Introduction The radial artery forearm flap (RAFF) is a versatile free tissue transfer used for many clinical presentations. RAFF donor sites typically require a split-thickness skin graft (STSG) for closure. Whilst early rehabilitation of RAFF donor site(s) following STSG commonly involves wrist immobilisation, best practice for this immobilisation procedure remains unknown. Purpose of the Study The purpose of this study was to systematically ‘map’ wrist immobilisation methods post-STSG of the RAFF wound and explore the impact of immobilisation methods on donor site morbidity. Methods A scoping review was completed. Literature searching was conducted from database inception to February 1, 2024 in PubMed, Medline, Cochrane, CINAHL, Embase, Web of Science. Title/abstract screening was conducted by one researcher, full text screening was conducted by two researchers independently. Data extraction included number of participants, participant age and gender, wrist immobilisation details and reported donor site complications. Critical appraisal of articles was not completed. Results Thirty-seven studies were included in the review. Thermoplastic orthoses (TPO) or ‘splinting’ (n = 22) and plaster casts (n = 8) were the most frequent immobilisation methods reported with 7 days (n = 15) the most frequent immobilisation period. Detail regarding type of TPO material and location/design of the splint/cast was limited. Frequent donor site morbidities included graft complications (n = 18), changes in sensation (n = 9) and infection (n = 7). Conclusion Best practice wrist immobilisation procedure for RAFF donor site following STSG cannot be concluded at this time. Additional prospective research is recommended to evaluate the association between wrist immobilisation and donor site morbidity for this complex procedure.

In hand injuries involving thumb impairment, rehabilitation must be conducted meticulously as it is essential for restoring hand function and facilitating return to daily life and work. The aim of this study is to investigate the effects of prescribing mobile games as home exercises on recovery outcomes in patients with thumb involvement due to thumb injuries and/or carpal tunnel syndrome. This randomized controlled trial included 31 patients who were randomly assigned to either the routine rehabilitation (RR) group or the mobile game (MG) group. The primary outcome measure was functional status, assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaire. Secondary outcomes included hand function evaluated with the Duruöz Hand Index (DHI), activity-related pain assessed using the Visual Analog Scale (VAS), range of motion (ROM) measured with a goniometer, edema assessed with a tape measure, and adherence to home exercises monitored using a home exercise tracking form. In both groups, statistically significant improvements were observed in all parameters after treatment compared to baseline (p < 0.05); however, no differences were found in the primary outcome measure (p > 0.05). In the between-group comparison, a significant difference in favor of the MG group was observed only for total active motion of the metacarpophalangeal joint and adherence to home exercises (p < 0.05). Mobile game-assisted home exercises appear feasible for patients with thumb involvement. While MCP joint motion improved significantly, no differences were found in pain or function. Further research is needed to confirm clinical relevance.

There is a lack of studies on the optimal duration and carry-over effect of superficial heat treatment to increase joint range of motion.This study aims to determine the optimal treatment duration of Fluidotherapy® and Hot Pack in improving wrist and finger active range of motion (AROM) and investigate possible carry-over effects. The study used a single-site, multi-arm quasi-experimental design. Participants aged 21-80 years with distal radius fracture or fracture and/or soft tissue injuries involving the finger or thumb were assigned consecutively to one of six groups of 10, 15 or 20 min Fluidotherapy® or Hot Pack treatment.All participants had goniometric assessment of their wrist or finger joint AROM adjacent to the injury site and were asked to rate the joint flexibility: (i) prior to treatment; (ii) immediately after treatment; and (iii) after 20 min of AROM mobilisation post-heat treatment. Subjects were asked to rate their joint flexibility again 2 h after the study visit, via telephone. Results were analysed using the Kruskal-Wallis test of association with significance P < 0.05. Participants who had 10 and 20 min Fluidotherapy® and 10 and 15 min Hot Pack treatment showed significant wrist flexion and extension AROM increase immediately after treatment. Participants who had 15 and 20 min Fluidotherapy®, and 15 and 20 min Hot Pack treatment showed further increase in wrist AROM after 20 min of mobilization. Participants with finger injuries in all the treatment groups showed no significant changes in MCPJ or PIPJ AROM immediately and 20 min after treatment.Participants in all treatment groups reported significantly increased wrist flexibility while participants who had 15 min Fluidotherapy® and 20 min Hot pack reported significantly increased MCPJ or PIPJ flexibility, compared to baseline, immediately, 20 min and 2 h after treatment. Although there were significant improvements in wrist extension and flexion AROM after 10 or 20 min of Fluidotherapy® and after 10 or 15 min of Hot Pack application, the improvement may not be considered clinically significant. Participants report of significantly improved wrist flexibility in all treatment groups and increased MCPJ and DIPJ flexibility in 2 groups immediately, 20 min, and 2 h after treatments demonstrated the potential of these 2 modalities as pain management adjuncts for pre-conditioning prior to mobilisation.

Tendon adhesions after hand surgery can severely impair motion and function. Although early mobilization is preferred, re-ruptures or complex trauma cases often require immobilization, increasing the risk of adhesion. This report presents two cases-one involving flexor pollicis longus (FPL) tendon re-rupture and another with multiple extensor tendon injuries-treated with a novel flossing intervention aimed at improving tendon gliding and soft tissue flexibility. In both cases, flossing therapy using a rubber compression band was introduced at 8 weeks postoperatively, following standard immobilization and rehabilitation protocols. Patients performed flossing exercises daily under supervised and home-based conditions. The FPL case showed an improvement in %TAM from 20.8% to 83.3%, and the extensor tendon case improved from 42.9%-50% to 96.4%-98.4% over 16 weeks. Both patients regained functional range of motion and returned to work without requiring tenolysis. Importantly, these improvements occurred when flossing was paired with active range of motion (AROM) exercises, rather than by flossing alone. Flossing, particularly when combined with active range of motion (AROM) exercises, may be a useful adjunct to conventional therapy for managing severe adhesions after tendon repair. These case reports suggest that improvements were likely achieved through the combined effect of flossing and conventional active exercises, rather than flossing alone. Further studies are needed to determine the optimal parameters and generalizability of this technique.

Access to hand therapy is a challenge in low to middle-income countries but is also restricted for many communities in high-income countries. As an essential part of the global rehabilitation community, hand therapists must consider how to extend access to basic hand therapy services and strengthen the capacity of the therapists who provide these services. This study aimed to identify capacity-strengthening strategies for generalist occupational therapists responsible for delivering hand therapy in the South African public health service. A consensus development methodology was employed. A hybrid consensus development conference was used to gather local and international evidence pertinent to the project's aim. A panel representing service users (n = 2), service providers (n = 5), research (n = 1), education (n = 1) and professional organisations (n = 5) systematically considered the evidence presented at the conference using a nominal group technique. The panel identified ten priority areas for action: supervision and support; resources; policy, leadership and governance; education and training; professional knowledge and skill; effective referral and care pathways; data and evidence for service improvement; professional attitudes, behaviours and dispositions; inter- and intra-disciplinary action and cohesion; and an intersectoral systems approach. The priority areas were categorized and are discussed as strategic, educational, organizational, and operational priorities for strengthening the capacity of generalist occupational therapists to deliver quality hand therapy. We suggest ways that both local and global hand therapy communities can take action to position hand therapy as an essential part of universal health coverage.

Limited research exists on the post-operative treatment of extensor pollicis longus (EPL) repair (tendon transfer and direct repair). Early active motion (EAM) and dynamic extension splinting (DES) are becoming more common compared to static casting. The aim of this systematic review was to determine whether EAM was superior to DES post EPL direct repair or tendon transfer. Outcomes of interest included range of motion, strength, and adverse events. A systematic search of AMED, EBSCO health database (CINAHL, MEDLINE, and SPORTDiscus), and Scopus was completed. Randomised control trials or cohort studies were included if they followed either an EAM or DES rehabilitation protocol and assessed total active motion, grip strength, pinch strength, or range of motion post EPL surgical repairs. Data extracted included the surgical procedure, rehabilitation protocols, and results. The Downs and Black checklist for clinical trial quality assessment was utilised to assess the methodological quality. Six studies met the inclusion criteria. Five studies included DES and two studies included EAM. Both interventions resulted in improvements in ROM, grip strength and pinch strength with neither intervention being superior. There was no increase in adverse outcomes by using EAM or DES. The risk of bias following assessment of methodological quality of included studies ranged from good to poor. The use of EAM should be considered post EPL repair or tendon transfer. EAM does not result in superior outcomes post EPL repair compared to DES, equally EAM does not appear to be inferior compared to DES.

Non-traumatic wrist disorders (NTWD) are commonly encountered across care settings, but current patterns of care and clinicians beliefs about the care they provide remains unclear. This study aimed to record management approaches to care for NTWD across clinical groups and care settings. Ethical approval was sought for an online cross-sectional survey of clinicians [1 Jul - 1 Nov 2023], comprising 18 questions exploring profession, work setting, exposure to NTWD, alongside diagnostic and management confidence. UK-based musculoskeletal (MSK) clinicians were invited to participate through special interest groups, online forums, social media and professional network emails. Variability was found in the domains of specificity of diagnosis and confidence in management which relates to exposure and profession. Variability was found in the domains of specificity of diagnosis and confidence in management which relates to exposure, profession and clinical setting. Several Patient Related Objective Measures (PROMS) were used by clinicians to assess treatment effect, set goals, and communicate with patients. This study provides the first description of UK clinicians management of non-traumatic wrist disorders across professional groups and healthcare settings. As evidence-based management remains elusive, deeper understanding of the clinical decision-making and practice behaviour of clinicians would have value in future studies into NTWD.

The first web space of hands has been understood to be important in daily activities involving the motions of cylindrical grasp and pinch. However, surgical and rehabilitation decision-making based on first web deficiency is challenging without clear definitions of function. This study aimed to evaluate the methods used to measure first web space and synthesize the evidence on its functional definition in children up to 18years old. This review followed Arksey and O'Malley's six-stage framework operationalized by the Joanna Briggs Institute (JBI) methodology for conducting a scoping review. In conjunction with a medical librarian, 4440 term combinations were searched on MEDLINE from inception until January 2023. Title/abstract and full-text screening processes were conducted, followed by charting, collating, and summarizing included articles by two independent reviewers. Of 162 studies screened, 20 studies were included. The first web space was most commonly measured in palmar abduction (50%) of the carpometacarpal angle (45%) radiographically (30%). Systematic methods were rarely used (5%) to evaluate activity and participation function of first web limitations. Definition of a cutoff angle or first-web span that represented sufficient functional outcome was difficult to synthesize due to a lack of standard measurement methods. While the first web function was quantified in the studies, these values are problematic due to inconsistent measurement methods. A standardized assessment of first web space impairment and its relationship with activity and participation function is clinically significant for evaluating the need and meaningful outcomes of surgical and therapy interventions in children.

To our knowledge, no previous studies have directly compared the effects of orthosis wear in males and females with thumb carpometacarpal (CMC) joint osteoarthritis. Therefore, this study aimed to analyze whether there are differences between males and females in pain, hand function, and grip strength following hand-based orthosis wear. The study included 14 male and 14 female participants with first- and second-degree CMC joint osteoarthritis. A hand-based orthosis was custom-molded for each participant. Pain, function, grip strength, and pinch strength were evaluated at baseline and after a 6-week period of orthosis wear. Twenty-eight participants (mean age: males 64.6 ± 5.1years; females 63.5 ± 3.2years) completed the study. After 6weeks of orthosis use, both males and females showed significant improvements in grip strength, pinch strength, hand function, daily activity performance, and pain reduction (all p < .05). Although both sexes benefited similarly in grip strength, pain, and function, females reported significantly greater improvement in satisfaction with hand function (p = .020). Mean adherence was 84.75%, with higher compliance observed in females. Although both groups experienced significant improvements in pain, function, grip strength, pinch strength, and overall satisfaction with orthosis wear, greater improvement in satisfaction with hand function was observed among females.

Hand trauma is common, and can be functionally limiting and psychologically distressing. Hand dysfunction that is persistent after trauma can be troublesome to manage. Patient-reported outcome measures (PROMs) are useful in assessing hand function, and an improvement has been associated with an increase in health-related quality of life. Hand therapy is important for managing patients with residual poor hand function after trauma, but minimal evidence exists to support commonly used treatments. This review aimed to evaluate the evidence for interventions, outcome measures, and the implications for future research in hand therapy. A systematic review with narrative synthesis was conducted. Randomised controlled trials of residual hand dysfunction after trauma were included. The primary outcome measures were PROMs validated in hand trauma. Secondary outcomes included symptoms of hand dysfunction or validated tests that evaluate hand function. 19 studies were included. Occupation-based interventions showed moderate strength of effect in improving hand function in terms of PROMs. Mirror therapy, robot-aided rehabilitation, orthotic management of the stiff hand, and oedema-reducing therapies were also evaluated. The findings were limited by a high risk of bias and lack of robust methodology in the included studies. PROMs were inconsistently utilised, along with a variety of other outcome measures. No firm recommendations for practice can be made based on the evidence included in this review. Well designed, multicentre trials are needed to generate more robust evidence. Standardisation of outcome measures and reporting, and the use of PROMs aligned with patient priorities will be crucial for advancing research in hand therapy.