The Internet has become a major resource for patients; however, patient education materials are frequently written at relatively high levels of reading ability. The purpose of this study was to evaluate the readability of patient education materials on the American Academy of Orthopaedic Surgeons (AAOS) web site. Readability scores were calculated for all patient education articles on the AAOS web site using 5 algorithms: Flesch Reading Ease, Flesch-Kincaid Grade Level, SMOG (Simple Measure of Gobbledygook) Grade, Coleman-Liau Index, and Gunning-Fog Index. The mean readability scores were compared across the anatomic categories to which they pertained. Using a liberal measure of readability, the Flesch-Kincaid Grade Level, 3.9% of articles were written at or below the recommended sixth-grade reading level, and 84% of the articles were written above the eighth-grade reading level. Articles in the present study had a lower mean Flesch-Kincaid Grade Level than those available in 2008 (p < 0.00005). Articles categorized as “Hand & Wrist” or “Foot & Ankle” had significantly lower mean Flesch-Kincaid Grade Level scores than the mean for all categories (p < 0.0005). Regardless of the algorithm used, the mean readability levels of AAOS articles are higher than generally recommended. Although the mean Flesch-Kincaid Grade Level was lower in the present study than it was in 2008, a need remains to improve the readability of AAOS patient education articles. Ensuring that online patient education materials are written at an appropriate reading grade level would be expected to improve physician-patient communication.

Post-traumatic elbow stiffness is a major cause of functional impairment after elbow trauma. A stiff elbow limits patients’ ability to position their hand in space for optimal use of their upper extremities, and as such, is a frequent indication for reoperation. This article reviews current concepts on the pathogenesis of post-traumatic elbow stiffness. Current nonoperative treatment options include therapy, bracing, and manipulation under anesthesia, while operative treatment options include arthroscopic and open arthrolysis. The pros and cons of various treatment options are discussed, with a focus on the evidence supporting their use, the expected functional gains, and associated complications. Future directions in post-traumatic elbow stiffness are highlighted.

Background: The purpose of this study was to determine the rates and types of complications and secondary surgeries after mini-open carpal tunnel release. Methods: A retrospective cohort study was performed for 1,328 patients who underwent mini-open carpal tunnel release from August 2008 to July 2013. Patients were excluded for acute trauma, the index procedure being revision surgery, neoplasm, age less than 18 years, incomplete records, and postoperative follow-up less than 1 month, which yielded 904 patients who underwent 1,144 surgeries. Results: Of 1,144 carpal tunnel releases performed, 14 (1.2%) were noted to have a complication at final follow-up, with no cases of major nerve or vessel injury. Fourteen patients (1.2%) underwent secondary surgery, including 11 cases for persistent or recurrent carpal tunnel syndrome and 3 cases for infection or hematoma. Chronic kidney disease was associated with an increased risk of complication. Diabetes mellitus, chronic kidney disease, and cervical radiculopathy were associated with an increased risk of secondary surgery. Conclusions: The short-term complication and secondary surgery rates of mini-open carpal tunnel release are low. Patients with diabetes mellitus, chronic kidney disease, and cervical radiculopathy should be counseled regarding risks of complication and secondary surgery.

Prior literature on the diagnostic accuracy of commonly used provocative tests for suspected carpal tunnel syndrome (CTS) is affected by research biases. The objectives of our study were to measure and compare the diagnostic accuracy of 4 commonly used provocative tests for CTS using electrodiagnostic study as the reference standard. We prospectively evaluated 85 hands in 55 patients with suspected CTS. Tinel sign, Phalen’s test, Durkan’s test, and Phdurkan test (a combination of wrist flexion and carpal compression) and subsequent electrodiagnostic testing were performed on all patients. Sensitivity and specificity were calculated using electrodiagnostic findings as the reference standard. McNemar test was used to compare differences in paired outcomes between provocative tests. Tinel sign had a sensitivity of 0.47 and specificity of 0.56. Phalen’s test had a sensitivity of 0.50 and specificity of 0.33. Durkan’s test had a sensitivity of 0.71 and specificity of 0.22. Phdurkan test had a sensitivity of 0.84 and specificity of 0.11. Median time to a positive Phdurkan test result was 3 seconds. McNemar tests showed significant differences (P < .05) in the proportions of positive results among all CTS provocative tests except between Tinel sign and Phalen’s test. Commonly performed provocative tests for suspected CTS differ in sensitivity and specificity. As the examination maneuver becomes more provocative, the test becomes more sensitive and less specific for CTS. Diagnostic III.