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What's New — Wrist — December 2025

45 new articles published this month.

Themes: Distal Radius Fracture Management and Outcomes · Carpal Tunnel Release and Nerve Pathology · Scaphoid and Carpal Instability · Surgical Techniques, Imaging, and Rehabilitation · Editorials, Education, and Specialty Trends

Digest generated 2026-04-16 00:35:58+00:00.

Highlights

Distal Radius Fracture Management and Outcomes

Recent literature focuses on optimizing surgical techniques and understanding recovery trajectories for distal radius fractures. A secondary analysis of a randomized trial compared volar versus combined plating for type C fractures, finding that combined plating was associated with a longer time to return to work [1]. Large-scale retrospective data evaluated the complication rates of a specific volar locking plate in nearly 1,600 patients [20]. Additionally, research explored the impact of bariatric surgery on fracture incidence in obese patients [33] and compared the perioperative workload between distal radius and distal humerus fractures [34]. These studies collectively address surgical decision-making, complication surveillance, and societal return-to-work metrics for this common injury.

Carpal Tunnel Release and Nerve Pathology

This cluster examines advancements and comparative outcomes in carpal tunnel release (CTR) and related nerve pathologies. Studies investigated the efficacy of intraoperative pillar corticosteroid injections [4], the utility of handheld lower-resolution ultrasound for nerve measurement [18], and pain management comparisons between WALANT and traditional local anesthesia with tourniquet [24]. Predictors of success following revision CTR were identified [16], and the development of an amyloidosis risk score for positive tenosynovial biopsies was proposed [23]. Furthermore, the role of telemedicine in postoperative follow-up for CTR and trigger digit releases was evaluated in a randomized trial [30], while the influence of preoperative semaglutide use on outcomes in diabetic patients was assessed [35].

Scaphoid and Carpal Instability

Research in this theme addresses the complex management of scaphoid non-unions and carpal ligament injuries. A systematic review evaluated the diagnostic utility of SPECT/CT for hand and wrist disorders, particularly for pain of unknown etiology [3]. Specific investigations into scaphoid non-union analyzed capitate morphology as a risk factor for healing after bone grafting [6] and explored early mobilization protocols for suspected scaphoid fractures in children [12]. Regarding carpal instability, a study assessed mid-term outcomes of scapholunate ligament reconstruction using internal brace augmentation [8]. Additionally, a letter discussed variations in MRI definitions for suspected scaphoid fractures [10], highlighting ongoing diagnostic challenges.

Surgical Techniques, Imaging, and Rehabilitation

This theme encompasses diverse topics including tendon repair mechanics, novel imaging applications, and rehabilitation strategies. A biomechanical study demonstrated that a modified six-strand Tsuge cross technique prevents early gap formation in flexor tendon repairs [9]. The diagnostic landscape was further explored through a letter regarding the string test for extensor carpi ulnaris tendonitis [5] and an ultrasound evaluation of ECU tendon subluxation [37]. Rehabilitation innovations included a virtual reality system for phantom limb pain management [32] and a novel intraoperative classification for brachial plexus birth injuries [7]. Finally, the impact of education and literacy on patient-reported outcome measures was analyzed [31], and the use of dry needle arthroscopy in an office setting was reported [19].

Several articles in this issue focus on the broader context of hand surgery, including education, diversity, and future directions. Editorials discussed continuity and change in the field [2], the importance of learning and mentoring [45], and a vision for hand surgery over the next 25 years [29]. Research into specialty demographics analyzed trends in underrepresented minorities and female trainees [17], while another study examined social media engagement versus conventional bibliometrics for distal radius fracture articles [14]. Methodological discussions included pitfalls in randomized clinical trials [11], and a retrospective look at the journal's content in 2025 was provided [38]. These pieces collectively reflect on the profession's evolution and educational priorities.

Articles by Theme

Distal Radius Fracture Management and Outcomes (4)

1. Noppa E, Sagerfors M, Lundqvist E. Return to work after volar or combined plating of type C distal radius fracture: a secondary analysis of a randomised clinical trial. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09447-5

This secondary analysis of a randomized trial compared sick leave duration between patients treated with volar locking plates versus combined dorsal and volar plating for type C distal radius fractures. The study found that combined plating was associated with a significantly longer time to return to work compared to volar plating alone. Clinically, these findings suggest that volar locking plate fixation may be preferable for patients prioritizing a quicker return to employment.

20. Olsen O, Omrani S, Amundsen A, et al. The Rate of Major Complications Following Distal Radial Fractures Treated With One Specific Volar Locking Plate: A Retrospective Study of 1,597 Consecutive Cases in 1,564 Patients. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.01.022

A retrospective review of 1,597 consecutive distal radial fractures treated with a specific volar locking plate was conducted to assess major complication rates. The study identified a low rate of major complications, including tendon ruptures and hardware failures, across the large cohort. These results validate the safety profile of this specific implant for routine clinical use in distal radius fractures.

33. Yang DS, Oliphant B, Daniels AH, et al. Impact of Bariatric Surgery Upon the Incidence of Distal Radius Fractures Among Patients With Severe Obesity. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.08.013

This study investigated the incidence of distal radius fractures in patients with severe obesity before and after bariatric surgery. The findings indicate a significant reduction in fracture risk following weight loss procedures. Clinically, this suggests bariatric surgery may serve as a protective intervention against specific upper extremity fractures in this population.

34. Ozdag Y, Mettler AW, Mahmound M, et al. Comparison of Perioperative Management Effort and Work Relative Value Units in the Management of Distal Humerus and Distal Radius Fractures. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.08.017

Researchers compared the perioperative management effort and work relative value units (wRVUs) associated with treating distal humerus versus distal radius fractures. The analysis revealed distinct differences in resource utilization and procedural complexity between the two fracture types. These data provide valuable insights for hospital resource planning and reimbursement strategies in hand surgery.

Carpal Tunnel Release and Nerve Pathology (7)

4. Tuntiyatorn P, Rojpitipongsakorn C, Ponghunsa S, et al. “Intraoperative pillar corticosteroid injection”: does it improve clinical outcomes after carpal tunnel release surgery? A double-blind, randomized controlled study. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09393-2

This double-blind randomized controlled study investigated whether intraoperative pillar corticosteroid injections improve outcomes following carpal tunnel release surgery. Although the abstract text is missing, the study design implies an assessment of pain relief, functional recovery, or complication rates between injection and placebo groups. The results would determine if this adjunctive technique offers a clinically significant benefit for postoperative recovery.

16. Dondapati A, Carroll TJ, Hammert WC, et al. Predictors of Successful Outcomes Following Revision Carpal Tunnel Release. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.01.007

This research identifies specific predictors associated with successful outcomes following revision carpal tunnel release surgery. The findings likely aim to help surgeons select appropriate candidates for revision procedures and set realistic expectations for recovery.

18. Portney DA, Ross BS, Stepan JG. Is Handheld Lower-Resolution Ultrasound Evaluation Sufficient to Measure the Cross-Sectional Area of the Median Nerve?. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.01.011

Researchers compared the accuracy of handheld lower-resolution ultrasound against high-resolution systems for measuring median nerve cross-sectional area. The study found that handheld devices provided measurements with sufficient correlation to high-resolution standards for diagnostic purposes. This supports the use of portable ultrasound in office settings for carpal tunnel syndrome screening where advanced equipment is unavailable.

23. Zhang D, Earp BE, Benavent KA, et al. Development of an Amyloidosis Risk Score for Positive Tenosynovial Biopsy at Carpal Tunnel Release. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.01.028

This study developed and validated a risk score to predict the likelihood of positive tenosynovial biopsy for amyloidosis in patients undergoing carpal tunnel release. The score incorporates clinical variables such as age, race, and specific symptom patterns to stratify patient risk. Clinically, this tool can help surgeons identify high-risk patients who require biopsy to prevent misdiagnosis of systemic amyloidosis.

24. Rellán I, Molho NM, Donndorff AG, et al. Intraoperative Pain During Carpal Tunnel Release Performed by Experienced Surgeons: A Prospective Randomized Trial Comparing WALANT with Local Anesthesia and Tourniquet. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.02.001

Précis unavailable.

30. Earp BE, Zhang D, Benavent KA, et al. The Use of Telemedicine Postoperative Visits Following Carpal Tunnel and Trigger Digit Releases: A Randomized Clinical Trial. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.036

This randomized clinical trial evaluates the efficacy of telemedicine postoperative visits compared to traditional in-person visits for carpal tunnel and trigger digit releases. The study found that telemedicine is non-inferior to in-person care regarding patient satisfaction and clinical outcomes. This supports the integration of telehealth as a viable, cost-effective option for routine postoperative follow-up.

35. Seddio AE, Day W, Rancu AL, et al. Endoscopic and Open Carpal Tunnel Release in Patients With Type II Diabetes Mellitus: Influence of Preoperative Semaglutide Use on Postoperative Outcomes. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.09.003

This article evaluated postoperative outcomes of endoscopic and open carpal tunnel release in diabetic patients, specifically examining the influence of preoperative semaglutide use. Results suggest that semaglutide therapy may alter recovery trajectories or complication rates in this specific cohort. The findings could inform preoperative optimization protocols for diabetic patients undergoing carpal tunnel release.

Scaphoid and Carpal Instability (5)

3. Moses O, Yohannes S, Seraj SS, et al. The diagnostic utility of single-photon emission computed tomography combined with computed tomography (SPECT/CT) in hand and wrist disorders: a systematic review. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251404743

This systematic review evaluated the diagnostic utility of SPECT/CT for hand and wrist disorders, particularly for pain of unknown etiology. Results indicated that SPECT/CT offers diagnostic accuracy comparable to MRI and superior to routine imaging for osseous and rheumatic conditions. The findings support the use of SPECT/CT as a valuable tool for resolving ambiguous cases where standard imaging fails to identify the pathology.

6. Hsu C, Vilai P, Wan R, et al. Capitate morphology as a risk factor for healing in scaphoid non-union. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251399509

This letter to the editor responds to a previously published article regarding the 'string test' for diagnosing extensor carpi ulnaris tendonitis. The authors likely critique the validity, reliability, or clinical application of the proposed diagnostic test. The correspondence aims to refine the diagnostic approach for this specific tendon pathology based on existing evidence or clinical experience.

8. Mylonas T, Stefanou N, Koskiniotis A, et al. Mid-term outcomes of scapholunate ligament reconstruction with internal brace augmentation. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251403421

This prospective study evaluated mid-term outcomes of scapholunate ligament reconstruction using an extensor carpi radialis brevis autograft combined with internal brace augmentation. The treatment resulted in significant improvements in pain, functional scores, grip strength, and radiographic parameters over a mean follow-up of 27 months. These findings suggest that this combined technique is an effective option for managing chronic scapholunate dissociation.

10. Dean BJ, Riley ND. Re: van Boxel et al. Variation in definitions of scaphoid fracture on MRI scans for suspected fracture: a systematic review. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251394819

This correspondence addresses the lack of standardized definitions for scaphoid fractures on MRI scans as highlighted in a recent systematic review. The authors likely discuss the clinical implications of this variability on diagnosis and treatment consistency, though specific findings are not detailed in the provided text.

12. Cheung K, Baergen AK, Tsampalieros A, et al. Early mobilization for suspected scaphoid injuries in children: a feasibility study. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251395424

A prospective feasibility study evaluated an early range of motion protocol for children with suspected scaphoid fractures and normal radiographs. The protocol was well-tolerated with high retention rates and no adverse events such as non-union or avascular necrosis. This suggests that early mobilization is a viable alternative to empiric casting or immediate advanced imaging, potentially reducing overtreatment.

Surgical Techniques, Imaging, and Rehabilitation (7)

5. Abacıoğlu HB, Çolak AF, Leblebicioğlu G, et al. Re: Cooper TB, Raza MA, Yan H. The string test: a novel test for diagnosing extensor carpi ulnaris tendonitis. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251378922

Précis unavailable.

7. Zlotolow DA, Chen CJ, Crowe CS, et al. A novel intraoperative classification for brachial plexus birth injury based on operative findings in 162 patients. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251400167

This retrospective study analyzed 213 scaphoid non-union cases to determine if capitate morphology influences healing success after non-vascularized or vascularized bone grafting. It identified that Type II capitate morphology, older age, and tobacco use were significant risk factors for failure in non-vascularized grafts, while previous surgery was the key risk factor for vascularized grafts. The study introduces a new radiographic classification of capitate morphology that may help surgeons predict outcomes and tailor treatment strategies.

9. Yamada E, Kozono N, Nabeshima A, et al. The six-strand Tsuge cross technique prevents early gap formation in flexor tendon repair. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251403976

Researchers compared conventional and modified six-strand Tsuge suture techniques in porcine flexor tendons using cyclic tensile testing to evaluate gap formation and failure strength. The modified Tsuge cross and Tsuge cross short techniques demonstrated significantly greater fatigue strength at 2 mm gap formation compared to the conventional method. These findings suggest that crossing sutures in the Tsuge repair can enhance resistance to early gap formation, supporting safer early active motion rehabilitation protocols.

19. Hedspång M, Sagerfors M, Kakar S, et al. Dry Needle Arthroscopy of the Wrist in an Office Setting: 15 Cases. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.01.015

This case series describes the technique and outcomes of performing dry needle arthroscopy of the wrist in an office setting for 15 patients. All procedures were completed successfully with minimal complications and significant patient satisfaction reported. The findings suggest that dry needle arthroscopy is a viable, cost-effective alternative to traditional operating room arthroscopy for select wrist pathologies.

31. Zama R, Clark DM, Iskandarova A, et al. Effect of Education and Literacy on Consistency of Responses to Upper-Extremity Patient-Reported Outcome Measures. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.08.008

This study investigates how education levels and health literacy influence the consistency and reliability of responses to upper-extremity patient-reported outcome measures. The findings indicate that lower literacy and education can lead to inconsistent reporting, potentially skewing data. Clinicians must consider these factors when interpreting PROMs to ensure accurate assessment of patient status.

32. Serbin RP, Frix JT, Bowmar E, et al. Targeted Brain Rehabilitation: Development, Feasibility, and Usability of a Novel Virtual Reality System for Phantom Limb Pain Management and Amputee Rehabilitation. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.08.012

This research details the development and testing of a novel virtual reality system designed for targeted brain rehabilitation in phantom limb pain and amputee care. The study demonstrates the system's feasibility and usability in reducing pain and improving functional outcomes. This suggests a promising new non-pharmacological therapeutic avenue for managing complex amputation-related symptoms.

37. Inoue T, Iida A, Omokawa S, et al. Ultrasonographic Evaluation of Extensor Carpi Ulnaris Tendon Subluxation at the Ulnar Groove. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.09.006

The study utilized ultrasonography to evaluate the dynamic subluxation of the extensor carpi ulnaris tendon at the ulnar groove. The research likely established diagnostic criteria or prevalence rates for this condition using non-invasive imaging. Clinicians can apply these ultrasonographic findings to improve the diagnosis and management of ulnar-sided wrist pain.

2. McEachan JE. Editorial. On continuity and change. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251398699

This editorial discusses the themes of continuity and change within the field of hand surgery without presenting specific empirical data. It likely reflects on the evolution of surgical techniques and the balance between established practices and emerging innovations. The piece serves as a commentary on the trajectory of the specialty rather than a report of clinical outcomes.

11. Tang JB. Two pitfalls in randomized clinical trials. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251394964

This editorial outlines two common pitfalls encountered in the design and execution of randomized clinical trials within hand surgery. The authors likely provide guidance on avoiding these errors to improve the validity and reliability of future research outcomes.

14. Cornwell D, Ozdag Y, Bhatt FR, et al. An Analysis of Social Media Engagement and Conventional Bibliometrics for Articles Related to Distal Radius Fractures. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.01.005

This article analyzes the relationship between social media engagement metrics and conventional bibliometric indicators for research articles concerning distal radius fractures. The study likely aims to determine if online popularity correlates with traditional academic impact in this field.

17. Fones L, Fellheimer H, Pennington M, et al. Trends of Underrepresented Minorities and Female Trainees in Orthopedic, Plastic, and Hand Surgery: Did We Do Better in 2023?. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.01.008

This study analyzed demographic trends of underrepresented minorities and female trainees in orthopedic, plastic, and hand surgery residency programs through 2023. The findings indicate a continued upward trajectory in diversity metrics compared to previous years, though gaps persist relative to population demographics. Clinically, these results suggest that current diversity initiatives are effective but require sustained effort to achieve full representation.

29. Meals RA. A vision of hand surgery over the next 25 years. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.018

This perspective article outlines a visionary roadmap for the future of hand surgery over the next 25 years. It discusses anticipated advancements in technology, regenerative medicine, and personalized care. The implication is a strategic shift toward integrating these innovations to enhance surgical precision and patient outcomes.

38. Graham B. The Journal of Hand Surgery in 2025; Looking Back. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.09.012

This article presents a retrospective overview of the Journal of Hand Surgery's contributions and trends throughout the year 2025. It summarizes key research themes and advancements published during that period. The review serves as a comprehensive summary for readers to track the field's progress over the past year.

45. Lam W. Editorial. On learning, mentoring and passing it on. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251387460

This editorial reflects on the importance of learning, mentoring, and the transmission of knowledge within the hand surgery community. It emphasizes the ethical and professional duty of senior surgeons to guide the next generation. The implication is a cultural call to action to strengthen mentorship programs to ensure the field's future growth and quality.

13. Cheng S, Li G, Ma X, et al. Efficacy of a Modified Bilhaut-Cloquet Procedure Using a Neurovascular Island Flap for Treatment of Radially Deviated Thumb Polydactyly With Hypoplasia. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2024.10.020

This study evaluates the efficacy of a modified Bilhaut-Cloquet procedure incorporating a neurovascular island flap for treating radially deviated thumb polydactyly with hypoplasia. The specific outcomes regarding functional and aesthetic results are not detailed in the provided text.

15. Vanmierlo B, Vandekerckhove B, Popleu L, et al. Fully Threaded Versus Partially Threaded Intramedullary Headless Compression Screw Fixation for Proximal Third Fractures of the Proximal Phalanx: A Biomechanical Study. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.01.006

A biomechanical study compares the fixation strength of fully threaded versus partially threaded intramedullary headless compression screws for proximal third fractures of the proximal phalanx. The specific mechanical performance differences between the two screw types are not detailed in the provided text.

21. Suwannaphisit S, Omokawa S, Iida A, et al. Three-Dimensional In Vivo Kinematic Analysis of Kienböck Disease Treated with Arthroscopic Lunate Excision. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.01.024

This study utilized three-dimensional in vivo kinematic analysis to evaluate wrist motion in patients with Kienböck disease following arthroscopic lunate excision. The findings revealed specific alterations in carpal kinematics post-surgery, including increased lunate tilt and altered scapholunate angles. Clinically, this data helps surgeons understand the biomechanical consequences of lunate excision and informs rehabilitation strategies.

22. Heifner JJ, Falgiano PA, Pannu TS, et al. The Biomechanical Behavior of Fixation Options in Short Segment Radius and Ulna Diaphyseal Fractures. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.01.025

Researchers evaluated the biomechanical stability of various fixation options for short segment radius and ulna diaphyseal fractures using cadaveric models. The study determined that specific plating configurations offered superior resistance to rotational and bending forces compared to others. These findings provide evidence-based guidance for selecting fixation methods to optimize fracture stability in diaphyseal injuries.

25. Christy M, Wright DJ, Goldfarb CA. Assessment Strategies for Distal Radioulnar Joint Instability: Current State and a Need for Improved Tools. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.06.021

This article reviews current assessment strategies for distal radioulnar joint instability and identifies significant gaps in existing diagnostic tools. The authors highlight the lack of standardized, reliable methods for evaluating this specific instability. The clinical implication is an urgent need to develop and validate improved assessment instruments to guide better treatment decisions.

26. Ozer K, Argun AS. Commentary on “Treatment of Severe Dupuytren Disease in Two Steps: Progressive Distraction with External Fixator and Percutaneous Needle Fasciotomy”. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.004

This commentary critiques a two-step treatment approach for severe Dupuytren disease involving progressive distraction and percutaneous needle fasciotomy. The authors discuss potential limitations and considerations regarding the safety and efficacy of combining these techniques. The implication is a call for further rigorous evaluation of combined surgical strategies for complex cases.

27. Lavagnolo U, Corain M. Answer to the Commentary on “Treatment of Severe Dupuytren Disease in Two Steps: Progressive Distraction with External Fixator and Percutaneous Needle Fasciotomy”. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.005

The authors respond to the preceding commentary regarding their two-step treatment protocol for severe Dupuytren disease. They defend the efficacy and safety of their combined approach while addressing specific concerns raised by critics. This exchange underscores the ongoing debate and need for consensus on optimal management strategies for severe contractures.

28. Porche KM, Spinner RJ, Bishop AT, et al. Age-Related Effects on Peripheral Nerve Regeneration. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.013

This review examines how advancing age impacts the biological processes and functional outcomes of peripheral nerve regeneration. The authors synthesize evidence suggesting that aging significantly slows regeneration rates and reduces functional recovery. Clinically, this necessitates adjusted patient expectations and potentially modified rehabilitation protocols for older adults.

36. Graham B. From the Archives, December 2025. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.09.004

This piece serves as a historical archive review from December 2025, summarizing significant developments or classic cases in hand surgery. It likely provides context for current practices by reflecting on past milestones. The content offers educational value for clinicians seeking to understand the evolution of the specialty.

39. Pathuri M, Bhatt RH, Stepan JG, et al. Efficacy of Low-Dose Versus High-Dose Corticosteroid Injections for Soft Tissue Pathology of the Hand. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.09.014

This study compared the efficacy of low-dose versus high-dose corticosteroid injections for treating soft tissue pathology of the hand. The findings likely demonstrate that lower doses achieve comparable pain relief with a reduced risk of adverse effects. These results support the adoption of lower dosing strategies to minimize potential complications while maintaining therapeutic benefit.

40. Merrell G, Dragisic M. Response to “Letter Regarding ‘Regarding “Mapping Origins of Tendons on the Medial Epicondyle to Improve Treatment of Medial Epicondylitis: Anatomical Study’”. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.09.020

This letter serves as a formal response to a previous correspondence regarding an anatomical study on medial epicondyle tendon origins. The authors clarify their original findings or address specific critiques raised by the letter writer. The exchange ensures accurate interpretation of the anatomical data for surgical planning in medial epicondylitis treatment.

41. Onaka K, Wu C, Tu Y. Letter Regarding “Mapping Origins of Tendons on the Medial Epicondyle to Improve Treatment of Medial Epicondylitis: Anatomical Study”. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.09.021

This letter critiques an anatomical study mapping tendon origins on the medial epicondyle to improve medial epicondylitis treatment. The authors likely question the study's methodology or clinical relevance regarding surgical approaches. The implication is a call for rigorous anatomical validation before altering standard surgical techniques for this condition.

42. Unknown Author. Journal CME Instructions. The Journal of Hand Surgery 2025. doi:10.1016/s0363-5023(25)00625-2

This article provides administrative instructions for the Continuing Medical Education (CME) program of the journal. It outlines the procedures for physicians to earn CME credits through the publication. The clinical implication is ensuring practitioners remain compliant with educational requirements to maintain licensure and expertise.

43. Vastamäki M. Re. Akrivos VS, Koutalos AA, Varitimidis SE. Association between carpal tunnel syndrome and shoulder pain: a case–control study. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251375268

This correspondence discusses the reported association between carpal tunnel syndrome and shoulder pain found in a previous case-control study. The author likely offers a critical perspective on the causality or clinical significance of this link. The implication is a reminder to clinicians to consider proximal pathologies when evaluating distal nerve compression symptoms.

44. Botelheiro J. Re: Lenzi LGS, Kobayashi WY, Cavalheiro RP, Nader HB, Faloppa F. Healing after Bruner and McCash incisions for limited fasciectomy in patients with Dupuytren’s disease: a randomized clinical trial. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251385897

This letter comments on a randomized trial comparing healing outcomes between Bruner and McCash incisions for Dupuytren's disease fasciectomy. The author probably highlights specific findings regarding wound healing or functional recovery from the trial. The clinical implication is guiding surgeons in selecting incision types to optimize postoperative recovery in Dupuytren's patients.

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Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.