The impact of blood flow restriction therapy on orthopaedic conditions of the upper extremity: a systematic review of randomized controlled trials

Introduction

Upper extremity injuries are highly prevalent and among the most common orthopaedic conditions treated (1,2). Physical therapy and exercise are critical components of rehabilitation for upper extremity injuries and degenerative processes as early rehabilitation may accelerate tissue healing, reduce inflammation and pain, and aid in preserving the surgical repair (3-5). However, some patients, especially those in the early postoperative recovery period, have significant load restrictions and cannot tolerate early aggressive motion or resistance therapy. Others may present with disuse atrophy due to underlying pain, leading to poor strength and endurance entering therapy (6-8). Thus, alternative recovery measures have been introduced and explored, including blood flow restriction therapy (BFRT) which promotes hypertrophy while decreasing muscle load requirements (9-13).

BFRT was first used in the context of physical therapy and has gained recognition recently as a supplemental modality for patients with poor strength, endurance, and chronic inflammation (14,15). BFRT utilizes a cuff to reduce arterial and venous blood flow to and from skeletal muscle. It is proposed that BFRT amplifies hypoxic conditions in the muscle, which enhances the natural changes in cellular metabolism and exercise stress response, including increasing muscle strength and hypertrophy (16,17). Furthermore, low oxygen tension from induced ischemia can induce angiogenesis, reactive oxygen species production, mitochondrial biogenesis, and glucose transporter 4 expression, all which have been shown to increase muscle mass and strength (18). Studies examining the effects aging has on skeletal muscle have shown that BFRT with low-intensity resistance training can prevent muscle weakness and atrophy after disuse, which is a critical problem post-surgical patients face after long periods of immobilization (19-22).

Despite the clinical promise of BFRT, there is a paucity of literature examining the use of BFRT in injuries and degenerative conditions affecting the upper extremity. Prior systematic reviews evaluated BFRT in healthy athletes instead, noting its improvements in muscle and overall sports performance (23). Evaluating if BFRT could enhance more traditional recovery protocols for ill patients is essential to determine whether or not this therapy adjunct can holistically improve patient outcomes and results. Furthermore, BFRT has been used to treat lower extremity conditions, however in order to minimize the considerable heterogeneity in study design, intervention protocols, and outcome measures when evaluating BFRT, our study was focused on solely upper extremity conditions.

The purpose of this systematic review of randomized controlled trials (RCTs) was to (I) analyze the available literature regarding the role of BFRT in upper extremity conditions and (II) evaluate its influence on functional and patient reported outcomes. We present this article in accordance with the PRISMA reporting checklist (available at https://aoj.amegroups.com/article/view/10.21037/aoj-25-31/rc) (24).

Methods

A protocol for this review was not previously registered in the international systematic review registry (PROSPERO). Other upper extremity protocols have been registered in PROSPERO (25), however, these vary in their protocol as it solely is reviewing shoulder pathology (rotator cuff, shoulder girdle, tendonitis) while this study evaluates additional upper extremity pathology, including fractures, elbow pathology (i.e., lateral epicondylitis), and osteoarthritis (OA).

Eligibility criteria

Studies were considered for inclusion based on the following Population-Intervention-Comparator-Outcomes-Study Design (PICOS) framework (26): (P) adults with upper-extremity musculoskeletal conditions; (I) BFRT used as an adjunct to traditional therapy; (C) traditional therapy alone or alternative rehabilitation protocols without BFRT; (O) studies reporting functional, strength, or patient-reported outcomes related to upper-extremity rehabilitation, (S) RCTs only.

This review excluded studies if they did not meet the PICOS criteria, if they were not in the English language, or did not have full-texts with full datasets available.

Search strategy

An electronic literature search was performed using PubMed, Embase, and Cochrane Trials from database inception to July 2024. Our search strategy was developed and modified with the assistance of the Northwestern University library and is in keeping with similar literature on the topic (25). The Boolean query involved a combination of the following medical subject headings and related synonyms: (“Upper Extremity”[Mesh] OR “Bones of Upper Extremity”[Mesh] OR hand[tiab] OR hands[tiab] OR arm[tiab] OR arms[tiab] OR wrist*[tiab] OR finger*[tiab] OR elbow* [tiab] OR axilla*[tiab] OR forearm*[tiab] OR thumb *[tiab] OR metacarpus[tiab] OR shoulder*[tiab] OR “upper extremit*”[tiab] OR upper limb *[tiab]) AND (“Blood Flow Restriction Therapy”[Mesh] OR “Blood flow restriction”[tiab] OR BFRT[tiab] OR “kaatsu”[tiab] OR BFR Therap*[tiab] OR “vascular occlusion”[tiab] OR “BFR Train*”[tiab]). Reference lists for included studies were also reviewed for studies that may be eligible for inclusion.

Study selection

Relevant title and abstract screening were conducted independently by two of the coauthors (D.H. and L.N.) to determine if the study met inclusion criteria. Duplicate studies were removed. For any study whose inclusion eligibility was questionable, articles were promoted to the full-text screening phase. Full-text articles were then screened for inclusion criteria. If a conflict occurred at this phase, a senior author (U.S.) reviewed the study for inclusion.

Data extraction

This study collected data from RCTs to compare the outcomes following recovery protocols with and without BFRT. Several variables were extracted, including number of patients per study, patient demographics, type of pathology, and functional outcomes.

Assessment of risk of bias in eligible studies

The risk of bias for each eligible RCT was evaluated using the Revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2.0) (27). This framework assesses the quality of randomized studies based on five domains: bias arising from the randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. Each domain is rated as low risk, some concerns, or high risk of bias, leading to an overall risk of bias judgment for each study. This structured approach ensures a comprehensive and standardized evaluation of bias in the included trials.

Analysis

Given the heterogenous nature of the sample size, type of injury, and outcomes of interest, standard descriptive statistics were used to report outcomes for all the included study findings. BFRT protocols were reviewed and are presented in a narrative manner.

Results

Literature search

A PRISMA flow diagram (Figure 1) depicts the results of the search strategy and criteria for inclusion. Our literature search generated 605 potential studies for screening. After removal of duplicates, 414 studies were left for review. Title and abstract screening eliminated 401 studies, leaving 13 available for full-text review. Upon completion of full-text review, four studies were deemed eligible and included for further analysis. Review of the reference lists for these four studies did not identify additional studies meeting the inclusion criteria.

Figure 1 PRISMA flow diagram depicting study selection for inclusion. RCT, randomized controlled trial.

Study characteristics and outcomes

Four studies were eligible for inclusion, comprising 133 total patients between BFRT and non-BFRT cohorts. An overview of the studies, their characteristics, and outcome measures are summarized in Table 1. The pathology treated included distal radius fractures (28,29), lateral elbow tendinopathy (30), and OA of the hand (31). One study involved operative intervention for the injury of interest (29), while the remaining three were treated nonoperatively (28,30,31). The BFRT training program varied by study (Table 1). Reported outcomes were grouped into the following categories: range of motion, strength, pain, and patient-reported outcome measures (PROMs). These categories were evaluated for differences between BFRT and non-BFRT cohorts.

Range of motion

Two studies reported range of motion outcomes before and after a dedicated training program, both studies focusing on distal radius fractures (28,29). Measurements analyzed included by Cancio et al. included flexion/extension and pronosupination arc of motion, while Fan et al. examined flexion, extension, pronation, supination, radial deviation, and ulnar deviation (28,29). There was no significant difference between all pre- and post-training measurements for both studies when comparing BFRT and non-BFRT study participants (Table 2).

Strength

All four studies reported a measurement of strength. Studies focused on the hand and wrist reported on a combination of grip, pinch (3-point, lateral), wrist flexion, and wrist extension strength (28,29,31). Karanasios et al. reported elbow flexor and extensor strength in addition to grip strength (30). Two of four studies identified improved strength for varied measurements in the BFRT group when compared to the non-BFRT group (29,30). The remaining two of four studies reported no differences in strength between group (Table 3) (28,31). Overall for strength, the pooled study results still favored BFRT but the difference was less pronounced (28-30).

Pain

All included studies reported an outcome on pain control before and after the training program. Pain levels were measured by visual analogue scale for all included studies. All four studies concluded that the BFRT group achieved a significant reduction in pain after the training program when compared to a non-BFRT cohort (28-31). A summary of pain control amongst the four studies is included in Table 4.

PROMs

Three studies reported one or more PROMs both before and after the training program, including Disabilities of the Arm, Shoulder, Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), Patient-Rated Tennis Elbow Evaluation (PRTEE), Functional Index of Hand Osteoarthritis (FIHOA), Global Assessment of Disease (GAD), and Patient Specific Functional Scale (PSFS) scoring systems (28,30,31). Two studies found a statistically significant improvement in the BFRT group when compared to the non-BFRT group (28,30). Specifically, Cancio et al. demonstrated that patients in the BFRT group displayed improved PWRE scores and greater reduction in PRWE scores compared to the control group after 8 weeks of BFRT (28). Similarly, Karanasios et al. demonstrated that patients undergoing BFRT had improved PRTEE at 6- and 12-week follow-up compared to those who underwent the sham intervention (30). Another study found improvement in PROMs for both BFRT and non-BFRT groups for DASH, FIHOA, GAD and PSFS with no statistically significant difference between groups (Table 5) (31). For PROMs, the pooled study results favored BFRT but the difference was less pronounced (28-30).

Study quality

The eligible studies were assessed for study quality using the Cochrane Risk of Bias Tool (27). All four studies were deemed to be low-risk for bias given that there was randomization, maintained intervention protocols, limited missing outcome data, and standardized measurement of outcomes (Figure 2).

Figure 2 Risk of bias summary using the Cochrane Risk of Bias Tool.

Complications

There were no complications reported amongst BFRT and non-BFRT participants among the eligible studies (28-31).

Discussion

The present study is an all-encompassing review of the available literature on BFRT as a treatment adjunct for upper extremity injuries and degenerative conditions. In this systematic review, the predominant benefits of BFRT came in the domains of pain control, strength, and PROMs. This was most pronounced for pain control where all studies favored the BFRT cohorts with significant improvement in pain scores when compared to a non-BFRT cohort (28-31). For PROMs and strength, the pooled study results still favored BFRT but the difference was less pronounced (28-30). Of the two studies that reported on range of motion outcomes, no difference was identified between BFRT and non-BFRT groups (28,29). No studies that met inclusion criteria favored the non-BFRT cohort for any outcome measured at all time points. Importantly, no complications were reported amongst all studies, which is in keeping with previous literature suggesting that BFRT is safe to undergo with minimal risk of harm (32,33).

Our findings are in keeping with several studies in the past decade that have examined BFRT as supplemental treatment in orthopaedic injuries and its subsequent effect on outcomes (23,34-39). Centner et al. conducted a systematic review and meta-analysis on the effects of BFRT as a supplement to resistance training and walking in older participants (age >50 years), concluding that the addition of BFRT elicited greater improvement in strength in this population (35). More recently, a 2021 systematic review examined the effects of strength and pain control in patients with various knee ailments, including OA, rheumatoid arthritis, patellofemoral pain, and anterior cruciate ligament tear. Their team found that low-resistance BFRT resulted in increased muscle strength and reduced pain scores when compared to conventional therapy (34).

There have been multiple advances in recent years within the field of upper extremity rehabilitation and treatment, including fracture care, athletic injuries, and degenerative conditions (40-51). BFRT is amongst the most rapidly evolving treatment modality (52). The first description of BFRT came in the 1960s and while it was not widely employed in medicine for much of the 20^th century, the field has seen rapid evolution over the past two decades (53). Much of the research into BFRT relates to the added benefit for muscle bulk and strength (54). The current literature on the use of BFRT as an adjunct to standard treatment protocols for fractures, overuse injuries, and other orthopaedic pathology is scarce, but gaining popularity. As the population continues to age with a concomitant rise in degenerative conditions, a desire to optimize both nonoperative and operative protocols for common orthopaedic complaints (55).

The precise mechanisms for how BFRT reduces pain and improves strength is not well known, though hypotheses and potential mechanisms have been proposed (56-58). With regards to pain control, one leading theory is the activation of the endogenous opioid system. Low-load resistance training with BFRT has been shown to increase beta-endorphin production, which is known to produce an analgesic effect by binding to opioid receptors (36). Other proposed theories include the recruitment of high threshold motor units, adaptations in the cardiovascular system, and conditioned pain modulation (36). The impact of BFRT on improved strength is thought to originate with the induced hypoxic environment, triggering a metabolic cascade that results in protein production, gene regulation, and recruitment of muscle fibers. Taken together, these effects promote greater strength and endurance (38,59-63).

There are several limitations to this study that should be acknowledged. For several outcomes that were measured, the superiority of BFRT was marginal and while it may reach statistical significance, the clinical significance remains uncertain. This, again, highlights the need for additional studies to further define the role of BFRT in rehabilitation and therapy protocols. Additionally, while this systematic review was an all-encompassing review of the available literature, our pooled total of 133 patients is a relatively small sample size. Future studies with more patients would strengthen the results and conclusions drawn from the present study. Perhaps the greatest limitation to this study is the considerable heterogeneity in study design, intervention protocols, and outcome measures. Due to the use of different outcome scoring among our studies, meta-analysis and heterogeneity analysis was not deemed appropriate. Consequently, findings must be interpreted with caution. As has been discussed, the literature on BFRT as a treatment adjunct in orthopaedic conditions is sparse, especially in the upper extremity. The strength of our study being all-encompassing carries the limitation of analyzing a diverse group of conditions and BFRT protocols. Pathology-specific BFRT studies with standardized outcome measures and recovery protocols are needed in the future to elucidate the benefits more effectively.

Conclusions

This study is a comprehensive review of the literature examining BFRT as an adjunct treatment for upper extremity conditions. Although the literature remains sparse on the topic, data from various level-I studies suggest that patients treated with BFRT may experience greater strength, improved pain control, and improved PROMs compared to a non-BFRT counterpart in the treatment of injuries and degenerative conditions of the upper extremity. Specifically, BFRT may be used to improve post injury strength and patient reported outcomes in distal radius fractures and lateral elbow tendinopathy. BFRT may also be used to improve post injury pain in these conditions as well as in patients with hand OA. Future large-scale studies with standardized outcome measures and recovery protocols are necessary to further define the benefits and/or drawbacks of BFRT in orthopaedic conditions of the upper extremity.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the PRISMA reporting checklist. Available at https://aoj.amegroups.com/article/view/10.21037/aoj-25-31/rc

Peer Review File: Available at https://aoj.amegroups.com/article/view/10.21037/aoj-25-31/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://aoj.amegroups.com/article/view/10.21037/aoj-25-31/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Blom AW, Donovan RL, Beswick AD, et al. Common elective orthopaedic procedures and their clinical effectiveness: umbrella review of level 1 evidence. BMJ 2021;374: [Crossref] [PubMed]
2. Karl JW, Olson PR, Rosenwasser MP. The Epidemiology of Upper Extremity Fractures in the United States, 2009. J Orthop Trauma 2015;29:e242-4. [Crossref] [PubMed]
3. Lee BG, Cho NS, Rhee YG. Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: aggressive versus limited early passive exercises. Arthroscopy 2012;28:34-42. [Crossref] [PubMed]
4. Quadlbauer S, Pezzei C, Jurkowitsch J, et al. Rehabilitation after distal radius fractures: is there a need for immobilization and physiotherapy? Arch Orthop Trauma Surg 2020;140:651-63. [Crossref] [PubMed]
5. Sgroi TA, Cilenti M. Rotator cuff repair: post-operative rehabilitation concepts. Curr Rev Musculoskelet Med 2018;11:86-91. [Crossref] [PubMed]
6. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 2009;41:687-708. [Crossref] [PubMed]
7. Sato S, Yoshida R, Murakoshi F, et al. Comparison between concentric-only, eccentric-only, and concentric-eccentric resistance training of the elbow flexors for their effects on muscle strength and hypertrophy. Eur J Appl Physiol 2022;122:2607-14. [Crossref] [PubMed]
8. Swansen T, Wright MA, Murthi AM. Postoperative Rehabilitation Following Rotator Cuff Repair. Phys Med Rehabil Clin N Am 2023;34:357-64. [Crossref] [PubMed]
9. Jing J, Zheng Q, Dong H, et al. Effects of upper extremity blood flow restriction training on muscle strength and hypertrophy: a systematic review and meta-analysis. Front Physiol 2024;15:1488305. [Crossref] [PubMed]
10. Sinnott MJ, Schneider N, Vanguri P. Effects of Blood Flow Restriction Training on the Upper Extremities: A Scoping Review. Cureus 2025;17:e79876. [Crossref] [PubMed]
11. Pavlou K, Korakakis V, Whiteley R, et al. The effects of upper body blood flow restriction training on muscles located proximal to the applied occlusive pressure: A systematic review with meta-analysis. PLoS One 2023;18:e0283309. [Crossref] [PubMed]
12. Garcia-Lopez E, Halvorson R, Shapiro L. Novel Tools to Approach and Measure Outcomes in Patients with Fractures. Hand Clin 2023;39:627-39. [Crossref] [PubMed]
13. Kamal RN, Shapiro LM. Innovation in Upper Extremity Fracture Treatment-Implementation of Advanced Techniques to Improve Outcomes. Hand Clin 2023;39:xi. [Crossref] [PubMed]
14. Cognetti DJ, Sheean AJ, Owens JG. Blood Flow Restriction Therapy and Its Use for Rehabilitation and Return to Sport: Physiology, Application, and Guidelines for Implementation. Arthrosc Sports Med Rehabil 2022;4:e71-6. [Crossref] [PubMed]
15. Anderson KD, Rask DMG, Bates TJ, et al. Overall Safety and Risks Associated with Blood Flow Restriction Therapy: A Literature Review. Mil Med 2022;187:1059-64. [Crossref] [PubMed]
16. Reeves GV, Kraemer RR, Hollander DB, et al. Comparison of hormone responses following light resistance exercise with partial vascular occlusion and moderately difficult resistance exercise without occlusion. J Appl Physiol 1985;2006:1616-22. [Crossref] [PubMed]
17. Suga T, Okita K, Morita N, et al. Intramuscular metabolism during low-intensity resistance exercise with blood flow restriction. J Appl Physiol 1985;2009:1119-24. [Crossref] [PubMed]
18. Saatmann N, Zaharia OP, Loenneke JP, et al. Effects of Blood Flow Restriction Exercise and Possible Applications in Type 2 Diabetes. Trends Endocrinol Metab 2021;32:106-17. [Crossref] [PubMed]
19. Yuan J, Wu L, Xue Z, et al. Application and progress of blood flow restriction training in improving muscle mass and strength in the elderly. Front Physiol 2023;14:1155314. [Crossref] [PubMed]
20. Rodrigo-Mallorca D, Loaiza-Betancur AF, Monteagudo P, et al. Resistance Training with Blood Flow Restriction Compared to Traditional Resistance Training on Strength and Muscle Mass in Non-Active Older Adults: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2021;18:11441. [Crossref] [PubMed]
21. Hsieh KL, Foster A, MacIntyre L, et al. Effect of Blood Flow Restriction on Gait and Mobility in Older Adults: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2024;21:1325. [Crossref] [PubMed]
22. Maciel Batista M, da Silva DSG, Bento PCB. Effects of Blood Flow Restriction Training on Strength, Muscle Mass and Physical Function in Older Individuals - Systematic Review and Meta-Analysis. Physical & Occupational Therapy In Geriatrics 2020;38:400-17.
23. Wortman RJ, Brown SM, Savage-Elliott I, et al. Blood Flow Restriction Training for Athletes: A Systematic Review. Am J Sports Med 2021;49:1938-44. [Crossref] [PubMed]
24. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Rev Esp Cardiol (Engl Ed) 2021;74:790-9. [Crossref] [PubMed]
25. Gholipour MA, Hamedi H, Seyedhoseinpoor T. Effects of exercise therapy with blood flow restriction on shoulder strength: protocol for a systematic review and meta-analysis. BMJ Open 2025;15:e097640. [Crossref] [PubMed]
26. Amir-Behghadami M, Janati A. Population, Intervention, Comparison, Outcomes and Study (PICOS) design as a framework to formulate eligibility criteria in systematic reviews. Emerg Med J 2020;37:387. [Crossref] [PubMed]
27. Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:l4898. [Crossref] [PubMed]
28. Cancio JM, Sgromolo NM, Rhee PC. Blood Flow Restriction Therapy after Closed Treatment of Distal Radius Fractures. J Wrist Surg 2019;8:288-94. [Crossref] [PubMed]
29. Fan Y, Bai D, Cheng C, et al. The effectiveness and safety of blood flow restriction training for the post-operation treatment of distal radius fracture. Ann Med 2023;55:2240329. [Crossref] [PubMed]
30. Karanasios S, Korakakis V, Moutzouri M, et al. Low-Load Resistance Training With Blood Flow Restriction Is Effective for Managing Lateral Elbow Tendinopathy: A Randomized, Sham-Controlled Trial. J Orthop Sports Phys Ther 2022;52:803-25. [Crossref] [PubMed]
31. Magni N, McNair P, Rice D. Six weeks of resistance training (plus advice) vs advice only in hand osteoarthritis: A single-blind, randomised, controlled feasibility trial. Musculoskelet Sci Pract 2022;57:102491. [Crossref] [PubMed]
32. Neto GR, Novaes JS, Dias I, et al. Effects of resistance training with blood flow restriction on haemodynamics: a systematic review. Clin Physiol Funct Imaging 2017;37:567-74. [Crossref] [PubMed]
33. Clark BC, Manini TM, Hoffman RL, et al. Relative safety of 4 weeks of blood flow-restricted resistance exercise in young, healthy adults. Scand J Med Sci Sports 2011;21:653-62. [Crossref] [PubMed]
34. Li S, Shaharudin S, Abdul Kadir MR. Effects of Blood Flow Restriction Training on Muscle Strength and Pain in Patients With Knee Injuries: A Meta-Analysis. Am J Phys Med Rehabil 2021;100:337-44. [Crossref] [PubMed]
35. Centner C, Wiegel P, Gollhofer A, et al. Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis. Sports Med 2019;49:95-108. [Crossref] [PubMed]
36. Hughes L, Patterson SD. The effect of blood flow restriction exercise on exercise-induced hypoalgesia and endogenous opioid and endocannabinoid mechanisms of pain modulation. J Appl Physiol 1985;2020:914-24. [Crossref] [PubMed]
37. Hughes L, Rosenblatt B, Haddad F, et al. Comparing the Effectiveness of Blood Flow Restriction and Traditional Heavy Load Resistance Training in the Post-Surgery Rehabilitation of Anterior Cruciate Ligament Reconstruction Patients: A UK National Health Service Randomised Controlled Trial. Sports Med 2019;49:1787-805. [Crossref] [PubMed]
38. Martin PM, Bart RM, Ashley RL, et al. An Overview of Blood Flow Restriction Physiology and Clinical Considerations. Curr Sports Med Rep 2022;21:123-8. [Crossref] [PubMed]
39. Stroobant L, Jacobs E, Arnout N, et al. Can blood flow restriction therapy improve quality of life and function in dissatisfied knee arthroplasty patients? Bone Joint J 2024;106-B:1416-25. [Crossref] [PubMed]
40. Yao J, Fogel N. Arthroscopic-Assisted Fracture Treatment in the Wrist. Hand Clin 2023;39:533-43. [Crossref] [PubMed]
41. Herzberg G, Burnier M, Ly L. Role for Wrist Hemiarthroplasty in Acute Irreparable Distal Radius Fracture in the Elderly. Hand Clin 2023;39:545-50. [Crossref] [PubMed]
42. Gilbert WB Jr, Jitendra Desai M. Intramedullary Nailing of Forearm Fractures. Hand Clin 2023;39:551-9. [Crossref] [PubMed]
43. Raducha JE, Pidgeon TS. Proximal Interphalangeal Joint Fractures: Various Approaches to Fixation. Hand Clin 2023;39:561-73. [Crossref] [PubMed]
44. Raducha JE, Weiss AC. Proximal Interphalangeal Joint Arthroplasty for Fracture. Hand Clin 2023;39:575-86. [Crossref] [PubMed]
45. Bhashyam AR, Chen N. Arthroscopic-Assisted Fracture Fixation About the Elbow. Hand Clin 2023;39:587-95. [Crossref] [PubMed]
46. Meaike JJ, Kakar S. Innovations in Small Joint Arthroscopy. Hand Clin 2023;39:523-31. [Crossref] [PubMed]
47. Bui GA, Huang JI. Intramedullary Screw Fixation of Metacarpal and Phalangeal Fractures. Hand Clin 2023;39:475-88. [Crossref] [PubMed]
48. Posey SL, Gaston RG. Staple Technology for Fracture Fixation and Joint Arthrodesis. Hand Clin 2023;39:505-13. [Crossref] [PubMed]
49. Rao SR, Pereira GF, Richard MJ. The Use of Patient-Specific Implants for the Treatment of Upper Extremity Fractures. Hand Clin 2023;39:489-503. [Crossref] [PubMed]
50. Zhuang T, Kamal RN. Strategies for Perioperative Optimization in Upper Extremity Fracture Care. Hand Clin 2023;39:617-25. [Crossref] [PubMed]
51. Putnam J. Rethinking Scaphoid Fixation. Hand Clin 2023;39:597-604. [Crossref] [PubMed]
52. Saraf A, Goyal M, Goyal K. Blood Flow Restriction Training-An Overview and Implication in New Generation Physical Therapy: A Narrative Review. J Lifestyle Med 2022;12:63-8. [Crossref] [PubMed]
53. Freitas EDS, Karabulut M, Bemben MG. The Evolution of Blood Flow Restricted Exercise. Front Physiol 2021;12:747759. [Crossref] [PubMed]
54. Charles D, White R, Reyes C, et al. A systematic review of the effects of blood flow restriction training on quadriceps muscle atrophy and circumference post ACL reconstruction. Int J Sports Phys Ther 2020;15:882-91. [Crossref] [PubMed]
55. Storheim K, Zwart JA. Musculoskeletal disorders and the Global Burden of Disease study. Ann Rheum Dis 2014;73:949-50. [Crossref] [PubMed]
56. Loenneke JP, Thiebaud RS, Abe T, et al. Blood flow restriction pressure recommendations: the hormesis hypothesis. Med Hypotheses 2014;82:623-6. [Crossref] [PubMed]
57. Loenneke JP, Fahs CA, Wilson JM, et al. Blood flow restriction: the metabolite/volume threshold theory. Med Hypotheses 2011;77:748-52. [Crossref] [PubMed]
58. Miller BC, Tirko AW, Shipe JM, et al. The Systemic Effects of Blood Flow Restriction Training: A Systematic Review. Int J Sports Phys Ther 2021;16:978-90. [Crossref] [PubMed]
59. Lorenz DS, Bailey L, Wilk KE, et al. Blood Flow Restriction Training. J Athl Train 2021;56:937-44. [Crossref] [PubMed]
60. Erickson LN, Lucas KCH, Davis KA, et al. Effect of Blood Flow Restriction Training on Quadriceps Muscle Strength, Morphology, Physiology, and Knee Biomechanics Before and After Anterior Cruciate Ligament Reconstruction: Protocol for a Randomized Clinical Trial. Phys Ther 2019;99:1010-9. [Crossref] [PubMed]
61. Yasuda T. Selected Methods of Resistance Training for Prevention and Treatment of Sarcopenia. Cells 2022;11:1389. [Crossref] [PubMed]
62. Vopat BG, Vopat LM, Bechtold MM, et al. Blood Flow Restriction Therapy: Where We Are and Where We Are Going. J Am Acad Orthop Surg 2020;28:e493-500. [Crossref] [PubMed]
63. Brightwell BD, Stone A, Li X, et al. Blood flow Restriction training After patellar INStability (BRAINS Trial). Trials 2022;23:88. [Crossref] [PubMed]