologic studies. Carroll, T. J., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic: Cubital tunnel – US and Nerve conduction studies This retrospective study assess the accuracy of ultrasound imaging (US) compared to nerve conduction studies (NCS) studies in diagnosing cubital tunnel syndrome. A total of 89 participants (115 ulnar nerves) were included in the present study. Participants were included if they reported that they presented with motor/sensory loss of ulnar innervated muscles/skin areas or paraesthesias in the ulnar distribution at the hand. The results showed that US was an effective alternative to NCS, with 91% of patients with clinically diagnosed cubital tunnel syndrome having positive NCS. There was also a correlation between US imaging and NCS severity. 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, ultrasound imaging could be utilised as an alternative to nerve conduction studies for the diagnosis of ulnar neuropathy at the elbow. The benefit of US imaging is that it's less expensive, faster, and less invasive compared to NCS. Considering that we cannot refer for nerve conduction studies, the use of US imaging may be a handy alternative. The use of US imaging may also be useful in excluding a space invading lesion or the presence of anconeus epitrochlearis, which may require surgical intervention. URL: https://doi.org/10.1016/j.jhsa.2023.08.014 Abstract Purpose: Given the relatively high false negative rate of electrodiagnostic studies (EDX) in patients with clinically diagnosed ulnar neuropathy at the elbow (UNE), we sought to determine whether an alternative objective test could more effectively detect UNE. Additionally, we proposed to determine the relationship between the cross-sectional area (CSA) of the ulnar nerve on ultrasound (US), EDX, and clinical symptoms. Methods: This was a retrospective study of patients presenting with symptomatic UNE. The performance characteristics of EDX versus ultrasound were calculated using the clinical diagnosis of UNE as the reference standard. Standard EDX studies and US of the ulnar nerve were analyzed. Maximal CSA of the ulnar nerve and EDX severity were analyzed for patients with each combination of US-positive/negative and EDX-positive/negative findings. Results: Analysis was performed on 89 patients and 115 nerves with signs and symptoms of cubital tunnel syndrome. In total, 56 (49%) nerves were diagnosed as mild UNE, 32 (28%) nerves were diagnosed as moderate UNE, 17 (15%) nerves were diagnosed as severe UNE, and 10 (8%) nerves were negative for UNE by EDX. Maximal–maximal CSA was highly correlated with disease severity as determined by nerve conduction studies/electromyography. Compared with EDX+/US+, patients with EDX−/US+ showed higher rates of ulnar sensory loss and elbow tenderness with similar rates of positive Tinel and intrinsic muscle atrophy. In this sample of patients with clinically diagnosed UNE, 91.3% of the patients demonstrated positive EDX studies, whereas 94.8% had a positive US. Conclusions: Ultrasound is an alternative to EDX that could be incorporated clinically in the diagnosis and management of UNE. Ultrasound was able to consistently detect clinically positive cubital tunnel syndrome demonstrating its utility as a confirmatory or supplemental test to the clinical assessment if one is required. Ultrasound additionally may be able to better identify patients with early stages of UNE with negative EDX 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