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Hand Rehabilitation and Outcomes

Hand rehabilitation principles: post-operative protocols, splinting, and evidence-based outcomes for common & complex diagnoses.

Overview

Hand rehabilitation strategies are critical for optimizing functional recovery across diverse pathologies, ranging from Dupuytren's disease to complex tendon repairs. For Dupuytren's disease, collagenase Clostridium histolyticum injection yields significant functional improvement five years post-treatment, with 70% of patients achieving a functional range of motion [1]. Surgical intervention combined with hand therapy reduces disability independent of the number of operated fingers [7], while safety and social factors remain strongly associated with functional recovery and quality of life [3]. Similarly, hand therapy is essential following surgery for severe camptodactyly to maintain passive extension and regain active extension [14].

Early and comprehensive rehabilitation protocols demonstrate superior outcomes in specific surgical contexts. Following volar locking plate fixation for distal radius fractures in middle-aged to elderly women, hand therapy improves functional outcomes and reduces pain at eight weeks compared to independent exercise [2]. In cases of disabling spasticity, combined surgery and early rehabilitation enhance function, activity, and satisfaction for at least one year [5]. For tendon repairs, early rehabilitation is beneficial [6], with the immediate active motion protocol after tendon transfer for claw deformity proving safe and offering earlier pain relief and quicker functional restoration compared to immobilization [24]. Furthermore, the partial-range active flexion protocol serves as a safe, efficient framework for flexor tendon repair, particularly where therapist assistance is unavailable [27].

Hand transplantation remains an effective treatment for selected patients, with function improving continuously for up to five years [4]. To standardize assessment, the ICF HandA provides a consensus on outcome measures for systematically evaluating function in hand injuries and disorders [8]. Hand therapists play a pivotal role in improving overall patient outcomes [11].

Anatomy & Pathophysiology

Osseous and Articular Mechanics

Accurate diagnosis and management of hand and carpal fractures and dislocations are predicated on a thorough physical examination and appropriate imaging to limit joint stiffness while preserving mobility and function [15]. Following non-surgical treatment of spiral and oblique metacarpal shaft fractures, finger strength was statistically significantly reduced, though its clinical relevance remains unclear [38]. In simulated distal interphalangeal joint fusion of the index and middle fingers, positioning the middle finger distal interphalangeal joint in either extension or 20° of flexion did not significantly affect grip strength or dexterity [52].

Neural and Tendon Pathophysiology

In radial nerve palsy treated with a flexor carpi ulnaris set of triple tendon transfer, hand function remains good even though the range of wrist motion and the strength of the wrist and fingers are less than normal [39]. Room still remains for improved thumb motion with both nerve and tendon transfer procedures for radial nerve paralysis reconstruction [61]. Fundamental muscle-tendon-joint mechanics studies allow for single-stage surgical reconstruction of hand function and early postoperative activity-based training in patients with cervical spinal cord injuries [48].

Neuromuscular and Cerebral Palsy Considerations

Targeted surgical intervention and undefined therapy interventions in hemiplegic cerebral palsy seemed to have little influence on activity and participation, although wrist/finger biomechanics and active range of motion improved [28]. Surgical reconstruction for thumb deformity in cerebral palsy aims to create a stable thumb capable of satisfactory grasp and release by decreasing deformity, balancing muscle forces, and stabilising joints [50]. Taping can be an effective option for repositioning the thumb and improves upper extremity function by controlling the thumb in palm mechanically and enabling sensorial input by maintaining the correct hand position in children with cerebral palsy [45]. Both intrinsic balancing techniques improved grasp, but only the House procedure restored hand kinematics approximating those of an intrinsic-activated hand [35].

Functional Assessment and Kinematics

Hand function was 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 [1]. The ICF HandA provides a consensus on outcome measures and instruments to systematically assess function in patients with hand injuries and disorders [8]. A novel finger grip dynamometer system can quantify a patient's symptoms easily and objectively by measuring each finger's grip strength simultaneously and recording the time course of grip motion [10]. Kinematic and clinical measurements can objectively and quantitatively evaluate skilled hand function in individuals with chemotherapy-induced peripheral neuropathy in clinical settings [36]. A 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 [40]. 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 [42]. Insights from the use of exercise relative motion orthoses to improve proximal interphalangeal joint motion may inform future biomechanical and clinical research on this underexplored topic [58].

Reconstructive and Congenital Outcomes

Toe-to-hand transfers for posttraumatic reconstruction of the hand displayed improved strength of thumb reconstructions and a reduced need for secondary surgery [49]. Touch screen technology has become increasingly relevant to hand function in modern society for children with normal hand formation, congenital differences, and neuromuscular disease [51]. Mirror hand-ulnar dimelia typically involves the entire upper limb, and treatment plans should consider predictors of function at each limb segment rather than just morphology [53].

Classification

ICF HandA: The International Classification of Functioning, Disability and Health (ICF) HandA provides a consensus on outcome measures and instruments to systematically assess function in patients with hand injuries and disorders [8].

Other Considerations: Dupuytren's Disease: Hand function was significantly improved with 70% of patients achieving a functional range of motion at 5 years following collagenase Clostridium histolyticum injection [1]. Safety and social issues of hand function and quality of life had an evident association with functional recovery [3]. Disability decreased after surgery and hand therapy independent of whether single or multiple fingers were operated on [7].

Hand Therapy & Rehabilitation: Hand therapy improved functional outcomes and reduced pain at 8 weeks after surgery compared to independent exercise in middle-aged to elderly women with distal radius fractures [2]. Therapeutic activities that mimic activities of daily living may be more beneficial than standard rehabilitation activities in the management of an injured hand in young adult patients [16]. There is a need for consistent hand therapy terminology around activity-based interventions, and both TIDieR and CERT reporting guidelines should be used to ensure thorough description of interventions [43]. Hand therapy literature consistently addresses body structures and functions but includes activities, participation, and environmental factors less often [44].

Outcome Measurement: 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 [10]. Large heterogeneity in the outcome domains being assessed or measured across studies highlights the need for a consistent core outcome set to be measured in future clinical research on hand flexor tendon injuries [23]. Multiple areas that patients identify as representing high-quality care are not reflected in current quality measures for hand surgery [47].

Specific Pathologies: There is a specific association between the category of hand disorder and the underlying pathology and prognosis in factitious hand disorders [21]. Limitations in hand function are common in all types of cerebral palsy, but characteristics of the disability vary considerably between different cerebral palsy subtypes [41]. A panel recommends adapting a simpler classification system resembling that for flexor tendons for extensor tendon injuries to facilitate surgical decision-making and rehabilitation [37]. There is a need for high-quality, collaborative research to guide management of a wider range of common hand fractures and joint injuries [46].

Clinical Presentation

Accurate diagnosis and management of hand and carpal fractures and dislocations are predicated on a thorough physical examination and appropriate imaging to limit joint stiffness while preserving mobility and function [15]. For acute injuries, therapeutic activities that mimic activities of daily living may be more beneficial than standard rehabilitation activities in the management of an injured hand in young adult patients [16]. In contrast, current evidence regarding the diagnosis of hand compartment syndrome is based mostly on case reports and small case series with varying etiology, lacking a consensus reference standard or reliable diagnostic criteria [20].

In chronic and post-surgical contexts, functional recovery is closely linked to safety and social issues of hand function and quality of life [3]. Hand therapy plays a critical role in the treatment of upper extremity injuries by coordinating edema control, pain management, and functional recovery [33]. Specific populations benefit from targeted interventions: hand therapy improves functional outcomes and reduces pain at 8 weeks after volar locking plate fixation of distal radius fractures in middle-aged to elderly women compared to independent exercise [2]; patients with decreased finger motion and various comorbidities may benefit from therapy provided in a clinic under the supervision of a certified hand therapist following distal radius fracture [32]; and advanced practice hand therapy for long-waitlisted patients with chronic hand conditions was associated with improvements in patient function and satisfaction [9].

For specific pathologies, hand function was 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 [1]. Safety and social issues of hand function and quality of life had an evident association with functional recovery after surgery and hand therapy in patients with Dupuytren's disease [3]. Hand transplant is an effective treatment in selected patients, with continual improvements in function seen for up to 5 years [4]. Hand surgery combined with early and comprehensive rehabilitation improves function, activity, and patient satisfaction in patients with disabling spasticity, with improvements lasting for at least 1 year [5]. Hand therapy resulted in statistically and clinically significant improvement in pain, grip strength, upper extremity function, and health-related quality of life for breast cancer survivors experiencing aromatase inhibitor-associated musculoskeletal syndrome in the hands and wrists [13].

Assessment and rehabilitation strategies must be tailored to specific conditions. Hand therapy is essential to maintain and further surgical improvement of passive extension and to regain active extension following surgery for severe camptodactyly [14]. The less affected hand should be evaluated and included in comprehensive treatment plans for children with hemiplegic cerebral palsy [12]. In factitious hand disorders, there is a specific association between the category of hand disorder and the underlying pathology and prognosis [21]. Patient factors associated with not using hand therapy following digital flexor tendon repair suggest that more uniform clinical practice should be sought [22].

Standardization of outcome measurement is critical for clinical practice and research. The ICF HandA provides a consensus on outcome measures and instruments to systematically assess function in patients with hand injuries and disorders [8]. Dividing the Patient-Rated Wrist and Hand Evaluation into two subscales could reduce the response burden, improve standardization of outcome measurement for clinicians, and provide precise insight into patient symptoms [31]. The large heterogeneity in the outcome domains being assessed or measured across studies highlights the need for a consistent core outcome set to be measured in future clinical research on hand flexor tendon injuries [23]. Hand therapists can play an important role in improving overall outcomes for patients [11].

Investigations

Plain radiography: Essential for accurate diagnosis and management of hand and carpal fractures and dislocations to limit joint stiffness while preserving mobility and function [15]. Radiographic deformity and nonsurgical treatment do not necessarily correlate with worse functional outcomes, particularly in patients over 60 years of age with distal radius fractures [55]. Range of motion, grip strength, and radiographic outcomes are similar between groups regarding time-to-surgery for distal radius fractures, with complication and revision rates being very low and comparable [30]. Preoperative narrowing of the thumb webspace and postoperative index finger metacarpophalangeal joint abnormality are associated with worse functional outcomes after surgical reconstruction of the transverse bone in cleft hand [69].

Other Considerations: Current evidence regarding the diagnosis of hand compartment syndrome is based mostly on case reports and small case series with varying etiology, lacking a consensus reference standard or reliable diagnostic criteria [20]. A patient regained satisfactory grip and thumb function with minimal donor site morbidity following functional reconstruction of a subtotal thumb metacarpal defect with a vascularized medial femoral condyle flap [29]. Clinical and radiological measurements showed the efficacy of an axial flap in increasing the volume and girth of the reconstructed thumb in Wassel IV thumb reconstructions [54]. The suture suspension arthroplasty technique for thumb CMC arthritis reconstruction yields good to excellent long-term clinical outcomes [65]. Evaluation of specific clinical and imaging findings is recommended to grade lumbrical muscle tears and determine suitable therapy [66]. Risk of disease progression and expectations following hand reconstruction in Hirayama disease must be managed carefully [19]. The study does not show clear benefit to advocate hand CTA in hand amputee patients [67].

Functional Assessment: Hand function was significantly improved with 70% of patients achieving a functional range of motion at 5 years following collagenase Clostridium histolyticum injection for Dupuytren's disease [1]. Disability decreased after surgery and hand therapy for Dupuytren contracture independent of single or multiple operated fingers [7]. Hand transplant is an effective treatment in selected patients with continual improvements in function seen for up to 5 years [4]. Hand abduction tracings are a quantitative outcome measure to follow recovery over time for intrinsic hand function in patients with severe ulnar neuropathy following surgical intervention [18]. All participants in a series of single case studies experienced clinically significant improvements in both body function/structure measurements of hand function and in their ability to participate in activities following paraffin and exercise treatment for scleroderma [68]. Early rehabilitation following hand tendon repair is beneficial [6]. Hand therapy improved functional outcomes and reduced pain at 8 weeks after surgery compared to independent exercise in middle-aged to elderly women with volar locking plate fixation of distal radius fractures [2]. The less affected hand in children with hemiplegic cerebral palsy should be evaluated and included in comprehensive treatment plans [12].

Treatment

Non-Operative

Nonoperative management is a primary consideration for several hand conditions. Orthoses effectively manage pediatric and adult trigger finger [59], while serial casting and splints should be attempted before open surgical release for posttraumatic proximal interphalangeal joint contracture in selected patients [57]. Early hand therapy and orthotics may benefit elderly patients with delayed wound healing after homodigital island flap repair [64]. For thoracic outlet syndrome in pediatric and young adult populations, nonoperative activity modification and physical therapy successfully managed few patients [60]. In breast cancer survivors with aromatase inhibitor-associated musculoskeletal syndrome, hand therapy significantly improved pain, grip strength, upper extremity function, and health-related quality of life [13]. Advanced practice hand therapy improves function and satisfaction in long-waitlisted patients with chronic hand conditions [9]. While a randomized study failed to show benefit for a 2-week course of hand therapy after short-incision carpal tunnel release [56], hand therapy generally improves functional outcomes and reduces pain at 8 weeks after volar locking plate fixation in middle-aged to elderly women compared to independent exercise [2]. Therapeutic activities mimicking activities of daily living may be more beneficial than standard rehabilitation for injured young adults [16].

Operative

Indications: Surgery is indicated for severe camptodactyly to regain active extension, for disabling spasticity to improve function and satisfaction, and for selected patients with Dupuytren's disease or claw deformity. Hand transplant is an effective treatment for selected patients with continual functional improvements up to 5 years [4]. In bilaterally affected children with congenital hand differences, surgery should be performed on the non-dominant hand first as it benefits most from surgery-induced body function improvement [63].

Surgical Approach / Technique: For severe camptodactyly, hand therapy is essential to maintain and further surgical improvement of passive extension and to regain active extension [14]. In patients with disabling spasticity, hand surgery combined with early and comprehensive rehabilitation improves function, activity, and patient satisfaction for at least 1 year [5]. For claw deformity, the immediate active motion protocol after tendon transfer is safe and offers earlier pain relief and quicker restoration of hand function compared with immobilization [24].

Implant Selection: The Arpe implant for trapeziometacarpal total joint arthroplasty demonstrates an acceptable long-term survival rate and restores good hand function [17].

Adjuncts: Collagenase Clostridium histolyticum injection for Dupuytren's disease resulted in significantly improved hand function, with 70% of patients achieving a functional range of motion at 5 years [1].

Other Considerations: Safety and social issues of hand function and quality of life are evidently associated with functional recovery after surgery and hand therapy in Dupuytren's disease [3]. Findings suggest a benefit of early rehabilitation after hand tendon repair [6]. The partial-range active flexion protocol is recommended as a safe, efficient, and generalizable framework for rehabilitation after flexor tendon repair and other hand disorders, particularly where therapist assistance is unavailable [27]. Patient factors associated with not using hand therapy following digital flexor tendon repair suggest that more uniform clinical practice should be sought [22]. Targeted surgical intervention and undefined therapy intervention seemed to have little influence on activity and participation in hemiplegic cerebral palsy, although wrist/finger biomechanics and active range of motion improved [28]. The less affected hand should be evaluated and included in comprehensive treatment plans for children with hemiplegic cerebral palsy [12]. Hand therapists play an important role in improving overall outcomes for patients [11]. The DASH questionnaire confirmed effectiveness in assessing traumatic hand injury patients, showing significant improvement in scores upon discharge from therapy [34]. There is little evidence to recommend any single management strategy for acute pain after hand injury or surgery [62].

Complications

Stiffness / Arthrofibrosis: Early rehabilitation following hand tendon repair provides benefit [6]. Hand therapy improved functional outcomes and reduced pain at 8 weeks after volar locking plate fixation of distal radius fracture in middle-aged to elderly women compared to independent exercise [2]. Advanced practice hand therapy for long-waitlisted patients with chronic hand conditions was associated with improvements in patient function and satisfaction [9]. Hand surgery combined with early and comprehensive rehabilitation improves function, activity, and patients' satisfaction in patients with disabling spasticity with improvement lasting for at least 1 year [5]. Despite recurrent scarring and contracture in the short and mid term, surgical release can provide significant improvements in hand function for recessive dystrophic epidermolysis bullosa [26].

Functional Recovery and Disease Progression: 70% of patients achieved a functional range of motion at 5 years following treatment with collagenase Clostridium histolyticum injection for Dupuytren's disease [1]. After surgery and hand therapy, disability decreased independent of single or multiple operated fingers in patients with Dupuytren contracture [7]. Safety and social issues of hand function and quality of life had an evident association with functional recovery in patients with Dupuytren's disease [3]. Risk of disease progression and expectations following hand reconstruction must be managed carefully in patients with Hirayama disease [19]. Intermediate long-term results of hand transplants have demonstrated functional return similar to that of replants [25]. Hand transplant is an effective treatment in selected patients with continual improvements in function seen for up to 5 years [4].

Other Considerations: Hand therapy resulted in statistically and clinically significant improvement in pain, grip strength, upper extremity function, and health related quality of life for breast cancer survivors experiencing aromatase inhibitor-associated musculoskeletal syndrome in the hands and wrists [13]. The Arpe implant for trapeziometacarpal total joint arthroplasty has an acceptable long-term survival rate and restores good hand function [17]. A novel finger grip dynamometer system can quantify a patient's symptoms easily and objectively by measuring each finger's grip strength at one time and recording the time course of grip motion [10]. Hand abduction tracings are a quantitative outcome measure to follow recovery over time for intrinsic hand function in patients with severe ulnar neuropathy following surgical intervention [18]. A patient with a subtotal thumb metacarpal defect regained satisfactory grip and thumb function with minimal donor site morbidity following reconstruction with a vascularized medial femoral condyle flap [29].

Recovery

Light activity (weeks): Specific timelines for light activity are not explicitly defined in the available evidence; however, functional improvements are noted at 8 weeks following surgery and hand therapy for distal radius fracture [2], and significant functional range of motion is achieved at 5 years following collagenase injection for Dupuytren's disease [1].

Full activity (months): Functional recovery trajectories vary by procedure, with hand transplants showing continual improvements for up to 5 years [4] and intermediate results demonstrating functional return similar to replants at 8 and 6 years post-transplant [25]. For patients with disabling spasticity, hand surgery combined with early rehabilitation improves function and satisfaction for at least 1 year [5]. In cases of recessive dystrophic epidermolysis bullosa, surgical release provides significant functional improvements despite recurrent scarring in the short and mid-term [26].

Complete recovery / outcome plateau (months): Long-term outcomes stabilize over extended periods, with the Arpe implant demonstrating acceptable survival and restored hand function at a minimum of 10 years follow-up for trapeziometacarpal total joint arthroplasty [17]. Hand function significantly improves with 70% of patients achieving a functional range of motion at 5 years following collagenase Clostridium histolyticum injection for Dupuytren's disease [1]. Disability decreases independent of single or multiple operated fingers after fasciectomy for Dupuytren contracture [7].

Rehabilitation protocol: Hand therapy improves functional outcomes and reduces pain at 8 weeks after surgery compared to independent exercise in middle-aged to elderly women with volar locking plate fixation of distal radius fracture [2]. Findings suggest the benefit of early rehabilitation after hand tendon repair [6]. Advanced practice hand therapy for long-waitlisted patients with chronic hand conditions is associated with improvements in patient function and satisfaction [9]. Risk of disease progression and expectations following hand reconstruction must be managed carefully in patients with Hirayama disease [19].

Functional milestones: Safety and social issues of hand function and quality of life have an evident association with functional recovery after surgery and hand therapy in patients with Dupuytren's disease [3]. Range of motion, grip strength, and radiographic outcomes are similar between groups for distal radius fracture surgery, with very low and comparable complication and revision rates [30]. Hand abduction tracings serve as a quantitative outcome measure to follow recovery over time for intrinsic hand function in patients with severe ulnar neuropathy following surgical intervention [18]. A novel finger grip dynamometer system can quantify symptoms objectively to contribute to the evaluation of hand function [10].

Other Considerations: Delaying replantation of digits overnight yields results comparable with immediate replantation in selected cases [70].

Key Evidence

  • [L4] Hand function was significantly improved, with 70% achieving a functional range of motion at 5 years. (10.1177/17531934211002383)
  • [L2] Hand therapy improved functional outcomes and reduced pain at 8 weeks after surgery compared to independent exercise. (10.1016/j.jhsa.2021.08.009)
  • [L4] Safety and social issues of hand function and quality of life had an evident association with functional recovery. (10.1016/j.jht.2014.11.006)
  • [L4] Hand transplant is an effective treatment in selected patients with continual improvements in function seen for up to 5 years. (10.1177/17531934251325654)
  • [L2] Hand surgery combined with early and comprehensive rehabilitation improves function, activity and patients' satisfaction in patients with disabling spasticity with improvement lasting for at least 1 year. (10.1177/1753193420918743)
  • [L4] Our findings suggest the benefit of early rehabilitation after hand tendon repair. (10.1016/j.jht.2014.09.005)
  • [L4] After surgery and hand therapy, disability decreased independent of single or multiple operated fingers. (10.1016/j.jhsa.2014.04.029)
  • [L4] The ICF HandA provides a consensus on outcome measures and instruments to systematically assess function in patients with hand injuries and disorders. (10.1177/1753193417706248)
  • [L3] Advanced practice hand therapy for long-waitlisted patients with chronic hand conditions was associated with improvements in patient function and satisfaction. (10.1016/j.jht.2019.08.003)
  • [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] Hand therapists can play an important role in improving overall outcomes for patients. (10.1016/j.jht.2017.12.001)
  • [L3] The less affected hand should be evaluated and included in comprehensive treatment plans for these children. (10.1177/1558944721990803)
  • [L4] This study demonstrates that hand therapy resulted in statistically and clinically significant improvement in pain, grip strength, upper extremity function, and health related quality of life. (10.1016/j.jht.2025.01.007)
  • [L4] Hand therapy is essential to maintain and further surgical improvement of passive extension and to regain active extension following surgery. (10.1016/j.jht.2014.12.004)
  • [L1] We suggest that therapeutic activities that mimic ADL may be more beneficial than standard rehabilitation activities in the management of an injured hand. (10.1016/j.jhsa.2007.08.008)
  • [L2] The Arpe implant has an acceptable long-term survival rate and restores good hand function. (10.1177/1753193419871660)
  • [L4] Hand abduction tracings are a quantitative outcome measure to follow recovery over time for intrinsic hand function and can be used in patients with severe ulnar neuropathy following surgical intervention. (10.1016/j.jht.2023.09.005)
  • [L4] Risk of disease progression and expectations following hand reconstruction must be managed carefully. (10.1016/j.jhsa.2024.06.010)
  • [L5] Current evidence regarding the diagnosis of hand compartment syndrome is based mostly on case reports and small case series with varying etiology, lacking a consensus reference standard or reliable diagnostic criteria. (10.1016/j.jhsa.2015.01.034)
  • [L4] There is a specific association between the category of hand disorder and the underlying pathology and prognosis. (10.1016/j.jhsa.2013.04.047)
  • [L3] Patient factors associated with not using hand therapy suggest that more uniform clinical practice should be sought. (10.1016/j.jht.2024.07.002)
  • [L2] The large heterogeneity in the outcome domains being assessed/measured across studies highlights the need for a consistent core outcome set to be measured in future clinical research on hand flexor tendon injuries. (10.1177/17531934251342732)
  • [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] Intermediate long-term results of hand transplants have demonstrated functional return similar to that of replants. (10.1016/j.jhsa.2008.02.015)
  • [L4] Despite recurrent scarring and contracture in the short and mid term, surgical release can provide significant improvements in hand function. (10.1177/17531934251313989)
  • [L5] The author recommends the partial-range active flexion protocol as a safe, efficient, and generalizable framework for rehabilitation after flexor tendon repair and other hand disorders, particularly where therapist assistance is unavailable. (10.1177/17531934211037112)
  • [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)
  • [Case_report] The patient regained satisfactory grip and thumb function with minimal donor site morbidity. (10.1016/j.jhsa.2014.06.002)
  • [L4] Range of motion, grip strength, and radiographic outcomes are similar between groups, and complication and revision rates were very low and comparable. (10.1016/j.jhsa.2022.12.018)
  • [L4] Dividing the Patient-Rated Wrist and Hand Evaluation into two subscales could reduce the response burden, improve standardization of outcome measurement for clinicians and provide precise insight into patient symptoms. (10.1177/17531934241306287)
  • [L2] Patients with decreased finger motion and various comorbidities may benefit from therapy provided in a clinic under the supervision of a certified hand therapist. (10.1016/j.jhsa.2015.01.036)
  • [L5] Hand therapy plays a critical role in the treatment of upper extremity injuries by coordinating edema control, pain management, and functional recovery. (10.5435/00124635-201008000-00003)
  • [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)
  • [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)
  • [L5] The panel recommends adapting a simpler classification system resembling that for flexor tendons and outlines specific treatment approaches for acute extensor tendon injuries in each zone to facilitate surgical decision-making and rehabilitation. (10.1177/17531934251363138)
  • [L4] Finger strength was statistically significantly reduced, but its clinical relevance remains unclear. (10.1186/s12891-025-08776-9)
  • [L3] This study shows that even though the range of wrist motion and the strength of the wrist and fingers are less than normal, hand function remains good. (10.1177/1753193416651574)
  • [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] Limitations in hand function are common in all types of CP, but characteristics of the disability vary considerably between different CP subtypes. (10.1016/j.jhsa.2008.02.032)
  • [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)
  • [L5] There is a need for consistent hand therapy terminology around activity-based interventions, and both TIDieR and CERT reporting guidelines should be used to ensure thorough description of interventions. (10.1016/j.jht.2020.10.001)
  • [L4] Hand therapy literature consistently addresses body structures and functions but includes activities, participation, and environmental factors less often; the authors recommend increasingly incorporating all WHO ICF domains to demonstrate the societal and personal impact of the profession. (10.1016/j.jht.2010.12.003)
  • [L1] Taping can be an effective option for repositioning the thumb and improves upper extremity function by controlling the thumb in palm mechanically and enabling sensorial input by maintaining the correct hand position. (10.1016/j.jht.2014.09.007)
  • [L1] There is a need for high-quality, collaborative research to guide management of a wider range of common hand injuries. (10.1177/1753193419865897)
  • [L4] Multiple areas that patients identify as representing high-quality care are not reflected in current quality measures for hand surgery. (10.1016/j.jhsa.2018.06.007)
  • [L5] The authors present fundamental muscle-tendon-joint mechanics studies that allow for single-stage surgical reconstruction of hand function and early postoperative activity-based training in patients with cervical spinal cord injuries. (10.1177/1753193419827814)
  • [L4] Improved strength of thumb reconstructions and reduced need for secondary surgery was also displayed. (10.1016/j.jhsa.2011.04.010)
  • [L5] Surgical reconstruction aims to create a stable thumb capable of satisfactory grasp and release by decreasing deformity, balancing muscle forces, and stabilising joints. (10.1177/1753193407087891)
  • [L3] Touch screen technology has become increasingly relevant to hand function in modern society. (10.1016/j.jhsa.2014.12.028)
  • [L2] Positioning the middle finger DIP joint in either extension or 20° of flexion did not significantly affect grip strength or dexterity, allowing other considerations such as appearance to be prioritized. (10.1016/j.jhsa.2014.06.021)
  • [L4] Mirror hand-ulnar dimelia typically involves the entire upper limb, and treatment plans should consider predictors of function at each limb segment rather than just morphology. (10.1177/17531934221116960)
  • [L4] Clinical and radiological measurements showed the efficacy of this reconstruction in increasing the volume and girth of the reconstructed thumb. (10.1016/j.jhsa.2015.02.032)
  • [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)
  • [L1] The randomized study failed to show benefit in a 2-week course of hand therapy after carpal tunnel release using a short incision. (10.1016/j.jhsa.2007.05.001)
  • [L5] Nonoperative treatment using serial casting and splints should be tried before attempting open surgical release, which should be done in selected patients. (10.1016/j.jhsa.2013.03.014)
  • [L4] These insights may inform future biomechanical and clinical research on this underexplored topic. (10.1016/j.jht.2022.12.002)
  • [L1] Orthoses are effective for non-surgical management of pediatric and adult trigger finger using various orthotic options. (10.1016/j.jht.2023.05.016)
  • [L4] Few patients were successfully managed with nonoperative activity modification and physical therapy. (10.1016/j.jhsa.2023.12.013)
  • [L4] However, room still remains for improved thumb motion with both procedures. (10.1016/j.jhsa.2019.12.009)
  • [L1] There is little evidence to recommend any single management strategy for acute pain after hand injury or surgery. (10.1016/j.jht.2019.09.029)
  • [L3] This may suggest that in bilaterally affected children surgery should be done at the non-dominant hand first since this hand would benefit most from surgery-induced body functions improvement. (10.1016/j.jht.2013.11.002)
  • [L2] Intervention with early hand therapy and orthotics may be useful in elderly patients with delayed wound healing. (10.1016/j.jhsa.2015.08.008)
  • [L4] The SSA technique for thumb CMC arthritis reconstruction yields good to excellent long-term clinical outcomes. (10.1177/15589447211003176)
  • [L4] The authors recommend evaluation of specific clinical and imaging findings to grade the injuries and determine suitable therapy. (10.1177/1753193418765716)
  • [L2] This study does not show clear benefit to advocate hand CTA. (10.1016/j.jhsa.2014.08.048)
  • [L4] All participants experienced clinically significant improvements in both body function/structure measurements of hand function and in their ability to participate in activities. (10.1016/j.jht.2008.06.009)
  • [L3] Preoperative narrowing of the thumb webspace and postoperative index finger metacarpophalangeal joint abnormality are associated with worse functional outcomes. (10.1016/j.jhsa.2013.11.002)
  • [L4] The results of delaying replantation of digits overnight give results comparable with those of immediate replantation in selected cases. (10.1016/j.jhsa.2018.03.047)

See Also

References

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[2] Efficacy of Hand Therapy After Volar Locking Plate Fixation of Distal Radius Fracture in Middle-Aged to Elderly Women: A Randomized Controlled Trial. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.08.009

[3] Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease. Journal of Hand Therapy. 2015. DOI: 10.1016/j.jht.2014.11.006

[4] UK Hand and Upper Limb Transplant Service, functional outcomes of the first six patients: A case series. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251325654

[5] Functional outcomes of spasticity-reducing surgery and rehabilitation at 1-year follow-up in 30 patients. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420918743

[6] The benefit of early rehabilitation following tendon repair of the hand: A population-based claims database analysis. Journal of Hand Therapy. 2015. DOI: 10.1016/j.jht.2014.09.005

[7] Hand Function and Quality of Life Before and After Fasciectomy for Dupuytren Contracture. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.04.029

[8] International Classification of Functioning, Disability and Health: development of an assessment set to evaluate functioning based on the Brief ICF Core Set for Hand Conditions – ICF HandA. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417706248

[9] A cohort investigation of patient-reported function and satisfaction after the implementation of advanced practice occupational therapy–led care for patients with chronic hand conditions at eight Australian public hospitals. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2019.08.003

[10] Assessment of grip-motion characteristics in carpal tunnel syndrome patients using a novel finger grip dynamometer system. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-01773-9

[11] Therapist perceptions of best practice as ordered by referral source: An exploratory survey. Journal of Hand Therapy. 2019. DOI: 10.1016/j.jht.2017.12.001

[12] Dexterity of the Less Affected Hand in Children With Hemiplegic Cerebral Palsy. HAND. 2021. DOI: 10.1177/1558944721990803

[13] The effectiveness of hand therapy for breast cancer survivors experiencing aromatase inhibitor-associated musculoskeletal syndrome in the hands and wrists. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.01.007

[14] Severe camptodactyly: A systematic surgeon and therapist collaboration. Journal of Hand Therapy. 2015. DOI: 10.1016/j.jht.2014.12.004

[15] Chapter 29 Hand/Carpal Fractures and Dislocations. 2021.

[16] Comparison of Therapeutic Activities With Therapeutic Exercises in the Rehabilitation of Young Adult Patients With Hand Injuries. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.08.008

[17] Trapeziometacarpal total joint arthroplasty for osteoarthritis: 199 patients with a minimum of 10 years follow-up. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419871660

[18] The hand diagram: A novel outcome measure following supercharged end-to-side anterior interosseous nerve to ulnar nerve transfer in severe compressive ulnar neuropathy. Journal of Hand Therapy. 2024. DOI: 10.1016/j.jht.2023.09.005

[19] Hirayama Disease: Surgical Restoration of Hand Function. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.06.010

[20] Acute Compartment Syndrome of the Hand. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.01.034

[21] Factitious Hand Disorders: Review of 29 Years of Multidisciplinary Care. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.04.047

[22] Hand therapy utilization following digital flexor tendon repair: Trends, timing, predictive factors, and association with reoperation. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.07.002

[23] Developing a core outcome set for hand flexor tendon injuries: a systematic review of treatment outcomes. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251342732

[24] A Randomized Clinical Trial Comparing Immediate Active Motion With Immobilization After Tendon Transfer for Claw Deformity. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.11.014

[25] Outcomes of the First 2 American Hand Transplants at 8 and 6 Years Posttransplant. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.02.015

[26] Clinical and functional outcomes of hand surgery for recessive dystrophic epidermolysis bullosa. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251313989

[27] Rehabilitation after flexor tendon repair and others: a safe and efficient protocol. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/17531934211037112

[28] Pre- and Postsurgical Evaluation of Hand Function in Hemiplegic Cerebral Palsy: Exemplar Cases. Journal of Hand Therapy. 2008. DOI: 10.1197/j.jht.2008.01.001

[29] Functional Reconstruction of Subtotal Thumb Metacarpal Defect With a Vascularized Medial Femoral Condyle Flap: Case Report. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.002

[30] Effect of Time-To-Surgery on Distal Radius Fracture Outcomes: A Systematic Review. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.12.018

[31] Computerized adaptive testing for PRWHE measurements using domains of pain and motor function. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934241306287

[32] Therapist-Supervised Hand Therapy Versus Home Therapy With Therapist Instruction Following Distal Radius Fracture. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.01.036

[33] Therapy After Injury to the Hand. American Academy of Orthopaedic Surgeon. 2010. DOI: 10.5435/00124635-201008000-00003

[34] The_Use_of_Disabilities_of_the_Arm,_Shoulder,_and_Hand_Questionnaire_in_Rehabili_S0894113006002262. n.d..

[35] Intrinsic Hand Muscle Function, Part 2: Kinematic Comparison of 2 Reconstructive Procedures. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.08.098

[36] Kinematic evaluation for impairment of skilled hand function in chemotherapy-induced peripheral neuropathy. Journal of Hand Therapy. 2019. DOI: 10.1016/j.jht.2017.06.003

[37] Extensor tendon repairs: consensus, current guidelines and recommendations. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251363138

[38] Impact of metacarpal shortening on finger strength following non-surgical treatment of spiral and oblique metacarpal shaft fractures. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08776-9

[39] An objective functional evaluation of the flexor carpi ulnaris set of triple tendon transfer in radial nerve palsy. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416651574

[40] The Use of the Motion Analysis System for Evaluation of Loss of Movement in the Finger. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.1999.0344

[41] Hand Function in Cerebral Palsy. Report of 367 Children in a Population-Based Longitudinal Health Care Program. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.02.032

[42] Using the Force–Time Curve to Determine Sincerity of Effort in People with Upper Extremity Injuries. Journal of Hand Therapy. 2011. DOI: 10.1016/j.jht.2010.07.005

[43] Physical activity, targeted therapeutic exercise, and purposeful activity: The need for clarity and patient centeredness. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2020.10.001

[44] Does Hand Therapy Literature Incorporate the Holistic View of Health and Function Promoted by the World Health Organization?. Journal of Hand Therapy. 2011. DOI: 10.1016/j.jht.2010.12.003

[45] Effects of taping the hand in children with cerebral palsy. Journal of Hand Therapy. 2015. DOI: 10.1016/j.jht.2014.09.007

[46] Treatment interventions for hand fractures and joint injuries: a scoping review of randomized controlled trials. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419865897

[47] Defining Quality in Hand Surgery From the Patient’s Perspective: A Qualitative Analysis. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.06.007

[48] Reach out and grasp the opportunity: reconstructive hand surgery in tetraplegia. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419827814

[49] Posttraumatic Reconstruction of the Hand—A Retrospective Review of 87 Toe-to-Hand Transfers Compared With an Earlier Report. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.04.010

[50] THE SRGICAL MANAGEMENT OF THUMB DEFORMITY IN CEREBRAL PALSY. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193407087891

[51] Hand Function With Touch Screen Technology in Children With Normal Hand Formation, Congenital Differences, and Neuromuscular Disease. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.12.028

[52] Simulated Distal Interphalangeal Joint Fusion of the Index and Middle Fingers in 0° and 20° of Flexion: A Comparison of Grip Strength and Dexterity. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.021

[53] Mirror hand-ulnar dimelia: a single centre experience with 13 patients. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221116960

[54] Use of an Axial Flap to Increase the Girth of Wassel IV Thumb Reconstructions. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.02.032

[55] Functional Outcomes After Nonsurgical Treatment of Distal Radius Fractures. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.04.006

[56] Outcomes of Carpal Tunnel Surgery With and Without Supervised Postoperative Therapy. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.05.001

[57] Management of Posttraumatic Proximal Interphalangeal Joint Contracture. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.03.014

[58] The use of exercise relative motion orthoses to improve proximal interphalangeal joint motion: A survey of Australian hand therapy practice. Journal of Hand Therapy. 2023. DOI: 10.1016/j.jht.2022.12.002

[59] Orthotic intervention options to non-surgically manage adult and pediatric trigger finger: A systematic review. Journal of Hand Therapy. 2023. DOI: 10.1016/j.jht.2023.05.016

[60] Thoracic Outlet Syndrome in the Pediatric and Young Adult Population. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.12.013

[61] Nerve Versus Tendon Transfer for Radial Nerve Paralysis Reconstruction. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.12.009

[62] Rehabilitation Interventions for Acute Pain Management After Hand Injury or Surgery: An Evidence Synthesis Overview. Journal of Hand Therapy. 2019. DOI: 10.1016/j.jht.2019.09.029

[63] Stronger relation between impairment and manual capacity in the non-dominant hand than the dominant hand in congenital hand differences; implications for surgical and therapeutic interventions. Journal of Hand Therapy. 2014. DOI: 10.1016/j.jht.2013.11.002

[64] Predictors of Proximal Interphalangeal Joint Flexion Contracture After Homodigital Island Flap. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.08.008

[65] Suture Suspension Arthroplasty for Thumb Carpometacarpal Arthritis Reconstruction: 12- to 14-Year Follow-up. HAND. 2021. DOI: 10.1177/15589447211003176

[66] Lumbrical muscle tear: clinical presentation, imaging findings and outcome. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418765716

[67] The Utility of Hand Transplantation in Hand Amputee Patients. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.08.048

[68] The Effect of Paraffin and Exercise on Hand Function in Persons with Scleroderma: A Series of Single Case Studies. Journal of Hand Therapy. 2009. DOI: 10.1016/j.jht.2008.06.009

[69] The Transverse Bone in Cleft Hand: A Case Cohort Analysis of Outcome After Surgical Reconstruction. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.11.002

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