Abstract Background Hand osteoarthritis (HOA) is a common and disabling condition that impairs hand function. Traditional joint protection programs (JPPs) are recommended for reducing pain and deformity and potentially slowing disease progression. While JPPs are supported by trials, programs are outdated, not co-designed and poorly implemented. Behavioral science frameworks and patient co-design methodologies may enhance relevance, adherence, effectiveness, and sustainability. Purpose This study aimed to map and characterize the behavioral components of JPPs for adults with HOA and to examine the extent of patient co‑design. Methods We conducted a scoping review with directed content analysis following Arksey and O’Malley’s framework. We used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines. Six databases and 1 clinical-trial registry were searched from inception to April 3, 2025. Eligible studies included any empirical design that included interventions described as “joint protection” or clearly aligned with its core components for adults with HOA. Two reviewers independently coded intervention content using the Behavior Change Technique Taxonomy version 1 and assessed the presence of patient co-design with criteria derived from Experience-Based Co-Design frameworks. Discrepancies were resolved by consensus. Results A total of 32 studies met the inclusion criteria. We identified 22 unique behavioral change techniques across 11 clusters. “Instruction on how to perform the behavior” was the most common item (32 studies, 100%), followed by “Behavior substitution” (23 studies, 72%) and “Restructuring the Physical Environment” (17 studies, 53%). Patient co-design was explicitly integrated in 8 studies, with varying methods and levels of engagement. In most cases, patient input was included during the intervention design stage, while only a few studies involved patients in iterative feedback and refinement. Only 1 study combined theoretically informed behavioral content with active patient co-design, highlighting a substantial gap in the development of JPPs for HOA. Conclusions Most JPPs for HOA incorporate behavioral change techniques but rarely systematically apply behavior change theory, clearly articulate behavioral change mechanisms or engage patients meaningfully in co-design. Integrating established behavioral frameworks with authentic patient co‑design could yield interventions that are both relevant and sustainable. Future programs development should embed systematic behavioral theory and genuine patient partnership from conception through refinement to support durable behavior change in people with HOA.

PURPOSE:Several clinical practice guidelines (CPGs) have been developed for complex regional pain syndrome (CRPS). The aim of our study was to appraise CPGs for non-pharmacological conservative management of CRPS. MATERIALS AND METHODS:We systematically searched five electronic databases, from inception to January 2025, to include CPGs that focused on non-pharmacological conservative management of CRPS. We used AGREE-II to evaluate the quality of the CPGs. Recommendations, aims, and treatment algorithms of the CPGs were presented in a narrative format, thematic analysis, and matrixes to summarise, categorise, and compare the findings of the guidelines. RESULTS:Nine CPGs met the inclusion criteria, including three updated versions of previously published guidelines. After accounting for updates, six unique guidelines were appraised. Two were rated as high-quality, two as moderate-quality, and two as low-quality. All CPGs scored > 60% in the AGREE-II domains of scope/purpose and clarity of presentation, while rigour of development was the lowest-scoring domain, with only two guidelines achieving ≥ 60%. No guideline addressed updating procedures. The most common interventions recommended by CPGs were pain management (100%) followed by functional restoration (83%), stress-loading (67%), psychotherapy (67%), edema management (67%), gentle active movements (67%), vocational rehabilitation (67%), normal functional activities (67%), general PT interventions (67%), and isometric-isotonic strengthening (67%). CONCLUSION:The methodological quality of many CPGs for non-pharmacological management of CRPS is low, particularly in the domain of rigour of development. Recommendations across guidelines are variable, often lacking detail, consistency, and integration of supporting evidence. Pain management, functional restoration, and inter/multidisciplinary care were the most commonly recommended considerations, while guidance on treatment frequency, dosage, and implementation strategies was limited.

PURPOSE:The purpose of this study was to compare the clinical outcomes, radiographs, and complications of radial head arthroplasty in patients with concomitant Monteggia or transolecranon fracture dislocations to patients with isolated radial head fractures. METHODS:A retrospective cohort comparison was performed, identifying unreconstructible radial head fractures that were treated with radial head arthroplasty. Patients >18 years of age with at least 1 year of follow-up were included. Patients with Monteggia or transolecranon fracture dislocations were matched by age (within 5 years), sex, and smoking status to patients with isolated radial head fractures for comparison. Outcome measures included range of motion, patient-reported outcome scores, complications, and reoperation rates. RESULTS:A total of 58 patients with a Monteggia (n = 38) or transolecranon fracture dislocation (n = 20) met the inclusion criteria and were matched to 58 patients with isolated radial head fractures. Clinical outcomes were similar across all three groups in range of motion and patient-reported outcome scores. There were significantly more complications and reoperations in the Monteggia and transolecranon fracture dislocation groups compared with the isolated radial head fracture group. Functional stiffness (flexion less than 30°-130°) and hardware irritation were more common in the Monteggia and transolecranon groups. Additionally, a higher incidence of ulnohumeral arthritis was identified in patients with transolecranon fractures (grades 3-4, 25%). CONCLUSIONS:There were similar functional outcomes achieved in patients who underwent radial head arthroplasty in Monteggia and transolecranon fracture dislocations compared with isolated radial head fractures. The Monteggia and transolecranon groups had a higher incidence of complications and higher rates of reoperation, specifically hardware irritation and elbow stiffness requiring removal of hardware (proximal ulna plate) and contracture release, respectively. TYPE OF STUDY/LEVEL OF EVIDENCE:Prognostic IV.

INTRODUCTION:Carpal tunnel syndrome may occur in association with distal radial fractures, and decompression is sometimes considered at the time of fixation. The flexor carpi radialis approach used for anterior plating may allow decompression without extending the incision into the palm. This study compared intracarpal canal pressure reduction achieved through this approach and the standard technique. METHODS:Twelve fresh-frozen upper extremities were studied. Within each pair, one limb underwent carpal tunnel release through the flexor carpi radialis approach and the contralateral limb through a standard open palmar incision. A balloon-tipped catheter connected to a pressure transducer was inserted proximal to the wrist crease and advanced distally to measure pressure at 5 mm intervals. The peak-pressure site was identified and used for measurements in the neutral position and during wrist flexion and extension. Measurements were obtained before and after release. Final dissection assessed completeness of release and iatrogenic injury. RESULTS:Pressure increased distally, peaking at 114 (SD 70) mmHg approximately 29 (SD 5) mm distal to the wrist crease, near the hook of the hamate. Pressure increased with both flexion and extension, with higher values in extension (201 (SD 12) mmHg) than flexion (133 (SD 17) mmHg,). Both techniques reduced pressure in the neutral position by approximately 75-85 mmHg. Complete release was confirmed in all specimens without tendon or nerve injury. CONCLUSION:The flexor carpi radialis approach provides pressure reduction comparable to the standard open technique and may allow decompression without a separate palmar incision.

Hand osteoarthritis is a leading cause of pain, disability, and reduced quality of life in older adults. Joint protection programs are recommended as a core component of self-management, but traditional delivery is limited by barriers to access. Digital programs can overcome these challenges for some people, but their reach and effectiveness depend on usability. We conducted a mixed methods usability study of a remotely delivered joint protection program designed for people with hand osteoarthritis. Twenty-three participants took part, recruited through purposeful sampling to ensure inclusion of groups often underrepresented in research. Usability was assessed using predefined task completion, browser-based eye-tracking, participant ratings, and think-aloud protocols, with iterative refinements applied between participants. Routine navigation tasks, such as navigating between different modules, accessing interactive activities, and viewing short videos, were consistently completed with high success. More complex interactive tasks, including drag-and-drop activities, scenario-based modules, and toggling videos to full screen, initially posed challenges. Over successive iterations, however, usability improved markedly, with later participants achieving near-perfect performance. Qualitative analysis revealed that participants valued clear language, short and focused videos, interactive elements, and the ability to proceed at their own pace, while raising concerns about excessive clicking, unclear instructions, and variation in age representation. Iterative refinements, including platform adjustments, clearer instructions and an introductory video, addressed these issues and contributed to improved performance. This study demonstrates that a remotely delivered, technology-enabled joint protection program for hand osteoarthritis is usable, accessible, and engaging across a diverse sample. Beyond refining the program itself, the study introduces a practical framework for iterative, equity-informed usability testing that can inform the design of future digital health interventions.

Objectives:To quantify patient preferences for key joint protection program (JPP) delivery components and identify preference segments to inform a patient-centred, technology-enabled program. Methods:Attributes and levels were developed via three focus groups with 16 people living with hand osteoarthritis (HOA). A discrete choice experiment (six attributes with two levels each; 16 choice tasks; three unlabelled alternatives; no opt-out) was fielded online. Choices were analysed using latent class choice models with effects coding. One to six class solutions were compared by Akaike Information Criterion/Bayesian Information Criterion and segment sizes. Within-class relative attribute importance was calculated from part-worth ranges and overall (class-adjusted) importance was computed using class membership probabilities. Results:A total of 150 participants with HOA completed the survey (89% women; mean age 68 years). Latent class modelling identified five distinct preference segments (segment sizes: 34%, 18%, 10.7%, 21.3% and 16%). Across segments, clinician-led question and answer (Q&A; class-adjusted importance 23.7%) and clinician-delivered exercise demonstrations (21.5%) consistently drove choices. Other features showed marked heterogeneity: one large segment strongly preferred short (2-7 min) videos (importance 56.1%) while others were indifferent to video length; interaction mode split respondents between asynchronous forums and live monthly meetings; and lived-experience guest speakers were valued by some segments but actively traded off by others. Quizzes were conflicting, adding value in some classes and reducing it in others. Conclusion:Delivery preferences were heterogeneous, but clinician involvement Q&A and clinician-led demonstrations anchored preferences. The remaining features functioned as tuneable options. A configurable JPP that preserves clinician touchpoints and allows patients to select preferred formats is best aligned with revealed preferences.

Purpose To compare the mid- to long-term outcomes of radial shortening osteotomy (RSO) and proximal row carpectomy (PRC) in treating Kienböck’s disease, using patient-reported outcomes, functional measures, and rates of secondary surgery. Methods This multicenter cohort study evaluated 47 patients treated between 1998 and 2024 (31 RSOs, 16 PRCs). Radial shortening osteotomy and PRC groups included patients with Lichtman stage 2 through 4 as follows: RSO stage 2, 8 patients; stage 3A, 10 patients; stage 3B, 13 patients; stage 4, 0 patients; PRC stage 2, 0 patients; stage 3A, 3 patients; stage 3B, 9 patients; and stage 4, 4 patients. Primary outcomes included Patient-Reported Wrist Evaluation (PRWE); Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH); and satisfaction scores. Secondary outcomes were grip strength, range of motion, complications, and secondary surgeries. Subgroup comparison of primary and secondary outcomes in Lichtman stages 3A and 3B was performed. Results At a mean follow-up of 10.4 years, RSO patients demonstrated lower and therefore improved PRWE (23.5 [IQR, 12.0-52.5]) and QuickDASH (11.4 [IQR, 6.9-29.5]) scores with higher satisfaction (86%) compared with PRC (PRWE, 38.5 [IQR, 23.0-54.0]; QuickDASH, 23.0 [IQR, 13.6-43.2]; satisfaction, 62%). Radial shortening osteotomy and grip strength were similar between the groups. Reoperation rates were similar, although secondary surgeries in the RSO group were generally more limited than those in the PRC group (eg, hardware removal vs total wrist fusion). Subgroup descriptive comparison confirmed RSO’s benefits even in stages 3A/3B. Conclusions Radial shortening osteotomy offers at least comparable outcomes with PRC in treating Kienböck’s disease, particularly in preserving joint function and patient satisfaction. Interestingly, RSO is also an effective joint-preserving option even in late-stage disease (Lichtman stages 3A/B), demonstrating lower PRWE and QuickDASH scores and higher satisfaction scores than PRC in these groups. Further large-scale studies are needed to confirm these findings and refine treatment protocols. Type of study/level of evidence Therapeutic IV.

Objective To evaluate the impact of an early, female-led orthopaedic workshop series on female medical students’ perceptions of the specialty. Design A mixed-methods study was conducted using paired pre- and post-workshop questionnaires and semi-structured focus groups. First- and second-year female medical students (2022–2025) participated in a two-session workshop led by female orthopaedic surgeons and trainees, consisting of a hands-on skills session and a seminar with discussion. Questionnaire data were analyzed using descriptive statistics and McNemar’s test for paired categorical variables (p<0.05). Qualitative data from free-text responses and five focus groups were thematically analyzed to consensus. Setting Study was conducted at Western University in London, Ontario, Canada. Participants Medical student participants were enrolled at the Schulich School of Medicine & Dentistry in London, Ontario, Canada. Results Forty students participated (mean age 24.4±2.8 years). Self-reported limited or no knowledge of orthopaedic surgery decreased significantly following the workshop (57.6% pre-workshop vs 15.0% post-workshop; p<0.001). Several perceived barriers decreased post-workshop, including viewing a “boys club” culture (70% to 50%; p=0.021), power tool use (25% to 12.5%; p=0.025), and physical strength requirements (60% to 27.5%; p=0.002). Expectation of gender discrimination also decreased (75% to 57.5%; p=0.035), while concern regarding training duration increased (32.5% to 52.3%; p=0.033). Qualitative analysis highlighted perceptions of a male-dominated culture and emphasized the value of female-only spaces and mentorship. Conclusions Early, female-led exposure to orthopaedic surgery was associated with improved knowledge and reduced several perceived barriers among female medical students. Such interventions may support efforts to increase gender diversity in orthopaedic surgery.

Hand osteoarthritis (HOA) is a prevalent chronic condition that impairs quality of life and daily functioning. While joint protection programs (JPPs) offer symptom management, they remain outdated, inaccessible, and poorly tailored to patient needs. This study leverages patient co-design to develop a novel, inclusive, technology-enabled JPP. Using an explanatory sequential design, a survey of 196 participants (88% female, mean age 66 ± 8 years) identified priority activities and challenges for patients with HOA. Key activities of daily living and occupational and functional tasks were rated using a 5-point Likert scale, with a Relative Importance Index (RII) calculated for each item. Qualitative semi-structured interviews with 20 purposefully sampled participants provided in-depth insights into lived experiences with HOA and preferences in JPPs. Quantitative analysis identified high-importance tasks, such as buttoning, gripping, and twisting, with RII scores exceeding 0.8, indicating strong positive sentiment. Functional impairments included issues with precision grip and gross motor tasks, and pain interference disrupted daily activities and social roles. Qualitative themes revealed the importance of strategies for sustaining meaningful activities, patient support communities, and barriers related to accessibility, including technological literacy and caregiving responsibilities. Findings emphasize the importance of co-designing JPPs that address functional impairments, incorporate patient support communities, and consider intersectional barriers. This approach fosters accessibility, adherence, and relevance, paving the way for improved outcomes in patients with HOA.

Background Perilunate fracture-dislocations represent a spectrum of devastating wrist injuries. They typically involve high-energy mechanisms, occur in young patients and are relatively uncommon. Our current knowledge on this rare wrist pathology is limited as most studies involve small retrospective case series and limited follow-up. Purpose The purpose of this study was to examine the functional, radiographic, and patient reported outcomes after perilunate injuries and evaluate surgical practice trends over time. Materials and Methods A retrospective review identified 123 patients who had open reduction and internal fixation of an acute perilunate injury at a single academic centre over a 30-year study period. Post-operative functional, patient-reported, and radiographic outcomes were assessed. The association of various surgical and injury-related variables on outcomes was examined using independent t-tests and ANOVA testing, with post-hoc analysis. Significance was set at p < 0.05. Results Fourty-seven patients participated with a mean follow-up of 14 years. All patients underwent urgent or semi-urgent operative intervention with a dorsal or combined approach. At final follow-up, mean patient-rated wrist evaluation score was 24.2, visual analogue scale pain score was 2.4, flexion-extension arc was 56% of the contralateral side and grip strength was 76%. Patients who underwent re-operation or injured their dominant hand had worse outcomes. Only 9% of patients were unable to return to their same job or a similar job as a result of their injury. Conclusions Overall, patients retain a relatively high level of function and report low pain scores long-term after perilunate injuries. Multi-centre, prospective studies are required going forward.

Background Perilunate spectrum injuries (PSI) are uncommon, but high-energy injuries that result in significant functional implications for patients. The existing literature on PSI is limited to small case-series and there are no evidence-based guidelines for management. Methods This manuscript outlines a protocol for a three-armed, national, multi-centre study, which includes a patient injury registry for PSI, as well as associated retrospective and prospective arms. The primary objective is to establish a national injury registry for patients who present with PSI. The secondary objectives are to examine the long-term clinical and radiographic outcomes of PSI, evaluate progression of these outcomes over time, and to examine the impact of specific operative and injury related factors on outcomes. Discussion This paper describes the protocol for a three-armed, multi-centre study of PSI. It outlines the rationale for the study as well as the relevant methodological details. An injury registry involving multiple centres is valuable given this is an uncommon injury with many potential variables affecting outcomes. Registry-based retrospective and prospective studies will benefit from the large clinical database provided by the registry and could be used to guide evidence-based treatment guidelines which are currently lacking in the literature. Trial registration Clinicaltrials.gov identifier: NCT04370626

OBJECTIVE:To evaluate whether the addition of an orthosis improved the efficacy of cortisone injection for the nonoperative management of trigger finger. DESIGN:Block randomized controlled trial. SETTING:Outpatient hand clinic. PARTICIPANTS:Individuals presenting to our center with Green severity grade 1-3 trigger finger, aged 18-80, were eligible for inclusion (N=226). Exclusion criteria were previous treatment with either a splint or cortisone injection, trigger thumb, >2 digits involved, grade 4 trigger, or an allergy to cortisone (N=118). INTERVENTIONS:Patients' hands were randomized to nighttime extension orthosis, cortisone injection, or combined treatment, stratified by the Green severity score and comorbid diabetes. MAIN OUTCOME MEASURES:Patient-reported outcome measures and the number of triggering occurrences with 10 repeated grips were collected at 6 weeks and 3, 6, and 12 months. RESULTS:The study included 104 patients representing 122 trigger fingers in 115 hands, with an average follow-up of 29 months. At 6 weeks, there was no significant difference in the incidence of triggering, symptom relief, or the Patient-Reported Wrist and Hand Evaluation score between injection or combined treatment groups. The overall success rate with conservative treatment was high, with 68.9% experiencing resolution or improvement of their symptoms. Grade 3 trigger fingers had a significantly higher rate of surgical release compared with lower-grade trigger fingers (39.1% vs 22.4%, P=.05). CONCLUSIONS:Our study shows no significant benefit of adding an orthosis to cortisone injection in all trigger grades. Overall success with conservative treatment was high (68.9%) in this cohort. Conservative management of grade 1 and 2 triggers is successful in about 75% of patients, regardless of whether treatment is an orthosis, injection, or both, compared with a 60% success rate for grade 3.

(1) Knowledge of the complex anatomy of the wrist and carpus is essential in the diagnosis and treatment of their injuries. (2) Injury pattern recognition and a high index of suspicion can ensure prompt treatment to optimize patient’s results. (3) Advanced imaging has improved the evaluation of these injuries and can aid in determining the optimal treatment. (4) Determining whether an injury can be treated nonoperatively or operatively continues to evolve. It involves the evaluation and consideration of many various factors. (5) Appropriate management can lead to excellent results in most complex injuries

BACKGROUND:Although the use of telemedicine has persisted in hand surgery and therapy practices beyond the COVID-19 pandemic, there remains a need for simple, validated means of remotely measuring finger joint range of motion for integration in fast-paced virtual clinics. We propose on-screen measurement, a technique previously validated in the elbow, which involves holding a goniometer up to the telemedicine appointment screen. PURPOSE:This study aimed to determine the reliability and concurrent validity of on-screen measurements relative to the gold standard, in-person goniometry. Congruence of management plans established at virtual and in-person appointments was as a secondary aim. STUDY DESIGN:Prospective Reliability and Agreement (Concurrent Validity) Study. METHODS:Patients with Dupuytren's disease assessed virtually and in-person were recruited from one surgeon's practice. Virtual and in-person measurements in maximal passive extension, time between appointments and treatment plans made at each visit were extracted from patients' charts. In-person assessors were blinded to previous telemedicine-based measurements and, after a 2-week washout period, the original assessor and two additional assessors re-measured joints from screenshots captured at telemedicine appointment. Descriptive and statistical analyses were used to evaluate inter-rater and intra-rater reliability as well as concurrent validity. RESULTS:Fifty-four eligible patients (191 joints; 102 digits) attended telemedicine and in-person appointments at a median of 31 days apart. Inter-rater and intra-rater reliability were excellent (intraclass correlation coefficient >0.96). The absolute mean difference between on-screen and in-person measurements was 8˚, with 61.7% of on-screen measurements falling within 10˚ of in-person measurements. Management plans made at the telemedicine appointment were congruent with those carried out in-person in 96.3% of cases. CONCLUSIONS:On-screen measurement is highly reliable with concurrent validity that compares to similar photography-based measurement studies. Our results suggest on-screen measurement may be a useful tool for initial consultation and triaging of patients with flexion contractures.

BACKGROUND:Complete and partial flexor tendon lacerations are challenging injuries to diagnose and manage. Imaging modalities can determine grade of laceration, and location of tendon ends preoperatively while detecting presence of adhesions, repair failure, and gap formation postoperatively. Despite these clear advantages, imaging modalities are underutilized because of issues with availability and concerns about accuracy. METHODS:A systematic search of MEDLINE and Embase was conducted to identify papers examining the accuracy of ultrasonography (US) and MRI in preoperative and postoperative management of flexor tendon lacerations. COVIDENCE was used in blinded selection of papers for abstract and full-text review. R Studio was used for meta-analysis of pooled sensitivities and specificities, diagnostic odds ratios, and summary receiver operating curves of both US and MRI. RESULTS:A total of 1197 papers were returned, with 40 being selected after full-text review and 24 being sufficient for statistical analysis. Significant heterogeneity existed for preoperative sensitivity of US and MRI, as well as preoperative specificity of US. MRI was more specific than US in the postoperative period (P < 0.01). Diagnostic odds ratios were >1 for all imaging modalities. The area under the curve for summary receiver operating curves in US preoperative, US postoperative, MRI preoperative, and MRI postoperative were 0.92, 0.81, 0.83, and 0.91, respectively. CONCLUSION:MRI is likely more specific than US in postoperative detection of tendon adhesions, tendon rupture, and gap formation following tendon repair. Notable heterogeneities exist in the literature, highlighting the future need for standardized comparisons of imaging modalities in preoperative management.

The purpose of this study was to evaluate carpal joint contact patterns after perilunate injuries and potential associations between functional and radiographic outcomes. Twenty-two patients with a computed tomography (CT) scan at least 2 years postoperatively were reviewed (mean follow-up 15 years). Assessment of carpal degenerative changes was done using Kellgren–Lawrence grading and CT-derived joint space area, which was calculated as the total area with interbone distance less than 2 mm. Increased joint space area signified a greater area with joint space narrowing and cartilage loss. Fifteen patients had severe joint space narrowing at the scaphocapitate and capitolunate joints. Nine and seven patients had severe narrowing at the radiolunate and radioscaphoid joints, respectively. Degenerative changes did not follow a typical scapholunate advanced collapse pattern. Increased scaphocapitate joint space area was associated with worse Patient Rated Wrist Evaluation scores ( r = −0.47, p = 0.02) and visual analogue scale pain scores ( r = −0.44, p = 0.03). This study suggests that patients with more severe degenerative changes after perilunate injuries may have worse functional outcomes. Level of evidence: IV

BACKGROUND:Mirror therapy is an effective intervention for improving outcomes when an affected extremity has severe movement restrictions or pain. PURPOSE:To investigate the effects of mirror therapy interventions on musculoskeletal injuries of the hand/wrist. STUDY DESIGN:Systematic review. METHODS:This systematic review was conducted in accordance with Cochrane and PRISMA guidelines and registered with Open Science Framework (DOI:XXX). The search was conducted in EMBASE, PubMed, and Scopus in April 2024. Search terms included hand and wrist injuries, mirror therapy, pain, range of motion, strength, and function. Descriptive synthesis was used to summarize the data for interventions and outcomes. The Cochrane RoB 2 tool was used for quality assessment. RESULTS:Samples ranged from 22 to 40 participants with a total of 220 participants. Five studies combined mirror therapy with active exercise and had comparator groups performing active exercises for the same duration. Mirror therapy intervention ranged from 20 to 75 minutes per session, two to five times a week for 3-8weeks. Mirror therapy interventions reduced pain, improved range of motion, strength, and function in most studies. Greater improvements for the mirror therapy groups than the comparator group were reported for pain, range of motion, and function in 20%-75% of the studies. Risk assessment for the seven studies resulted in one high, four moderate, and two low quality studies. CONCLUSIONS:Moderate quality evidence suggests that mirror therapy interventions may be effective at reducing pain, improving range of motion, strength and function for musculoskeletal hand and wrist injuries. Further investigation is warranted with larger trials with more homogenous interventions.