Research Updates

The ASHT Research Division offers research updates to increase awareness of emerging research in the field of hand and upper extremity therapy. Each month, the Research Division releases a brief summary of an original published research paper selected by members of the Research Division.

2026 Research Updates

January Research Update

Nonsurgical Treatment Versus Surgical Treatment in Displaced Metacarpal Spiral Fractures: Extended 4.5-Year Follow-Up of a Previously Randomized Controlled Trial

Summary Provided by Katherine Loomis, PhD, OTR/L, CHT

This follow-up study evaluates long-term outcomes of nonsurgical vs. surgical treatment of displaced spiral metacarpal shaft fractures to determine if treatment differences emerge over an extended period of time. Thirty-four of the original 42 participants were re-evaluated at a mean of 4.5 years post injury. The nonsurgical group underwent early unrestricted mobilization, while the surgical group underwent open reduction and internal fixation and 2 weeks immobilization prior to active mobilization. The primary outcome measure was grip strength of the injured hand (vs. the uninjured hand), and secondary outcomes included DASH scores, finger range of motion (MP/PIP/DIP and total active motion), and frequency of complications.

The authors found that nonsurgical treatment remained noninferior to surgical treatment for long-term outcomes. The mean grip strength was 95% of the uninjured hand in both groups (103% vs. 96% when adjusted for hand dominance). DASH scores for both groups were excellent and similar (nonsurgical: 1.9, surgical: 2.3). Rotational deformities and range of motion deficits were seen with a similar frequency and to similar extents in both groups. Six surgical patients required revision surgery including implant removal, while no nonsurgical patients needed further procedures. From these results, the authors conclude that nonsurgical treatment with early mobilization for patients with displaced metacarpal spiral fractures is a viable approach that avoids surgical risks and potential implant removal.

Citation: Peyronson, F., Ostwald, C. S., Edsfeldt, S., Hailer, N. P., Giddins, G., & Muder, D. (2025). Nonsurgical Treatment Versus Surgical Treatment in Displaced Metacarpal Spiral Fractures: Extended 4.5-Year Follow-Up of a Previously Randomized Controlled Trial. The Journal of Hand Surgery (American Ed.).

Journal Source: Journal of Hand Surgery

Access the Journal Article Here

Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Lori Algar, OTD, OTR/L, CHT, ASHT Research Division Director at lori.algar@gmail.com.

2025 Research Updates

December Research Update

The American Society of Shoulder and Elbow Therapists’ consensus statement on rehabilitation for anatomic total shoulder arthroplasty

Summary completed by Priya Bakshi, OTD, OTR, CHT

What are the rehabilitation guidelines following anatomical total shoulder arthroplasty (ATSA)? A consensus statement.

A Delphi consensus method was employed to inform rehabilitation guidelines across three phases of recovery following ATSA, with a threshold of 67% agreement used to define consensus. Two separate surveys regarding practice patterns for rehabilitation following ATSA were sent to the American Society of Shoulder and Elbow Therapists (ASSET) and to the American Society for Shoulder and Elbow Surgeons (ASES). The response rates were 34% (37/110) for ASSET and 15% (120/810) for ASES.

In phase 1 (first six weeks), protection of subscapularis (SSc) repair is prioritized. ASES panel reached consensus on limiting external rotation (ER) to 30 degrees for lesser tuberosity osteotomy (LTO) and 20 degrees for SSc peel or tenotomy. ASES and ASSET panel reached consensus for allowing hand only to greater trochanter the first six weeks. ASES consensus on passive elevation goals in this phase was 130, 120 and 90 degrees for LTO, SSc tenotomy and peel respectively; ASSET panel reached consensus at 120 degrees elevation with no differentiation for SSc takedown. Consensus was not reached regarding sling wear duration, which ranged from four to six weeks of immobilization.

In phase 2 (7 to 12 weeks), ASSET and ASES panel reached consensus that stretching ER can progress safely up to 60 degrees with arm by side and in increasing angles of scaption. ASES survey showed surgeons allow internal rotation (IR) behind back but ASSET panel agree to limit IR to sacrum. Consensus was reached that closed chain exercises were not indicated in phase 2 but AROM against gravity with weight of the arm was allowed to activate deltoid, rotator cuff and scapula muscles.

In phase 3 (12 weeks+), ASSET and ASES panel reached consensus that patients may stretch in all planes without precautions as tolerated and closed chain exercises are permitted. While there was no consensus on a specific maximum weightlifting limit (ranged from 15 to 25 pounds), the panels agreed that high-impact loading activities such as bench pressing, wood chopping, and using a sledgehammer are not advised.

Citation: Kennedy JS, Garrigues GE, Pozzi F, Zens MJ, Gaunt B, Phillips B, et al. The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation for anatomic total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2020;29(10):2149-62.

Journal Source: Journal of Shoulder and Elbow Surgery

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November Research Update

Effects of upper extremity blood flow restriction training on muscle strength and hypertrophy: a systematic review and meta-analysis

Summary completed by Renee McDade, OTR/L, CHT

Muscle weakness and reduced muscle strength are common symptoms in musculoskeletal disorders. Resistance training is a primary treatment to combat this weakness; however, in older populations or with specific conditions, the traditional high load strength training can be difficult to implement. In recent years, low load resistance training with blood flow restriction (LL-BFRT) has been adopted primarily for lower extremity conditions.

A literature review of the four major databases was completed. Inclusion criteria included: study design of randomized control trials written in English, participants of 18 years of age or older, an intervention including an experimental group treated with LL-BFRT vs a control group created with high load resistance training alone, and pre/post measurements of the biceps or triceps strength and/or size.

Results included a total of 11 articles and 220 participants. LL-BRFT and high load resistance training showed similar effects in improving muscle strength, though the evidence is limited.

Citation: Jing J, Zheng Q, Dong H, Wang Y, Wang P, Fan D and Xu Z (2025) Effects of upper extremity blood flow restriction training on muscle strength and hypertrophy: a systematic review and meta-analysis. Front. Physiol. 15:1488305.

Journal Source: Frontiers in Physiology

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October Research Update

Comparison of the Effects of Volar-Assisted and Elastic Wrist Splints on Edema, Pain, Grip Strength, and Functionality in Pregnant Women With Carpal Tunnel Syndrome.

Summary by April Bryant OTD, OTR/L, CHT

Carpal tunnel syndrome (CTS) commonly affects pregnant women in the third trimester at a rate of approximately 63%. Hormonal changes, gestational diabetes and gestational edema can all contribute to CTS. This prospective study investigated the effect of volar-assisted splint vs. elastic splint on edema, pain, grip strength and upper extremity function in 41 pregnant women. The women were educated on digital tendon glides and provided with either a volar assisted splint or an elastic splint.

Outcome measures included VAS pain assessment, Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH), Boston Carpal Tunnel Questionnaire (BCTQ), grip strength with Jamar hand dynamometer and edema with volumetric measurements. While both treatment groups showed improvement in pain, edema, grip strength and functionality, it was noted that the elastic splint group has a more significant improvement with pain, functionality and grip strength.

Limitations of the study include small, sample size and lack of control group. Despite these limitations, the study showed that splinting (particularly elastic splinting) could be a viable treatment modality for pregnant women with CTS.

Citation: Cavus, F. M., Maden, C., & Turhan, B. (2024). Comparison of the effects of Volar-Assisted and elastic wrist splints on edema, pain, grip strength, and functionality in pregnant women with Carpal Tunnel syndrome. Hand.

Journal Source: Hand

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September Research Update

Which elective hand surgery procedures do hand therapists think would benefit from preoperative skilled therapy?

Summary by Lori Algar, OTD, OTR/L, CHT

This survey study gathered the perspective of members of the British Association of Hand Therapy regarding five elective hand procedures (carpal tunnel release (CTR), cubital tunnel release (CuTR), Dupuytren's fasciectomy, trapeziectomy and trigger finger release (TFR) and the outcome benefit from preoperative hand therapy. There were 37 respondents (only a 5% response rate). According to the participants, they felt that trapeziectomy had the highest potential for preoperative therapy benefit. CTR was found to have contradictory responses regarding preoperative benefit of skilled therapy and TFR and CuTR were found to have low support for preoperative skilled therapy benefit. The researchers conclude that these findings should be interpreted with caution related to the low response rate.

Citation: Babiker-Moore T, Clark C, Kavanagh E, Crook TB. Which elective hand surgery would benefit most from preoperative therapy interventions to enhance surgical outcomes? A survey of hand therapists. Hand Therapy. 2025: 30; 143-151.

Journal Source: Hand Therapy

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August Research Update

Dynamic hand and finger load distribution patterns in the first year following surgically treated distal radius fracture

Summary by Sophie Goloff, MS, OTR/L, CHT

This prospective study followed the load distribution during gripping in patients after a surgically treated distal radius fracture over the course of a year. Manugraphy is a technique for measuring dynamic load distribution while gripping a cylinder. Manugraphy allows greater insight into grasp patterns and load distribution as compared to the static measurements provided by grip strength measurement. Participants were measured at months three, six and 12 where they were administered the QuickDASH and assessed on grip strength, wrist/digit ROM, and grasp load distribution via a pressure sensitive cylinder. The thumb, fingers, and thenar and hypothenar eminence areas were analyzed to determine grip patterns.

Wrist and finger ROM measurements all showed improvement over the course of follow-ups, as did the QuickDASH. Grip strength measurements improved significantly at each time point. Significant changes in load distribution of the injured versus uninjured hand were found for the first, second and fourth finger rays, as well as the thenar and hypothenar eminences at the three-month mark, these differences reduced at subsequent follow-ups. These changes were found to correlate significantly to the other objective measures examined in the study.

The injured hand demonstrated a greater load on the thumb and index finger and a lower load on the thenar and hypothenar eminences as compared to the uninjured side. The authors note that this is consistent with previous literature of pinch strength improving before grip after distal radius fractures and note that this pattern allows the increased reliance on intrinsic hand muscles instead of extrinsic hand muscles that cross the wrist. Additionally, the initial decrease in loading over the thenar and hypothenar eminences could be due to lacking finger flexibility or pain with pressure closer to full force grip. This study concludes that manugraphy provides valuable insight into grip patterns that can help guide targeted rehabilitation interventions and richer explanations of hand function.

Citation: Karnatz, J., Harms, C., Fischer, D.-C., & Mittlmeier, T. (2025). Dynamic hand and finger load distribution patterns in the first year following surgically treated distal radius fracture. BMC Musculoskeletal Disorders, 26(1), 486.

Journal Source: BMC Musculoskeletal Disorders

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July Research Update

Commuting Time and Musculoskeletal Pain in the Relationship with Working Time: A Cross-Sectional Study

Summary by Alyssa Phillips, CScD, MOT, OTR/L

While a daily commute is often a necessary occupation for working individuals (clinicians and clients alike), what is the cost?

This study used data from a Korean Working Conditions Survey to investigate the relationship between commute time and musculoskeletal pain, with an emphasis on co-exposure to long working hours and shift work. Though this study looked at back pain and lower extremity pain, this summary places focus on the 28,490 individuals that contributed data for upper extremity (shoulders, neck and/or upper limbs (arms, elbows, wrists, hands, etc.)) pain. Exposure to long working hours, shift work, and poor ergonomics have been studied for their impact on sleep, recovery, and resulting upper extremity pain, however, those factors did not solely explain the upper extremity pain being reported by employees.

So, what was a consistent factor and possible explanation for those experiencing upper extremity pain in a variety of careers? The data shows that individuals with college or higher education, non-shift workers, and those with higher salary ranges were well represented in the group with upper extremity pain. While a variety of factors could explain why upper extremity pain was highest in workers who work less than 40 hours per week and in offices, it appears that the commuting time (up to 2 hours) had quite the effect. An increase in commute time was related to an increase in pain across the variety in employees surveyed, even with ergonomics considered.

When evaluating a client, it could be worth asking and considering the impact their commute has on their condition, their healing, and their musculoskeletal pain.

Citation: Ryu, H., Cho, S. S., Kim, J. I., Choi, S. H., & Kim, N. (2025). Commuting time and musculoskeletal pain in the relationship with working time: A cross-sectional study. Annals of Occup Environ Med, 37, e4.

Journal Source: Annals of Occupational and Environmental Medicine

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June Research Update

The Efficacy of Exercise Therapy for Rotator Cuff-Related Shoulder Pain According to the FITT Principle: A Systematic Review with Meta-analyses

Summary by Ricky Altahif, OTD, OTR, CHT

This systematic review with meta-analyses explored the effectiveness of exercise therapy for rotator cuff-related shoulder pain (RCRSP) through the lens of the FITT principle (Frequency, Intensity, Type, and Time), which describes specific elements of exercise prescription. The authors synthesized results from 22 randomized controlled trials (n = 1,281 participants) to determine which specific exercise parameters were most beneficial for improving pain, disability and quality of life. This systematic review found that motor control exercise programs (e.g. exercises that emphasize movement control, proprioception and dynamic stabilization) were slightly more effective than nonspecific exercises in reducing pain and disability across short, medium and long-term follow-ups. While eccentric and scapula-focused exercises showed some promise in reducing pain in the medium term, the evidence supporting these approaches was inconsistent and of low certainty. There was no significant difference in outcomes between high- and low-load exercise programs. Notably, no studies directly compared exercise frequency or duration, revealing a key gap in the literature on exercise prescription for RCRSP.

This review supports including motor control exercises when treating patients with RCRSP. Results suggest these exercises may offer a small but clinically meaningful advantage in managing pain and disability. The study also notes a gap in standardized exercise reporting and encourages future research and clinical practice to incorporate the FITT principle into reporting for more targeted and reproducible interventions.

Citation: Lafrance, S., Charron, M., Dubé, M.-O., Desmeules, F., Roy, J.-S., Juul-Kristensen, B., Kennedy, L., & McCreesh, K. (2024). The Efficacy of Exercise Therapy for Rotator Cuff–Related Shoulder Pain According to the FITT Principle: A Systematic Review With Meta-analyses. The Journal of Orthopaedic and Sports Physical Therapy, 54(8), 499–512.

Journal Source: The Journal of Orthopaedic and Sports Physical Therapy

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May Research Update

What is the psychological impact after upper-extremity (UE) amputation?

Summary provided by Melanie Hubbuck, MS, OTD, OTR/L, CHT

This prognostic, retrospective cohort study utilized the TriNetX database, or a multinational/institutional database with 94 different healthcare organizations and 110 million patients to pursue population-level incidence rates of psychiatric condition development after upper extremity amputation. Patients who underwent any type of UE amputation over a 12-year span between January 1, 2010 and December 31, 2022 were included for a total of 25,091 patients with incidence of new psychiatric diagnosis after amputation assessed. Chi-squared analyses were performed to evaluate incidence of psychiatric condition among amputation levels, and odds ratios were used to compare psychiatric condition occurrence rate post-amputation relative to general population, and general UE surgical population. The researchers found approximately one in six patients who undergo UE amputation will develop a psychiatric condition within three years with much higher incidence rates than the general population, and more pronounced with amputations proximal to the hand. This study highlights the importance of regular mental health screenings and a multi-disciplinary approach in working with individuals post UE amputation.

Citation: Dussik, C.M., Phan, A., Coombs, J., Chang-Sing, E., Park, JM. A., Wilbur, D. (2025). Postoperative psychiatric outcomes after upper-extremity amputations. Journal of Hand Surgery, (In Press).

Journal Source: Journal of Hand Surgery (In Press)

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April Research Update

Sustainable Practices in Hand Therapy: A Global Perspective

Summary provided by Tauni Malmgren, OTD

Although sustainability awareness exists in broader healthcare contexts, there is limited research or targeted initiatives focusing on hand therapy. This study aims to fill this gap by investigating hand therapists' awareness, practices, challenges and potential strategies related to sustainability. A worldwide survey, disseminated through social media and professional networks, gathered information on sustainability awareness, practices and educational needs from 113 participants, with the majority hailing from North America (34%) and Europe (32%). While a majority of hand therapists (91%) recognize climate change as a critical issue, only 34% actively implement sustainable practices, revealing a notable gap between awareness and action. Key barriers to adopting eco-friendly measures include a lack of awareness (59%), limited access to sustainable materials (56.6%) and time constraints (54%). Despite some efforts, such as reusing components (65%), knowledge of reusable materials remains low (17%), and recycling practices, particularly for thermoplastics, are inadequate (74.3%). The findings emphasize the urgent need for improved education, better resource availability and policy reforms to bridge this gap and promote sustainable practices in hand therapy.

Here are some ideas from the article for hand therapists who want to incorporate sustainability into their practice:

Recycling Initiatives: Set up recycling stations and participate in recycling activities for responsible waste management.
Waste Reduction Efforts: Use multiple waste bins for segregation, reduce disposable materials, and cut down on plastic use.
Digital and Electronic Adoption: Go digital to reduce paper waste and enhance operational efficiency.
Resource Repurposing and Reuse: Focus on repurposing and reusing materials during therapy sessions.
Energy Conservation Measures: Adopt energy-saving practices, including the use of energy-efficient appliances.
Sustainable Practices in Clinical Operations: Incorporate eco-friendly products and programs into business models.

Citation: Farzad M, Naqui Z, MacDermid J, Cuypers S. Sustainable practices in hand therapy: a global perspective. J Hand Surg Eur Vol. Published online 2024:17531934241246451.

Journal Source: Journal of Hand Surgery (European Volume)

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March Research Update

What Factors Influence Variability in Thumb Carpometacarpal Arthroplasty Care? A Survey of ASSH Members

Summary provided by Chelsea Gonzalez, OTD, OTR/L, CHT

Hand surgeons throughout the country were surveyed to analyze the variability in referral to hand therapy following CMC arthroplasty. 811 surgeons responded to the electronic survey, which included multiple choice response for demographics, years of experience, preferred surgical technique and post-operative practices (including time of immobilization and referral to hand therapy). Results of the survey suggest that the top reason for referral to surgery post-op was the strength of business relationship between hand therapists and surgeons. Surgeons employed by the same medical center, surgeons who have been practicing between 0-5 years and surgeons in private practice who employ their own hand therapist tend towards referring to in-person hand therapy for greater than six visits. Surgeons practicing for 25+ years were less likely to have a business relationship and were less likely to refer patients to hand therapy post arthroplasty. They were also more likely to perform an LRTI. Meanwhile, surgeons practicing 0-5 years were more likely to perform a suspensionplasty.

While this study was geared towards hand surgeons to raise awareness of their biases and habits when it comes to post-op referrals, hand therapists should be aware of the importance of establishing business relationships with surgeons when it comes to maintaining and building referral sources.

Citation: Barret PC, Hackley DT, Lockhart ES, Yu-Shan AA, Bravo CJ, Apel PJ. What Factors Influence Variability in Thumb Carpometacarpal Arthroplasty Care? A Survey of ASSH Members. HAND. 2025;20(1):129-135.

Journal Source: HAND

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February Research Update

Neuromuscular Electrical Stimulation of Upper Limbs in Patients with Cerebral Palsy: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Summary Provided by Jenny M. Dorich, PhD, MBA, OTR/L, CHT

Is neuromuscular electrical stimulation (NMES) an effective intervention in improving upper limb outcomes in individuals with cerebral palsy (CP)? This systematic review included seven randomized controlled trial (RCT) studies with six of the seven studies rated as being “good” or “excellent” quality. Study findings indicate NMES is an effective intervention for improving upper extremity function, muscle strength and spasticity in individuals with spastic CP affecting the upper limbs. Wrist range of motion was not improved at any time point. Upper limb function was the only factor that individuals had gains in at three months follow up. Study findings provide evidence that NMES can be an effective treatment intervention in improving short-term strength and spasticity in the upper limbs of individuals with CP with gains in upper limb function that are longer lasting.

Citation: Ou, C., Shiue, C., Huan, Y., Liou, T, Chen, H, & Kuo, T. (2024). Neuromuscular electrical Stimulation of upper limbs in patients with cerebral palsy: A systematic review and meta-analysis of randomized controlled trials. American Journal of Physical Medicine & Rehabilitation, 102(2), 151-158.

Journal Source: American Journal of Physical Medicine & Rehabilitation

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January Research Update

An overview of rehabilitation approaches for focal hand dystonia in musicians: A scoping review

Summary Provided by Jenny M. Dorich, PhD, MBA, OTR/L, CHT

What approach should be taken in rehabilitating focal hand dystonia in musicians? This scoping review included 17 studies investigating rehabilitation of musicians with focal hand dystonia. An array of therapeutic interventions were reported with no specific intervention or treatment approach predominating. A variety of therapy interventions are applied in the therapeutic management of focal hand dystonia in musicians, thus individualized treatment is advised. Patient education and collaboration with music educators are noted as beneficial in facilitating return to performance.

Citation: Catellani, I., Arcuri, P., Vita, F., Platano, D., Boccolari, P., Lanfranchi, E., Fairplay, T., Tedeschi, R. (2024). An overview of rehabilitation approaches for focal hand dystonia in musicians: A scoping review. Clinical Rehabilitation, 1-11.

Journal Source: Clinical Rehabilitation

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