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Functional Biomechanics

Hand functional biomechanics: kinematics, muscle activation, dexterity assessment limitations, and impact on ADLs.

Overview

Orthopaedic management and rehabilitation of distal radius fractures must be grounded in a sound knowledge of the biomechanical interaction of the different structures involved [1]. Functional range of motion is critical for directing indications for surgery and rehabilitation, and for assessing the outcome of treatment [5]. Effective surgery restores biomechanical motions so patients have optimum use, as digits require sensation and freedom of motion to enable patients to use them effectively [19].

Kinematic variability resulting from tasks like the Jebsen-Taylor Hand Function Test can inform the selection of tasks for kinematic evaluation and provide expected variability for comparison to patient populations [2]. Kinematic motion analysis has potential to advance the evaluation and management of upper-extremity disorders, but broad application requires validation and standardization of upper-extremity-specific protocols, as well as decreased logistical and cost burdens [7]. Surface electromyographic signals can be used to identify maximal versus submaximal efforts in people with upper extremity injuries [63].

Recent developments in experimental tendon repairs and clinical outcomes of newer repair techniques summarize critical mechanical factors affecting performance [8]. A relative motion flexion orthosis for postoperative management of zone I/II flexor digitorum profundus repair can lead to similar mobility and functional recovery as other early active motion protocols, with certain practical advantages and without major complications [9]. More unstable and mechanically inefficient postures in thumb key pinch are compensated by functional capacity [10].

Advancements in vibrotactile measurement techniques include comparisons of hardware features and testing protocols, with discussions of advantages, limitations, and recommendations for clinical implementation [60]. The Patient Specific Functional Scale (PSFS) provides a method to assess individual functional limitations, can be completed in a shorter period of time than the DASH, and was more acceptable to patients than the DASH [62]. Return-to-activity criteria after anterior cruciate ligament reconstruction (ACLR) should objectively account for strength and function [64].

Anatomy & Pathophysiology

Osseous and Joint Mechanics

Distal radius fractures alter wrist pathomechanics, necessitating orthopaedic management and rehabilitation based on the biomechanical interaction of involved structures [1]. The metacarpophalangeal joint represents a joint with 5 kinematic degrees of freedom from a mechanical perspective [17]. Thumb motion capability was unaffected by sex and handedness [44].

Ligamentous and Soft Tissue Dynamics

Biomechanical concepts such as stress, strain, and moments are necessary for understanding the basic science underlying hand therapy treatment techniques [26]. Active and passive intrinsic reconstruction methods improved basic grasp and release kinematics in experimental cadaver hand models [32]. Both intrinsic balancing techniques improved grasp, but only the House procedure restored hand kinematics approximating those of an intrinsic-activated hand [36].

Kinematics and Grip Function

Kinematic motion analysis has potential to advance evaluation and management of upper-extremity disorders, but requires validation, standardization of protocols, and reduced logistical/cost burdens for broad application [7]. Kinematic analysis of the thumb carpometacarpal (CMC) joint is effective in differentiating surgical treatments used for end-stage osteoarthritis [43]. During cylinder grip, DIP joints consistently initiate flexion last, and synchronization increases significantly by the end of motion compared to the beginning [45]. Further analysis of the dynamics of the cylinder grip is required to fully understand it in healthy individuals [29]. Lateral grip styles involve more whole-arm, stabilizing movements, while dynamic grip styles require fine dexterous movements [48].

Neuromuscular Control and Pathology

Measurement of individual finger forces enables accurate biomechanical modeling of the hand and determination of disease effects on hand function [3]. Kinematic and clinical measurements objectively and quantitatively evaluate skilled hand function in individuals with chemotherapy-induced peripheral neuropathy (CIPN) in clinical settings [38]. Isometric hand tests improve the measurement of intrinsic and extrinsic hand muscle strength [39]. The dominant hand is stronger than the nondominant hand, with no difference in three hand strength measurements made under the same conditions [46]. Finger strength was statistically significantly reduced following non-surgical treatment of spiral and oblique metacarpal shaft fractures, though clinical relevance remains unclear [47].

Limited joint mobility of the thumb and index finger may cause temporal changes in precision grip force control, leading to reduced manual dexterity [35]. Individuals with hand osteoarthritis modulate grip force magnitude and temporal parameters, apply higher grip forces at liftoff and peak, and demonstrate longer latency compared to controls [41]. Grip-load force adjustments are not completely determined by the mechanics of object motion; nonmechanical factors related to movement performance, such as perceptual factors, may affect the coupling [42]. The opposite hand can be used as a reference to analyze a hand's load-distribution pattern [37].

Classification

Biomechanical Interaction: Orthopaedic management and rehabilitation for distal radius fractures should be based on the biomechanical interaction of the involved structures [1].

Kinematic Motion Analysis: Kinematic evaluation results provide expected variability for comparison to patient populations [2]. Kinematic motion analysis has potential to advance the evaluation and management of upper-extremity disorders [7]. Broad application of kinematic motion analysis requires validation and standardization of upper-extremity-specific protocols [7], decreased logistical and cost burdens [7], and measurement of individual finger forces to provide more accurate biomechanical models of the hand [3] and determine the effect of disease on hand functions [3].

Patellofemoral Pain Syndrome: Patellofemoral pain may derive from a combination of physical activity in the context of pathological kinematics [6]. Combined balance and perturbation training modifies underlying neuromuscular control and biomechanics in women with patellofemoral pain syndrome [4].

Low Back Pain: No differences in physical abilities were observed among low back pain subgroups [11]. Further studies are needed to elucidate if different types of low back pain are related to altered biomechanics, physiology, and function [11].

Adolescent Soccer Players: Neuromuscular and lower limb biomechanical differences exist between male and female elite adolescent soccer players during unanticipated run and crosscut maneuvers [12]. Additional biomechanical and neuromuscular differences in adolescent soccer players are potential risk factors [12].

Thrower’s Shoulder: Updates on the thrower's shoulder anatomy, mechanics, pathomechanics, and treatment are essential for clinicians and researchers [13].

Metacarpophalangeal Joint: The metacarpophalangeal joint represents a joint with 5 kinematic degrees of freedom from a mechanical perspective [17].

Flexor Tendon Repair: Classification of angular measurement according to tested systems does not reflect the patient's perspective after flexor tendon repair [40]. Classification of angular measurement limits the precision of the measurement after flexor tendon repair [40]. Classification of angular measurement adds little value to the measurement itself after flexor tendon repair [40].

Brachial Plexus Birth Palsy: Scapulothoracic and glenohumeral components of shoulder motion are more specific than humerothoracic measures to diagnostic classification in children with brachial plexus birth palsy [52].

Proximal Interphalangeal Joint: The physiological incongruity of the 2 articular surfaces of the proximal interphalangeal joint was defined quantitatively [55].

Tendon Dimension Measurement: Methods to measure tendon dimensions are categorized into destructive, contact, and non-contact techniques [57]. Tendon dimension measurement methods are distinguished between in vivo and ex vivo applications [57].

ACL Reconstruction: The 5 adjustable-loop femoral cortical systems for soft tissue ACL reconstruction exhibited different biomechanical properties [58].

Clinical Presentation

A sound knowledge of the biomechanical interaction of involved structures is required for the orthopaedic management and rehabilitation of distal radius fractures [1]. Comprehensive assessment is essential to ascertain the full extent of functional limitations in hand pathology [28]. This includes a systematic process of performing a comprehensive physical examination of the hand, incorporating vascular, sensory, and motor assessments, to ensure appropriate treatment and optimal patient outcomes [27].

Inspection and palpation must account for bilateral changes in tendon structure in patients with unilateral insertional or midportion Achilles or patellar tendinopathy [14]. The asymptomatic side should not be used as a reference in clinical practice for these patients [14]. In lateral elbow tendinopathy, signs of maladaptive motor patterns emerge when grip force becomes painful compared with age- and sex-matched controls [31].

Range-of-motion evaluation relies on the functional range of motion of finger joints, which directs surgical indications, rehabilitation strategies, and outcome assessment [5]. Kinematic variability from the Jebsen-Taylor Hand Function Test informs task selection for kinematic evaluation and provides expected variability for comparison to patient populations [2]. Measurement of individual finger forces yields more accurate biomechanical models of the hand and determines the effect of disease on hand functions [3]. Subjects with stenosing tenosynovitis demonstrate a significant decrease in maximum velocity in slow fist tasks [28]. Insights from exercise relative motion orthoses to improve proximal interphalangeal joint motion may inform future biomechanical and clinical research on this underexplored topic [15].

Stability and special tests must consider the quadriga phenomenon, caused by interconnected flexor digitorum profundus tendons, which significantly affects strength testing, movement assessment, and rehabilitation exercise selection [34]. Understanding the anatomy and biomechanics of the quadriga phenomenon improves diagnosis and treatment [34]. Clavicular shortening of -10% affects scapular kinematics and might produce clinical symptoms [33]. Center of pressure measurement detected sensorimotor functional deficits following surgical treatment of the shoulder joint in patients with confirmed successful clinical and functional outcomes [30].

Red-flag patterns and broader biomechanical considerations include patellofemoral pain, which may derive from a combination of physical activity in the context of pathological kinematics [6]. Combined balance and perturbation training modifies underlying neuromuscular control and biomechanics, leading to symptomatic relief in women with patellofemoral pain syndrome [4]. Neuromuscular and lower limb biomechanical differences exist between male and female elite adolescent soccer players during an unanticipated run and crosscut maneuver [12]. No differences were observed among low back pain subgroups regarding physical abilities, and further studies are needed to elucidate if different types of low back pain are related to altered biomechanics, physiology, and function [11].

Updates on the thrower's shoulder, including anatomy, mechanics, pathomechanics, and treatment, are essential for clinicians and researchers treating or investigating the shoulder [13]. Understanding the basic science of cartilage and the changes that occur in osteoarthritis is imperative to develop novel strategies to diagnose and treat this disorder [16]. Improved understanding of carpal motion patterns may lead to changes in functional rehabilitation following injury and in surgical management [18]. Kinematic motion analysis has potential to advance the evaluation and management of upper-extremity disorders, but broad application requires validation and standardization of upper-extremity-specific protocols and decreased logistical and cost burdens [7].

Investigations

Plain radiography: Orthopaedic management and rehabilitation for distal radius fractures should be based on knowledge of the biomechanical interaction of involved structures [1]. Radiographic deformity and nonsurgical treatment do not necessarily correlate with worse functional outcomes in distal radius fractures, particularly in patients over 60 years of age [21]. Morphologic features measurable on anteroposterior pelvic radiographs do not correlate with ultrasound-measured hip flexion in asymptomatic young adult women [22]. Specific hip osteoarthritic morphological characteristics alter spinopelvic motion to a greater extent than others, as anteroposterior pelvic radiograph findings correlate with sagittal spinopelvic motion [70]. The presence of radiographic dynamic convergence of the distal radioulnar joint does not influence clinical outcomes after the Darrach procedure [66].

MRI: The minimum ischiofemoral space during dynamic activities was smaller than axial MRI measurements [73].

Functional and Kinematic Assessment: Functional range of motion is important for directing indications for surgery and rehabilitation, and for assessing treatment outcomes [5]. Patellofemoral pain may derive from a combination of physical activity in the context of pathological kinematics [6]. Patients with femoroacetabular impingement syndrome squat lower and slower than healthy controls during the double-leg squat [81]. Differences in squat depth between patients with femoroacetabular impingement syndrome and healthy controls are reflected across the entirety of the lower extremity in the sagittal plane [81].

Ultrasound: Ultrasonography has the capacity to evaluate force recovery objectively in functioning free muscle transfers [79]. Morphologic features measurable on anteroposterior pelvic radiographs do not correlate with ultrasound-measured hip flexion in asymptomatic young adult women [22].

Other Considerations: Further studies with appropriate diagnostic procedures are needed to elucidate if different types of low back pain are related to altered biomechanics, physiology, and function [11]. Monitoring both symptomatic and asymptomatic tendon structures is important in patients with unilateral insertional or midportion Achilles tendinopathy or patellar tendinopathy [14]. The asymptomatic side should not be used as a reference in clinical practice for patients with unilateral insertional or midportion Achilles tendinopathy or patellar tendinopathy [14]. Understanding the basic science of cartilage and changes in osteoarthritis is imperative to develop novel strategies to diagnose and treat the disorder [16]. EOS® standing full-leg radiographs use lower radiation doses and contain more radiographic information than other methods for measuring migration percentage in ambulant children with cerebral palsy [61]. Anatomic anterolateral ligament reconstruction did not reduce anterolateral rotational laxity in biomechanical analysis of simulated clinical testing [67]. Treatment of a hip capsular injury with platelet-rich plasma and bone marrow aspirate concentrate therapy resulted in marked improvement in kinematic and kinetic performance measures and MRI appearance of the torn hip capsule and gluteus minimus tendon [71]. The ischiofemoral space was reduced in female participants compared with male participants during standing and walking, despite a lack of kinematic differences between the sexes [73]. Abnormal cold sensitivity and its severity in hand injuries have a multifactorial aetiology involving bony, vascular, and neural components [80]. Hand grip strength, vitamin D status, and diets might be considered diagnostic non-invasive predictors of bone health for clinical use in epidemiological contexts for 6–12 year old school children [83]. Dimensional discrepancies and functional outcomes are improved by scapula stabilization procedures in obstetric brachial plexus paralysis patients [84].

Treatment

General Principles and Assessment

Orthopaedic management and rehabilitation must be grounded in a sound knowledge of the biomechanical interaction of the different structures involved [1]. Functional range of motion is critical for directing indications for surgery and rehabilitation, as well as for assessing the outcome of treatment [5]. Effective surgery restores biomechanical motions to ensure optimum use, requiring digits to have both sensation and freedom of motion [19]. Kinematic variability derived from hand function tests can inform the selection of tasks for kinematic evaluation and provide expected variability for comparison to patient populations [2]. Furthermore, an improved understanding of carpal motion patterns may lead to changes in functional rehabilitation following injury and in surgical management [18].

Non-Operative

Conservative management strategies vary by pathology but often serve as the first line of defense or a bridge to surgical intervention. For patellofemoral pain syndrome, combined balance and perturbation training effectively modifies underlying neuromuscular control and biomechanics, leading to symptomatic relief in women [4]. In internal snapping hip, nonoperative measures are usually successful [76]. For proximal interphalangeal joint extension contractures that have plateaued with nonsurgical management, passive manipulation is a viable alternative [74]. Moderate nonprogressive coxa vara in childhood often does not require surgery [65]. Rehabilitation protocols should be comprehensive; exercises focused on force control may help restore gait biomechanics in patients following anterior cruciate ligament reconstruction [54], and future protocols for total knee arthroplasty should consider the replaced knee as well as the non-replaced knee and surrounding joints [59]. The benefits of a knee brace are attributed to mechanical action, enhanced coordination, and a psychological effect [50]. Additionally, radiographic deformity and nonsurgical treatment of distal radius fractures do not necessarily correlate with worse functional outcomes, particularly in patients over 60 years of age [21].

Operative

Indications: Surgical management of coxa vara in childhood is indicated for progressive, painful, unilateral deformity or leg-length discrepancy [65]. For internal snapping hip refractory to nonoperative therapy, surgical tendon lengthening is a viable approach [76]. In hemiplegic cerebral palsy, targeted surgical intervention and undefined therapy intervention seemed to have little influence on activity and participation, although wrist/finger biomechanics and active range of motion improved [51].

Surgical Approach / Technique: Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors [72]. Hand surgery and hand therapy practice interventions, including the use of relative motion flexion orthoses for management of non-surgical and surgical extensor mechanism injuries, may benefit from an in-depth look at extensor mechanism zone III and IV anatomy and biomechanics [68].

Implant Selection: Evidence does not specify implant selection criteria within the provided data; however, novel techniques such as an asymmetric 6-strand flexor tendon repair using porcine tendons demonstrate improved biomechanical performance [53]. Recent developments in experimental tendon repairs and clinical outcomes of newer repair techniques summarize critical mechanical factors affecting performance [8].

Alignment / Balancing Strategy: More unstable and mechanically inefficient postures in thumb key pinch are compensated by functional capacity [10].

Pain Management: The immediate active motion protocol after tendon transfer for claw deformity is safe and has similar outcomes compared with immobilization, with the added advantage of earlier pain relief and quicker restoration of hand function [49].

Adjuncts: A relative motion flexion orthosis for postoperative management of zone I/II flexor digitorum profundus repair can lead to similar mobility and functional recovery as other early active motion protocols, with certain practical advantages and without major complications [9].

Other Considerations: Hand function was significantly improved after treatment with collagenase Clostridium histolyticum injection for Dupuytren’s disease, with 70% achieving a functional range of motion at 5 years [20].

Complications

Other Considerations: Abnormal joint motion caused by ligamentous and joint laxity may have a deleterious long-term clinical effect [69]. Further studies with long-term follow-up are needed to determine whether the grafted area in Autologous Matrix-Induced Chondrogenesis will maintain structural and functional integrity over time [24].

Recovery

Light activity (weeks): Early postoperative management of zone I/II flexor digitorum profundus repair utilizes a relative motion flexion orthosis, which facilitates early active motion protocols with similar mobility and functional recovery to other methods, while offering practical advantages and lacking major complications [9]. For flexor digitorum profundus repair specifically, biomechanical parameters suggest the Corkscrew anchor may be superior for early passive mobilization protocols [95].

Full activity (months): Reconstruction of the anterior cruciate ligament using iliotibial band autograft (ITB ACLR) restores normal, symmetric, physiologic kinetic and kinematic function in the growing knee by 1 year after surgery [25]. Isolated gracilis tendon harvesting does not result in strength loss and maintains good functional outcomes [86]. Significant improvements in quality of life and functional capabilities are achieved following femoral osteotomy for osteonecrosis of the femoral head, although physical recovery requires an extended duration [82].

Complete recovery / outcome plateau (months): ITB ACLR maintains normal kinetic and kinematic parameters for up to 20 years [25]. Hand function remains significantly improved 5 years after treatment with collagenase Clostridium histolyticum injection for Dupuytren’s disease, with 70% of patients achieving a functional range of motion [20]. Further studies with long-term follow-up are required to determine whether the grafted area maintains structural and functional integrity over time following Autologous Matrix-Induced Chondrogenesis for focal cartilage defects in the knee [24].

Rehabilitation protocol: Combined balance and perturbation training modifies underlying neuromuscular control and biomechanics, leading to symptomatic relief in women with patellofemoral pain syndrome [4]. Both brace conditions produce immediate changes in sagittal and transverse plane kinematics at the ankle for patients with predominant lateral knee osteoarthritis and valgus malalignment after anterior cruciate ligament reconstruction [93]. Further research is needed combining upper limb orthoses with task-specific training and measuring outcomes over the medium to long term for children with cerebral palsy or brain injury [85].

Functional milestones: Functional range of motion is important for directing indications for surgery and rehabilitation, and for assessing the outcome of treatment [5]. Assessment of kinematic variability during the Jebsen-Taylor Hand Function Test provides expected variability for comparison to patient populations and informs selection of tasks for kinematic evaluation [2]. Measurement of individual finger forces provides more accurate biomechanical models of the hand and determines the effect of disease on hand functions [3]. A novel finger grip dynamometer system that measures each finger's grip strength at one time and records the time course of grip motion can quantify a patient's symptoms easily and objectively, contributing to the evaluation of hand function [90]. The motion analysis system provides useful data about actual anatomical deficits in injured fingers by recording dynamic changes in joint angles, though the evaluation is time-consuming [91]. More unstable and mechanically inefficient postures in thumb key pinch are compensated by functional capacity [10].

Other Considerations: A holistic approach addressing both physical and mental aspects is crucial for long-term functional outcomes after hand injury [23]. Recent developments in experimental tendon repairs and clinical outcomes of newer repair techniques summarize critical mechanical factors affecting performance [8]. The slopes of the force-generation and force-decay phases of the Force-Time curve did not validly measure the sincerity of effort in participants with upper extremity injury, perhaps because they were protective of their injured hand and exerted only submaximal effort even at their best grip attempt [92]. All neuromuscular and biomechanical characteristics remained invariable between testing sessions despite concentration changes in estradiol and progesterone across the menstrual cycle [94].

Key Evidence

  • [L3] Clinically, this highlights the need for orthopaedic management and rehabilitation to be based on a sound knowledge of the biomechanical interaction of the different structures involved. (10.1177/1758998315574352)
  • [L4] Results can be used to inform selection of tasks for kinematic evaluation and provide expected variability for comparison to patient populations. (10.1016/j.jht.2018.10.002)
  • [L4] Measurement of individual finger forces can provide more accurate biomechanical models of the hand and determine the effect of disease on hand functions. (10.1016/j.jht.2020.04.002)
  • [L2] These changes indicate that the intervention effectively modified underlying neuromuscular control and biomechanics, leading to symptomatic relief. (10.1186/s12891-026-09610-6)
  • [L4] The functional range of motion is important for directing indications for surgery and rehabilitation, and assessing outcome of treatment. (10.1177/1753193414533754)
  • [L3] Rather, PFP may derive from a combination of physical activity in the context of pathological kinematics. (10.1177/0363546516679139)
  • [L5] Kinematic motion analysis has exciting potential to advance the evaluation and management of upper-extremity disorders; however, broad application will require validation and standardization of upper-extremity-specific protocols in addition to decreased logistical and cost burdens. (10.1016/j.jhsa.2022.07.016)
  • [L4] Recent developments in experimental tendon repairs and clinical outcomes of newer repair techniques have been reviewed to summarize critical mechanical factors affecting performance. (10.1177/1753193413492914)
  • [L4] It can lead to similar mobility and functional recovery as other early active motion protocols, with certain practical advantages and without major complications. (10.1016/j.jht.2019.05.002)
  • [L4] We conclude that the more unstable and mechanically inefficient postures are compensated by functional capacity. (10.1258/ht.2012.012016)
  • [L4] No differences were observed among the LBP subgroups, and further studies with appropriate diagnostic procedures are needed to elucidate if different types of LBP are related to altered biomechanics, physiology, and function. (10.3390/life11030226)
  • [L4] Additional biomechanical and neuromuscular differences were also identified as potential risk factors. (10.1177/0363546507307400)
  • [L5] Updates on the thrower's shoulder, including anatomy, mechanics, pathomechanics, and treatment, are essential for clinicians and researchers treating or investigating the shoulder. (10.1016/j.arthro.2022.02.024)
  • [L3] These results stress the importance of monitoring both symptomatic and asymptomatic tendon structures and in addition highlight that the asymptomatic side should not be used as reference in clinical practice. (10.1007/s00167-019-05495-2)
  • [L4] These insights may inform future biomechanical and clinical research on this underexplored topic. (10.1016/j.jht.2022.12.002)
  • [L5] Understanding the basic science of cartilage and the changes that occur in osteoarthritis is imperative to develop novel strategies to diagnose and treat this disorder. (10.1016/j.csm.2004.08.007)
  • [L5] From a mechanical perspective, the metacarpophalangeal joint represents a joint with 5 kinematic degrees of freedom. (10.1016/j.jhsa.2008.10.004)
  • [L5] Improved understanding of this motion pattern may lead to changes in functional rehabilitation following injury and in surgical management. (10.5435/00124635-201001000-00007)
  • [L5] Ideally, digits need sensation and freedom of motion to enable patients to use them effectively, and effective surgery restores biomechanical motions so patients have optimum use. (10.1016/j.hcl.2013.08.003)
  • [L4] Hand function was significantly improved, with 70% achieving a functional range of motion at 5 years. (10.1177/17531934211002383)
  • [L4] Radiographic deformity and nonsurgical treatment do not necessarily correlate with worse functional outcomes, particularly in patients over 60 years of age. (10.1016/j.jhsa.2012.04.006)
  • [L4] Morphologic features that are measurable on anteroposterior pelvic radiographs do not correlate with ultrasound-measured hip flexion. (10.2106/jbjs.19.01088)
  • [L4] A holistic approach addressing both physical and mental aspects is crucial for long-term functional outcomes. (10.1016/j.jht.2023.10.002)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L4] The ITB ACLR appears to restore normal, symmetric, physiologic kinetic and kinematic function in the growing knee by 1 year after reconstruction, with maintenance of normal parameters for up to 20 years. (10.1177/0363546520927399)
  • [Paper] This introductory article lays the foundation of biomechanical concepts such as stress, strain, and moments, which are necessary for understanding the basic science underlying hand therapy treatment techniques. (10.1016/j.jht.2011.12.006)
  • [L5] This current concepts review presents a systematic process of performing a comprehensive physical examination of the hand including vascular, sensory, and motor assessments, which is essential for appropriate treatment and providing the patient the opportunity for the best outcome. (10.1016/j.jhsa.2014.04.026)
  • [L3] Those subjects demonstrate a significant decrease in maximum velocity in slow fist tasks, highlighting the need for comprehensive assessment to ascertain the full extent of functional limitations that can occur in the setting of hand pathology. (10.1177/1558944717729218)
  • [L4] However, to fully understand the cylinder grip in healthy individuals, further analysis of the dynamics of the cylinder grip is required. (10.1016/j.jhsa.2009.12.031)
  • [L3] Centre of pressure measurement detected sensorimotor functional deficits following surgical treatment of the shoulder joint in patients with confirmed successful clinical and functional outcomes. (10.1007/s00167-021-06751-0)
  • [L3] Signs of maladaptive motor patterns emerge when grip force becomes painful. (10.1016/j.jse.2024.11.001)
  • [L5] Active and passive intrinsic reconstruction methods improved basic grasp and release kinematics in experimental cadaver hand models. (10.1016/j.jhsa.2014.09.031)
  • [L5] The results suggest that clavicular shortening of -10% affects scapular kinematics and might produce clinical symptoms. (10.1177/0363546509355143)
  • [L5] The quadriga phenomenon, caused by interconnected flexor digitorum profundus tendons, significantly affects clinical situations including strength testing, movement assessment, and rehabilitation exercise selection; understanding its anatomy and biomechanics improves diagnosis and treatment. (10.1177/1753193411430810)
  • [L2] Limited joint mobility of the thumb and index finger may cause temporal changes in precision grip force control, which can lead to reduced manual dexterity. (10.1016/j.jht.2013.05.007)
  • [L5] Both intrinsic balancing techniques improved grasp, but only the House procedure restored hand kinematics approximating those of an intrinsic-activated hand. (10.1016/j.jhsa.2013.08.098)
  • [L4] To analyze a hand's load-distribution pattern, the opposite hand can be used as a reference. (10.1016/j.jhsa.2018.02.016)
  • [L3] Our kinematic and clinical measurements objectively and quantitatively evaluate skilled hand function in individuals with CIPN in clinical settings. (10.1016/j.jht.2017.06.003)
  • [L4] The new isometric hand tests improve the measurement of intrinsic and extrinsic hand muscle strength. (10.1177/1753193410363532)
  • [L4] Classification of angular measurement according to the tested systems does not reflect the patient's perspective; it limits the precision of the measurement and adds little value to the measurement itself. (10.1016/j.jhsa.2018.06.010)
  • [L3] Individuals with hand OA modulate grip force magnitude and temporal parameters but apply higher grip forces at liftoff and peak, and demonstrate longer latency compared to controls. (10.1016/j.jht.2011.06.002)
  • [L4] Grip-load force adjustments are not completely determined by the mechanics of object motion; nonmechanical factors related to movement performance, for instance perceptual factors, may affect the coupling. (10.1197/j.jht.2007.06.002)
  • [L5] Kinematic analysis of the thumb CMC joint is effective in differentiating surgical treatments used for end-stage OA. (10.1016/j.jhsa.2007.02.009)
  • [L3] Thumb motion capability was unaffected by sex and handedness. (10.1016/j.jhsa.2014.08.012)
  • [L4] The dynamic interaction of finger joints during cylinder grip shows specific patterns, with DIP joints consistently initiating flexion last and synchronization increasing significantly by the end of motion compared to the beginning. (10.1177/1753193412444399)
  • [L4] Finger strength was statistically significantly reduced, but its clinical relevance remains unclear. (10.1186/s12891-025-08776-9)
  • [L4] Lateral grip styles involve more whole-arm, stabilizing movements while dynamic grip styles require fine dexterous movements. (10.1016/j.jht.2021.03.004)
  • [L1] The immediate active motion protocol is safe and has similar outcomes compared with immobilization, with the added advantage of earlier pain relief and quicker restoration of hand function. (10.1016/j.jhsa.2008.11.014)
  • [L4] The benefits of the knee brace are due to the mechanical action, an enhanced coordination, and a psychological effect. (10.1007/s001670100202)
  • [L4] The targeted surgical intervention and undefined therapy intervention seemed to have little influence on activity and participation, although wrist/finger biomechanics and active range of motion improved. (10.1197/j.jht.2008.01.001)
  • [L4] Scapulothoracic and glenohumeral components of shoulder motion are more specific than humerothoracic measures to diagnostic classification. (10.1016/j.jse.2013.06.023)
  • [L5] A novel flexor tendon repair technique with improved biomechanical performance may be available for use in flexor tendon repairs. (10.1177/1558944716685829)
  • [L4] Rehabilitation should include exercises focused on force control to potentially help restore gait biomechanics. (10.1002/ksa.70129)
  • [L5] The physiological incongruity of the 2 articular surfaces of the PIP joint was defined quantitatively. (10.1016/j.jhsa.2007.09.001)
  • [L4] This review categorizes methods for measuring tendon dimensions into destructive, contact, and non-contact techniques, distinguishing between in vivo and ex vivo applications to address the need for accurate measurements in understanding tendon mechanics and planning surgical interventions. (10.1186/s13018-018-1056-y)
  • [L5] The 5 adjustable-loop femoral cortical systems exhibited different biomechanical properties. (10.1177/23259671221146788)
  • [L4] The review provides a comprehensive overview of advancements in vibrotactile measurement techniques, comparing hardware features and testing protocols while discussing advantages, limitations, and recommendations for clinical implementation. (10.1016/j.jht.2011.01.001)
  • [L3] These images use lower radiation doses and contain more radiographic information. (10.1186/s12891-019-2746-2)
  • [L3] The PSFS provides a method to assess individual functional limitations, can be completed in a shorter period of time than the DASH and was more acceptable to the patients than the DASH. (10.1016/s0363-5023(12)60062-8)
  • [L4] The study aimed to identify the specific amount of motion allowed within four different immobilization devices and the level of function allowed within each device to establish data for evidence-based decisions. (10.1016/j.jht.2009.07.011)
  • [L3] Return-to-activity criteria after ACLR should objectively account for strength and function. (10.1177/0363546520940310)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L4] Nearly one-half of patients had dynamic convergence of the DRUJ when stressed radiographically; however, the presence of radiographic dynamic convergence did not influence clinical outcomes. (10.1016/j.jhsa.2012.08.044)
  • [L5] Anatomic ALL reconstruction did not reduce anterolateral rotational laxity. (10.1177/2325967116s00027)
  • [L5] Hand surgery and hand therapy practice interventions, including use of RMF orthoses for management of non-surgical and surgical EM injuries may benefit from an in-depth look at the EM zone III and IV anatomy and biomechanics. (10.1016/j.jht.2023.01.002)
  • [L5] There is some evidence that abnormal joint motion caused by ligamentous and joint laxity may have a deleterious long-term effect clinically, and the influence of gender and hormonal environment is under investigation as a factor in evaluation and treatment of musculoskeletal disease. (10.1016/j.jhsa.2008.09.012)
  • [L3] These data suggest that specific hip osteoarthritic morphological characteristics listed above alter spinopelvic motion to a greater extent than others. (10.1302/0301-620x.105b5.bjj-2022-0945.r1)
  • [L4] He also demonstrated marked improvement in kinematic and kinetic performance measures and MRI appearance of the torn hip capsule and gluteus minimus tendon. (10.1007/s00167-012-2232-y)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L3] The minimum ischiofemoral space during dynamic activities was smaller than axial MRI measurements, and the space was reduced in female participants compared with male participants during standing and walking despite a lack of kinematic differences between the sexes. (10.1177/0363546517712990)
  • [L4] The study demonstrates that this approach can be a viable alternative for patients who have plateaued with nonsurgical management. (10.1016/j.jhsa.2022.01.023)
  • [L4] Although nonoperative measures are usually successful in the treatment of internal snapping hip, surgical tendon lengthening is a viable approach in cases refractory to nonoperative therapy. (10.1177/03635465020300042201)
  • [L4] This study demonstrated that ultrasonography has the capacity to evaluate force recovery objectively. (10.1016/j.jhsa.2014.06.120)
  • [L4] The causes of abnormality and severity suggest a multifactorial aetiology with bony, vascular and neural components. (10.1177/1753193409354184)
  • [L3] Our findings demonstrate key differences in DLS biomechanics between patients with FAIS and healthy controls, confirming our hypotheses that FAIS patients squat lower and slower than healthy controls, and that the differences in squat depth would be reflected across the entirety of the lower extremity in the sagittal plane. (10.1177/2325967124s00188)
  • [L3] Significant improvements in quality of life and functional capabilities can be achieved following femoral osteotomy, though physical recovery requires an extended duration. (10.1016/j.arth.2025.06.066)
  • [L4] These parameters might be considered diagnostic non-invasive predictors of bone health for clinical use in epidemiological contexts. (10.1186/s12891-023-06960-3)
  • [L4] Dimensional discrepancies and functional outcomes are improved by scapula stabilization procedures. (10.1007/s11552-014-9640-z)
  • [L1] Further research is needed combining upper limb orthoses with task-specific training and measuring outcomes over the medium to long term. (10.1016/j.jht.2017.09.006)
  • [L3] Additionally, good functional outcome as well as excellent knee-specific subjective outcome was found. (10.1007/s00167-019-05790-y)
  • [L4] This new system that measures each finger's grip strength at one time and records the time course of grip motion could quantify a patient's symptoms easily and objectively, which may contribute to the evaluation of hand function. (10.1186/s13018-020-01773-9)
  • [L4] The motion analysis system provides useful data about actual anatomical deficits in injured fingers by recording dynamic changes in joint angles, though the evaluation is time-consuming. (10.1054/jhsb.1999.0344)
  • [L3] The slopes of the force-generation and force-decay phases of the Force-Time curve did not validly measure the sincerity of effort in participants with upper extremity injury, perhaps because they were protective of their injured hand and exerted only submaximal effort even at their best grip attempt. (10.1016/j.jht.2010.07.005)
  • [L3] Both brace conditions produced immediate changes in sagittal and transverse plane kinematics at the ankle. (10.1177/0363546515624677)
  • [L3] All neuromuscular and biomechanical characteristics remained invariable between testing sessions despite concentration changes in estradiol and progesterone. (10.1007/s00167-007-0302-3)
  • [L5] Based on these biomechanical parameters, the Corkscrew anchor may be superior for early passive mobilization protocols. (10.1016/j.jhsa.2013.11.023)

See Also

References

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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.

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