BACKGROUND:Orthotic management alone or with hand therapy (+HT) are cornerstones of nonoperative management for thumb carpometacarpal osteoarthritis, yet comparative data are scarce. PURPOSE:To compare outcomes over the course of 12 months for orthotic management alone vs +HT for patients with thumb carpometacarpal arthritis. STUDY DESIGN:Prospective observational. METHODS:We identified patients from our ongoing prospective nonoperative carpometacarpal osteoarthritis registry who elected for treatment with orthotic management alone or +HT from 2019-2023. We collected baseline and 1-, 2-, 6-, and 12-month surveys as well as patient-reported outcome measures. We used bivariate mixed-effect regression analyses to compare continuous variables between groups. RESULTS:A total of 25 orthotic management alone and +41 HT patients were identified. The +HT group had significant improvements in brief Michigan Hand Questionnaire (bMHQ) scores from baseline (mean 67 [SD 12]) at 1 and 2 months (53[5] and 51[8], respectively), and for Patient-Reported Outcomes Measurement Information System Pain Interference scores from baseline (56[2]) at 1 and 2 months (51[6] and 51[5], respectively). The orthotic management alone group had significant improvements in bMHQ scores from baseline (mean 63 [SD 15]) at 2 and 6 months (52[10] and 48[9], respectively), and for Patient-Reported Outcomes Measurement Information System Pain Interference scores from baseline (57[5]) at 2 and 6 months (51[9] and 50[8], respectively). Approximately 12% of patients in both groups received a corticosteroid injection by 12 months. CONCLUSIONS:Patients choosing +HT for initial management of their thumb carpometacarpal arthritis had some earlier benefits than those choosing orthotic management alone. Relatively few patients choosing either of these approaches progressed to corticosteroid injections within 12 months of initiating care. We need larger cohorts with better retention to improve comparisons of carpometacarpal osteoarthritis nonoperative care options.
BACKGROUND:Stiffness of the proximal interphalangeal (PIP) joint is a common complication following trauma or surgery. Recurrence remains a clinical challenge due to persistent tissue contractile activity, and no standardized method exists to predict long-term outcomes. PURPOSE:To evaluate the contraction test as a tool for detecting residual contractile activity in patients with PIP joint flexion contracture treated with an elastic tension digital neoprene orthosis, and to assess its usefulness in predicting recurrence of stiffness to guide therapeutic decisions. STUDY DESIGN:Longitudinal retrospective cohort study. METHODS:Fifty-seven patients with PIP joint flexion contracture were treated with an elastic tension digital neoprene orthosis between July and December 2022. Patients were assigned to wear the orthosis either 20-22 hours or 10-14 hours daily during the first three weeks. Passive range of motion and contraction test values were recorded at baseline and during follow-up for up to six months. Improvements in extension and persistence of contractile activity were analyzed. RESULTS:At baseline, the contraction test was positive in all patients. After three weeks, the mean cumulative gain in passive range of motion was 29° in the longer-wear group and 19° in the shorter-wear group. The contraction test remained positive in 95% of patients at this stage. At the end of follow-up, 49% of patients (28/57) achieved a negative contraction test, and no recurrence was observed among those who continued treatment. Conversely, patients with a persistent positive test (51%) showed a higher risk of recurrence despite improvements in extension. The greatest gains in extension occurred during the first three weeks, followed by stabilization at approximately three and a half months. CONCLUSIONS:The contraction test provides an objective measure of residual contractile activity and is useful for predicting recurrence of PIP joint stiffness after treatment with an elastic tension digital neoprene orthosis. It may support clinical decision-making regarding continuation or discontinuation of orthotic treatment, contributing to more personalized management of contractures.
BACKGROUND:After a stroke, wrist and hand dysfunction usually develops from extended non-use and lack of home-based repetitive training, greatly influencing affect daily living and general quality of life. Wearable mobile and traditional electromyography biofeedback devices as biofeedback-based rehabilitation tools offer an intriguing solution for task-specific training, thereby improving user involvement and functional recovery. PURPOSE:The main aim of this study was to find out how satisfied people with wrist and hand dysfunction who had recently had a stroke were with using a wearable mobile biofeedback device (Pheezee) compared to traditional electromyography biofeedback. STUDY DESIGN:Crossover trial. METHODS:Thirty subacute stroke (male 16 and female 14) participants with wrist and hand dysfunction participated in the study. All participants received 1 week of training using the Pheezee, then 1 week using traditional electromyography biofeedback. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) scale measured user satisfaction. RESULTS:The Mann-Whitney U test applied for between-group comparisons. The wearable mobile biofeedback device demonstrated significantly higher user satisfaction in terms of weight, safety, durability, comfort, simplicity of use, and effectiveness (p < 0.05). However, no significant differences were observed between the two modalities concerning adjustment component (p > 0.05). QUEST 2.0 device subscale total eight items were higher in the Pheezee device group (3.69 ± 0.26) compared to the traditional electromyography biofeedback device group (3.18 ± 0.18) mean and SD respectively, demonstrating a mean difference of 0.52 points (16.3% higher user satisfaction). CONCLUSIONS:Wearable mobile biofeedback devices show promise as supportive tools in stroke rehabilitation and can be feasibly integrated into home-based task-specific training programs. Their ability to raise engagement and adherence to rehabilitation could help stroke survivors have better functional results and quality of life.
BACKGROUND:Carpal tunnel syndrome is a prevalent peripheral neuropathy caused by median nerve compression at the wrist, with higher incidence in women. While motor and sensory impairments are well-established, broader effects on cognitive-motor integration and biomechanical properties remain underexplored, necessitating a multidimensional evaluation. PURPOSE:This study aimed to investigate the effects of carpal tunnel syndrome severity on cognitive, sensorimotor, biomechanical, and functional outcomes in women using descriptive and clinical measurement approaches. STUDY DESIGN:Cross-sectional study. METHODS:One hundred female participants (mean age: 42.7 ± 10.1 years) were included: 75 patients with mild, moderate, or severe carpal tunnel syndrome and 25 healthy controls. Laterality judgment was assessed using the Recognise app, and reaction time with the BlazePod system. Motor and sensory functions were evaluated using grip strength (dynamometer), pain intensity (Numerical Rating Scale), two-point discrimination, and nerve conduction studies. Abductor pollicis brevis muscle stiffness was measured with MyotonPRO, and functional status was determined via the Boston Carpal Tunnel Questionnaire. RESULTS:Carpal tunnel syndrome patients showed significantly reduced grip strength (mean difference: 10.9 kg; p < 0.001), longer reaction times (mean difference: 366.5 ms; p < 0.001), and lower laterality judgment accuracy (mean difference: 35.1%; p < 0.001) compared to controls. Sensory conduction velocity declined (mean difference: 54.2 m/s; p < 0.001), while distal motor latency increased (mean difference: 4.7 ms; p < 0.001). Muscle stiffness (F = 33.9, p < 0.001) and pain intensity (F = 73.8, p < 0.001) were significantly higher in severe carpal tunnel syndrome. Reaction time showed moderate negative correlations with grip strength and laterality accuracy (r ≈ -0.53 to -0.58; p < 0.01). CONCLUSIONS:Female patients with carpal tunnel syndrome exhibit impairments in cognitive, sensorimotor, biomechanical, and functional domains. The progressive nature of these impairments and their interrelationships support the need for comprehensive, multidimensional assessment and personalized rehabilitation strategies.
BACKGROUND:Carpal bone mobilization and neural mobilization techniques have been proposed as effective interventions to improve median nerve physiology at the wrist in patients with carpal tunnel syndrome. However, the isolated and immediate effects of these techniques remain unclear. PURPOSE:To analyze the immediate effects of carpal bone mobilization and median nerve mobilization on electrophysiological parameters in patients with carpal tunnel syndrome. STUDY DESIGN:Three-arm, parallel-group randomized controlled trial with 1:1:1 allocation ratio. METHODS:A total of 74 patients with carpal tunnel syndrome (57 women; mean [SD] age: 54.64 [11.80] years) were included. Participants were randomly assigned to three groups: neural-group (n = 25), which received three sets of 15 neural mobilization repetitions; joint-group (n = 24), which received five 30-second applications of carpal bone mobilization; and control-group (n = 25), which received no intervention. Electrophysiological variables were assessed before and immediately after the intervention in all groups. RESULTS:A significant between-group increase in motor conduction velocity was observed in the joint mobilization group compared with the control group (mean difference: 2.23 m/s; 95% CI: 0.81-3.64; p < 0.001) and the neural mobilization group (mean difference: 2.22 m/s; 95% CI: 0.81-3.65; p < 0.001). Within-group analysis showed significant increases in motor conduction velocity (1.94 ± 2.30 m/s; p < 0.001) and sensory conduction velocity (0.96 ± 11.36 m/s; p = 0.01) in the joint mobilization group. Additionally, a significant increase in sensory amplitude (2.30 ± 5.11; p = 0.03) was observed in the neural mobilization group. CONCLUSIONS:Carpal bone mobilization produces immediate improvements in sensory and motor conduction velocities in patients with carpal tunnel syndrome. Neural mobilization may have a modest effect on sensory amplitude of the median nerve; however, these findings should be interpreted with caution.
BACKGROUND:Traumatic elbow and forearm injuries involving a peripheral nerve injury are complex and costly due to combined nerve and soft tissue involvement, often resulting in sensory, motor, and pain impairments that limit daily activities, work, and social participation. Early, comprehensive assessment of peripheral nerve injury associated with elbow or forearm trauma is therefore essential to optimize patient outcomes. PURPOSE:This case series aims to describe the development and practicality of the Upper Extremity Peripheral Nerve Screen (UEPNS) for individuals post elbow/forearm trauma. STUDY DESIGN:Prospective Case series. METHODS:Tool development was informed through recommendations, literature review and clinical experience. Face validity was examined through interviews and survey of hand therapists. A pilot study with clinicians and a case series involving three subjects with elbow trauma was used to examine practicality. RESULTS:UEPNS items were judged to have good face validity, and administration was considered practical by pilot testing. Early identification of peripheral nerve injury occurred in three subjects with elbow/forearm trauma and guided subsequent intervention planning. CONCLUSIONS:The results suggest the UEPNS is a practical screening tool with positive outcomes in identifying a peripheral nerve injury in patients with elbow/forearm trauma and measuring symptoms over the duration of the subject's treatment.
BACKGROUND:Functional impairments in the upper extremities of stroke patients lead to significant limitations in quality of life and independence. Technological developments can create effective treatment alternatives in neurological rehabilitation in upper extremity rehabilitation. PURPOSE:The aim of this study was to evaluate the feasibility and effectiveness of a virtual reality (VR)-mediated gamified upper extremity rehabilitation program added to traditional rehabilitation in patients with hemiplegia. STUDY DESIGN:Randomized-controlled-pilot trial METHODS: Twenty-nine participants with hemiplegia were enrolled in this study between May 2023 and January 2024. Participants were randomized into two groups: VR group (n=15) and control group (n=14). All participants received a conventional rehabilitation program. In addition, participants in the VR group received 20 sessions (45 min each session) of a gamified upper extremity exercise program with a non-immersive VR system, while participants in the control group received 20 sessions (45 min each session) of a home exercise program. The primary outcomes were recruitment rate, dropout rate, safety and adherence. Fugl-Meyer Assessment, Functional Independence Scale (motor subscale), hand grip strength (dynamometer) and Stroke Impact Scale were used as secondary outcome measures. Results are reported using descriptive statistics integrated with qualitative findings. RESULTS:The study included 3.4 stroke patients per month, with a dropout rate of 7%. There were no serious adverse events associated with the VR-mediated upper limb rehabilitation program. The adherence rate of the participants in the VR group was 96%. Group median values in secondary outcome measures (FMA, FIM, handgrip strength, SIS) showed positive changes at 1 and 3 months after the intervention. CONCLUSION:The VR-mediated upper extremity rehabilitation program in stroke patients was safe and showed high adherence, adequate recruitment and dropout rates. Therefore, a definitive study with a higher number of participants can be conducted.
BACKGROUND:Patient education is fundamental in hand rehabilitation; however, evidence regarding the effectiveness of patient education strategies on trauma-related distress, functional outcomes and patient perceptions remains limited. PURPOSE:To compare the effects of verbal, written, and video-based education on trauma-related distress, functional outcomes, and patient perceptions in occupational hand and forearm injuries. STUDY DESIGN:Randomized, controlled, single-blinded, parallel-group clinical trial (NCT06229028). METHODS:Patients aged 18-65 years with occupational hand and forearm injuries were randomly allocated to one of three groups: (1) Verbal(reference), (2) Leaflet, or (3) Video-based instruction. Primary outcomes were post-traumatic stress (Impact of Event Scale-Revised [IES-R]) and state anxiety (State-Trait Anxiety Inventory-State [STAI-S]). Secondary outcomes were hand strength (grip and pinch strength) and hand function (Michigan Hand Outcomes Questionnaire [MHQ]). Normality was assessed using the Shapiro-Wilk test. Between-group comparisons were performed using the Kruskal-Wallis test, and within-group changes were analyzed using the Wilcoxon signed-rank test, with Bonferroni-adjusted post hoc analyses. Effect sizes were calculated. Assessments were conducted at baseline and 3months. RESULTS:Seventy-five patients (mean age: 39.45 ± 10.41 years; 86.7% male) completed the study. Significant within-group reductions in IES-R scores were observed in the leaflet and video-based groups. Mean changes were 5.84 (95% CI:-0.19 to 11.87), 12.84 (95% CI:5.79-19.89), and 13.08 (95% CI:8.31-17.85) points in the verbal, leaflet, and video-based groups, respectively. No significant between-group differences were found for IES-R and STAI-S scores (p > 0.05). A significant overall between-group difference was observed in tip pinch strength (p = 0.039; ε² = 0.06) and the MHQ work performance (p = 0.038; ε² = 0.06), with small effect sizes. Patient perception did not differ across groups (p > 0.05). CONCLUSIONS:Verbal, written, and video-based education were associated with improvements in psychological and functional outcomes following occupational hand and forearm injuries, with no consistent superiority of any single method. Educational delivery format may therefore be tailored according to patient preference and clinical context.
BACKGROUND:Chronic hand pain significantly impacts function and quality of life. While self-management strategies are critical for symptom management, there is limited research on clinicians' perspectives regarding patient adherence to these strategies before and after initiating therapy. PURPOSE:This study aimed to examine self-management strategies prescribed by hand therapists for chronic hand pain and to explore clinician perceptions of patient adherence and effectiveness across the continuum of care. STUDY DESIGN:Cross-sectional survey. METHODS:A survey was distributed to members of the American Society of Hand Therapists (ASHT). Respondents (n = 120) reported their practice patterns, prescribed self-management strategies, perceived patient adherence, and factors influencing strategy use. Descriptive statistics were used to analyze quantitative data, and qualitative responses were thematically analyzed. RESULTS:Most clinicians (92%) reported treating chronic hand pain. Prior to therapy, patients most used over-the-counter medications, prescribed medications, and heat modalities. Clinicians most frequently prescribed exercise/stretching (97%), joint protection strategies (96%), and ergonomic modifications (94%). Heat modalities and exercise/stretching were perceived as the most beneficial strategies, whereas cold modalities and TENS were rated least beneficial. Factors negatively influencing adherence included time constraints, cost, and lack of knowledge, while greater health literacy and access to healthcare providers improved self-management. CONCLUSIONS:Hand therapists actively prescribe self-management strategies for chronic hand pain, but adoption and adherence vary due to multiple factors. Enhancing patient education, addressing barriers, and promoting individualized self-management plans may improve long-term adherence and outcomes. Future research should explore patient perspectives on self-management and its impact on functional outcomes.
Background Manual therapy applications can also be used in the conservative treatment of patients with Glenohumeral Osteoarthritis (GHOA). Purpose To compare the effectiveness of manual therapy plus exercise applications vs exercise alone in patients with GHOA. Study Design A randomized controlled clinical trial. The trial was registered at ClinicalTrials.gov, number NCT03958227. Methods Forty patients with GHOA were evaluated for treatment. The patients were randomly divided into two groups which were the exercise group and manual therapy plus exercise group. Both groups underwent a similar exercise program three times a week for 5 weeks. After drop outs (mean ± SD age, 60.1 ± 8.7 years; 22 female) 30 patients completed the study. Pain, range of motion, muscle strength, functionality, health-related quality of life were assessed with before and after 5 weeks of treatment. Patient satisfaction was assessed after treatment. Results After treatment, a statistically significant improvements in pain, joint range of motion, muscle strength, functionality, and quality of life were observed in both groups (p < 0.05). Shoulder internal rotation (p = 0.03), (ES = 0.15) and external rotation (p = 0.04), (ES = 0.25) ROM, abduction, internal rotation and external rotation muscle strength (p = 0.01, p = 0.009, p = 0.03), (ES = 0.21, ES = 0.22, ES = 0.14) DASH (p = 0.005), (ES = 0.25) and ASES (p = 0.005), (ES = 0.24) and PCS-12 (p = 0.004), (ES = 0.25) scores were improved in favor of the manual therapy group between groups. Conclusions Adding manual therapy to exercise programs in patients with Glenohumeral Osteoarthritis may be effective in reducing pain, increasing joint range of motion, muscle strength, functionality, and quality of life.
Background Early rehabilitation is important after distal radius fractures, but evidence for Proprioceptive Neuromuscular Facilitation remains limited. Purpose This study aimed to evaluate the effect of a Proprioceptive Neuromuscular Facilitation-based early exercise program on functional prognosis after surgical fixation of distal radius fractures, compared with standard postoperative care. Study Design A retrospective observational study. Methods In this retrospective observational study, 114 surgically treated patients from January-December 2023 were allocated to a control group receiving standard postoperative care or an early exercise group receiving additional Proprioceptive Neuromuscular Facilitation-based exercise starting 3-4 weeks after surgery. Outcomes included wrist range of motion, grip strength, pain level, Disabilities of the Arm, Shoulder, and Hand (DASH) score, time to return to work, and radiographic healing at 12 weeks. Results At 6 weeks after surgery, the early exercise group showed greater wrist flexion (4.9°), extension (4.3°), pronation (5.4°), and supination (4.9°) than the control group. Grip strength was 3.1 kg higher (p = 0.002), Visual Analog Scale pain scores were 1.4 points lower (p = 0.001), and the mean DASH score was better (p = 0.015). Time to return to work was shorter (p = 0.002), and the healing rate at 12 weeks after surgery was higher (p = 0.002). Conclusions Proprioceptive Neuromuscular Facilitation-based early exercise significantly enhanced wrist motion, grip strength, pain relief, and disability reduction, leading to faster return to work and improved fracture healing. These results support incorporating structured Proprioceptive Neuromuscular Facilitation-based rehabilitation into standard postoperative care for distal radius fractures.
Background: Physical therapy is crucial for rehabilitating hand function after spinal cord injury (SCI), but it is time-and effort-intensive. New approaches that foster engagement and accelerate motor learning are needed. Purpose: This study examined whether augmented sensory feedback (ASF) delivered through virtual reality (VR) can improve motor performance and neural activation in persons with SCI. Study Design: Experimental study. Methods: VR compatibility was integrated with a custom-developed smart glove system that informs users when secure object grasp was achieved during training of functional grasp tasks. Six participants with incomplete cervical-level SCI performed a grasp-and-place task under three training conditions: no ASF, glove-based ASF, and VR-based ASF. Training trial-blocks provided multimodal (visual and audio) ASF cues about secure grasp at progressively reduced delays to induce a sense of agency through conditioned perceptions of intentional binding. Results: Compared with no ASF, VR-based ASF significantly improved performance (p < 0.05) for metrics of reduced motion path length (51.5%) and shorter trial completion times (-44.6%). VR training also correspondingly produced the greatest increases in electroencephalography activity. Conclusions: Findings should be interpreted cautiously, given the small sample size and single-session design. Still, results from this study suggest VR-enhanced ASF can positively support motor learning and neuroplasticity after SCI through greater cognitive-level engagement. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Background Parkinson's disease is a movement disorder that causes progressive limitations in the upper extremity. The cervical region plays an important role in sensorimotor control because it contains intense proprioceptive afferents. Purpose This study aimed to examine the effect of cervical sensorimotor training on upper extremity in Parkinson's disease within the framework of International Classification of Functioning, Disability, and Health (ICF). Study Design A single-center, single-blinded, randomized controlled trial (Clinical Trials Registration Number: NCT05241015). Methods Twenty-seven Parkinson's disease patients (63.4 ± 8.74 years of age) were randomly divided into the control group (n = 12) and the cervical sensorimotor training (n = 15). While control group received conventional physiotherapy for upper extremity, the cervical sensorimotor training group received cervical sensorimotor training additionally (3 days/8 weeks, 24 sessions). Body structure and functions (BS&F) were evaluated with the Unified Parkinson's Disease Rating Scale (UPDRS) I-III-Total, Fahn Tolesa Marin (FTM) clinical tremor rating scale, finger tapping test (FTT), New York posture rating chart, Parkinson fatigue scale, grip/pinch strength, Craniocervical Flexion Test (CCFT), cervical muscles endurance tests, joint position error (JPE), Semmes Weinstein Monofilament Test (SWMT), and pressure pain threshold. Activity and participation (A&P) were evaluated with UPDRS II, Purdue Pegboard Test (PPT), dual tasks on PPT, Disabilities of the Arm, Shoulder, and Hand (DASH), and Parkinson's Disease Questionnaire (PDQ-39). Results In BS&F, a significant improvement in favor of the cervical sensorimotor training group was observed in cervical, shoulder, elbow, and wrist JPE, CCFT activation score, and CCFT performance index (p < 0.05); however, there were no significant differences between groups in UPDRS I-III-Total, FTM clinical tremor rating scale, FTT, New York posture rating chart, Parkinson fatigue scale, cervical muscles endurance tests, grip/pinch strength, SWMT, or pressure pain threshold (p > 0.05). In A&P, a significant improvement in favor of the control group was found only in the PDQ-39 ADL subscale score (p < 0.05). No significant differences were observed between groups in UPDRS II, PPT, dual tasks on PPT, DASH, or other subparameters of PDQ-39 (p > 0.05). Conclusions Cervical sensorimotor training appears to be more effective in increasing the strength and endurance of deep cervical muscles, cervical proprioception, and proprioception of all joints in upper extremity in BS&F within the framework of ICF in Parkinson's disease.
Background The ability to engage in upper extremity rehabilitation exercise is shaped as much by a patient’s identity, values, beliefs and daily realities as it is by their physical impairments and diagnosis. Purpose and Design Written by a person living with chronic neck, shoulder and hand pain, this message to clinicians paper describes how psychological and social factors influence patients’ engagement in upper extremity rehabilitation exercises. Key messages The narrative explains that a patient’s trust in their therapist supports engagement in exercises, but that trust is not automatic and grows only after feeling seen, heard, and treated with dignity and respect. It considers how therapists’ own assumptions, viewpoints, and power positions can shape the rehabilitation goals that are prioritized, how exercise adherence is interpreted and how “success” in rehabilitation is defined. Factors such as pain, fear, exhaustion, motivation, time, finances, and available support are not barriers to overcome, but real-life circumstances to work with because they shape a patient’s ability to engage in prescribed exercises. Conclusions Tailoring exercise therefore requires reflection, partnership, creativity, and an understanding of the context patients live in.
Background Residual symptoms after carpal tunnel release are often unexplained by static diagnostic methods. This case highlights a potentially overlooked cause: proximal median nerve gliding dysfunction. Purpose To report a case of persistent post-carpal tunnel release thumb numbness diagnosed and treated using dynamic ultrasonography and targeted manual therapy. Study Design Case report. Methods A woman in her 40s had persistent thumb numbness 2 years after endoscopic carpal tunnel release for carpal tunnel syndrome (ICD-10: G56.0). Dynamic short-axis ultrasonography with manual provocation was performed at the proximal elbow. A diagnostic hydrorelease and subsequent ultrasound-guided neuromobilization were used. Nerve excursion and symptoms were tracked for a 2-year follow-up. Results Dynamic ultrasonography revealed absent median nerve excursion relative to the brachial artery at the proximal elbow. Diagnostic hydrorelease produced immediate but transient symptom relief. After five weekly sessions of ultrasound-guided neuromobilization, nerve excursion increased, and the patient's symptoms resolved. At 2-year follow-up, the patient remained symptom-free with sustained dynamic gliding. Conclusions Clinicians should consider dynamic proximal median nerve dysfunction in patients with persistent symptoms after carpal tunnel release. Dynamic ultrasonography is a valuable tool for identifying this overlooked pathology, and targeted ultrasound-guided therapies may provide effective treatment.
