Hand Therapy

Limited research exists on the post-operative treatment of extensor pollicis longus (EPL) repair (tendon transfer and direct repair). Early active motion (EAM) and dynamic extension splinting (DES) are becoming more common compared to static casting. The aim of this systematic review was to determine whether EAM was superior to DES post EPL direct repair or tendon transfer. Outcomes of interest included range of motion, strength, and adverse events.

A systematic search of AMED, EBSCO health database (CINAHL, MEDLINE, and SPORTDiscus), and Scopus was completed. Randomised control trials or cohort studies were included if they followed either an EAM or DES rehabilitation protocol and assessed total active motion, grip strength, pinch strength, or range of motion post EPL surgical repairs. Data extracted included the surgical procedure, rehabilitation protocols, and results. The Downs and Black checklist for clinical trial quality assessment was utilised to assess the methodological quality.

Six studies met the inclusion criteria. Five studies included DES and two studies included EAM. Both interventions resulted in improvements in ROM, grip strength and pinch strength with neither intervention being superior. There was no increase in adverse outcomes by using EAM or DES. The risk of bias following assessment of methodological quality of included studies ranged from good to poor.

The use of EAM should be considered post EPL repair or tendon transfer. EAM does not result in superior outcomes post EPL repair compared to DES, equally EAM does not appear to be inferior compared to DES.

Access to hand therapy is a challenge in low to middle-income countries but is also restricted for many communities in high-income countries. As an essential part of the global rehabilitation community, hand therapists must consider how to extend access to basic hand therapy services and strengthen the capacity of the therapists who provide these services. This study aimed to identify capacity-strengthening strategies for generalist occupational therapists responsible for delivering hand therapy in the South African public health service.

A consensus development methodology was employed. A hybrid consensus development conference was used to gather local and international evidence pertinent to the project’s aim. A panel representing service users (n = 2), service providers (n = 5), research (n = 1), education (n = 1) and professional organisations (n = 5) systematically considered the evidence presented at the conference using a nominal group technique.

The panel identified ten priority areas for action: supervision and support; resources; policy, leadership and governance; education and training; professional knowledge and skill; effective referral and care pathways; data and evidence for service improvement; professional attitudes, behaviours and dispositions; inter- and intra-disciplinary action and cohesion; and an intersectoral systems approach.

The priority areas were categorized and are discussed as strategic, educational, organizational, and operational priorities for strengthening the capacity of generalist occupational therapists to deliver quality hand therapy. We suggest ways that both local and global hand therapy communities can take action to position hand therapy as an essential part of universal health coverage.

In hand injuries involving thumb impairment, rehabilitation must be conducted meticulously as it is essential for restoring hand function and facilitating return to daily life and work. The aim of this study is to investigate the effects of prescribing mobile games as home exercises on recovery outcomes in patients with thumb involvement due to thumb injuries and/or carpal tunnel syndrome.

This randomized controlled trial included 31 patients who were randomly assigned to either the routine rehabilitation (RR) group or the mobile game (MG) group. The primary outcome measure was functional status, assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaire. Secondary outcomes included hand function evaluated with the Duruöz Hand Index (DHI), activity-related pain assessed using the Visual Analog Scale (VAS), range of motion (ROM) measured with a goniometer, edema assessed with a tape measure, and adherence to home exercises monitored using a home exercise tracking form.

In both groups, statistically significant improvements were observed in all parameters after treatment compared to baseline (p < 0.05); however, no differences were found in the primary outcome measure (p > 0.05). In the between-group comparison, a significant difference in favor of the MG group was observed only for total active motion of the metacarpophalangeal joint and adherence to home exercises (p < 0.05).

Mobile game–assisted home exercises appear feasible for patients with thumb involvement. While MCP joint motion improved significantly, no differences were found in pain or function. Further research is needed to confirm clinical relevance.

The radial artery forearm flap (RAFF) is a versatile free tissue transfer used for many clinical presentations. RAFF donor sites typically require a split-thickness skin graft (STSG) for closure. Whilst early rehabilitation of RAFF donor site(s) following STSG commonly involves wrist immobilisation, best practice for this immobilisation procedure remains unknown.

The purpose of this study was to systematically ‘map’ wrist immobilisation methods post-STSG of the RAFF wound and explore the impact of immobilisation methods on donor site morbidity.

A scoping review was completed. Literature searching was conducted from database inception to February 1, 2024 in PubMed, Medline, Cochrane, CINAHL, Embase, Web of Science. Title/abstract screening was conducted by one researcher, full text screening was conducted by two researchers independently. Data extraction included number of participants, participant age and gender, wrist immobilisation details and reported donor site complications. Critical appraisal of articles was not completed.

Thirty-seven studies were included in the review. Thermoplastic orthoses (TPO) or ‘splinting’ (n = 22) and plaster casts (n = 8) were the most frequent immobilisation methods reported with 7 days (n = 15) the most frequent immobilisation period. Detail regarding type of TPO material and location/design of the splint/cast was limited. Frequent donor site morbidities included graft complications (n = 18), changes in sensation (n = 9) and infection (n = 7).

Best practice wrist immobilisation procedure for RAFF donor site following STSG cannot be concluded at this time. Additional prospective research is recommended to evaluate the association between wrist immobilisation and donor site morbidity for this complex procedure.

Handedness and hemispheric dominance are thought to influence manual performance, especially dexterity and grip strength, which underpin daily and occupational function. We investigated the effects of handedness and hemispheric dominance (inferred from a neurobehavioral inventory) on dexterity and grip strength, focusing on whether balanced hemispheric dominance confers advantages in mixed-handed/ambidextrous individuals.

This cross-sectional study included 182 adults (aged 19–50 years) who completed the Edinburgh Handedness Inventory to identify hand dominance and a neurobehavioral inventory to assess hemispheric dominance. Grip strength was measured using Constant 14,192-709E and Saehan Pinch Gauge SH5005, while dexterity was evaluated with the Purdue Pegboard Test. Statistical analyses were performed using SPSS 16, with significance set at P < 0.05.

Right-handed participants exhibited significantly higher dexterity in the right hand (P < 0.001), while left-handed individuals showed greater grip strength in both hands, with marginal significance in the right hand (P = 0.046). Mixed-handed/ambidextrous individuals showed significantly higher assembly dexterity scores (P < 0.001). Interhemispheric balance was marginally associated with improved assembly dexterity (P = 0.05), suggesting its role in enhancing motor coordination.

Hand dominance and hemispheric dominance significantly influence motor performance. Balanced hemispheric function in mixed-handed/ambidextrous individuals enhances complex coordination tasks, highlighting potential benefits for rehabilitation strategies. Future research should explore these relationships using neuroimaging techniques and include a broader demographic range to further investigate underlying neural mechanisms.

The objective of this study is to undertake a comparative analysis of the values obtained from the Semmes-Weinstein Monofilament Test (SWMT) when conducted with the eyes open, eyes closed, and in a noisy environment, in a sample of healthy individuals.

The SWMT was applied to 70 healthy individuals with a mean age of 29.0 ± 10.51 years under three conditions: eyes open, eyes closed, and in a noisy environment. The first, second, and fifth fingertips of the subjects were evaluated, with the dominant and non-dominant hands being considered separately. The evaluations conducted with the eyes open and eyes closed were carried out in a quiet environment. The evaluation conducted with the individual’s eyes open was performed with a screen. In the test conducted in a noisy environment, the participants’ eyes were kept open.

The median SWMT values were #2.83 for all tested distal phalanx palmar surfaces in both dominant and non-dominant hands. It was determined that the tests performed with eyes closed on the thumb of the dominant hand gave better results than the tests performed with eyes open (p < 0.01). No statistically significant differences were detected between noisy and quiet testing conditions across the tested sites.

Visual deprivation can enhance tactile detection in healthy individuals. We highlight the significance of visual input in tactile assessments and propose that visual manipulation may serve as a promising approach in somatosensory re-education.

Peripheral nerve injuries can lead to paralysis, sensory loss, chronic pain, and profound psychological and vocational consequences. Recent UK guidelines recommend biopsychosocial rehabilitation, yet qualitative evidence suggest gaps in service provision. This study explored current rehabilitation and perceived barriers among therapists treating adults with peripheral nerve injuries.

A cross-sectional online survey was distributed to UK physiotherapists and occupational therapists experienced in upper and lower limb peripheral nerve injury rehabilitation. Questions captured demographics, treatment strategies before and after reinnervation, access to psychological support, and perceived organisational barriers. Descriptive analysis was undertaken.

Fifty-three respondents (60% physiotherapists, 40% occupational therapists) completed the survey; 70% had more than 10 years’ experience. Ninety eight percent of respondents treated adults with upper limb nerve injuries. Motor and sensory interventions (active and passive range of motion, splinting, strength training, and functional activity) were reported as “always/frequently” used by >80% of respondents. Over a quarter of respondents (28%) occasionally/rarely used pain neuroscience education. Other specific psychological interventions including cognitive behavioural techniques and mindfulness were rarely used (<30% always/frequently). Over half respondents reported no outpatient access to clinical psychology. Organisational barriers included limited time, funding, skilled staff, and absence of local guidelines. However, 83% believed therapists could deliver more psychologically informed care.

UK rehabilitation for adults with peripheral nerve injuries remains predominantly biomedical, with limited integration of psychologically informed care and limited access to Clinical Psychology. Addressing systemic barriers and evaluating digital or hybrid models may enable more biopsychosocial, patient-centred care.

Tendon adhesions after hand surgery can severely impair motion and function. Although early mobilization is preferred, re-ruptures or complex trauma cases often require immobilization, increasing the risk of adhesion.

This report presents two cases—one involving flexor pollicis longus (FPL) tendon re-rupture and another with multiple extensor tendon injuries—treated with a novel flossing intervention aimed at improving tendon gliding and soft tissue flexibility.

In both cases, flossing therapy using a rubber compression band was introduced at 8 weeks postoperatively, following standard immobilization and rehabilitation protocols. Patients performed flossing exercises daily under supervised and home-based conditions.

The FPL case showed an improvement in %TAM from 20.8% to 83.3%, and the extensor tendon case improved from 42.9%–50% to 96.4%–98.4% over 16 weeks. Both patients regained functional range of motion and returned to work without requiring tenolysis. Importantly, these improvements occurred when flossing was paired with active range of motion (AROM) exercises, rather than by flossing alone.

Flossing, particularly when combined with active range of motion (AROM) exercises, may be a useful adjunct to conventional therapy for managing severe adhesions after tendon repair. These case reports suggest that improvements were likely achieved through the combined effect of flossing and conventional active exercises, rather than flossing alone. Further studies are needed to determine the optimal parameters and generalizability of this technique.