Pub Date : 2025-10-01DOI: 10.1016/j.jht.2025.02.004
Maryam Farzad BSc, MSc, PhD, Occupational Therapy, Post-Doctorate Fellowship, Assistant Professor , Tara Packham OTReg, BSc, MSc, PhD, Assistant Professor , Joy MacDermid BSc, MSc, PhD, Professor, Co-Director, Professor Rehabilitation Science , Fatemeh Mohammadi BSc, MSc, Occupational Therapy , Seyed Ali Hosseini BSc, MSc, PhD, OT Professor , Reza Shahriar Kamrani MD, Professor , Hooman Shariatzadeh MD , Ali Koushan MD, Assistant Professor , Seyed Hadi Kalantar MD, Orthopedic Trauma Surgeon , Enayatollah Bakhshi Professor
Background
Complex Regional Pain Syndrome (CRPS) is a debilitating condition with profound physical and psychological impacts, necessitating comprehensive assessment tools for effective evaluation.
Purpose
This study aimed to validate the Persian version of the Hamilton Inventory for Complex Regional Pain Syndrome (HI-CRPS) and assess its reliability and validity in individuals diagnosed with CRPS.
Study Design
A cross-sectional clinical measurement study evaluated the Persian version of HI-CRPS.
Methods
A sample of 64 individuals diagnosed with CRPS from pain and hand surgeon clinics completed the Persian versions of the patient-reported (PR-HI-CRPS) and clinicians based (CB-HI-CRPS). Test-retest reliability was assessed after 1 week, and responsiveness was measured after 3 months. Baseline scores, ceiling effects, internal consistency (Cronbach's alpha), and construct validity (correlations with related measures) were examined. Effect sizes and standardized response means (SRM) were calculated to gauge responsiveness.
Results
Baseline scores for PR-HI-CRPS and CB-HI-CRPS were 77.8 and 14.9, respectively. Around 18% of PR-HI-CRPS and 16% of CB-HI-CRPS respondents exhibited ceiling effects. Internal consistency for PR-HI-CRPS (Cronbach's alpha: 0.71–0.91) and CB-HI-CRPS (alpha: 0.90) was satisfactory. PR-HI-CRPS (ICC: 0.86) and CB-HI-CRPS (ICC: 0.97) showed robust test-retest reliability. Construct validity was confirmed by significant correlations between PR-HI-CRPS subscales and related measures (p < 0.01). Structural validity was confirmed by confirmatory factor analysis. PR-HI-CRPS displayed an effect size of 0.79 and a standardized response mean (SRM) of 0.88.
Conclusions
The Persian version of the HI-CRPS demonstrated satisfactory internal consistency, test-retest reliability, construct validity, and responsiveness. It can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts.
{"title":"Psychometric evaluation of the Hamilton Inventory to evaluate signs and symptoms in patients with Complex Regional Pain Syndrome (CRPS)","authors":"Maryam Farzad BSc, MSc, PhD, Occupational Therapy, Post-Doctorate Fellowship, Assistant Professor , Tara Packham OTReg, BSc, MSc, PhD, Assistant Professor , Joy MacDermid BSc, MSc, PhD, Professor, Co-Director, Professor Rehabilitation Science , Fatemeh Mohammadi BSc, MSc, Occupational Therapy , Seyed Ali Hosseini BSc, MSc, PhD, OT Professor , Reza Shahriar Kamrani MD, Professor , Hooman Shariatzadeh MD , Ali Koushan MD, Assistant Professor , Seyed Hadi Kalantar MD, Orthopedic Trauma Surgeon , Enayatollah Bakhshi Professor","doi":"10.1016/j.jht.2025.02.004","DOIUrl":"10.1016/j.jht.2025.02.004","url":null,"abstract":"<div><h3>Background</h3><div>Complex Regional Pain Syndrome (CRPS) is a debilitating condition with profound physical and psychological impacts, necessitating comprehensive assessment tools for effective evaluation.</div></div><div><h3>Purpose</h3><div>This study aimed to validate the Persian version of the Hamilton Inventory for Complex Regional Pain Syndrome (HI-CRPS) and assess its reliability and validity in individuals diagnosed with CRPS.</div></div><div><h3>Study Design</h3><div>A cross-sectional clinical measurement study evaluated the Persian version of HI-CRPS.</div></div><div><h3>Methods</h3><div>A sample of 64 individuals diagnosed with CRPS from pain and hand surgeon clinics completed the Persian versions of the patient-reported (PR-HI-CRPS) and clinicians based (CB-HI-CRPS). Test-retest reliability was assessed after 1 week, and responsiveness was measured after 3 months. Baseline scores, ceiling effects, internal consistency (Cronbach's alpha), and construct validity (correlations with related measures) were examined. Effect sizes and standardized response means (SRM) were calculated to gauge responsiveness.</div></div><div><h3>Results</h3><div>Baseline scores for PR-HI-CRPS and CB-HI-CRPS were 77.8 and 14.9, respectively. Around 18% of PR-HI-CRPS and 16% of CB-HI-CRPS respondents exhibited ceiling effects. Internal consistency for PR-HI-CRPS (Cronbach's alpha: 0.71–0.91) and CB-HI-CRPS (alpha: 0.90) was satisfactory. PR-HI-CRPS (ICC: 0.86) and CB-HI-CRPS (ICC: 0.97) showed robust test-retest reliability. Construct validity was confirmed by significant correlations between PR-HI-CRPS subscales and related measures (<em>p</em> < 0.01). Structural validity was confirmed by confirmatory factor analysis. PR-HI-CRPS displayed an effect size of 0.79 and a standardized response mean (SRM) of 0.88.</div></div><div><h3>Conclusions</h3><div>The Persian version of the HI-CRPS demonstrated satisfactory internal consistency, test-retest reliability, construct validity, and responsiveness. It can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"38 4","pages":"Pages 858-870"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jht.2025.02.003
Holly Cordray BS , Miguel Fiandeiro BA , Manisha Banala BBA , John R. Vaile BS , Sarah L. Struble MD , Meagan Pehnke MS, OTR/L, CHT, CLT , Apurva S. Shah MD MBA , Shaun D. Mendenhall MD
Background
Assessing upper extremity function accurately in the clinic hinges on valid, reliable outcome measures and patient engagement. Especially in pediatric care and research, video-game-based and play-based assessments may help motivate performance and support more effective clinical evaluation.
Purpose
This systematic review critically appraised the gamified assessments available for pediatric upper extremity function.
Study Design
Systematic review (PROSPERO: CRD42023460034).
Methods
Databases included PubMed, Embase, CINAHL, and Scopus. Eligible studies evaluated psychometrics and included children under 18 years. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, two reviewers independently screened studies, extracted data, assessed risk of bias, and rated psychometrics and evidence quality by the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) methodology.
Results
Reviewers screened 2513 studies; 27 reports describing nine outcome measures were included. The observer-rated Assisting Hand Assessment (AHA) family, which includes four age-based versions for children with unilateral hand dysfunction and the Both Hands Assessment for bilateral dysfunction, has extensive psychometric evidence. These are well-structured, reliable, and feasible assessments that engage patients with age-appropriate toys and board games while evaluating functions such as grasp, fine-motor adjustment, and bimanual coordination. Validation for additional upper extremity conditions is warranted. We also recommend two video-game-based kinematic measures, which quantify upper extremity function objectively. Abilities Captured Through Interactive Video Evaluation (ACTIVE) is appropriate for degenerative neuromuscular diseases; ACTIVE was the only kinematic assessment in this review with at least moderate-quality evidence of sufficient psychometrics. However, based on preliminary evidence, a recently developed dragon-themed video game is a strong candidate for quantifying joint range of motion, potentially serving a broader patient population than ACTIVE.
Conclusions
Overall, we endorse the AHA family as a set of well-structured, reliable, and feasible observer-rated assessments that engage patients through play sessions thoughtfully geared toward different developmental stages. Two kinematic measures are promising and warrant further study.
{"title":"Gamified assessments of pediatric upper extremity function: A systematic review and appraisal","authors":"Holly Cordray BS , Miguel Fiandeiro BA , Manisha Banala BBA , John R. Vaile BS , Sarah L. Struble MD , Meagan Pehnke MS, OTR/L, CHT, CLT , Apurva S. Shah MD MBA , Shaun D. Mendenhall MD","doi":"10.1016/j.jht.2025.02.003","DOIUrl":"10.1016/j.jht.2025.02.003","url":null,"abstract":"<div><h3>Background</h3><div>Assessing upper extremity function accurately in the clinic hinges on valid, reliable outcome measures and patient engagement. Especially in pediatric<span> care and research, video-game-based and play-based assessments may help motivate performance and support more effective clinical evaluation.</span></div></div><div><h3>Purpose</h3><div>This systematic review critically appraised the gamified assessments available for pediatric upper extremity function.</div></div><div><h3>Study Design</h3><div>Systematic review (PROSPERO: CRD42023460034).</div></div><div><h3>Methods</h3><div><span><span>Databases included PubMed, Embase<span>, CINAHL, and </span></span>Scopus. Eligible studies evaluated </span>psychometrics<span> and included children under 18 years. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, two reviewers independently screened studies, extracted data, assessed risk of bias, and rated psychometrics and evidence quality by the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) methodology.</span></div></div><div><h3>Results</h3><div>Reviewers screened 2513 studies; 27 reports describing nine outcome measures were included. The observer-rated Assisting Hand Assessment (AHA) family, which includes four age-based versions for children with unilateral hand dysfunction and the Both Hands Assessment for bilateral dysfunction, has extensive psychometric evidence. These are well-structured, reliable, and feasible assessments that engage patients with age-appropriate toys and board games while evaluating functions such as grasp, fine-motor adjustment, and bimanual coordination. Validation for additional upper extremity conditions is warranted. We also recommend two video-game-based kinematic measures, which quantify upper extremity function objectively. Abilities Captured Through Interactive Video Evaluation (ACTIVE) is appropriate for degenerative neuromuscular diseases<span>; ACTIVE was the only kinematic assessment in this review with at least moderate-quality evidence of sufficient psychometrics. However, based on preliminary evidence, a recently developed dragon-themed video game is a strong candidate for quantifying joint range of motion, potentially serving a broader patient population than ACTIVE.</span></div></div><div><h3>Conclusions</h3><div>Overall, we endorse the AHA family as a set of well-structured, reliable, and feasible observer-rated assessments that engage patients through play sessions thoughtfully geared toward different developmental stages. Two kinematic measures are promising and warrant further study.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"38 4","pages":"Pages 715-725"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jht.2025.02.002
Nathan Short PhD, OTR/L, CHT , Donna Walls OTD, OTR/L, CHT , Marsha Rutland PT, BSPT, MEd, ScD
{"title":"Dry needling: A tool to address tightness of the interossei?","authors":"Nathan Short PhD, OTR/L, CHT , Donna Walls OTD, OTR/L, CHT , Marsha Rutland PT, BSPT, MEd, ScD","doi":"10.1016/j.jht.2025.02.002","DOIUrl":"10.1016/j.jht.2025.02.002","url":null,"abstract":"","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"38 4","pages":"Pages 907-910"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jht.2025.02.014
Ehab Ahmed , Mohamed Raafat Atteya , Aisha Alansari , Rania Youssef , Rehab Ismail , Yasser A. Safoury , Saud M. Alrawaili , Enas Abutaleb , Mohamed Eldesoky
Background
Flexor tendon injuries in zone II of the hand pose serious clinical complications due to the high risk of adhesion formation and suboptimal clinical outcomes, although controlled active motion (CAM) and early passive mobilization (EPM) are standard protocols used during rehabilitation.
Objective
This randomized trial compared functional outcomes between CAM and EPM systems after zone II flexor tendon repair.
Methods
Forty patients with entire zone II flexor digitorum profundus and superficialis tears were randomly assigned to either the CAM or EPM protocol for 12 weeks’ rehabilitation. Total active motion (TAM), grip strength, and disability of the arm, shoulder, and hand (DASH) scores were assessed in the 6th and 12th week after the repair. Two-way mixed ANOVA was used to determine the effect of the treatment regarding the type of protocol and time within and between groups, as well as, Cohen’s d was used to calculate the effect size.
Results
There was a significant improvement over time in both groups for all measured outcomes (p < 0.001). However, CAM showed superior results than EPM across all time points (6th and 12th week); for TAM (p < 0.05, Cohen's d =11.8 and 9.9), grip strength (p < 0.05, Cohen's d = 7.97 and 9.7), and DASH score (p < 0.05, Cohen's d = 5.8 and 5.5). By 12 weeks, 80% of CAM patients achieved an "excellent" rating according to the Strickland formula of the TAM grading compared with 55% for the EPM group.
Conclusion
While both CAM and EPM protocols improve functional status after zone II flexor tendon repair, CAM confers a distinct early advantage in a digital range of motion and manual function compared with EPM. These data support the preferred adoption of the CAM rehabilitation approach after area II flexor tendon surgical repair.
{"title":"A randomized controlled trial comparing controlled active motion and early passive mobilization protocols for rehabilitation of repaired flexor tendons in zone II","authors":"Ehab Ahmed , Mohamed Raafat Atteya , Aisha Alansari , Rania Youssef , Rehab Ismail , Yasser A. Safoury , Saud M. Alrawaili , Enas Abutaleb , Mohamed Eldesoky","doi":"10.1016/j.jht.2025.02.014","DOIUrl":"10.1016/j.jht.2025.02.014","url":null,"abstract":"<div><h3>Background</h3><div>Flexor tendon injuries in zone II of the hand pose serious clinical complications due to the high risk of adhesion formation and suboptimal clinical outcomes, although controlled active motion (CAM) and early passive mobilization (EPM) are standard protocols used during rehabilitation.</div></div><div><h3>Objective</h3><div>This randomized trial compared functional outcomes between CAM and EPM systems after zone II flexor tendon repair.</div></div><div><h3>Methods</h3><div><span>Forty patients with entire zone II flexor digitorum<span> profundus and superficialis tears were randomly assigned to either the CAM or EPM protocol for 12 weeks’ rehabilitation. Total active motion (TAM), grip strength, and disability of the arm, shoulder, and hand (DASH) scores were assessed in the 6th and 12th week after the repair. Two-way mixed ANOVA was used to determine the effect of the treatment regarding the type of protocol and time within and between groups, as well as, Cohen’s </span></span><em>d</em><span> was used to calculate the effect size.</span></div></div><div><h3>Results</h3><div>There was a significant improvement over time in both groups for all measured outcomes (<em>p</em> < 0.001). However, CAM showed superior results than EPM across all time points (6th and 12th week); for TAM (<em>p</em> < 0.05, Cohen's <em>d</em> =11.8 and 9.9), grip strength (<em>p</em> < 0.05, Cohen's <em>d</em> = 7.97 and 9.7), and DASH score (<em>p</em> < 0.05, Cohen's <em>d</em> = 5.8 and 5.5). By 12 weeks, 80% of CAM patients achieved an \"excellent\" rating according to the Strickland formula of the TAM grading compared with 55% for the EPM group.</div></div><div><h3>Conclusion</h3><div>While both CAM and EPM protocols improve functional status<span> after zone II flexor tendon repair, CAM confers a distinct early advantage in a digital range of motion and manual function compared with EPM. These data support the preferred adoption of the CAM rehabilitation approach after area II flexor tendon surgical repair.</span></div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"38 4","pages":"Pages 817-824"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jht.2025.01.002
Ricardo A. Torres-Guzman MD , Virginia Bailey BA , Andrew J. James BS , Justin Stehr OTR/L, CHT , Patrick Assi MD
Background
Restoration of hand function postextended radial forearm free flap (E-RFFF) is vital but challenging due to complex forearm anatomy and potential complications like reduced range of motion and sensory deficits. Traditional rehabilitation protocols often do not effectively address these issues.
Purpose
This study aims to explore the effectiveness of a hand therapy protocol that incorporates early active motion to enhance recovery outcomes after E-RFFF.
Study Design
Case series.
Methods
The protocol was applied retrospectively to eight patients undergoing E-RFFF between 2022 and 2024, assessing variables such as edema, pain, range of motion, strength, and sensation at two postoperative follow-ups.
Results
Initial findings indicate the protocol facilitated improvements in thumb opposition, wrist movements, and forearm rotations with stable sensory outcomes. Pain management and edema control were effectively addressed, highlighting the protocol's comprehensive nature. There were no instances of flap failure among the patients.
Discussion
The approach centers on early active motion, including "Dart Thrower’s Motion,” tailored to individual recovery phases. This method showed promising results in enhancing function and reducing complications, suggesting potential modifications to standard post-E-RFFF care.
Conclusions
The study suggests that integrating early active and patient-specific hand therapy post-E-RFFF can significantly improve outcomes, challenging the conventional reliance on more passive postsurgery practices. Future research should expand on these findings to refine and generalize the protocol.
{"title":"Hand function recovery after extended radial forearm free flap: A case series of a progressive therapy protocol","authors":"Ricardo A. Torres-Guzman MD , Virginia Bailey BA , Andrew J. James BS , Justin Stehr OTR/L, CHT , Patrick Assi MD","doi":"10.1016/j.jht.2025.01.002","DOIUrl":"10.1016/j.jht.2025.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Restoration of hand function postextended radial forearm free flap<span> (E-RFFF) is vital but challenging due to complex forearm anatomy and potential complications like reduced range of motion and sensory deficits. Traditional rehabilitation protocols often do not effectively address these issues.</span></div></div><div><h3>Purpose</h3><div>This study aims to explore the effectiveness of a hand therapy protocol that incorporates early active motion to enhance recovery outcomes after E-RFFF.</div></div><div><h3>Study Design</h3><div>Case series.</div></div><div><h3>Methods</h3><div>The protocol was applied retrospectively to eight patients undergoing E-RFFF between 2022 and 2024, assessing variables such as edema, pain, range of motion, strength, and sensation at two postoperative follow-ups.</div></div><div><h3>Results</h3><div><span>Initial findings indicate the protocol facilitated improvements in thumb opposition, wrist movements, and forearm rotations with stable sensory outcomes. Pain management and edema control were effectively addressed, highlighting the protocol's comprehensive nature. There were no instances of </span>flap failure among the patients.</div></div><div><h3>Discussion</h3><div>The approach centers on early active motion, including \"Dart Thrower’s Motion,” tailored to individual recovery phases. This method showed promising results in enhancing function and reducing complications, suggesting potential modifications to standard post-E-RFFF care.</div></div><div><h3>Conclusions</h3><div>The study suggests that integrating early active and patient-specific hand therapy post-E-RFFF can significantly improve outcomes, challenging the conventional reliance on more passive postsurgery practices. Future research should expand on these findings to refine and generalize the protocol.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"38 4","pages":"Pages 896-902"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The optimal nonoperative treatment for a Boutonniere deformity remains controversial.
Purpose
We aimed to evaluate the effect of nonsurgical treatment methods on finger motion for Boutonniere deformities.
Study Design
Retrospective cohort study.
Methods
Conservative treatments included hand therapy, orthotic wear, and home finger exercises. Digit range of motion (ROM) and injury characteristics also were evaluated. Based upon active ROM at the proximal interphalangeal joint, digits were graded as Poor, Good, or Excellent, and then a change in ROM grade was calculated from pre- to post-treatment for each digit. Standard statistical analyses were performed to evaluate for significant influences on changes in ROM grade.
Results
One hundred and eleven digits (106 patients) were included. Traumatic injury was most common (87.4%). All digits but one received an orthotic. Average treatment and follow-up time was 14.6 weeks. Pre-treatment, there were 63 Poor, 29 Good, and 19 Excellent digits, with average total arc of motion of 47.3, 78.4, 84.2°, respectively (p < 0.01). Post-treatment, there were 28 Poor, 34 Good, and 49 Excellent digits, with average total arc of motion of 57.0, 81.4, 98.4°, respectively (p < 0.01). Forty nine digits had no change in ROM grade post-treatment, 37 had one grade of improvement, 18 had two grades of improvement, and seven had one grade worse. Across these four cohorts, digits that began treatment within 6 weeks of injury had the greatest amount of improvement (p = 0.02), whereas deformity from inflammatory arthritis were less likely to respond to treatment (p = 0.045). Otherwise, there were no differences in type or length of conservative treatment across cohorts (p > 0.1).
Conclusions
Improvement in digit ROM was associated with initiation of treatment within 6 weeks, but not with any particular type or length of conservative treatment. One to two grades of ROM improvement can be achieved, although deformity can persist even after dedicated conservative management.
{"title":"Nonoperative treatment of the Boutonniere deformity: Is there a difference in outcomes?","authors":"Yixuan Tong MD, Megan Donnelly MD, Nader Paksima DO, MPH","doi":"10.1016/j.jht.2025.02.013","DOIUrl":"10.1016/j.jht.2025.02.013","url":null,"abstract":"<div><h3>Background</h3><div>The optimal nonoperative treatment for a Boutonniere deformity remains controversial.</div></div><div><h3>Purpose</h3><div>We aimed to evaluate the effect of nonsurgical treatment methods on finger motion for Boutonniere deformities.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Methods</h3><div>Conservative treatments included hand therapy, orthotic<span><span> wear, and home finger exercises. Digit range of motion (ROM) and injury characteristics also were evaluated. Based upon active ROM at the </span>proximal interphalangeal joint, digits were graded as Poor, Good, or Excellent, and then a change in ROM grade was calculated from pre- to post-treatment for each digit. Standard statistical analyses were performed to evaluate for significant influences on changes in ROM grade.</span></div></div><div><h3>Results</h3><div>One hundred and eleven digits (106 patients) were included. Traumatic injury was most common (87.4%). All digits but one received an orthotic. Average treatment and follow-up time was 14.6 weeks. Pre-treatment, there were 63 Poor, 29 Good, and 19 Excellent digits, with average total arc of motion of 47.3, 78.4, 84.2°, respectively (<em>p</em> < 0.01). Post-treatment, there were 28 Poor, 34 Good, and 49 Excellent digits, with average total arc of motion of 57.0, 81.4, 98.4°, respectively (<em>p</em> < 0.01). Forty nine digits had no change in ROM grade post-treatment, 37 had one grade of improvement, 18 had two grades of improvement, and seven had one grade worse. Across these four cohorts, digits that began treatment within 6 weeks of injury had the greatest amount of improvement (<em>p</em><span> = 0.02), whereas deformity from inflammatory arthritis were less likely to respond to treatment (</span><em>p</em> = 0.045). Otherwise, there were no differences in type or length of conservative treatment across cohorts (<em>p</em> > 0.1).</div></div><div><h3>Conclusions</h3><div>Improvement in digit ROM was associated with initiation of treatment within 6 weeks, but not with any particular type or length of conservative treatment. One to two grades of ROM improvement can be achieved, although deformity can persist even after dedicated conservative management.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"38 4","pages":"Pages 810-816"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jht.2025.02.005
Cameron Van Oort BSc (Kin), MSc (Kin), MScOT, CHT
Background
Annular ligament displacement (ALD) is a common pediatric condition whereby the annular ligament slips over the radius and remains trapped between the radial head and capitellum. It can be reduced with relative ease by performing passive pronation or supination with concomitant pressure over the radial head. However, ALD is more likely to recur after the initial incident, concerning for both the patient and caregivers.
Purpose
This article describes the successful conservative management of a 2 year, 4 month old female patient with recurrent ALD, having occurred six times in an 8 month period.
Methods
The role of an orthosis, targeted exercises, and education for caregivers for treating recurrent ALD is discussed.
Results
At each follow up and final 18 month follow up no ALD events had occurred.
Conclusions
Previous literature discussing treatment for recurrent ALD has examined teaching caregivers to reduce the elbow at home or teaching reductions via telehealth. However, there is a dearth of research around treating the issue so recurrence does not occur. This conservative intervention demonstrates a potential avenue for treating chronic recurrent ALD to eliminate subsequent events.
{"title":"A case report of recurrent annular ligament displacement in a pediatric patient","authors":"Cameron Van Oort BSc (Kin), MSc (Kin), MScOT, CHT","doi":"10.1016/j.jht.2025.02.005","DOIUrl":"10.1016/j.jht.2025.02.005","url":null,"abstract":"<div><h3>Background</h3><div>Annular ligament displacement (ALD) is a common pediatric condition whereby the annular ligament slips over the radius and remains trapped between the radial head and capitellum. It can be reduced with relative ease by performing passive pronation or supination with concomitant pressure over the radial head. However, ALD is more likely to recur after the initial incident, concerning for both the patient and caregivers.</div></div><div><h3>Purpose</h3><div>This article describes the successful conservative management of a 2 year, 4 month old female patient with recurrent ALD, having occurred six times in an 8 month period.</div></div><div><h3>Methods</h3><div>The role of an orthosis, targeted exercises, and education for caregivers for treating recurrent ALD is discussed.</div></div><div><h3>Results</h3><div>At each follow up and final 18 month follow up no ALD events had occurred.</div></div><div><h3>Conclusions</h3><div>Previous literature discussing treatment for recurrent ALD has examined teaching caregivers to reduce the elbow at home or teaching reductions via telehealth. However, there is a dearth of research around treating the issue so recurrence does not occur. This conservative intervention demonstrates a potential avenue for treating chronic recurrent ALD to eliminate subsequent events.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"38 4","pages":"Pages 903-906"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jht.2025.02.007
Kemal Erol Assoc. Prof. MD , Ezgi Akyildiz Tezcan MD , Süleyman Akgöl MD
<div><h3>Background</h3><div><span>Primary Sjögren's syndrome<span> (pSS) is a chronic, systemic autoimmune disease. Musculoskeletal and </span></span>neurological system involvement occurs in patients with pSS, which may lead to impairment in hand function. Hand dysfunction and its underlying causes remain an underexplored area in pSS.</div></div><div><h3>Purpose</h3><div>This study aims to evaluate hand function in patients with newly diagnosed pSS, exploring the associations with disease activity, clinical parameters, and radiographic and ultrasonographic findings.</div></div><div><h3>Study Design</h3><div>Cross-sectional.</div></div><div><h3>Methods</h3><div><span>Fifty patients with newly diagnosed pSS and 50 healthy controls were recruited in this study. Hand functions were evaluated using the Duruöz Hand Index (DHI) and hand grip strength measurements. Detailed hand physical examination was made. Carpal tunnel syndrome<span><span> (CTS) was assessed with the CTS −6 questionnaire and electrodiagnostic<span> methods. Hands A-P radiography was evaluated for joint erosion, joint space narrowing. Ultrasonographic assessment of hand was made for intercarpal and metacarpophalangeal joint </span></span>synovitis<span> and extensor tenosynovitis. Additional evaluations included the </span></span></span>Hospital Anxiety and Depression Scale<span><span> (HADS), Short Form-36 (SF-36), Fatigue severity scale (FSS) and the European League Against </span>Rheumatism (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI).</span></div></div><div><h3>Results</h3><div>Patients with pSS exhibited significantly higher DHI scores compared to controls (<em>p</em> = 0.027, <em>r</em> = 0.22) and lower non-dominant hand grip strength (<em>p</em> = 0.016, <em>r</em> = 0.30), while dominant hand grip strength did not differ significantly (<em>p</em> = 0.520, <em>r</em> = 0.08). Higher HADS anxiety (<em>p</em> < 0.001, <em>r</em> = 0.63) and depression scores (<em>p</em> < 0.001, <em>r</em> = 0.55) were noted in pSS patients. Additionally, these patients had reduced SF-36 scores (<em>p</em> < 0.001, <em>r</em> = 0.53). DHI scores were significantly correlated with ESSDAI (ρ = 0.413, <em>p</em> = 0.003), SF-36 (ρ = −0.605, <em>p</em> < 0.001), HADS (**ρ = 0.307 for anxiety, <em>p</em> = 0.030; ρ = 0.286 for depression, <em>p</em> = 0.044), hand grip strength (ρ = −0.298 for dominant hand, <em>p</em> = 0.036; ρ = −0.280 for non-dominant hand, <em>p</em><span> = 0.049), Health Assessment Questionnaire (HAQ) (ρ = 0.893, </span><em>p</em> < 0.001), and FSS (ρ = 0.378, <em>p</em><span> = 0.007). Ultrasonographic evaluations revealed synovitis<span> and/or tenosynovitis in 18% of patients, while CTS was detected in 32%.</span></span></div></div><div><h3>Conclusions</h3><div>This study highlights significant hand function impairments in newly diagnosed pSS patients, with DHI scores correlating with disease activity, psychological well-being, and general hea
背景：原发性Sjögren综合征（pSS）是一种慢性、全身性自身免疫性疾病。pSS患者会累及肌肉骨骼和神经系统，这可能导致手部功能受损。手功能障碍及其潜在原因在pSS中仍然是一个未被充分探索的领域。目的：本研究旨在评估新诊断的pSS患者的手功能，探讨其与疾病活动度、临床参数、x线和超声检查结果的关系。研究设计：横断面。方法：新诊断pSS患者50例，健康对照50例。使用Duruöz手部指数（DHI）和手部握力测量来评估手功能。进行了详细的手部体检。采用CTS -6问卷和电诊断法评估腕管综合征（Carpal tunnel syndrome， CTS）。手部A-P片评估关节糜烂，关节间隙狭窄。对腕间、掌指关节滑膜炎和伸肌腱滑膜炎进行了手超声检查。其他评估包括医院焦虑和抑郁量表（HADS）、短表36 （SF-36）、疲劳严重程度量表（FSS）和欧洲抗风湿病联盟（EULAR） Sjögren综合征疾病活动指数（ESSDAI）。结果：pSS患者DHI得分明显高于对照组（p = 0.027, r = 0.22），非优势手握力明显低于对照组（p = 0.016, r = 0.30），优势手握力差异无统计学意义（p = 0.520, r = 0.08）。pSS患者有较高的HADS焦虑（p < 0.001, r = 0.63）和抑郁评分（p < 0.001, r = 0.55）。此外，这些患者的SF-36评分降低（p < 0.001, r = 0.53）。DHI评分与esdai （ρ = 0.413, p = 0.003）、SF-36 （ρ = -0.605, p < 0.001）、HADS(焦虑组**ρ = 0.307, p = 0.030；抑郁ρ = 0.286, p = 0.044)，握力(优势手ρ = -0.298, p = 0.036；非优势手的ρ = -0.280, p = 0.049)、健康评估问卷（HAQ） （ρ = 0.893, p < 0.001）和FSS （ρ = 0.378, p = 0.007）。超声检查显示18%的患者有滑膜炎和/或腱鞘炎，32%的患者有CTS。结论：本研究强调了新诊断的pSS患者的显著手功能损伤，DHI评分与疾病活动、心理健康和一般健康相关。这些发现强调了使用先进的诊断工具进行早期和全面的手部评估对改善患者预后的重要性。
{"title":"Exploring hand function in newly diagnosed primary Sjögren’s syndrome: Clinical, radiographic, and ultrasonographic insights","authors":"Kemal Erol Assoc. Prof. MD , Ezgi Akyildiz Tezcan MD , Süleyman Akgöl MD","doi":"10.1016/j.jht.2025.02.007","DOIUrl":"10.1016/j.jht.2025.02.007","url":null,"abstract":"<div><h3>Background</h3><div><span>Primary Sjögren's syndrome<span> (pSS) is a chronic, systemic autoimmune disease. Musculoskeletal and </span></span>neurological system involvement occurs in patients with pSS, which may lead to impairment in hand function. Hand dysfunction and its underlying causes remain an underexplored area in pSS.</div></div><div><h3>Purpose</h3><div>This study aims to evaluate hand function in patients with newly diagnosed pSS, exploring the associations with disease activity, clinical parameters, and radiographic and ultrasonographic findings.</div></div><div><h3>Study Design</h3><div>Cross-sectional.</div></div><div><h3>Methods</h3><div><span>Fifty patients with newly diagnosed pSS and 50 healthy controls were recruited in this study. Hand functions were evaluated using the Duruöz Hand Index (DHI) and hand grip strength measurements. Detailed hand physical examination was made. Carpal tunnel syndrome<span><span> (CTS) was assessed with the CTS −6 questionnaire and electrodiagnostic<span> methods. Hands A-P radiography was evaluated for joint erosion, joint space narrowing. Ultrasonographic assessment of hand was made for intercarpal and metacarpophalangeal joint </span></span>synovitis<span> and extensor tenosynovitis. Additional evaluations included the </span></span></span>Hospital Anxiety and Depression Scale<span><span> (HADS), Short Form-36 (SF-36), Fatigue severity scale (FSS) and the European League Against </span>Rheumatism (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI).</span></div></div><div><h3>Results</h3><div>Patients with pSS exhibited significantly higher DHI scores compared to controls (<em>p</em> = 0.027, <em>r</em> = 0.22) and lower non-dominant hand grip strength (<em>p</em> = 0.016, <em>r</em> = 0.30), while dominant hand grip strength did not differ significantly (<em>p</em> = 0.520, <em>r</em> = 0.08). Higher HADS anxiety (<em>p</em> < 0.001, <em>r</em> = 0.63) and depression scores (<em>p</em> < 0.001, <em>r</em> = 0.55) were noted in pSS patients. Additionally, these patients had reduced SF-36 scores (<em>p</em> < 0.001, <em>r</em> = 0.53). DHI scores were significantly correlated with ESSDAI (ρ = 0.413, <em>p</em> = 0.003), SF-36 (ρ = −0.605, <em>p</em> < 0.001), HADS (**ρ = 0.307 for anxiety, <em>p</em> = 0.030; ρ = 0.286 for depression, <em>p</em> = 0.044), hand grip strength (ρ = −0.298 for dominant hand, <em>p</em> = 0.036; ρ = −0.280 for non-dominant hand, <em>p</em><span> = 0.049), Health Assessment Questionnaire (HAQ) (ρ = 0.893, </span><em>p</em> < 0.001), and FSS (ρ = 0.378, <em>p</em><span> = 0.007). Ultrasonographic evaluations revealed synovitis<span> and/or tenosynovitis in 18% of patients, while CTS was detected in 32%.</span></span></div></div><div><h3>Conclusions</h3><div>This study highlights significant hand function impairments in newly diagnosed pSS patients, with DHI scores correlating with disease activity, psychological well-being, and general hea","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"38 4","pages":"Pages 886-895"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jht.2025.02.001
Benjamin Basseri BA, Stone Streeter BA, Jose Gutierrez Naranjo MD, Aviva L. Wolff EdD, OT, CHT
<div><h3>Background</h3><div><span><span>This easibility cohort study follows a prior randomized control pilot trial that examined the feasibility and impact of a formal </span>Musculoskeletal Health for Musicians (MHM) program. In this follow-up study, an expanded program was designed to target hand and arm pain by adding exercises for the wrist, elbow, forearm, and hand intrinsic muscles. The MHM program combines education with exercise instruction to prevent pain and </span>injury in musicians.</div></div><div><h3>Purpose</h3><div>The aim of this study was to design and implement an expanded MHM program targeted at arm and hand pain and formally assess feasibility and overall adherence and changes in performance-related pain scores. The hypothesis was that the program would be feasible and high adherence to the expanded MHM program would lead to improvements in patient-reported hand and arm pain.</div></div><div><h3>Study Design</h3><div>Feasiblity Cohort Study</div></div><div><h3>Methods</h3><div><span>Musicians were administered a questionnaire prior to and after implementation of the expanded MHM program. The questionnaire collected data on practice habits, type of instrument, number of years of playing, and instrument playing level. The validated, Musculoskeletal Pain<span> Interference and Impact Questionnaire for Musicians (MPIIQM) was used to collect data at baseline and ≥1 month after implementation of the MHM. It included categories related to frequency, intensity, duration and location of pain, and impact of pain on playing habits. A customized survey (rated 1–5) captured adherence across five categories. The two-part expanded MHM program included a 30-minute lecture on overuse injuries, musculoskeletal pain conditions, and anatomy related to performance mechanics, with extra focus on the hand and arm anatomy. The second, 70-minute component included a workshop covering five domains: warm up exercises, pacing/breaks, posture/playing positions, “smart” practice habits, and specific pre-performance and exercises </span></span><em>plus the hand specific program</em>. The exercise section contained an additional 10-minute module focused on hand exercises.</div></div><div><h3>Results</h3><div>All 48 subjects recruited for the study participated in the expanded 100-minute MHM program suggesting that attending such a program is feasible. Of these patients only 17 responded to the follow-up survey and were included in the final analysis. The mean age was 24 ± 7 years 71% female, and 29% male. Participants played their instrument for an average of 16 ± 7 years and practiced an average of 14 ± 9.5 h/wk. At baseline, the pain level was 4.5/10 and did not change at follow up (4.5/10). Our preliminary results demonstrated low adherence to the MHM in 3/5 domains (smart practice, posture, pacing) and high adherence in physical warm-up and exercises.</div></div><div><h3>Conclusions</h3><div>An expanded MHM program targeting the hand and arm is feasi
{"title":"Feasibility and impact of an expanded upper extremity musculoskeletal health for musicians (MHM) program on arm and hand pain in musicians","authors":"Benjamin Basseri BA, Stone Streeter BA, Jose Gutierrez Naranjo MD, Aviva L. Wolff EdD, OT, CHT","doi":"10.1016/j.jht.2025.02.001","DOIUrl":"10.1016/j.jht.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div><span><span>This easibility cohort study follows a prior randomized control pilot trial that examined the feasibility and impact of a formal </span>Musculoskeletal Health for Musicians (MHM) program. In this follow-up study, an expanded program was designed to target hand and arm pain by adding exercises for the wrist, elbow, forearm, and hand intrinsic muscles. The MHM program combines education with exercise instruction to prevent pain and </span>injury in musicians.</div></div><div><h3>Purpose</h3><div>The aim of this study was to design and implement an expanded MHM program targeted at arm and hand pain and formally assess feasibility and overall adherence and changes in performance-related pain scores. The hypothesis was that the program would be feasible and high adherence to the expanded MHM program would lead to improvements in patient-reported hand and arm pain.</div></div><div><h3>Study Design</h3><div>Feasiblity Cohort Study</div></div><div><h3>Methods</h3><div><span>Musicians were administered a questionnaire prior to and after implementation of the expanded MHM program. The questionnaire collected data on practice habits, type of instrument, number of years of playing, and instrument playing level. The validated, Musculoskeletal Pain<span> Interference and Impact Questionnaire for Musicians (MPIIQM) was used to collect data at baseline and ≥1 month after implementation of the MHM. It included categories related to frequency, intensity, duration and location of pain, and impact of pain on playing habits. A customized survey (rated 1–5) captured adherence across five categories. The two-part expanded MHM program included a 30-minute lecture on overuse injuries, musculoskeletal pain conditions, and anatomy related to performance mechanics, with extra focus on the hand and arm anatomy. The second, 70-minute component included a workshop covering five domains: warm up exercises, pacing/breaks, posture/playing positions, “smart” practice habits, and specific pre-performance and exercises </span></span><em>plus the hand specific program</em>. The exercise section contained an additional 10-minute module focused on hand exercises.</div></div><div><h3>Results</h3><div>All 48 subjects recruited for the study participated in the expanded 100-minute MHM program suggesting that attending such a program is feasible. Of these patients only 17 responded to the follow-up survey and were included in the final analysis. The mean age was 24 ± 7 years 71% female, and 29% male. Participants played their instrument for an average of 16 ± 7 years and practiced an average of 14 ± 9.5 h/wk. At baseline, the pain level was 4.5/10 and did not change at follow up (4.5/10). Our preliminary results demonstrated low adherence to the MHM in 3/5 domains (smart practice, posture, pacing) and high adherence in physical warm-up and exercises.</div></div><div><h3>Conclusions</h3><div>An expanded MHM program targeting the hand and arm is feasi","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"38 4","pages":"Pages 736-744"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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