Search Results

Endoscopic versus open carpal tunnel surgery: Risk factors and rates of revision surgery. Carroll, T. J., et al. (2023) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Carpal tunnel release revision - Endoscopic vs open procedures This retrospective study assessed the rate of revision following endoscopic and open release for carpal tunnel syndrome (CTS). A total of 4,388 participants took part in the study. Several additional variables were collected and they included demographic information, comorbidities, and lifestyle factors. The results showed that endoscopic CTS was associated with 3 times greater odds of requiring revision surgery within one year, compared to open carpal tunnel release. In addition, male sex, concurrent cubital tunnel syndrome, tobacco use, and diabetes were also associated with a greater risk of needing revision. 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, endoscopic carpal tunnel release is associated with a higher risk of revision surgery within one year compared to open carpal tunnel release. Other factors associated with a greater risk of revision included concurrent cubital tunnel syndrome, tobacco use, and the presence of diabetes. These findings appear to be in contrast with other minimally invasive procedures such as the percutaneous release of A1 pulley for trigger finger which present with good long-term outcomes. URL: https://doi.org/10.1016/j.jhsa.2023.05.002 Abstract Introduction: The purpose of our study was to compare the 1-year revision surgery rates and outcomes of open versus endoscopic carpal tunnel release. Our hypothesis was that, compared to open release, endoscopic carpal tunnel release was an independent risk factor for revision surgery within 1-year. Methods: This was a retrospective cohort study of 4338 patients undergoing isolated endoscopic or open carpal tunnel release. Demographic data, medical comorbidities, surgical approach, need for revision surgery, hand dominance, history of prior injection, and Patient Reported Outcomes Measurement Information System upper extremity (UE), pain interference (PI) and physical function scores were analyzed. Multivariable analysis was used to identify the risk factors for revision surgery within one year of the index procedure. Results: In total, 3280 patients (76%) underwent open and 1058 (24%) underwent endoscopic carpal tunnel release. Within one year of the index procedure, 45 patients required revision carpal tunnel release. The average time to revision was 143 days. The rate of revision carpal tunnel release in the open group was 0.71% compared to 2.08% in the endoscopic group. Multivariable analysis demonstrated that endoscopic surgery, male sex, cubital tunnel syndrome, tobacco use, and diabetes were associated independently with revision surgery. Conclusions: In this study, we found that endoscopic carpal tunnel release was associated independently with a 2.96 times greater likelihood of requiring revision carpal tunnel release within one year, compared to open carpal tunnel release. Male sex, concurrent cubital tunnel syndrome, tobacco use, and diabetes also were associated independently with greater risk of needing revision carpal tunnel release within one year. 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

Comparison of immobilization periods following open reduction and internal fixation of distal radius fracture: A systematic review and meta-analysis. Ghaddaf, A. A., et al. (2021) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic: Radius fracture ORIF – Early mobilisation This systematic review aimed at comparing functional outcomes, pain, and adverse events between different periods of immobilization following open reduction and internal fixation (ORIF) of distal radius fractures (DRF) (volar locking plate). Seven randomised controlled studies, for a total of 469 participants were included in the study. Participants were randomised to either undergo immobilisation for 5-6 weeks or less than 3. The results showed that surgeons preferred to immobilise a DRF ORIF for 1-2 weeks after fixation. The number of adverse events did not differ between the two immobilisation durations and shorter immobilisation presented with functional and grip strenght benefits. 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, limited immobilisation (i.e. max 3 weeks) after distal radius fracture ORIF does not lead to more adverse events. This concept is supported by another review, making the decision on longer or shorter immobilisation dependent on clinicians' and patients' preferences. Shorter periods of immobilisation are not only appropriate following DRF ORIF but also for the conservative treatment of undisplaced/minimally displaced DRF. URL: https://doi.org/10.1016/j.jht.2021.06.004 Abstract Introduction: The use of volar locking plate (VLP) in the fixation of fracture fragments promised a new era in the management of distal radius fracture (DRF). Purpose of the Study: To compare the patient-reported outcomes, functional outcomes, pain, and adverse events between the different periods of immobilization following open reduction and internal fixation of DRFs with VLP. Methods: We searched Medline/Pubmed, Web of Science, Ovid, and CINAHL. The inclusion criteria was randomized controlled trials that compared different immobilization periods after open reduction and internal fixation of DRFs with VLP. The last search was performed on 2 June 2020. The different immobilization periods were divided into the following 3 groups: ≤1-week group, 2-3-week group, and 5-6-week group. Results: Seven eligible randomized controlled trials provided data on 509 patients. We found that compared to 5-6-week group, ≤1-week and 2-3-week groups showed a reduction in overall Patient-Reported Wrist Evaluation score (SMD = –0.48, 95% CI –0.73 to –0.22, P < .001; SMD = –0.69, 95% CI –0.97 to –0.41, P < .001, respectively). We also found that there were improvements in the other patient-reported outcomes including overall Disabilities of the Arm, Shoulder, and Hand score and pain; and functional outcomes including overall grip strength and range of motion measures in favor of ≤1-week and 2-3-week groups. Conclusion: This systematic review and meta-analysis showed that compared to immobilization for 5 to 6 weeks after DRF repair, immobilization for ≤1 week or 2-3 weeks showed improvements in the patients-reported outcomes and functional outcomes. The differences between the 3 immobilization groups may not be clinically important considering the small changes as follow up progresses. 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 meta-synthesis of carpal tunnel syndrome treatment options: Developing consolidated clinical treatment recommendations to improve practice. Baker, N. A., J. Dole and S. C. Roll (2021) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic: Thermal modalities - Carpal tunnel syndrome This article provides a comprehensive overview of treatments for carpal tunnel syndrome (CTS). After reviewing 30 professional or clinical sources, 6 primary guidelines were identified and rated according to a modified GRADE approach, which was originally suggested by the Cochrane group for systematic reviews. This resulted in 52 different CTS treatment recommendations. The overall ratings for individual treatments were strongly support (6), conditionally support (15), conditionally against (13), strongly against (3), and no consensus (9). The overall rating of each individual intervention was based on the information provided by the guidelines. Thermal modalities appeared to be either conditionally supported or advised against (see tables 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, carpal tunnel syndrome (CTS) has been treated with a multitude of approaches. Surgery, splinting, and steroids are currently strongly supported. Thermal modalities are currently conditionally supported or advised against. In the future, the integration of precision medicine will allow the selection of the best treatment given patients' characteristics/findings from subjective and objective assessments. For further information on carpal tunnel syndrome, refer to the whole database. URL: https://doi.org/10.1016/j.apmr.2021.03.034 Abstract Carpal tunnel syndrome (CTS) treatment contains ambiguities across and within disciplines. This meta-synthesis of professional guidelines consolidates clinical treatment recommendations for CTS treatment and classifies them by strength of evidence. We conducted a search of Google, Google Scholar, and PubMed for published clinical treatment recommendations for CTS. A systematic hand search was completed to identify additional professional organizations with published recommendations. We extracted any mentioned treatment from all sources but developed our final consolidated clinical treatment recommendations only from select rigorous guidelines based on the Institute of Medicine (IOM) criteria for trustworthy guidelines. We translated rating systems of the primary guidelines into a universal rating system to classify recommendations for consolidated clinical treatment recommendations. Our search yielded 30 sources that mentioned a total of 55 CTS treatments. Six of the sources met the IOM inclusion criteria. These primary guidelines provided recommendations for 46 of the 55 treatments, which were consolidated into 12 broad treatment categories. Surgery, positioning, and steroids were strongly supported. Conservative treatments provided by rehabilitation professionals were conditionally supported. Pharmaceuticals, supplements, and alternative treatments were not generally supported. CTS is a complex condition with a wide variety of treatments provided by a multitude of disciplines. Our consolidated clinical treatment recommendations offer a comprehensive outline of available treatments for CTS and contributes to the process of developing best practices for its treatment. 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

Duration of cast immobilization in distal radial fractures: A systematic review. van Delft, E. A., van Gelder, T. G., de Vries, R., Vermeulen, J. and Bloemers, F. W. (2019). Level of Evidence: 2a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Distal radius fracture – Short period of immobilisation This systematic review examined the duration of immobilization for nonoperatively treated distal radial fractures (DRF). A total of 12 trials with 1063 patients were included. Results showed that grip strength was better in the short term in those patients treated with a shorter period of immobilisation. There was no difference in fracture positioning (x-ray), range of motion, and pain between different periods of immobilisation. As a results, a shorter period of immobilisation for conservatively treated DRF is not inferior to longer periods of immobilisation. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, a shorter period of immobilization (three weeks) should be considered for nonoperatively treated distal radial fractures. This message appears to be consistent across the literature. Remember that utilising tenderness on palpation for fracture healing may be misleading and a time-based approach to return to activities may be more appropriate. URL: https://doi.org/10.1055%2Fs-0039-1683433 Abstract Objective: The duration of immobilization in distal radial fractures is disputed in the current literature. There are still no long-term superior outcomes of operative treatment in comparison to nonoperative treatment. A systematic review was initiated to assess the clinical controversy on the duration of the immobilization period for nonoperatively treated distal radial fractures. Materials and Methods: A comprehensive search was performed in the PubMed, Embase, and Wiley/Cochrane Library databases and a manual reference check of the identified systematic reviews and meta-analyses was executed. Eligible studies were randomized controlled trials that compared two periods of immobilization, with reported functional, patient-reported, and radiological outcomes. Two reviewers independently agreed on eligibility, and assessed methodological quality and extracted outcome data. Results: The initial search yielded 3.384 studies. Twelve trials, with 1063 patients, were included in this systematic review. Grip strength and patient-reported outcome were better in patients treated by a shorter period of immobilization. There was no difference in pain, range of motion, or radiological outcome between different periods of immobilization. Owing to heterogeneity of studies, data were unsuitable for pooling. Conclusion: Included studies showed that there might be a preference for a shorter period of immobilization in nonoperatively treated distal radius fractures. Therefore, shortening the period of immobilization in distal radial fractures to a maximum of three weeks should be considered. Future research should include homogeneous groups of patients to draw valid conclusions on the appropriate period of immobilization for nonoperatively treated 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

Randomized controlled trial of an internet-based self-guided hand exercise program to improve hand function in people with systemic sclerosis: the Scleroderma Patient-centered Intervention Network Hand Exercise Program (SPIN-HAND) trial. Kwakkenbos, L., et al. (2022). Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Scleroderma - Hand Therapy This is a randomised controlled trial assessing the effectiveness of the SPIN-HAND Program for people with systemic sclerosis. The SPIN-HAND Program is an online self-guided exercise program freely available to anybody signing up. A total of 466 participants were randomized to either receive access to the program or usual care. The primary outcome was the Cochin Hand Function Scale, which was assessed at baseline and 3 months post-randomization. The results showed that offering access to the program did not improve hand function, likely due to low offer uptake, program access, and minimal usage among those who accessed the program. Despite these findings, you can still use the website to learn more about Scleroderma and get ideas for hand and upper limb exercises for these patients. https://tools.spinsclero. com 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, offering access to an online self-guided hand exercise program may not improve hand function in people with Scleroderma. To improve engagement with your patients, it may be best to see patients face to face and work through the online programme together. There are a lot of resources available on the website, including goal setting, which has been shown as an important aspect to increase exercise completion in our patients. URL: https://doi.org/10.1186/s13063-022-06923-4 Abstract Background: Systemic sclerosis (scleroderma; SSc) is a rare autoimmune connective tissue disease. Functional impairment of hands is common. The Scleroderma Patient-centered Intervention Network (SPIN)-HAND trial compared effects of offering access to an online self-guided hand exercise program to usual care on hand function (primary) and functional health outcomes (secondary) in people with SSc with at least mild hand function limitations. Methods: The pragmatic, two-arm, parallel-group cohort multiple randomized controlled trial was embedded in the SPIN Cohort. Cohort participants with Cochin Hand Function Scale (CHFS) scores ≥ 3 and who indicated interest in using the SPIN-HAND Program were randomized (3:2 ratio) to an offer of program access or to usual care (targeted N = 586). The SPIN-HAND program consists of 4 modules that address (1) thumb flexibility and strength; (2) finger bending; (3) finger extension; and (4) wrist flexibility and strength. The primary outcome analysis compared CHFS scores 3 months post-randomization between participants offered versus not offered the program. Secondary outcomes were CHFS scores 6 months post-randomization and functional health outcomes (Patient-Reported Outcomes Measurement Information System profile version 2.0 domain scores) 3 and 6 months post-randomization. Results: In total, 466 participants were randomized to intervention offer (N = 280) or usual care (N = 186). Of 280 participants offered the intervention, 170 (61%) consented to access the program. Of these, 117 (69%) viewed at least one hand exercise instruction video and 77 (45%) logged into the program website at least 3 times. In intent-to-treat analyses, CHFS scores were 1.2 points lower (95% CI − 2.8 to 0.3) for intervention compared to usual care 3 months post-randomization and 0.1 points lower (95% CI − 1.8 to 1.6 points) 6 months post-randomization. There were no statistically significant differences in other outcomes. Conclusion: The offer to use the SPIN-HAND Program did not improve hand function. Low offer uptake, program access, and minimal usage among those who accessed the program limited our ability to determine if using the program would improve function. To improve engagement, the program could be tested in a group format or as a resource to support care provided by a physical or occupational therapist. 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

Impact of bracing and therapy services on perioperative costs for patients undergoing distal biceps tendon repair. Baylor, J. L., Kloc, A., Delma, S., Foster, B. K. and Grandizio, L. C. (2023) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Distal biceps repair - Splinting and rehabilitation This retrospective study assessed the cost of distal biceps tendon repair with or without bracing and rehabilitation. A total of 36 participants were included. Of these 36 participants, eight had neither rehab nor bracing, 11 had both bracing and rehab, 17 received either a brace or rehab. The results showed that the inclusion and bracing contributed to 20% of the total costs. A case series presented by one of the authors suggests that most patients had an optimal recovery when following an immediate range of movement and no bracing. 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, postoperative bracing and rehabilitation for distal biceps repair account for 20% of the total perioperative charges. It is possible that these costs may not be justified given the positive outcomes associated with no bracing and early movement. However, it is possible, that for those people involved in manual work, further guidance is beneficial. In addition, this study did not take into consideration the potential benefit of a pre-surgical physio/OT session to set goals and expectations, which could improve satisfaction with surgery. URL: https://doi.org/10.1016/j.jhsa.2023.04.019 Abstract PURPOSE: This study aimed to quantify and assess perioperative costs in an integrated healthcare system for patients undergoing distal biceps tendon (DBT) repair with and without the use of postoperative bracing and formal physical (PT) or occupational (OT) therapy services. In addition, we aimed to define clinical outcomes after DBT repair using a brace-free, therapy-free protocol. METHODS: We retrospectively reviewed all cases of DBT repairs within our integrated system from 2015 to 2021. We performed a retrospective review of a series of DBT repairs utilizing the brace-free, therapy-free protocol. For patients with our integrated insurance plan, a cost analysis was conducted. Claims were subdivided to assess total charges, costs to the insurer, and patient costs. Three groups were created for comparisons of total costs: (1) patients who had both postoperative bracing and PT/OT, (2) patients who had either postoperative bracing or PT/OT, and (3) patients who had neither postoperative bracing nor PT/OT. RESULTS: A total of 36 patients had our institutional insurance plan and were included in the cost analysis. For patients using both bracing and PT/OT, these services contributed 12% and 8% of the total perioperative costs, respectively. Implant costs accounted for 28% of the overall cost. Forty-four patients were included in the retrospective review with a mean follow-up of 17 months. The overall QuickDASH was 12; two cases resulted in unresolved neuropraxia, and there were no cases of re-rupture, infection, or reoperation. CONCLUSIONS: Within an integrated healthcare system, postoperative bracing and PT/OT services increase the cost of care for DBT repair and account for 20% of the total perioperative charges in cases where bracing and therapy are used. Considering the results of prior investigations indicating that formal PT/OT and bracing offer no clinical advantages over immediate range of motion (ROM) and self-directed rehabilitation, upper-extremity surgeons should forego routine brace and PT/OT utilization after DBT repair. 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

Behaviour Change Techniques to promote self-management and home exercise adherence for people attending physiotherapy with musculoskeletal conditions: A scoping review and mapping exercise. Chester, R., et al. (2023) Level of Evidence: 3a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Exercise completion - Useful strategies This is a scoping review that aims to identify behaviour change techniques (BCTs) utilised to improve home exercise adherence for people with musculoskeletal conditions. The study found that a range of BCTs such as goal setting, self-monitoring, feedback, and social support were useful in helping patients complete their exercises. In the picture below, the authors highlighted steps that can be taken to help somebody with knee osteoarthritis improve the exercise completion rate. Similar steps can be taken to help patients with hand and upper limb conditions complete their exercise programmes. 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, self-efficacy, social support and task appreciation are the most important determinants of home exercise adherence and self-management in musculoskeletal conditions. This study is a nice addition to previous research showing that a maximum of 2-3 exercises boost treatment compliance in patients. URL: https://doi.org/10.1016/j.msksp.2023.102776 Abstract Background: Many patients with musculoskeletal problems do not adhere to home exercises or self-management advice provided by physiotherapists. This is due to numerus factors, many of which can be targeted by Behaviour Change Techniques. Objectives 1) Undertake a scoping review to identify the modifiable determinants (barriers and facilitators) of home exercise adherence and self-management for the physiotherapy management of people with musculoskeletal problems and map them to the Theoretical Domains Framework and Behaviour Change Techniques. 2) For determinants with supporting evidence from ≥2 studies, provide examples of Behaviour Change Techniques for clinical practice. Design: This review follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Method: Four electronic databases were searched from inception to December 2022. Two independent reviewers carried out manuscript selection, data extraction, quality assessment, and mapping, the latter using the Theory and Techniques Tool. Results: Thirteen modifiable determinants were identified in 28 studies. The most frequently identified were self-efficacy, social support, and task appreciation. Determinants were mapped to 7 of 14 Theoretical Domains Framework categories, which in turn mapped onto 42 of 93 Behaviour Change Techniques, the most common being problem solving and instruction on how to perform behaviour. Conclusions: By identifying determinants to home exercise adherence and self-management and mapping these to Behaviour Change Techniques, this review has improved understanding of their selection, targeting, and potential application to musculoskeletal physiotherapy practice. This provides support for physiotherapists targeting the determinants of importance for the patient in front of them. 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

Misdiagnosis in Amyotrophic Lateral Sclerosis. Thomson, C. G., Hutchinson, P. R. and Stern, P. J. (2023) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic Topic: Amyotrophic Lateral Sclerosis - Diagnosis This is an expert opinion on how to avoid missing Amyotrophic Lateral Sclerosis (ALS) in patients presenting with symptoms mimicking an entrapment neuropathy. Thus, the authors indicate how symptoms of ALS can mimic those of compressive neuropathies, such as carpal or cubital tunnel syndromes. Clinicians should maintain a heightened awareness of ALS and consider red flag symptoms such as the absence of sensory symptoms, profound weakness and atrophy in multiple body regions, progressively global symptoms over time, presence of fasciculations/twitching and bulbar symptoms when assessing their 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, we should be aware of the signs and symptoms of ALS, as it can easily be misdiagnosed as compression neuropathy. If any of the red flags listed above are present, and we are unable to reproduce symptoms with common orthopaedic tests, we should consider other differential diagnoses and possibly refer the patient to a specialist. Have a look at other interesting cases of uncommon entrapment neuropathies of the musculocutaneous, median and ulnar nerves. URL: https://doi.org/10.1016/j.jhsa.2023.03.023 Abstract The symptoms of amyotrophic lateral sclerosis (ALS) can mimic those of compressive neuropathies, such as carpal and cubital tunnel syndromes, especially early in a patient?s clinical course. We surveyed members of the American Society for Surgery of the Hand and found that 11% of active and retired members have performed nerve decompression surgeries on patients later diagnosed with ALS. Hand surgeons are commonly the first providers to evaluate patients with undiagnosed ALS. As such, it is important to be aware of the history, signs, and symptoms of ALS to provide an accurate diagnosis and prevent unnecessary morbidities, such as nerve decompression surgery, which invariably results in poor outcomes. The major ?red flag? symptoms warranting further work-up include weakness without sensory symptoms, profound weakness and atrophy in multiple nerve distributions, progressively bilateral and global symptoms, presence of bulbar symptoms (such as tongue fasciculations and speech/swallowing difficulties), and, if surgery is performed, failure to improve. If any of these red flags are present, we recommend neurodiagnostic testing and prompt referral to a neurologist for further work-up and treatment. 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

Non-or minimally displaced distal radial fractures in adult patients: three weeks versus five weeks of cast immobilization: A randomized controlled trial. Bentohami, A., et al. (2019). Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Distal radius fracture – Conservative management This randomised controlled study compared the effects of 3 vs 5 weeks of cast immobilisation in people with non- or minimally displaced distal radial fractures. A total of 72 patients were included in the study, with 7 lost to follow-up at one year. Only patients with unilateral stable and minimally displaced fractures were included in the study. QuickDASH was measured at follow-up only. Several patients did not complete this outcome at 12 months, which reduces the strength of the study. Results showed 3 weeks of cast immobilisation led to similar outcomes in function and complications compared to 5 weeks of immobilisation. 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, immobilising adults with a non- or minimally displaced distal radial fractures for 3 weeks appears to be safe. From a functional point of view, it provides similar benefits to a 5 weeks immobilisation. Shortening the immobilisation duration may be particularly appropriate in those patients that are at greater risk of developing CRPS. If you are interested in CRPS or distal radius fracture, have a look at the relative databases. URL: https://doi.org/10.1055/s-0038-1668155 Abstract Background: Patients with non- or minimally displaced distal radial fractures, that do not need repositioning, are mostly treated by a short-arm cast for a period of 4 to 6 weeks. A shorter period of immobilization may lead to a better functional outcome. Purpose: We conducted a randomized controlled trial to evaluate whether the duration of cast immobilization for patients with non- or minimally displaced distal radial fractures can be safely shortened toward 3 weeks. Materials and Methods: The primary outcomes were patient-reported outcomes measured by the Patient-Related Wrist Evaluation (PRWE) and Quick Disability of Arm, Shoulder and Hand (QuickDASH) score after 1-year follow-up. Secondary outcome measures were: PRWE and QuickDASH earlier in follow-up, pain (Visual Analog Scale), and complications like secondary displacement. Results: Seventy-two patients (male/female, 23/49; median age, 55 years) were included and randomized. Sixty-five patients completed the 1-year follow-up. After 1-year follow up, patients in the 3 weeks immobilization group had significantly better PRWE (5.0 vs. 8.8 points, p  = 0.045) and QuickDASH scores (0.0 vs. 12.5, p  = 0.026). Secondary displacement occurred once in each group. Pain did not differ between groups ( p  = 0.46). Conclusion: Shortening the period of immobilization in adult patients with a non- or minimally displaced distal radial fractures seems to lead to equal patient-reported outcomes for both the cast immobilization groups. Also, there are no negative side effects of a shorter period of cast immobilization. Therefore, we recommend a period of 3 weeks of immobilization in patients with distal radial fractures that do not need repositioning. 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

Exploring the role of artificial intelligence chatbot on the management of scaphoid fractures. Seth, I., Lim, B., Xie, Y., Hunter-Smith, D. J. and Rozen, W. M. (2023) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic: ChatGPT scaphoid management – Information for patients This study investigated the potential of ChatGPT in assisting in the management of scaphoid fractures. A series of prompts such as "In 300 words, what is the most appropriate treatment for scaphoid fracture management?" were provided to ChatGPT and a series of hand surgeons and specialist assessed the quality of the response. The specialists also assessed adherence to guidelines, complexity of language, management for different patient populations, consistency of recommendations and quality of evidence. The results showed that ChatGPT provided a basic correct management description. 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, artificial intelligence (e.g. ChatGPT) has the potential to provide useful information to patients who have been diagnosed with a scaphoid fracture. For the most part, ChatGPT appears to provide responses which adhere to guidelines and use appropriate language complexity. Despite these positive findings it is important to remember that it is still early days and responses can be inaccurate in some instances. Another important thing to be aware of is that ChatGPT hallucinates when you ask them for scientific reference. In other words, it makes up references that have never been published. If you want to read more about how AI is affecting the field of hand therapy, read this synopsis. URL: https://doi.org/10.1177/17531934231169858 Abstract not available 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

Is pain in the uninjured arm associated with unhelpful thoughts and distress regarding symptoms during recovery from upper-extremity injury? Romere, C., et al. (2023) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Uninjured hand - Increased use and pain This is a cross-sectional study assessing the association between unhelpful thinking and pain intensity in the uninjured arm in people who have had an isolated unilateral upper-extremity injury. A total of 141 adult participants were included in the present study. The results showed that greater pain intensity in both the uninjured and injured arms was independently associated with greater unhelpful thinking regarding symptoms. Additionally, greater self-efficacy was independently associated with better pain-coping 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, pain intensity in the uninjured arm during recovery from upper-extremity injury is associated with unhelpful thinking regarding symptoms. If patients complain of contralateral pain, we should not only assess the uninjured limb but also consider whether they present with unhelpful thinking regarding their symptoms. Additionally, interventions such as mindfulness meditation, cognitive behavioural therapy, physical activity, and relaxation strategies can be effective in improving pain and coping in patients with musculoskeletal injuries. URL: https://doi.org/10.1016/j.jhsa.2023.03.019 Abstract Purpose: During recovery from upper-extremity injury, patients sometimes express concerns regarding pain associated with increased use of the uninjured limb. Concerns about discomfort associated with increased use may represent a manifestation of unhelpful thoughts such as catastrophic thinking or kinesiophobia. We asked the following questions: (1) Among people recovering from an isolated unilateral upper-extremity injury, is pain intensity in the uninjured arm associated with unhelpful thoughts and feelings of distress regarding symptoms, accounting for other factors? (2) Is pain intensity in the injured extremity, magnitude of capability, or accommodation of pain associated with unhelpful thoughts and feelings of distress regarding symptoms? Methods: In this cross-sectional study of new or returning patients presenting to a musculoskeletal specialist for care for an upper-extremity injury, the patients completed scales that were used to measure the following: pain intensity in the uninjured arm, pain intensity in the injured arm, upper-extremity–specific magnitude of capability, symptoms of depression, symptoms of health anxiety, catastrophic thinking, and accommodation of pain. Multivariable analysis was used to evaluate factors associated with pain intensity in the uninjured arm, pain intensity in the injured arm, magnitude of capability, and pain accommodation, controlling for other demographic and injury-related factors. Results: Greater pain intensity in both uninjured and injured arms was independently associated with greater unhelpful thinking regarding symptoms. A greater magnitude of capability and pain accommodation were independently associated with less unhelpful thinking regarding symptoms. Conclusions: Given that greater pain intensity in the uninjured upper extremity is associated with greater unhelpful thinking, clinicians can be attuned to patient concerns about contralateral pain. Clinicians can facilitate recovery from upper-extremity injury by evaluating the uninjured limb as well as identifying and ameliorating unhelpful thinking regarding symptoms. 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

Relative motion orthoses for early active motion after finger extensor and flexor tendon repairs: A systematic review. Shaw, A. V., Verma, Y., Tucker, S., Jain, A. and Furniss, D. (2023) Level of Evidence: 2a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Relative motion extension/flexion splint - Do we have enough evidence This systematic review assessed the use of relative motion (RM) orthoses for early active motion after finger extensor and flexor tendon repairs. A total of ten studies were included in the review. The modified cochrane risk of bias tool was utilised to assess study quality. The results showed that there were more studies available for the use of RM in extensor compared to flexor tendon repair. The findings support the use of RM splinting for zone V and VI extensor, however, there is still limited evidence for their use in extensor zone IV and VIII as well as flexors zone I and II. 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 a relative motion (RM) splint can be used with confidence for zone V and VI extensor tendon repair. However, there is still not enough evidence to support their use for extensor zone IV and VII or flexor tendon repairs. The findings from this review are consistent with what has been previously shown. URL: https://doi.org/10.1016/j.jht.2023.02.011 Abstract BACKGROUND: The relative motion (RM) orthosis was introduced over 40 years ago for extensor tendon rehabilitation and more recently applied to flexor tendon repairs. PURPOSE: We systematically reviewed the evidence for RM orthoses following surgical repair of finger extensor and flexor tendon injuries including indications for use, configuration and schedule of orthosis wear, and clinical outcomes. STUDY DESIGN: Systematic review. METHODS: A PRISMA-compliant systematic review searched eight databases and five trial registries, from database inception to January 7, 2022. The protocol was registered prospectively (CRD42020211579). We identified studies describing patients undergoing rehabilitation using RM orthoses after surgical repair of acute tendon injuries of the finger and hand. RESULTS: For extensor tendon repairs, ten studies, one trial registry and five conference abstracts met inclusion criteria, reporting outcomes of 521 patients with injuries in zones IV-VII. Miller's criteria were predominantly used to report range of motion; with 89.6% and 86.9% reporting good or excellent outcomes for extension lag and flexion deficit, respectively. For flexor tendon repairs, one retrospective case series was included reporting outcomes in eight patients following zones I-II repairs. Mean total active motion was 86%. No tendon ruptures were reported due to the orthosis not protecting the repair for either the RME or RMF approaches. DISCUSSION: Variation was seen in use of RME plus or only, use of night orthoses and orthotic wear schedules, which may be the result of evolution of the RM approach. Since Hirth et al's 2016 scoping review, there are five additional studies, including two RCTs reporting the use of the RM orthosis in extensor tendon rehabilitation. CONCLUSIONS: There is now good evidence that the RM approach is safe in zones V-VI extensor tendon repairs. Limited evidence currently exists for zones IV and VII extensor and for flexor tendon repairs. Further high-quality clinical studies are needed to demonstrate its safety and efficacy. 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