Search Results

Alternative models to support weight loss in chronic musculoskeletal conditions: Effectiveness of a physiotherapist-delivered intensive diet programme for knee osteoarthritis, the POWER randomised controlled trial. Kim, A., et al. (2024) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 (4/4 thumbs up) Type of study: Therapeutic Topic: Weight management - Diet This randomised controlled trial assessed the effectiveness of physiotherapists delivering a very low-energy diet (VLED) program alongside exercise for individuals with knee osteoarthritis (OA) and overweight or obesity. A total of 88 participants were randomised into an intervention group (VLED + exercise) and a control group (exercise only) and underwent six videoconference sessions over six months. The results showed that the intervention group significantly lost more weight (8.1%) compared to the control group (1%), with improvements in BMI, waist circumference, pain, function, and global knee improvement. The VLED program was safe and effective, suggesting implications for future care models. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, it is possible to deliver a very low energy diet (VLED) program supplementary to exercise for individuals who are overweight or obese. Anybody interested in adding this to their skill set would need to upgrade their nutritional knowledge, but the benefit of implementing this in our practice are likely to significantly benefit our patients. If you consider for example symptomatic hand OA, it appears that being overweight may contribute to the disease process as well as increasing the risk of developing it, and the risks associated due to cardiovascular risks. URL: https://doi.org/10.1136/bjsports-2023-107793 Abstract Objectives: To determine if physiotherapists can deliver a clinically effective very low energy diet (VLED) supplementary to exercise in people with knee osteoarthritis (OA) and overweight or obesity. Methods: 88 participants with knee OA and body mass index (BMI) >27 kg/m2 were randomised to either intervention (n=42: VLED including two daily meal replacement products supplementary to control) or control (n=46: exercise). Both interventions were delivered by unblinded physiotherapists via six videoconference sessions over 6 months. The primary outcome was the percentage change in body weight at 6 months, measured by a blinded assessor. Secondary outcomes included BMI, waist circumference, waist-to-hip ratio, self-reported measures of pain, function, satisfaction and perceived global change, and physical performance tests. Results: The intervention group lost a mean (SD) of 8.1% (5.2) body weight compared with 1.0% (3.2) in the control group (mean (95% CI) between-group difference 7.2% (95% CI 5.1 to 9.3), p<0.001), with significantly lower BMI and waist circumference compared with control group at follow-up. 76% of participants in the intervention group achieved ≥5% body weight loss and 37% acheived ≥10%, compared with 12% and 0%, respectively, in the control group. More participants in the intervention group (27/38 (71.1%)) reported global knee improvement than in the control group (20/42 (47.6%)) (p=0.02). There were no between-group differences in any other secondary outcomes. No serious adverse events were reported. Conclusion: A VLED delivered by physiotherapists achieved clinically relevant weight loss and was safe for people with knee OA who were overweight or obese. The results have potential implications for future service models of care for OA and obesity.Trial registration number NIH, US National Library of Medicine, Clinicaltrials.gov NCT04733053 (1 February 2021).Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The datasets used and/or analysed during the current trial will be made available from the corresponding author on reasonable request. 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

Splinting for carpal tunnel syndrome. Karjalainen, T. V., et al. (2023) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 thumb up) Type of study: Therapeutic Topic: Carpal tunnel syndrome - Splinting This Cochrane review and meta-analysis assessed the effectiveness of splinting for carpal tunnel syndrome (CTS). A total of 29 trials involving 1937 adults with CTS were included. The results showed that short-term splinting may not significantly improve symptoms or hand function compared to no treatment. Night-time splinting may be more beneficial in the short term. It is also still unclear whether splinting reduces the need for surgery and improved quality of life improvements in the long term. Consider that splinting has minimal side effects and it is a relatively cheap option, it could be used as a first line treatment for people with CTS. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, splinting may provide limited to no benefits in reducing symptoms in the short term (< 3 months) and may not improve hand function in the short or long term. Nevertheless, considering its low cost and the minimal side effects associated with its use, it is worth trialing in people with carpal tunnel syndrome. Overall, it appears that night-time splinting may lead to a higher rate of overall improvement in the short term. Have a look at the whole database to get an understanding of where the research is at on this topic. URL: https://doi.org/10.1002/14651858.cd010003.pub2 Abstract BACKGROUND: Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve causing pain and numbness and tingling typically in the thumb, index and middle finger. It sometimes results in muscle wasting, diminished sensitivity and loss of dexterity. Splinting the wrist (with or without the hand) using an orthosis is usually offered to people with mild-to-moderate findings, but its effectiveness remains unclear. OBJECTIVES: To assess the effects (benefits and harms) of splinting for people with CTS. SEARCH METHODS: On 12 December 2021, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, AMED, CINAHL, ClinicalTrials.gov, and WHO ICTRP with no limitations. We checked the reference lists of included studies and relevant systematic reviews for studies. SELECTION CRITERIA: Randomised trials were included if the effect of splinting could be isolated from other treatment modalities. The comparisons included splinting versus no active treatment (or placebo), splinting versus another disease-modifying non-surgical treatment, and comparisons of different splint-wearing regimens. We excluded studies comparing splinting with surgery or one splint design with another. We excluded participants if they had previously undergone surgical release. DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, extracted data, assessed study risk of bias and the certainty in the body of evidence for primary outcomes using the GRADE approach, according to standard Cochrane methodology. MAIN RESULTS: We included 29 trials randomising 1937 adults with CTS. The trials ranged from 21 to 234 participants, with mean ages between 42 and 60 years. The mean duration of CTS symptoms was seven weeks to five years. Eight studies with 523 hands compared splinting with no active intervention (no treatment, sham-kinesiology tape or sham-laser); 20 studies compared splinting (or splinting delivered along with another non-surgical intervention) with another non-surgical intervention; and three studies compared different splinting regimens (e.g. night-time only versus full time). Trials were generally at high risk of bias for one or more domains, including lack of blinding (all included studies) and lack of information about randomisation or allocation concealment in 23 studies. For the primary comparison, splinting compared to no active treatment, splinting may provide little or no benefits in symptoms in the short term (< 3 months). The mean Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) (scale 1 to 5, higher is worse; minimal clinically important difference (MCID) 1 point) was 0.37 points better with splint (95% confidence interval (CI) 0.82 better to 0.08 worse; 6 studies, 306 participants; low-certainty evidence) compared with no active treatment. Removing studies with high or unclear risk of bias due to lack of randomisation or allocation concealment supported our conclusion of no important effect (mean difference (MD) 0.01 points worse with splint; 95% CI 0.20 better to 0.22 worse; 3 studies, 124 participants). In the long term (> 3 months), we are uncertain about the effect of splinting on symptoms (mean BCTQ SSS 0.64 better with splinting; 95% CI 1.2 better to 0.08 better; 2 studies, 144 participants; very low-certainty evidence). Splinting probably does not improve hand function in the short term and may not improve hand function in the long term. In the short term, the mean BCTQ Functional Status Scale (FSS) (1 to 5, higher is worse; MCID 0.7 points) was 0.24 points better (95% CI 0.44 better to 0.03 better; 6 studies, 306 participants; moderate-certainty evidence) with splinting compared with no active treatment. In the long term, the mean BCTQ FSS was 0.25 points better (95% CI 0.68 better to 0.18 worse; 1 study, 34 participants; low-certainty evidence) with splinting compared with no active treatment. Night-time splinting may result in a higher rate of overall improvement in the short term (risk ratio (RR) 3.86, 95% CI 2.29 to 6.51; 1 study, 80 participants; number needed to treat for an additional beneficial outcome (NNTB) 2, 95% CI 2 to 2; low-certainty evidence).  We are uncertain if splinting decreases referral to surgery, RR 0.47 (95% CI 0.14 to 1.58; 3 studies, 243 participants; very low-certainty evidence).  None of the trials reported health-related quality of life. Low-certainty evidence from one study suggests that splinting may have a higher rate of adverse events, which were transient, but the 95% CIs included no effect. Seven of 40 participants (18%) reported adverse effects in the splinting group and 0 of 40 participants (0%) in the no active treatment group (RR 15.0, 95% CI 0.89 to 254.13; 1 study, 80 participants).  There was low- to moderate-certainty evidence for the other comparisons: splinting may not provide additional benefits in symptoms or hand function when given together with corticosteroid injection (moderate-certainty evidence) or with rehabilitation (low-certainty evidence); nor when compared with corticosteroid (injection or oral; low certainty), exercises (low certainty), kinesiology taping (low certainty), rigid taping (low certainty), platelet-rich plasma (moderate certainty), or extracorporeal shock wave treatment (moderate certainty). Splinting for 12 weeks may not be better than six weeks, but six months of splinting may be better than six weeks of splinting in improving symptoms and function (low-certainty evidence). AUTHORS' CONCLUSIONS: There is insufficient evidence to conclude whether splinting benefits people with CTS. Limited evidence does not exclude small improvements in CTS symptoms and hand function, but they may not be clinically important, and the clinical relevance of small differences with splinting is unclear. Low-certainty evidence suggests that people may have a greater chance of experiencing overall improvement with night-time splints than no treatment. As splinting is a relatively inexpensive intervention with no plausible long-term harms, small effects could justify its use, particularly when patients are not interested in having surgery or injections. It is unclear if a splint is optimally worn full time or at night-time only and whether long-term use is better than short-term use, but low-certainty evidence suggests that the benefits may manifest in the long term. 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

Magnetic resonance imaging abnormalities in the shoulder and wrist joints of asymptomatic elite athletes. Fredericson, M., et al. (2009) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Diagnostic Topic: Pathological MRI findings - Asymptomatic wrists and shoulders This prospective study assessed the presence of MRI abnormalities in asymptomatic elite athletes, particularly focusing on shoulder and wrist joints. A total of 33 asymptomatic participants (15 gymnasts, 6 swimmers, 13 volleyball players) were included in the study and underwent MRI imaging of the shoulder and wrist. Participants were then asked at the 3 years follow-up whether they presented with pain in either of these joints. The results showed that a large proportion of participants presented with moderate to severe changes on imaging at the shoulder (especially volleyball players and swimmers) and wrist (gymnasts). At the 3 years follow up, only three athletes reported presenting with pain or injuring their wrist. 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, MRI abnormalities are common in asymptomatic elite athletes, particularly in the shoulder and wrist joints of swimmer/volleyball players and gymnasts respectively. Care must be taken to interpret these findings in the context of the athlete's clinical history and physical examination. These findings are in line with recent research showing that "pathological changes" of the TFCC on MRI imaging are common in asymptomatic people. URL: https://doi.org/10.1016/j.pmrj.2008.09.004 Abstract Objective: To characterize abnormalities on magnetic resonance images (MRI) in the shoulder and wrist joints of asymptomatic elite athletes to better define the range of “normal” findings in this population. Design: Cohort study. Setting: Academic medical center. Subjects: Division IA collegiate volleyball players (n=12), swimmers (n=6), and gymnasts (n=15) with no history of injury or pain and normal physical examination results. Interventions: None. Main Outcome: Measures Grade of severity of MRI changes of the shoulder and wrist joints. A 3- to 4-year follow-up questionnaire was administered to determine the clinical significance of the asymptomatic findings. Results: All athletes demonstrated at least mild imaging abnormalities in the joints evaluated. Shoulder: Volleyball players had moderate and severe changes primarily in the labrum (50% moderate, 8% severe), rotator cuff (25% moderate, 17% severe), bony structures (33% moderate), and tendon/muscle (25% moderate, 8% severe). Swimmers had moderate changes primarily in the labrum (83% moderate) and ligament (67% moderate). Wrist: All gymnasts had changes in the wrist ligaments (40% mild, 60% moderate), tendons (53% mild, 47% moderate), and cartilage (60% mild, 33% moderate, 7% severe). Most gymnasts exhibited bony changes (20% normal, 47% mild, 26% moderate, 7% severe), the presence of cysts/fluid collections (80%), and carpal tunnel changes (53%). Swimmers had no wrist abnormalities. At follow-up interview, only 1 swimmer and 1 volleyball player reported shoulder problems during the study. Additionally, only 1 gymnast reported a wrist injury during their career. Conclusion: Asymptomatic elite athletes demonstrate MRI changes of the shoulder (swimmers and volleyball players) and wrist (gymnasts) similar to those associated with abnormalities for which medical treatment and sometimes surgery are advised. Given the somewhat high frequency of these asymptomatic findings, care must be taken to correlate clinical history and physical examination with MRI findings in these patients with 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

Design and fabrication of the Cubital Tunnel Control Orthosis (CTCO). Cancio, J. M., Jones, K. A., Stanley, B., Truax, C. and Nuelle, J. A. V. (2021) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic: Cubital tunnel – Dynamic splint This paper described the creation of a custom dynamic splint for Cubital tunnel syndrome. The splint aims at alleviating pressure on the ulnar nerve at the cubital tunnel level, whilst allowing for 90 degrees of elbow flexion and passive extension. Materials used for fabrication include Aquatube, thermoplastic, and soft padded elastic bands for to provide an extension component to the splint. Two separate thermoplastic sheets were created. One for the arm and the other for the forearm. The two thermoplastic splints were joined with aquatube, which were positioned along the centre of rotation of the elbow, which contributed to providing an extension torque. In addition, soft elastic bands of velcro loop were utilised to provide additional elbow extension torque (see pictures 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, a dynamic splint may be a useful alternative to a static extension night splinting for cubital tunnel syndrome. Overall it appears that cubital tunnel splints are useful and the choice of static vs dynamic splints are a matter of clinician's and patient's preference. If you are interested in other cubital tunnel synopses, have a look at the entire database. URL: https://doi.org/10.1016/j.jht.2020.05.005 No Abstract 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

Diagnostic performance of artificial intelligence for detection of scaphoid and distal radius fractures: A systematic review. Oeding, J. F., et al. (2024) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic: Artificial intelligence – Scaphoid and distal radius fracture detection The systematic review assessed the effectiveness of artificial intelligence (AI) in detecting scaphoid and distal radius fractures compared to human experts. A total of 21 studies, which included 55,541 participants (with associated x-rays) were included. The results showed that AI models present with promising diagnostic performance, with high accuracy and area under the curve values. AI models performed comparably or better than human experts in most cases, especially for occult fractures when they were trained on that. The study suggests that AI can assist in detecting subtle fractures and improve diagnostic efficiency. 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, articificial intelligence (AI) models demonstrated good performance, with high accuracy and area under the receiver operator characteristic curve (AUROC) values. It appears that radiology clinics have already started using AI, as I have seen x-rays images with the GLEAMER (one of the AI softwares) on several occasions when reviewing my patients' imaging through inteleviewer. If you are interested in the use of AI for hand surgery/therapy, have a look at this synopsis. URL: https://doi.org/10.1016/j.jhsa.2024.01.020 Abstract Purpose: To review the existing literature to (1) determine the diagnostic efficacy of artificial intelligence (AI) models for detecting scaphoid and distal radius fractures and (2) compare the efficacy to human clinical experts. Methods: PubMed, OVID/Medline, and Cochrane libraries were queried for studies investigating the development, validation, and analysis of AI for the detection of scaphoid or distal radius fractures. Data regarding study design, AI model development and architecture, prediction accuracy/area under the receiver operator characteristic curve (AUROC), and imaging modalities were recorded. Results: A total of 21 studies were identified, of which 12 (57.1%) used AI to detect fractures of the distal radius, and nine (42.9%) used AI to detect fractures of the scaphoid. AI models demonstrated good diagnostic performance on average, with AUROC values ranging from 0.77 to 0.96 for scaphoid fractures and from 0.90 to 0.99 for distal radius fractures. Accuracy of AI models ranged between 72.0% to 90.3% and 89.0% to 98.0% for scaphoid and distal radius fractures, respectively. When compared to clinical experts, 13 of 14 (92.9%) studies reported that AI models demonstrated comparable or better performance. The type of fracture influenced model performance, with worse overall performance on occult scaphoid fractures; however, models trained specifically on occult fractures demonstrated substantially improved performance when compared to humans. Conclusions: AI models demonstrated excellent performance for detecting scaphoid and distal radius fractures, with the majority demonstrating comparable or better performance compared with human experts. Worse performance was demonstrated on occult fractures. However, when trained specifically on difficult fracture patterns, AI models demonstrated improved performance. Clinical Relevance: AI models can help detect commonly missed occult fractures while enhancing workflow efficiency for distal radius and scaphoid fracture diagnoses. As performance varies based on fracture type, future studies focused on wrist fracture detection should clearly define whether the goal is to (1) identify difficult-to-detect fractures or (2) improve workflow efficiency by assisting in routine tasks. 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

Advancements in De Quervain tenosynovitis management: A comprehensive network meta-analysis. Chong, H. H., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: De Quervain tenosynovitis - Therapeutic options This is a systematic review and meta-analysis assessing nonsurgical treatment options for De Quervain tenosynovitis. Fourteen studies for a total of 823 participants were included in this review. The interventions assessed included cortisone injections, splinting, and extracorporeal shock wave therapy. The results showed that extracorporeal shockwave therapy was most effective in the short and medium term, while corticosteroid injections with immobilisation were ideal for long-term relief. Other treatments like acupuncture and splinting alone showed limited benefits. The study suggests corticosteroid injections with short immobilisation as the primary treatment, with extracorporeal shockwave therapy as an adjunct therapeutic option. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, corticosteroid injections with short-duration immobilisation should be considered the primary therapeutic option for De Quervain tenosynovitis, especially for long term outcomes. Extracorporeal shockwave therapy could be utilised as an adjunct therapeutic option. Splinting alone did not appear to provide large benefits in the treatment of this condition. This seems to be in line with a study published in the past. If you are interested in providing exercises for people with De Quervain tenosynovitis, they appear to be safe and they do not exacerbate patients' symptoms. URL: https://doi.org/10.1016/j.jhsa.2024.03.003 Abstract Purpose: This study presents a network meta-analysis aimed at evaluating nonsurgical treatment modalities for De Quervain tenosynovitis. The primary objective was to assess the comparative effectiveness of nonsurgical treatment options. Methods: The systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Searches were performed in multiple databases, and studies meeting predefined criteria were included. Data extraction, risk of bias assessment, and statistical analysis were carried out to compare treatment modalities. The analysis was categorized into short-term (within six weeks), medium-term (six weeks up to six months), and long-term (one year) follow-up. Results: The analysis included 14 randomized controlled trials encompassing various treatment modalities for De Quervain tenosynovitis. In the short-term, extracorporeal shockwave therapy demonstrated statistically significant improvement in visual analog scale pain scores compared with placebo. Extracorporeal shockwave therapy also ranked highest in the treatment options based on its treatment effects. Corticosteroid injections (CSIs) combined with casting and laser therapy with orthosis showed favorable outcomes. Corticosteroid injection alone, platelet-rich plasma injections alone, acupuncture, and orthosis alone did not significantly differ from placebo in visual analog scale pain score. In the medium-term, extracorporeal shockwave therapy remained the top-ranking option for visual analog scale pain score, followed by CSI with casting. In the long-term (one year), CSI alone and platelet-rich plasma injections demonstrated sustained pain relief. Combining CSI with orthosis also appeared promising when compared with CSI alone. Conclusions: Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for De Quervain tenosynovitis. Extracorporeal shockwave therapy can be considered a secondary option. Alternative treatment modalities, such as isolated therapeutic injection, should be approached with caution because they did not show substantial benefits over placebo. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Cervical manipulation versus thoracic or cervicothoracic manipulations for the management of neck pain. A systematic review and meta-analysis. Carrasco-Uribarren, A., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Neck pain – Cervical vs thoracic manipulation This systematic review and meta-analysis assessed the effectiveness of cervical thrust or non-thrust manipulations versus thoracic or cervicothoracic manipulations for treating neck pain. The review included six studies and found no significant differences between the two types of manipulations in terms of pain intensity, disability, and cervical range of motion. The certainty of evidence varied from very low to moderate, suggesting that both types of manipulations are equally effective in improving pain, disability, and range of motion in patients with neck pain. 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 no significant difference in effectiveness between cervical thrust or non-thrust manipulations and thoracic or cervicothoracic manipulations for improving pain, disability, and range of motion in patients with neck pain. Considering that cervical manipulation have a greater risk of adverse events, the use of cervicothoracic mobilisation/manipulations may be safer. URL: https://doi.org/10.1016/j.msksp.2024.102927 Abstract Background: Cervical and thoracic thrust or non-thrust manipulations have shown to be effective in patients with neck pain, but there is a lack of studies comparing both interventions in patients with neck pain. Objective: To investigate the effects of cervical thrust or non-thrust manipulations compared to thoracic or cervicothoracic manipulations for improving pain, disability, and range of motion in patients with neck pain. Design: Systematic review and meta-analysis. Method Searches were performed in PubMed, PEDro, Cochrane Library, CINHAL, and Web of Science databases from inception to May 22, 2023. Randomized clinical trials comparing cervical thrust or non-thrust manipulations to thoracic or cervicothoracic manipulations were included. Methodological quality was assessed with PEDro scale, and the certainty of evidence was evaluated using GRADE guidelines. Results: Six studies were included. Meta-analyses revealed no differences between cervical thrust or non-thrust manipulations and thoracic or cervicothoracic manipulations in pain intensity, disability, or cervical range of motion in any plane. The certainty of evidence was downgraded to very low for pain intensity, to moderate or very low for disability and to low or very low for cervical range of motion. Conclusion: There is moderate to very low certainty evidence that there is no difference in effectiveness between cervical thrust or non-thrust manipulations and thoracic or cervicothoracic manipulations for improving pain, disability, and range of motion in patients with neck pain. 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 aetiology of fracture and nonunion in the hook of the hamate. Campbell, F. C., Jones, S. W. and Campbell, D. A. (2024) Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Diagnostic, Therapeutic Topic: Hook of hamate fractures - Diagnosis and treatment This expert opinion discusses fractures of the hook of the hamate bone in the hand. The authors explains the anatomy and vascular supply of the hook of hamate, highlighting its function as a pulley for the flexor digitorum profundus of the little and ring finger. This pulley feature of the hook of hamate is suggested as one of the reasons why traumatic fractures of the hook often develop into non-union. The authors also challenge the traditional belief of direct trauma as the primary cause of hook of hamate fractures, suggesting that tendon-induced bone stress may contribute to a higher predisposition to fractures. 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, fractures of the hook of the hamate may require immobilisation of the wrist and ulnar two digits to attempt reducing loading forces through the hook of the hamate. However, considering that these fractures are often missed by primary care provider and they are seen later in the recovery phase, ORIF or excision may be required. If you are interested in further information on the diagnosis and treatment of hook of hamate fractures, have a look at this synopsis. URL: https://doi.org/10.1177/17531934241235803 Abstract Fractures of the hook of the hamate are traditionally thought to be caused by direct trauma. A review of the anatomy and function of the hamate hook suggests that fracture is more likely as a result of a fatigue response that develops in the hook from repetitive load applied by the adjacent deep flexor tendons. Additional vascular compromise, from direct pressure of the tendons on critical local vessels, reduces blood flow leading to both mechanical and vascular effects that create pathological osseous change and weakening. These changes are likely to predispose to stress fracture and nonunion in repetitive gripping activities and are consistent with radiological 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

Ultrasound examination of acute soft tissue lesions in the elbow has good intra rater reliability and acceptable agreement with MRI. Hallgren, H. B., Nicolescu, D., Törnqvist, L., Casselgren, M. and Adolfsson, L. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: Ultrasound imaging vs MRI – Elbow This diagnostic study assessed the diagnostic agreement between ultrasound (US) and MRI imaging in the assessment of acute soft tissue lesions of the elbow. A total of 116 participant underwent US imaging. Of these, 58 agreed to undergo further MRI imaging. The results showed that agreement between US and MRI results indicated good agreement for soft tissue injuries. A problem with the present study is that only a subgroup of participants underwent MRI imaging as well. 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 shows good reliability and agreement with MRI in diagnosing soft tissue injuries following acute elbow. US is therefore a valuable and accessible imaging modality for hand therapists in the acute setting, particularly for assessing ligament injuries. If you are interested in the use of US imaging in hand therapy setting, have a look at the entire database. URL: https://doi.org/10.1016/j.jse.2024.01.050 Abstract Background: Ultrasound (US) has been suggested a valuable complement to clinical and radiological examinations in elbow trauma. Magnetic resonance imaging (MRI) has been the method of choice, despite fair to moderate interrater reliability (IRR). US has potential advantages but is assessor dependent and IRR scarcely examined. The primary aim of the present study was to investigate IRR for US and secondarily inter-observer agreement (IOA) between US and MRI in the acute phase after elbow trauma. Acute phase was defined as 2 weeks and, if applicable, the following weekend. The hypothesis was that US reliability would be at least substantial for complete muscle or ligament lesions. Methods 116 patients (50 men, median age 47 [range 19-87] years) suffering an elbow trauma with dislocation and/or fracture were included. Exclusion criteria were prior injury to the same elbow, and US and/or MRI not possible within 16 days. During US the condition of muscle origins at the epicondyles and collateral and annular ligament complexes was recorded in a pre-designed protocol, with the alternatives intact, partially or completely torn. 72 patients had a second US examination the same day by an independent upper extremity surgeon. 58 of the 116 patients underwent an MRI before or after the US, evaluated by 2 radiologists using the same protocol. IOA and IRR between assessors and modalities were analyzed with kappa statistics and interpreted according to Landis and Koch. Perfect agreement (PA) was reported in percent. Results: US examination within 2 weeks was feasible with tolerable discomfort. Defining muscle origins and ligaments as intact or completely torn the US IRR ranged from substantial to near perfect (kappa 0,63-1; PA 93-100%). Intact tissues vs tear (partial and complete tear combined) or intact vs partial vs complete tear resulted in kappa values from moderate to substantial and PA 74%-96% with lowest reliability for the muscle origins. The IOA between MRI and US ranged from fair to near perfect for no tear vs complete tear (kappa 0,25-1; PA 65-100%). Agreement between no tear and tear (partial and complete together) ranged from fair to substantial (0,25-0,66; PA 63-89%) and no tear vs partial or complete tear ranged from fair to moderate (0,25-0,53; PA 50-79%). Conclusion: US in the acute setting is suitable and reliable for diagnosis of ligament injuries in the elbow and is in addition fast, cheap and easily accessible. The agreement with MRI seems to vary with the structure assessed and severity of the lesions, ranging from fair to near perfect. 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

Tin ring splint treatment for osteoarthritis of the distal interphalangeal joints. Tada, K., et al. (2019) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Dipj osteoarthritis - figure 8 splint This case series assessed the use of a tin ring splint for treating osteoarthritis in the distal interphalangeal joint. A total of 30 participants were included in the study and they were asked to wear the splint as needed for pain relief, with follow-up assessments completed at 1, 3, and 6 months. The results indicated clinically relevant pain reduction and high patient satisfaction with the splint's usability and appearance. Participants reported a reduction in wearing frequency of the splint over time. Unfortunately, the study did not include a control group. 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 splint to limit distal interphalangeal joint motion may help reducing pain in people with osteoarthritis. It is however possible that people's symptoms would improve over time independently of splint wearing (no control group in this study). Other alternatives to immobilisation for hand osteoarthritis include resistance training for the hands or the use of topical cannabinoids. If you are interested in hand osteoarthritis assessment and treatment, have a look at the full database. URL: https://doi.org/10.1177%2F1558944718760003 Abstract Background: We made a tin ring splint for osteoarthritis of the distal interphalangeal joint that looks attractive and is easy to wear. We report the treatment results with this splint. Methods: We enrolled 30 patients with painful osteoarthritis of the distal interphalangeal joint in this study. A tin ring splint was made with tin alloy containing small quantities of silver. Patients were instructed to wear the splint when they felt pain. Patients were assessed before splint use and after 1, 3, and 6 months of splint use. Endpoints included the numeric pain scale, active arc of motion of the distal interphalangeal joint, Hand 20, functional assessment criteria of the upper extremities, and treatment satisfaction. In addition, data were collected on time to symptom relief and satisfaction related to usability and appearance of the splint (0 = dissatisfied, 10 = satisfied). Results: The numeric pain scale showed significant pain improvement from 58.4 ± 4.1 at baseline to 33.1 ± 4.5 at 1 month, and the Hand 20 score also showed significant improvement from 35.0 ± 4.3 at baseline to 20.2 ± 3.2 after 6 months. Active arc of motion were not changed significantly. Most patients responded that symptoms were relieved by the 10th day after treatment. Satisfaction related to usability was 8.9 ± 0.3, and appearance was 7.6 ± 0.4. Conclusions: A tin ring splint quickly reduced pain, and satisfaction related to usability and appearance was high. This splint could be one choice for conservative treatment of osteoarthritis of the distal interphalangeal joint. 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

Minimalist training: Is lower dosage or intensity resistance training effective to improve physical fitness? A narrative review. Behm, D. G., et al. (2023) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic: Resistance training - For beginners This narrative review explored the effectiveness of minimalist training, focusing on lower dosage resistance training to improve physical fitness. It discusses literature on optimal dosage effects, suggesting lower resistance training can still enhance muscle strength and endurance for sedentary individuals or beginners. The review recommends multi-joint exercises, which seem to be more effective than single-joint exercises. To prevent progressing plateau, the authors suggest increasing training volume over time. In terms of training frequency, it appears that for beginners, training 2 days vs 3 days per week does not make much difference. 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, minimal resistance training can lead to improvements in physical fitness, particularly for sedentary individuals or beginners. A single weekly resistance training session, with lower sets and intensity, appears to provide some benefits during the first 8-12 weeks. Once people reach 8-12 weeks of light training, a short but more intense workout is likely to provide additional benefits. This approach will still save people lots of time whilst providing 80% of resistance training benefit. URL: https://doi.org/10.1007/s40279-023-01949-3 Abstract Background: Findings from original research, systematic reviews, and meta-analyses have demonstrated the effectiveness of resistance training (RT) on markers of performance and health. However, the literature is inconsistent with regards to the dosage effects (frequency, intensity, time, type) of RT to maximize training-induced improvements. This is most likely due to moderating factors such as age, sex, and training status. Moreover, individuals with limited time to exercise or who lack motivation to perform RT are interested in the least amount of RT to improve physical fitness. Objectives: The objective of this review was to investigate and identify lower than typically recommended RT dosages (i.e., shorter durations, lower volumes, and intensity activities) that can improve fitness components such as muscle strength and endurance for sedentary individuals or beginners not meeting the minimal recommendation of exercise. Methods: Due to the broad research question involving different RT types, cohorts, and outcome measures (i.e., high heterogeneity), a narrative review was selected instead of a systematic meta-analysis approach. Results: It seems that one weekly RT session is sufficient to induce strength gains in RT beginners with < 3 sets and loads below 50% of one-repetition maximum (1RM). With regards to the number of repetitions, the literature is controversial and some authors report that repetition to failure is key to achieve optimal adaptations, while other authors report similar adaptations with fewer repetitions. Additionally, higher intensity or heavier loads tend to provide superior results. With regards to the RT type, multi-joint exercises induce similar or even larger effects than single-joint exercises. Conclusion: The least amount of RT that can be performed to improve physical fitness for beginners for at least the first 12 weeks is one weekly session at intensities below 50% 1RM, with < 3 sets per multi-joint exercise. 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 use of non-invasive skin traction orthosis in managing phalangeal fractures. Yang, Z., Ong, C. X. L. and Jiang, J. K. H. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Phalanx fracture - Traction splint This retrospective study assessed the use of non-invasive skin traction splints for the management of phalangeal fractures. A total of fourteen participants with proximal or middle phalanx, intra-articular or extra-articular fractures were included. These participants were provided with hand-based and forearm-based splints, which allowed the application of finger traction distally to the fracture by using strapping tape. This splint in combination with traction was utilised for 3 weeks followed by the use of splinting only for the remaining weeks of immobilisation. The strapping tape was changed every week during the hand therapy review. Have a look at the picture below to see what the splint and traction system looks like. Unfortunately, the study did not provide a control group assessing the benefit of adding traction compared to no traction. 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-invasive skin traction splints may be useful in treating phalangeal fractures which are borderline surgical candidates. It is however unclear whether this approach provides better fracture alignment compared to a traditional splinting approach due to the lack of a control group in this study. URL: https://doi.org/10.1016/j.jht.2023.12.012 Abstract Background: Phalangeal fractures are amongst the most challenging injuries that hand surgeons and hand therapists treat. Traditionally, these have been managed operatively, but are often fraught with potential problems including contractures, deformities and loss of motion. Purpose: To provide evidence supporting the use of non-invasive skin traction orthosis as an effective treatment option. Study design: Retrospective cohort. Methods: We performed a retrospective review of outpatients with phalangeal fractures treated with non-invasive skin traction orthoses in our institution from January 2021 till June 2022. Demographic information, injury specifics and radiological findings were extracted from medical records. Outcome measures included total arc of motion (TAM) and dorsal angulation angles. Results: Fourteen patients (17 fractures) with a mean age of 48 years (SD21.3) were included. Ten patients had single digit injuries, while four patients had two digits in traction within the same splint. 70.6% were proximal phalangeal fractures. 76.5% of the fractures were extra-articular and 58.8% non-comminuted. Median duration of orthosis use was 18 days (IQR 8–21). Patients with forearm-based orthoses had significantly longer traction time. There was a significant improvement (p = 0.001) from median baseline TAM (124°) to final TAM readings (245°). Younger patients with ulnar digit fractures or extra-articular fractures had a shorter rehabilitation period. There is no significant difference in clinical outcomes between the use of forearm-based or hand-based orthoses. Conclusion: We recommend the use of the hand-based non-invasive skin traction orthosis as an option in managing phalangeal fractures as it is a simple, inexpensive and non-invasive procedure with promising results. Care must be taken to ensure frequent change of traction tapes to maintain good skin integrity, and to avoid loss of tension. Radiological imaging should be performed after each traction tape change to ensure good alignment is maintained. 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