Pub Date : 2026-01-30DOI: 10.1016/j.jhsg.2025.100944
Eileen M. Colliton MD , John R. Fowler MD
Purpose
Carpal tunnel syndrome (CTS) is a common compressive neuropathy with no gold standard for diagnosis. The CTS-6 questionnaire is a previously validated tool used to determine the likelihood that a patient has CTS; however, numbness and tingling in the median nerve distribution is not a required symptom for a positive test result. The purpose of this study was to re-evaluate the components of the CTS-6 questionnaire to determine if a more succinct carpal tunnel screening tool could be developed.
Methods
A database of 295 upper extremities who had previously undergone CTS-6 testing were analyzed. All charts were reviewed to determine which patients were offered carpal tunnel release, used as the reference standard for a true positive diagnosis. We split the data into training (80%) and test (20%) sets that were used to develop and validate a decision tree for CTS, respectively. The performance metrics for this decision tree, the CTS-6 questionnaire, and variations of the questionnaire were calculated.
Results
The CTS-6 had a sensitivity of 76%, specificity of 60%, and overall accuracy of 71%. Variations of the CTS-6 had sensitivity of 72% to 93% and specificity of 37% to 65%, where a higher sensitivity came at the cost of lower specificity. The CTS decision tree had the best performance metrics, with 100% sensitivity, 65% specificity, and 88% overall accuracy.
Conclusions
A simple CTS decision tree has the potential to be an efficient screening tool to assist in determining which patients may be a good candidate for carpal tunnel release. Further investigation into this screening tool in a larger patient population should be performed to determine its usefulness in a clinical setting.
{"title":"Analysis of the CTS-6 Questionnaire and Development of a Carpal Tunnel Syndrome Decision Tree","authors":"Eileen M. Colliton MD , John R. Fowler MD","doi":"10.1016/j.jhsg.2025.100944","DOIUrl":"10.1016/j.jhsg.2025.100944","url":null,"abstract":"<div><h3>Purpose</h3><div>Carpal tunnel syndrome (CTS) is a common compressive neuropathy with no gold standard for diagnosis. The CTS-6 questionnaire is a previously validated tool used to determine the likelihood that a patient has CTS; however, numbness and tingling in the median nerve distribution is not a required symptom for a positive test result. The purpose of this study was to re-evaluate the components of the CTS-6 questionnaire to determine if a more succinct carpal tunnel screening tool could be developed.</div></div><div><h3>Methods</h3><div>A database of 295 upper extremities who had previously undergone CTS-6 testing were analyzed. All charts were reviewed to determine which patients were offered carpal tunnel release, used as the reference standard for a true positive diagnosis. We split the data into training (80%) and test (20%) sets that were used to develop and validate a decision tree for CTS, respectively. The performance metrics for this decision tree, the CTS-6 questionnaire, and variations of the questionnaire were calculated.</div></div><div><h3>Results</h3><div>The CTS-6 had a sensitivity of 76%, specificity of 60%, and overall accuracy of 71%. Variations of the CTS-6 had sensitivity of 72% to 93% and specificity of 37% to 65%, where a higher sensitivity came at the cost of lower specificity. The CTS decision tree had the best performance metrics, with 100% sensitivity, 65% specificity, and 88% overall accuracy.</div></div><div><h3>Conclusions</h3><div>A simple CTS decision tree has the potential to be an efficient screening tool to assist in determining which patients may be a good candidate for carpal tunnel release. Further investigation into this screening tool in a larger patient population should be performed to determine its usefulness in a clinical setting.</div></div><div><h3>Type of study/level of evidence</h3><div>Diagnostic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100944"},"PeriodicalIF":0.0,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1016/j.jhsg.2025.100923
Laura S. Dameron BS , Nicholas C. Bank MD , Narayan Raghava MD , Stephen Himmelberg MD , Gregory M. Knoll MD
Purpose
The primary aim was to compare postoperative complications at 90 days and 1 year following trigger finger release (TFR) in patients with versus without glucagon-like peptide-1 receptor agonist (GLP-1 RA) exposure. GLP-1 RAs are increasingly used for managing diabetes and obesity. These drugs’ impact on surgical outcomes, particularly wound healing and fibrosis, is not well understood.
Methods
A retrospective matched cohort study was conducted using the TriNetX US Collaborative Network. Patients undergoing TFR were stratified by GLP-1 RA exposure within 1 year before or after surgery. Propensity score matching was applied to balance demographics, metabolic risk factors, and comorbidities. Primary outcomes included rates of scarring, postoperative pain, wound complications, and repeat TFR at both 90 days and 1 year.
Results
Each cohort included 4,283 matched patients. GLP-1 RA exposure was associated with significantly increased risk of scarring (90 days: 1.5% vs 0.9%, 1 year: 2.3% vs 1.5%), postoperative pain (90 days: 13.2% vs 10.6%, 1 year: 21.6% vs 16.9%), and wound complications (90 days: 1.7% vs 0.9%, 1 year: 2.3% vs 1.4%). Repeat TFR was significantly higher only at 1 year (11.4% vs 9.5%). There were no significant differences in infection rates, systemic complications, or health care utilization at either timepoint.
Conclusions
GLP-1 RA use is independently associated with increased risks of postoperative pain, scarring, wound complications, and repeat surgery following TFR. The delayed increase in repeat TFR suggests a possible long-term effect on tendon or wound healing that warrants further investigation.
Type of study/level of evidence
Prognostic III.
目的：比较暴露胰高血糖素样肽-1受体激动剂（GLP-1 RA）与未暴露胰高血糖素样肽-1受体激动剂（GLP-1 RA）患者在触发指释放（TFR） 90天和1年后的术后并发症。GLP-1 RAs越来越多地用于治疗糖尿病和肥胖症。这些药物对手术结果的影响，特别是伤口愈合和纤维化的影响，目前还不清楚。方法采用TriNetX美国协同网络进行回顾性匹配队列研究。通过术前或术后1年内GLP-1 RA暴露对TFR患者进行分层。倾向评分匹配用于平衡人口统计学、代谢危险因素和合并症。主要结局包括90天和1年的疤痕率、术后疼痛、伤口并发症和重复TFR。结果每组纳入匹配患者4283例。GLP-1 RA暴露与瘢痕形成（90天：1.5% vs 0.9%， 1年：2.3% vs 1.5%）、术后疼痛（90天：13.2% vs 10.6%， 1年：21.6% vs 16.9%）和伤口并发症（90天：1.7% vs 0.9%， 1年：2.3% vs 1.4%）的风险显著增加相关。重复TFR仅在1年时显著升高（11.4% vs 9.5%）。两组在感染率、全身并发症或医疗保健利用方面均无显著差异。结论：glp -1 RA的使用与TFR术后疼痛、瘢痕、伤口并发症和重复手术的风险增加独立相关。重复TFR的延迟增加表明可能对肌腱或伤口愈合有长期影响，值得进一步研究。研究类型/证据水平预后
{"title":"The Influence of Glucagon-like Peptide-1 Receptor Agonists on Outcomes Following Trigger Finger Release","authors":"Laura S. Dameron BS , Nicholas C. Bank MD , Narayan Raghava MD , Stephen Himmelberg MD , Gregory M. Knoll MD","doi":"10.1016/j.jhsg.2025.100923","DOIUrl":"10.1016/j.jhsg.2025.100923","url":null,"abstract":"<div><h3>Purpose</h3><div>The primary aim was to compare postoperative complications at 90 days and 1 year following trigger finger release (TFR) in patients with versus without glucagon-like peptide-1 receptor agonist (GLP-1 RA) exposure. GLP-1 RAs are increasingly used for managing diabetes and obesity. These drugs’ impact on surgical outcomes, particularly wound healing and fibrosis, is not well understood.</div></div><div><h3>Methods</h3><div>A retrospective matched cohort study was conducted using the TriNetX US Collaborative Network. Patients undergoing TFR were stratified by GLP-1 RA exposure within 1 year before or after surgery. Propensity score matching was applied to balance demographics, metabolic risk factors, and comorbidities. Primary outcomes included rates of scarring, postoperative pain, wound complications, and repeat TFR at both 90 days and 1 year.</div></div><div><h3>Results</h3><div>Each cohort included 4,283 matched patients. GLP-1 RA exposure was associated with significantly increased risk of scarring (90 days: 1.5% vs 0.9%, 1 year: 2.3% vs 1.5%), postoperative pain (90 days: 13.2% vs 10.6%, 1 year: 21.6% vs 16.9%), and wound complications (90 days: 1.7% vs 0.9%, 1 year: 2.3% vs 1.4%). Repeat TFR was significantly higher only at 1 year (11.4% vs 9.5%). There were no significant differences in infection rates, systemic complications, or health care utilization at either timepoint.</div></div><div><h3>Conclusions</h3><div>GLP-1 RA use is independently associated with increased risks of postoperative pain, scarring, wound complications, and repeat surgery following TFR. The delayed increase in repeat TFR suggests a possible long-term effect on tendon or wound healing that warrants further investigation.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100923"},"PeriodicalIF":0.0,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1016/j.jhsg.2025.100904
J. Terrence Jose Jerome MBBS, DNB
Impacted fractures of the base of the middle phalanx frequently lead to joint incongruity and functional impairment. Although percutaneous intramedullary elevation of depressed articular fragments has been described previously, PRIME (Percutaneous—Pin, Reduce, Internal Fixation, Mobilize Early) represents a technical refinement that emphasizes true closed intramedullary disimpaction under local anesthesia, fully subcutaneous short-cut K-wire fixation, and a protocol of immediate active postoperative proximal interphalangeal (PIP) motion. It was applied in six consecutive patients with acute impacted base of the middle phalanx fractures involving the PIP joint. At final follow-up, patients demonstrated average PIP flexion of 90°, a mean visual analog scale pain score of 0.5, and a Disability of the Arm, Shoulder and Hand score of 1.3. Radiographs confirmed maintained reduction and union in all cases, with no major complications. The PRIME technique may provide a reproducible, minimally invasive method for restoring joint congruity and promoting early motion while reducing the risk of stiffness and soft tissue trauma. By integrating stable fixation and immediate rehabilitation, PRIME facilitates rapid recovery and excellent functional outcomes with minimal postoperative discomfort.
{"title":"Percutaneous Intramedullary Reduction of Impacted Fractures at the Base of the Middle Phalanx: Surgical Technique","authors":"J. Terrence Jose Jerome MBBS, DNB","doi":"10.1016/j.jhsg.2025.100904","DOIUrl":"10.1016/j.jhsg.2025.100904","url":null,"abstract":"<div><div>Impacted fractures of the base of the middle phalanx frequently lead to joint incongruity and functional impairment. Although percutaneous intramedullary elevation of depressed articular fragments has been described previously, PRIME (Percutaneous—Pin, Reduce, Internal Fixation, Mobilize Early) represents a technical refinement that emphasizes true closed intramedullary disimpaction under local anesthesia, fully subcutaneous short-cut K-wire fixation, and a protocol of immediate active postoperative proximal interphalangeal (PIP) motion. It was applied in six consecutive patients with acute impacted base of the middle phalanx fractures involving the PIP joint. At final follow-up, patients demonstrated average PIP flexion of 90°, a mean visual analog scale pain score of 0.5, and a Disability of the Arm, Shoulder and Hand score of 1.3. Radiographs confirmed maintained reduction and union in all cases, with no major complications. The PRIME technique may provide a reproducible, minimally invasive method for restoring joint congruity and promoting early motion while reducing the risk of stiffness and soft tissue trauma. By integrating stable fixation and immediate rehabilitation, PRIME facilitates rapid recovery and excellent functional outcomes with minimal postoperative discomfort.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100904"},"PeriodicalIF":0.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1016/j.jhsg.2025.100936
Adam Mosa MD, MSc , Neill Y. Li MD , Alexander Chamessian MD, PhD , Lara W. Crock MD, PhD , Catherine M. Curtin MD , Allan Belzberg MD , Sarah Buday PhD , Bryan J. Loeffler MD , Christopher Janney , Mark A. Mahan MD , Amy M. Moore MD
Neuropathic pain following brachial plexus and peripheral nerve injury represents one of the most debilitating and least effectively treated sequelae of nerve trauma.
Where are we now?
Neuropathic pain affects a majority of patients with severe nerve injuries and is frequently more disabling than associated motor or sensory deficits. The current scientific understanding implicates maladaptive peripheral and central nervous system changes, including neuroma formation, nociceptor hyperexcitability, central sensitization, and cortical reorganization. Contemporary management relies on multimodal strategies incorporating rehabilitation, pharmacotherapy, psychological support, neuromodulation, and select surgical interventions; however, most patients experience only partial or temporary relief, underscoring the persistent gap between mechanistic insight and durable clinical benefit.
Where do we need to go?
There remains a critical need for more effective, durable, and patient-centered approaches to neuropathic pain. Improved stratification tools, including biologic, imaging, and electrophysiologic biomarkers, are required to guide personalized treatment selection. Existing preclinical models inadequately capture the psychosocial and functional dimensions of pain, limiting translational relevance. Future therapies must better integrate biological, technological, and psychosocial domains while prioritizing pain relief as an outcome equal in importance to motor and sensory recovery.
How do we get there?
Progress will depend on multidisciplinary collaboration that aligns surgical innovation, targeted pharmacologic therapies, neuromodulation technologies, and structured psychological support. One target for growth in the field will be establishing multicenter registries and consensus-built outcome measures, which will be essential to evaluate real-world effectiveness and inform best practices. Continued refinement of biologically rational surgical strategies, emerging neuromodulation platforms, and integrative rehabilitation tools offer a pathway toward care models that address both pain and function. Meaningful improvements in quality of life for patients with nerve injury–related neuropathic pain may be achieved.
{"title":"Perioperative Treatment of Neuropathic Pain (Nerve SPACE 2025)","authors":"Adam Mosa MD, MSc , Neill Y. Li MD , Alexander Chamessian MD, PhD , Lara W. Crock MD, PhD , Catherine M. Curtin MD , Allan Belzberg MD , Sarah Buday PhD , Bryan J. Loeffler MD , Christopher Janney , Mark A. Mahan MD , Amy M. Moore MD","doi":"10.1016/j.jhsg.2025.100936","DOIUrl":"10.1016/j.jhsg.2025.100936","url":null,"abstract":"<div><div>Neuropathic pain following brachial plexus and peripheral nerve injury represents one of the most debilitating and least effectively treated sequelae of nerve trauma.</div></div><div><h3>Where are we now?</h3><div>Neuropathic pain affects a majority of patients with severe nerve injuries and is frequently more disabling than associated motor or sensory deficits. The current scientific understanding implicates maladaptive peripheral and central nervous system changes, including neuroma formation, nociceptor hyperexcitability, central sensitization, and cortical reorganization. Contemporary management relies on multimodal strategies incorporating rehabilitation, pharmacotherapy, psychological support, neuromodulation, and select surgical interventions; however, most patients experience only partial or temporary relief, underscoring the persistent gap between mechanistic insight and durable clinical benefit.</div></div><div><h3>Where do we need to go?</h3><div>There remains a critical need for more effective, durable, and patient-centered approaches to neuropathic pain. Improved stratification tools, including biologic, imaging, and electrophysiologic biomarkers, are required to guide personalized treatment selection. Existing preclinical models inadequately capture the psychosocial and functional dimensions of pain, limiting translational relevance. Future therapies must better integrate biological, technological, and psychosocial domains while prioritizing pain relief as an outcome equal in importance to motor and sensory recovery.</div></div><div><h3>How do we get there?</h3><div>Progress will depend on multidisciplinary collaboration that aligns surgical innovation, targeted pharmacologic therapies, neuromodulation technologies, and structured psychological support. One target for growth in the field will be establishing multicenter registries and consensus-built outcome measures, which will be essential to evaluate real-world effectiveness and inform best practices. Continued refinement of biologically rational surgical strategies, emerging neuromodulation platforms, and integrative rehabilitation tools offer a pathway toward care models that address both pain and function. Meaningful improvements in quality of life for patients with nerve injury–related neuropathic pain may be achieved.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100936"},"PeriodicalIF":0.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1016/j.jhsg.2025.100942
Jenna L. Dvorsky MS , Michael R. Kann BE , Christopher Gonzalez BS , Andrew Gordon BS , James Kim BS , Angela Hardi MS , John Fowler MD
Purpose
In hand and upper-extremity surgery, there are many patient-reported outcome measures (PROMs) used to quantify symptom severity and track patient progress. However, there remains variability and uncertainty regarding the true or most appropriate minimal clinically important difference (MCID) values for each. This systematic review summarized the reported MCIDs for the most commonly used outcome instruments in hand and upper-extremity surgery.
Methods
The published literature was searched using strategies designed by a medical librarian for the concepts of MCID; the Boston Carpal Tunnel Questionnaire; the Disabilities of the Arm, Shoulder, and Hand Score (DASH); the Michigan Hand Outcomes Questionnaire; carpel tunnel syndrome; and other hand/upper limb disorders with related synonyms. These strategies were executed in Embase, Ovid-Medline All, CINAHL Plus, Scopus, and Web of Science from database inception. Studies retrieved from the database literature search were imported to Endnote. Any duplicate citations were identified and removed. The remaining citations were imported to Covidence screening software for further screening analysis.
Results
In total, 25 studies published from 1998 to 2025 were included in final data extraction and analysis. Among these, 9 (36.0%) reported the MCID value for BCTQ, 4 (16.0%) reported the MCID value for the MHQ and DASH, and 12 (48.0%) reported the MCID value for the Quick Disabilities of the Arm, Shoulder, and Hand.
Conclusions
This comprehensive systematic review summarized the reported MCIDs for the Boston Carpal Tunnel Questionnaire, DASH, Quick Disabilities of the Arm, Shoulder, and Hand, and Michigan Hand Questionnaire, all of which are commonly used hand and upper-extremity PROMs. Reported MCIDs for a given PROM can vary not only with the population or diagnosis of patients included but also with the methods used to calculate meaningful change in these patients.
Clinical relevance
This systematic review reports the MCIDs for common hand and upper-extremity outcome measures, providing surgeons with reference values to interpret patient-reported changes, while also demonstrating variability in MCID based on diagnosis and methodology. This can help distinguish meaningful improvement for different clinical and patient settings in addition to aid design of studies with clinically relevant end points in upper-extremity surgery.
在手部和上肢手术中，有许多患者报告的结果测量（PROMs）用于量化症状严重程度和跟踪患者进展。然而，每种方法的真实或最合适的最小临床重要差异（MCID）值仍然存在可变性和不确定性。本系统综述总结了已报道的用于手部和上肢手术的最常用预后器械的MCIDs。方法采用医学图书馆员针对MCID概念设计的策略检索已发表的文献；波士顿腕管问卷；臂、肩、手残疾评分（DASH）；密歇根手部结果问卷；腕管综合征；以及其他有相关同义词的手部/上肢疾病。这些策略在Embase， Ovid-Medline All, CINAHL Plus， Scopus和Web of Science中从数据库建立开始执行。从数据库文献检索中检索到的研究被导入到Endnote。发现并删除任何重复引用。将剩余的引文输入到冠状病毒筛查软件中进行进一步的筛查分析。结果共纳入1998 - 2025年发表的25篇研究，纳入最终数据提取和分析。其中，9例（36.0%）报告了BCTQ的MCID值，4例（16.0%）报告了MHQ和DASH的MCID值，12例（48.0%）报告了手臂、肩部和手部的快速残疾的MCID值。结论本研究对波士顿腕管调查问卷、DASH、手臂、肩膀和手的快速残疾以及密歇根手调查问卷中报道的mcid进行了全面的系统综述，这些都是常用的手部和上肢PROMs。给定胎膜早破所报告的MCIDs不仅随患者的人群或诊断而变化，而且随用于计算这些患者有意义变化的方法而变化。本系统综述报告了常见手部和上肢预后指标的mccid，为外科医生解释患者报告的变化提供了参考价值，同时也证明了基于诊断和方法的MCID的可变性。这有助于区分不同临床和患者环境下的有意义的改善，并有助于设计具有上肢手术临床相关终点的研究。
{"title":"Reported Minimal Clinically Important Differences for Patient-Reported Outcome Measures in Hand and Upper-Extremity Surgery: A Systematic Review","authors":"Jenna L. Dvorsky MS , Michael R. Kann BE , Christopher Gonzalez BS , Andrew Gordon BS , James Kim BS , Angela Hardi MS , John Fowler MD","doi":"10.1016/j.jhsg.2025.100942","DOIUrl":"10.1016/j.jhsg.2025.100942","url":null,"abstract":"<div><h3>Purpose</h3><div>In hand and upper-extremity surgery, there are many patient-reported outcome measures (PROMs) used to quantify symptom severity and track patient progress. However, there remains variability and uncertainty regarding the true or most appropriate minimal clinically important difference (MCID) values for each. This systematic review summarized the reported MCIDs for the most commonly used outcome instruments in hand and upper-extremity surgery.</div></div><div><h3>Methods</h3><div>The published literature was searched using strategies designed by a medical librarian for the concepts of MCID; the Boston Carpal Tunnel Questionnaire; the Disabilities of the Arm, Shoulder, and Hand Score (DASH); the Michigan Hand Outcomes Questionnaire; carpel tunnel syndrome; and other hand/upper limb disorders with related synonyms. These strategies were executed in Embase, Ovid-Medline All, CINAHL Plus, Scopus, and Web of Science from database inception. Studies retrieved from the database literature search were imported to Endnote. Any duplicate citations were identified and removed. The remaining citations were imported to Covidence screening software for further screening analysis.</div></div><div><h3>Results</h3><div>In total, 25 studies published from 1998 to 2025 were included in final data extraction and analysis. Among these, 9 (36.0%) reported the MCID value for BCTQ, 4 (16.0%) reported the MCID value for the MHQ and DASH, and 12 (48.0%) reported the MCID value for the Quick Disabilities of the Arm, Shoulder, and Hand.</div></div><div><h3>Conclusions</h3><div>This comprehensive systematic review summarized the reported MCIDs for the Boston Carpal Tunnel Questionnaire, DASH, Quick Disabilities of the Arm, Shoulder, and Hand, and Michigan Hand Questionnaire, all of which are commonly used hand and upper-extremity PROMs. Reported MCIDs for a given PROM can vary not only with the population or diagnosis of patients included but also with the methods used to calculate meaningful change in these patients.</div></div><div><h3>Clinical relevance</h3><div>This systematic review reports the MCIDs for common hand and upper-extremity outcome measures, providing surgeons with reference values to interpret patient-reported changes, while also demonstrating variability in MCID based on diagnosis and methodology. This can help distinguish meaningful improvement for different clinical and patient settings in addition to aid design of studies with clinically relevant end points in upper-extremity surgery.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100942"},"PeriodicalIF":0.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1016/j.jhsg.2025.100938
Katherine M. Gerull MD , David M. Brogan MD, MSc , Harvey Chim MD , Bryan J. Loeffler MD , Megan M. Jack MD , Robert J. Spinner MD , Macyn M. Stonner OTD
Where are we?
There have been numerous advances over the last decade in peripheral nerve surgery and rehabilitation following nerve transfers. In particular, advances in nerve allografts, nerve wraps, peripheral nerve sheath tumor treatment, and bionic limb technology have expanded the therapeutic landscape for patients with nerve injuries, tumors, and limb loss. Rehabilitation strategies have improved significantly, largely through advances such as the Donor Activation Focused Rehabilitation Approach. Nerve allografts show promise for short digital nerve gaps, though outcomes for proximal injuries remain controversial. Nerve wraps and connectors are widely available, but their efficacy has been controversial, perhaps due to heterogeneity in materials and limited high-quality research studies. In peripheral nerve sheath tumors, molecular subtyping has improved classification, yet reliable preoperative distinction between benign and malignant tumors remains a challenge. Bionic limb reconstruction has been improved through advances in targeted reinnervation, osseointegration, and myoelectric control, although prosthetic abandonment, phantom limb pain, and high costs remain barriers.
Where do we need to go?
Future progress requires rigorous empirical evidence to define effective rehabilitation protocols, clarifying the role of allografts versus autografts and determining the clinical utility of nerve wraps and connectors. Improved diagnostic tools are necessary for accurate tumor characterization, and novel systemic therapies are needed for malignant tumors with poor survival outcomes. In bionic limb reconstruction, future advances should integrate intuitive prosthetic control, sensory feedback, and improve pain management while ensuring equitable access to these technologies.
How do we get there?
Achieving these goals will require multicenter, nonconflicted, randomized clinical trials; the development of standardized outcome measures; and investment in translational research across cellular biology, imaging, and device development. Collaborative interdisciplinary research is critical to developing evidence-based protocols and technologies. Together, these strategies can continue to accelerate our understanding of peripheral nerve injury, disease, and rehabilitation.
{"title":"Ongoing Clinical Challenges in Nerve Surgery (Nerve SPACE 2025)","authors":"Katherine M. Gerull MD , David M. Brogan MD, MSc , Harvey Chim MD , Bryan J. Loeffler MD , Megan M. Jack MD , Robert J. Spinner MD , Macyn M. Stonner OTD","doi":"10.1016/j.jhsg.2025.100938","DOIUrl":"10.1016/j.jhsg.2025.100938","url":null,"abstract":"<div><h3>Where are we?</h3><div>There have been numerous advances over the last decade in peripheral nerve surgery and rehabilitation following nerve transfers. In particular, advances in nerve allografts, nerve wraps, peripheral nerve sheath tumor treatment, and bionic limb technology have expanded the therapeutic landscape for patients with nerve injuries, tumors, and limb loss. Rehabilitation strategies have improved significantly, largely through advances such as the Donor Activation Focused Rehabilitation Approach. Nerve allografts show promise for short digital nerve gaps, though outcomes for proximal injuries remain controversial. Nerve wraps and connectors are widely available, but their efficacy has been controversial, perhaps due to heterogeneity in materials and limited high-quality research studies. In peripheral nerve sheath tumors, molecular subtyping has improved classification, yet reliable preoperative distinction between benign and malignant tumors remains a challenge. Bionic limb reconstruction has been improved through advances in targeted reinnervation, osseointegration, and myoelectric control, although prosthetic abandonment, phantom limb pain, and high costs remain barriers.</div></div><div><h3>Where do we need to go?</h3><div>Future progress requires rigorous empirical evidence to define effective rehabilitation protocols, clarifying the role of allografts versus autografts and determining the clinical utility of nerve wraps and connectors. Improved diagnostic tools are necessary for accurate tumor characterization, and novel systemic therapies are needed for malignant tumors with poor survival outcomes. In bionic limb reconstruction, future advances should integrate intuitive prosthetic control, sensory feedback, and improve pain management while ensuring equitable access to these technologies.</div></div><div><h3>How do we get there?</h3><div>Achieving these goals will require multicenter, nonconflicted, randomized clinical trials; the development of standardized outcome measures; and investment in translational research across cellular biology, imaging, and device development. Collaborative interdisciplinary research is critical to developing evidence-based protocols and technologies. Together, these strategies can continue to accelerate our understanding of peripheral nerve injury, disease, and rehabilitation.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100938"},"PeriodicalIF":0.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1016/j.jhsg.2025.100940
John Fowler MD , David Wright MD , David Cholok MD , Sandip Biswal MD , Summer Gibbs PhD , Sameer Shah MD , Tom Quick MD , Ek Tsoon Tan PhD , Ryckie Wade PhD , O. Kenny Nwawka MD , Jonathan Winograd MD
<div><h3>Background</h3><div>Localizing nerve injury, defining injury severity, and estimating prognosis are critical factors in surgical decision-making when indicating patients for operative intervention following traumatic nerve injury.</div></div><div><h3>Where are we now?</h3><div>Current methods for localizing nerve injury and determining severity of injury include physical examination, electrodiagnostic studies, imaging including ultrasound and magnetic resonance imaging, and surgical exploration. However, these methods remain suboptimal, especially in cases of segmental or multilevel injury as is often seen in blunt force trauma as well as in cases of partial (axonotmetic) injury. A period of observation is often required to determine if spontaneous recovery will occur. In neurotmetic injuries, it is challenging to accurately determine the zone of injury intraoperatively to ensure that reconstruction is performed using healthy, viable nerve. As a result of these shortcomings, it has been difficult to accurately and consistently classify nerve injury according to location and severity which has resulted in difficulty estimating the prognosis for many injuries.</div></div><div><h3>Where do we need to go?</h3><div>Better diagnostic methods are needed to be able to accurately determine the location of nerve injury to direct surgical intervention and determine prognosis, especially in blunt, ballistic, multilevel, or segmental injuries. Additionally, improved methods are needed to evaluate partial axonotmetic injuries in which the epineurium remains grossly intact on inspection intraoperatively, but with varying degrees of axonotmetic injury within the nerve. This includes a need for both noninvasive preoperative imaging and biomarkers as well as intraoperative modalities to more accurately determine the degree of intraneural damage and assist in preoperative indications and intraoperative decision-making. Improving these diagnostic modalities will allow classification of injuries by location and severity on a more consistent and accurate basis, leading to improved ability to estimate prognosis, surgical indications, and intraoperative decision-making.</div></div><div><h3>How do we get there?</h3><div>Emerging diagnostic modalities, including simultaneous positron emission tomography and magnetic resonance imaging, nerve-specific fluorescence imaging, quantitative ultrasound and magnetic resonance imaging, peripheral nerve diffusion tensor imaging, magnetic resonance neurography, polarization-sensitive optical coherence tomography, and serum biomarkers for peripheral nerve injury, offer promising advances that may help better localize and define injury severity in peripheral nerve injury. More research and funding are needed to better understand how best to apply each of these modalities for traumatic nerve injury, leading to broader adoption, more accurate classification and consistent reporting of data that can be linked to patient outcomes
{"title":"Localizing Nerve Injury, Defining Injury Severity, and Estimating Prognosis (Nerve SPACE 2025)","authors":"John Fowler MD , David Wright MD , David Cholok MD , Sandip Biswal MD , Summer Gibbs PhD , Sameer Shah MD , Tom Quick MD , Ek Tsoon Tan PhD , Ryckie Wade PhD , O. Kenny Nwawka MD , Jonathan Winograd MD","doi":"10.1016/j.jhsg.2025.100940","DOIUrl":"10.1016/j.jhsg.2025.100940","url":null,"abstract":"<div><h3>Background</h3><div>Localizing nerve injury, defining injury severity, and estimating prognosis are critical factors in surgical decision-making when indicating patients for operative intervention following traumatic nerve injury.</div></div><div><h3>Where are we now?</h3><div>Current methods for localizing nerve injury and determining severity of injury include physical examination, electrodiagnostic studies, imaging including ultrasound and magnetic resonance imaging, and surgical exploration. However, these methods remain suboptimal, especially in cases of segmental or multilevel injury as is often seen in blunt force trauma as well as in cases of partial (axonotmetic) injury. A period of observation is often required to determine if spontaneous recovery will occur. In neurotmetic injuries, it is challenging to accurately determine the zone of injury intraoperatively to ensure that reconstruction is performed using healthy, viable nerve. As a result of these shortcomings, it has been difficult to accurately and consistently classify nerve injury according to location and severity which has resulted in difficulty estimating the prognosis for many injuries.</div></div><div><h3>Where do we need to go?</h3><div>Better diagnostic methods are needed to be able to accurately determine the location of nerve injury to direct surgical intervention and determine prognosis, especially in blunt, ballistic, multilevel, or segmental injuries. Additionally, improved methods are needed to evaluate partial axonotmetic injuries in which the epineurium remains grossly intact on inspection intraoperatively, but with varying degrees of axonotmetic injury within the nerve. This includes a need for both noninvasive preoperative imaging and biomarkers as well as intraoperative modalities to more accurately determine the degree of intraneural damage and assist in preoperative indications and intraoperative decision-making. Improving these diagnostic modalities will allow classification of injuries by location and severity on a more consistent and accurate basis, leading to improved ability to estimate prognosis, surgical indications, and intraoperative decision-making.</div></div><div><h3>How do we get there?</h3><div>Emerging diagnostic modalities, including simultaneous positron emission tomography and magnetic resonance imaging, nerve-specific fluorescence imaging, quantitative ultrasound and magnetic resonance imaging, peripheral nerve diffusion tensor imaging, magnetic resonance neurography, polarization-sensitive optical coherence tomography, and serum biomarkers for peripheral nerve injury, offer promising advances that may help better localize and define injury severity in peripheral nerve injury. More research and funding are needed to better understand how best to apply each of these modalities for traumatic nerve injury, leading to broader adoption, more accurate classification and consistent reporting of data that can be linked to patient outcomes ","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100940"},"PeriodicalIF":0.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-27DOI: 10.1016/j.jhsg.2025.100935
Ethan Blum MEng , David J. Wright MD , Yusha Katie Liu MD, PhD , Christopher J. Dy MD, MPH.
Background
Treatment of peripheral nerve injury remains one of the most challenging aspects of reconstructive surgery. Functional outcomes remain inconsistent, high-quality evidence is limited, and major knowledge gaps persist.
Where are we now?
When evaluating patients for peripheral nerve injury, the treating physician must ascertain several critical factors to help inform decision-making, including the timing, mechanism, localization, and severity of the injury. Current algorithms rely on history, physical examination, electrodiagnostic studies, imaging, and occasionally operative exploration to establish a diagnosis. The surgeon must decide if the injury will recover spontaneously or if further operative intervention is indicated to achieve the best possible functional outcome. Accurate prognostication remains challenging secondary to the difficulty grouping patients into homogenous cohorts based on patient and injury characteristics, as well as heterogenous outcome measures. Intraoperatively, determining both the severity and zone of injury remains challenging. Surgical treatment strategies include neurolysis, primary repair, nerve grafting, nerve transfer, or tendon transfers. Functional outcomes assessment is currently performed using Medical Research Council muscle grading, range of motion measures, and various sensory measures, which remain subjective with inconsistent intraobserver and interobserver reliability. Nerve-specific patient reported outcomes measures remain limited.
Where do we need to go?
Diagnostic improvements are needed to more quickly and accurately define injury severity and determine which patients will benefit from surgical intervention. Intraoperatively, accurate determination of both the zone of injury and the functional status of the proximal nerve is also needed. Reproducible outcome measures that can be easily adopted across multiple institutions are needed to facilitate high-quality evidence that can help guide treatment decisions.
How do we get there?
Multicenter collaborative efforts are needed to focus clinical research priorities using reproducible diagnostic criteria to accurately define injury severity, establish consistency in surgical techniques and treatment algorithms, and accurately and reproducibly measure outcomes. Further translational efforts in imaging, biomaterials, and basic science research are also needed. By aligning research priorities with patient-centered outcomes, the field can begin to close the gap between surgical innovation and functional recovery.
{"title":"Current Gaps and Future Directions in Brachial Plexus, Upper-Extremity and Lower-Extremity Nerve Injuries (Nerve SPACE 2025)","authors":"Ethan Blum MEng , David J. Wright MD , Yusha Katie Liu MD, PhD , Christopher J. Dy MD, MPH.","doi":"10.1016/j.jhsg.2025.100935","DOIUrl":"10.1016/j.jhsg.2025.100935","url":null,"abstract":"<div><h3>Background</h3><div>Treatment of peripheral nerve injury remains one of the most challenging aspects of reconstructive surgery. Functional outcomes remain inconsistent, high-quality evidence is limited, and major knowledge gaps persist.</div></div><div><h3>Where are we now?</h3><div>When evaluating patients for peripheral nerve injury, the treating physician must ascertain several critical factors to help inform decision-making, including the timing, mechanism, localization, and severity of the injury. Current algorithms rely on history, physical examination, electrodiagnostic studies, imaging, and occasionally operative exploration to establish a diagnosis. The surgeon must decide if the injury will recover spontaneously or if further operative intervention is indicated to achieve the best possible functional outcome. Accurate prognostication remains challenging secondary to the difficulty grouping patients into homogenous cohorts based on patient and injury characteristics, as well as heterogenous outcome measures. Intraoperatively, determining both the severity and zone of injury remains challenging. Surgical treatment strategies include neurolysis, primary repair, nerve grafting, nerve transfer, or tendon transfers. Functional outcomes assessment is currently performed using Medical Research Council muscle grading, range of motion measures, and various sensory measures, which remain subjective with inconsistent intraobserver and interobserver reliability. Nerve-specific patient reported outcomes measures remain limited.</div></div><div><h3>Where do we need to go?</h3><div>Diagnostic improvements are needed to more quickly and accurately define injury severity and determine which patients will benefit from surgical intervention. Intraoperatively, accurate determination of both the zone of injury and the functional status of the proximal nerve is also needed. Reproducible outcome measures that can be easily adopted across multiple institutions are needed to facilitate high-quality evidence that can help guide treatment decisions.</div></div><div><h3>How do we get there?</h3><div>Multicenter collaborative efforts are needed to focus clinical research priorities using reproducible diagnostic criteria to accurately define injury severity, establish consistency in surgical techniques and treatment algorithms, and accurately and reproducibly measure outcomes. Further translational efforts in imaging, biomaterials, and basic science research are also needed. By aligning research priorities with patient-centered outcomes, the field can begin to close the gap between surgical innovation and functional recovery.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100935"},"PeriodicalIF":0.0,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-24DOI: 10.1016/j.jhsg.2025.100943
Sarah Romans MD , Adam Mosa MD , Lindley B. Wall MD, MSc
Purpose
Upper-extremity surgery for children with cerebral palsy (CP) aims to address spasticity, improve function, and enhance quality of life. Although previous research has focused on functional outcomes, limited data exist regarding the broader impact of these surgeries on families. This study examines the psychosocial, functional, and familial impacts of upper-extremity surgery in CP patients, which in turn would to inform preoperative education and postoperative support strategies.
Methods
Parents/guardians of children with CP who underwent upper-extremity surgery at least 6 months prior were recruited. Participants completed the validated Impact on Family Scale survey and participated in semistructured interviews exploring family experiences. Thematic analysis of interview transcripts was performed, with intercoder reliability achieved through independent coding. Survey data were analyzed to identify common family impacts.
Results
Thirteen interviews were conducted (11 parents, two patients). Thematic analysis identified six overarching themes: (1) functional and mobility improvements, including range of motion; (2) independence in activities of daily living; (3) positive cosmetic impacts; (4) patient psychosocial outcomes, such as increased confidence and social engagement; (5) family-level psychosocial outcomes, including stress during recovery and the importance of external family support systems; and (6) interactions with the care team. Impact on Family Scale survey results had a mean score of 55.1 and revealed that psychosocial and financial burdens varied, with the highest agreement for statements emphasizing normalization of the child’s condition.
Conclusions
Upper-extremity surgery for CP has profound physical and psychosocial impacts on both patients and their families. Improvements in functional independence, confidence, and aesthetics were commonly observed; however, emotional challenges during recovery were notable. The findings underscore the importance of setting realistic expectations, providing robust preoperative education, and ensuring access to psychosocial support systems. Future studies should investigate longitudinal outcomes and interventions to better support families during the surgical journey.
{"title":"Impact on Families of Upper Extremity Surgical Treatment for Children with Cerebral Palsy","authors":"Sarah Romans MD , Adam Mosa MD , Lindley B. Wall MD, MSc","doi":"10.1016/j.jhsg.2025.100943","DOIUrl":"10.1016/j.jhsg.2025.100943","url":null,"abstract":"<div><h3>Purpose</h3><div>Upper-extremity surgery for children with cerebral palsy (CP) aims to address spasticity, improve function, and enhance quality of life. Although previous research has focused on functional outcomes, limited data exist regarding the broader impact of these surgeries on families. This study examines the psychosocial, functional, and familial impacts of upper-extremity surgery in CP patients, which in turn would to inform preoperative education and postoperative support strategies.</div></div><div><h3>Methods</h3><div>Parents/guardians of children with CP who underwent upper-extremity surgery at least 6 months prior were recruited. Participants completed the validated Impact on Family Scale survey and participated in semistructured interviews exploring family experiences. Thematic analysis of interview transcripts was performed, with intercoder reliability achieved through independent coding. Survey data were analyzed to identify common family impacts.</div></div><div><h3>Results</h3><div>Thirteen interviews were conducted (11 parents, two patients). Thematic analysis identified six overarching themes: (1) functional and mobility improvements, including range of motion; (2) independence in activities of daily living; (3) positive cosmetic impacts; (4) patient psychosocial outcomes, such as increased confidence and social engagement; (5) family-level psychosocial outcomes, including stress during recovery and the importance of external family support systems; and (6) interactions with the care team. Impact on Family Scale survey results had a mean score of 55.1 and revealed that psychosocial and financial burdens varied, with the highest agreement for statements emphasizing normalization of the child’s condition.</div></div><div><h3>Conclusions</h3><div>Upper-extremity surgery for CP has profound physical and psychosocial impacts on both patients and their families. Improvements in functional independence, confidence, and aesthetics were commonly observed; however, emotional challenges during recovery were notable. The findings underscore the importance of setting realistic expectations, providing robust preoperative education, and ensuring access to psychosocial support systems. Future studies should investigate longitudinal outcomes and interventions to better support families during the surgical journey.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100943"},"PeriodicalIF":0.0,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-24DOI: 10.1016/j.jhsg.2025.100939
Eliana B. Saltzman MD , Daniel Y. Hong MD , Roger Cornwall MD , Heather L. Baltzer MD, MSc , Thomas J. Wilson MD , Jenny M. Dorich PhD, CHT , Caroline Miller , Avi M. Giladi MD, MS , Paige M. Fox MD, PhD
Because of the relative infancy of peripheral nerve injury research, there is a lack of standardization of nomenclature and language. The lack of consistency among researchers and publications leads to difficulties assessing outcomes and comparing across patients, surgeons, and interventions.
Where Are We Now?
Current efforts in nerve research are focused on determining appropriate-study outcomes and the validation of these for both physicians and patients to reflect the goals of care. Siloed efforts across multiple institutions and specialties limit progress.
Where Do We Need to Go?
Future efforts in peripheral nerve injury clinical research should focus on aligning multiple core outcome sets in a reproducible fashion across similar conditions while integrating the patient experience. As outcomes are being implemented, there is a need to measure them accurately using group consensus and technology to limit bias.
How Do We Get There?
Collaboration between experts through individual surgeons and societal efforts to align on a minimal core set of outcomes is paramount. Integration into the electronic medical record will increase the feasibility of surgeons to use these outcomes as both research and clinical tools.
{"title":"Challenges in Clinical Research for Nerve Injuries (Nerve SPACE 2025)","authors":"Eliana B. Saltzman MD , Daniel Y. Hong MD , Roger Cornwall MD , Heather L. Baltzer MD, MSc , Thomas J. Wilson MD , Jenny M. Dorich PhD, CHT , Caroline Miller , Avi M. Giladi MD, MS , Paige M. Fox MD, PhD","doi":"10.1016/j.jhsg.2025.100939","DOIUrl":"10.1016/j.jhsg.2025.100939","url":null,"abstract":"<div><div>Because of the relative infancy of peripheral nerve injury research, there is a lack of standardization of nomenclature and language. The lack of consistency among researchers and publications leads to difficulties assessing outcomes and comparing across patients, surgeons, and interventions.</div></div><div><h3>Where Are We Now?</h3><div>Current efforts in nerve research are focused on determining appropriate-study outcomes and the validation of these for both physicians and patients to reflect the goals of care. Siloed efforts across multiple institutions and specialties limit progress.</div></div><div><h3>Where Do We Need to Go?</h3><div>Future efforts in peripheral nerve injury clinical research should focus on aligning multiple core outcome sets in a reproducible fashion across similar conditions while integrating the patient experience. As outcomes are being implemented, there is a need to measure them accurately using group consensus and technology to limit bias.</div></div><div><h3>How Do We Get There?</h3><div>Collaboration between experts through individual surgeons and societal efforts to align on a minimal core set of outcomes is paramount. Integration into the electronic medical record will increase the feasibility of surgeons to use these outcomes as both research and clinical tools.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100939"},"PeriodicalIF":0.0,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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