Journal of Hand Therapy RSS feed: Current Issue. The Journal of Hand Therapy is designed for hand therapists, occupational and physical therapists, and other hand specialists involved in the rehabilitation of disabling hand problems. The Journal functions as a source of education and information by publishing scientific and clinical articles. Regular features include original reports, clinical reviews, case studies, editorials, and book reviews. http://www.jhandtherapy.org/?rss=yesElsevier Inc.en © 2012 Hanley & Belfus. Published by Elsevier Inc. All rights reserved. Journal of Hand Therapy0894-1130252April 2012 © 2012 Hanley & Belfus. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jhandtherapy.org/article/PIIS0894113011001530/abstract?rss=yesHand therapy is often described as an integration of art and science. The art component to our profession is vital as it ensures our overall approach to management addresses each patient’s unique characteristics and individual circumstances. It is the creative aspect of our job, and for most hand therapists, it is very natural and effortless.The Science behind the Art of Hand TherapyVictoria Priganc10.1016/j.jht.2011.11.002Journal of Hand Therapy 25, 2 (2012)2012-04-01Journal of Hand Therapy2012-04-01252S0894-1130(12)X0002-4Editorial115115http://www.jhandtherapy.org/article/PIIS0894113011001748/abstract?rss=yesAbstract: This article provides a general overview of the biomechanical principles associated with hand therapy. Specifically, it reviews the basic topics of material properties (including both theoretical principles and practical concepts), static analysis (including forces, moments, muscle forces, and Newton’s laws), and ends with a clinical example involving analysis of the risk of damage to the A3 pulley.Understanding the Biomechanical Nature of Musculoskeletal TissueAndrew R. Karduna10.1016/j.jht.2011.12.006Journal of Hand Therapy 25, 2 (2012)2012-04-01Journal of Hand Therapy2012-04-01252S0894-1130(12)X0002-4Science Section116122http://www.jhandtherapy.org/article/PIIS0894113011001141/abstract?rss=yesAbstract: Bone is a connective tissue containing cells, fibers, and ground substance. There are many functions in the body in which the bone participates, such as storing minerals, providing internal support, protecting vital organs, enabling movement, and providing attachment sites for muscles and tendons. Bone is unique because its collagen framework absorbs energy, whereas the mineral encased within the matrix allows bone to resist deformation. This article provides an overview of the structure and function of bone tissue from a macroscopic to microscopic level and discusses the physiological processes contributing to upper extremity bone health. It concludes by discussing common conditions influencing upper extremity bone health.Specialized Connective Tissue: Bone, the Structural Framework of the Upper ExtremityAlyssa M. Weatherholt, Robyn K. Fuchs, Stuart J. Warden10.1016/j.jht.2011.08.003Journal of Hand Therapy 25, 2 (2012)2011-11-02Journal of Hand Therapy2011-11-02252S0894-1130(12)X0002-4Science Section123132http://www.jhandtherapy.org/article/PIIS089411301100086X/abstract?rss=yesAbstract: Due to their unique hierarchical structure and composition, tendons possess characteristic biomechanical properties, including high mechanical strength and viscoelasticity, which enable them to carry and transmit mechanical loads (muscular forces) effectively. Tendons are also mechanoresponsive by adaptively changing their structure and function in response to altered mechanical loading conditions. In general, mechanical loading at physiological levels is beneficial to tendons, but excessive loading or disuse of tendons is detrimental. This mechanoadaptability is due to the cells present in tendons. Tendon fibroblasts (tenocytes) are the dominant tendon cells responsible for tendon homeostasis and repair. Tendon stem cells (TSCs), which were recently discovered, also play a vital role in tendon maintenance and repair by virtue of their ability to self-renew and differentiate into tenocytes. TSCs may also be responsible for chronic tendon injury, or tendinopathy, by undergoing aberrant differentiation into nontenocytes in response to excessive mechanical loading. Thus, it is necessary to devise optimal rehabilitation protocols to enhance tendon healing while reducing scar tissue formation and tendon adhesions. Moreover, along with scaffolds that can mimic tendon matrix environments and platelet-rich plasma, which serves as a source of growth factors, TSCs may be the optimal cell type for enhancing repair of injured tendons.Tendon Biomechanics and Mechanobiology—A Minireview of Basic Concepts and Recent AdvancementsJames H-C. Wang, Qianping Guo, Bin Li10.1016/j.jht.2011.07.004Journal of Hand Therapy 25, 2 (2012)2011-09-20Journal of Hand Therapy2011-09-20252S0894-1130(12)X0002-4Science Section133141http://www.jhandtherapy.org/article/PIIS0894113011001165/abstract?rss=yesAbstract: Peripheral nerves are composed of motor and sensory axons, associated ensheathing Schwann cells, and organized layers of connective tissues that are in continuity with the tissues of the central nervous system. Nerve fiber anatomy facilitates conduction of electrical impulses to convey information over a distance, and the length of these polarized cells necessitates regulated axonal transport of organelles and structural proteins for normal cell function. Nerve connective tissues serve a protective function as the limb is subjected to the stresses of myriad limb positions and postures. Thus, the tissues are uniquely arranged to control the local nerve fiber environment and modulate physical stresses. In this brief review, we describe the microscopic anatomy and physiology of peripheral nerve and the biomechanical properties that enable nerve to withstand the physical stresses of everyday life.Peripheral Nerve: From the Microscopic Functional Unit of the Axon to the Biomechanically Loaded Macroscopic StructureKimberly S. Topp, Benjamin S. Boyd10.1016/j.jht.2011.09.002Journal of Hand Therapy 25, 2 (2012)2011-12-02Journal of Hand Therapy2011-12-02252S0894-1130(12)X0002-4Science Section142152http://www.jhandtherapy.org/article/PIIS0894113011001372/abstract?rss=yesAbstract: Edema is a normal response to injury. Even the smallest injury is associated with some inflammation, and initial edema is part of the normal inflammatory process. However, edema becomes a concern when it persists beyond the inflammatory phase. Once we have progressed into the rebuilding, or fibroplastic phase of healing, edema will delay healing and contribute to complications such as pain and stiffness. Early prevention and management to prevent this progression are therefore critical. This article discusses edema in relation to stages of healing and presents the research behind techniques available to the clinician to manage localized extracellular upper extremity edema in the patient with an intact lymphatic system.Edema: A Silent but Important FactorJune P. Villeco10.1016/j.jht.2011.09.008Journal of Hand Therapy 25, 2 (2012)2012-01-04Journal of Hand Therapy2012-01-04252S0894-1130(12)X0002-4Clinical Section153162http://www.jhandtherapy.org/article/PIIS0894113011001529/abstract?rss=yesAbstract: Hand therapists need to understand the basic science behind the therapy they carry out and the current evidence to make the best treatment decisions. The purpose of this article was to review current conservative therapeutic management of patients with rheumatoid arthritis (RA) or osteoarthritis (OA) of the hand. Treatment interventions such as orthotics, exercise, joint protection, modalities, and adaptive equipment are discussed from a basic science and evidence-based practice perspective.Osteoarthritis and Rheumatoid Arthritis: Conservative Therapeutic ManagementJeanine Beasley10.1016/j.jht.2011.11.001Journal of Hand Therapy 25, 2 (2012)2012-02-13Journal of Hand Therapy2012-02-13252S0894-1130(12)X0002-4Clinical Section163172http://www.jhandtherapy.org/article/PIIS0894113011001517/abstract?rss=yesAbstract: Despite advances in understanding of the mechanical aspects of tendon management with improved suture technique and early stress application with postoperative therapy, clinical results remain inconsistent after repair, especially within the synovial regions. Complementary research to enhance the intrinsic pathway of healing, suppress the extrinsic pathway of healing, and manipulate frictional resistance to tendon gliding is now the focus of current basic science research on tendons. In the future, application of these new biologic therapies may increase the “safety zone” (or tolerance for load and excursion without dysfunctional gapping) as therapists apply stress to healing tendons and may alter future rehabilitation protocols by allowing greater angles of motion (and thus tendon excursion), increased external load, and decreased time in protective orthoses (splints). However, at this time, the stronger repair techniques and the application of controlled stress remain the best and most well-supported intervention after tendon injury and repair in the recovery of functional tendon excursion and joint range of motion. The hand therapist's role in this process remains a critical component contributing to satisfactory outcomes.Managing the Injured Tendon: Current ConceptsRoslyn B. Evans10.1016/j.jht.2011.10.004Journal of Hand Therapy 25, 2 (2012)2012-02-13Journal of Hand Therapy2012-02-13252S0894-1130(12)X0002-4Clinical Section173190http://www.jhandtherapy.org/article/PIIS0894113011001542/abstract?rss=yesAbstract: This article reviews the current opinion of the histopathological findings of common elbow, wrist, and hand tendinopathies. Implications for client management including examination, diagnosis, prognosis, intervention, and outcomes are addressed. Concepts for further research regarding common therapeutic interventions are discussed.Tendinopathies of the Elbow, Wrist, and Hand: Histopathology and Clinical ConsiderationsJane M. Fedorczyk10.1016/j.jht.2011.12.001Journal of Hand Therapy 25, 2 (2012)2012-04-01Journal of Hand Therapy2012-04-01252S0894-1130(12)X0002-4Clinical Section191201http://www.jhandtherapy.org/article/PIIS0894113011001578/abstract?rss=yesAbstract: Treatment of peripheral nervous system (PNS) pathology presents intervention challenges to every therapist. Many of the current and future interventions will be directed at restoring the normal anatomy, function, and biomechanical properties of the PNS, restoring normal neural physiology and ultimately patient function and quality of life. Present interventions use mechanical (movement) or electrical procedures to affect various properties of the peripheral nerve. The purpose of this article was to apply basic science to clinical practice. The pathology and accompanying structural and biomechanical changes in the PNS will be presented in three specific areas commonly encountered in the clinic: nerve injury and laceration; compression neuropathies; and neuropathic pain and neural tension dysfunction. The intent is to address possible interventions exploring the clinical reasoning process that combines basic science and evidence-based best practice. The current lack of literature to support any one intervention requires a strong foundation and understanding of the PNSs’ structure and function to refine current and develop new intervention strategies. Current evidence will be presented and linked with future considerations for intervention and research. During this interlude of development and refinement, best practice will rely on sound clinical reasoning skills that incorporate basic science to achieve a successful outcome when treating these challenging patients.Interventions in the Disturbances in the Motor and Sensory EnvironmentMark T. Walsh10.1016/j.jht.2011.12.004Journal of Hand Therapy 25, 2 (2012)2012-04-01Journal of Hand Therapy2012-04-01252S0894-1130(12)X0002-4Clinical Section202219http://www.jhandtherapy.org/article/PIIS0894113011001384/abstract?rss=yesAbstract: The prescription of an effective therapeutic exercise program requires the right dosage of the right exercise, at the right time for that patient. The therapist must understand and apply training principles effectively in the presence of pathology, injury, or otherwise unhealthy tissue. The intervention goal is to close the gap between current performance and the desired goal or capacity. Although there may be a preferred linear path from current performance to optimal outcome, complexities of the human body, internal factors, and external variables may create barriers to this direct path. Successful programs include key program design considerations such as ensuring a stable baseline before progression, treating the right impairments and activity limitations, understanding contextual factors, considering the principles of specificity and optimal loading, and applying dosing principles. Program progression can be achieved through increases in total exercise volume and/or through manipulation of exercise challenges at the same exercise volume. Effective application of these principles will guide patients toward their goals as quickly and efficiently as possible.Effective Therapeutic Exercise Prescription: The Right Exercise at the Right DoseLori Thein Brody10.1016/j.jht.2011.09.009Journal of Hand Therapy 25, 2 (2012)2012-01-04Journal of Hand Therapy2012-01-04252S0894-1130(12)X0002-4Clinical Section220232http://www.jhandtherapy.org/article/PIIS0894113011001554/abstract?rss=yesAbstract: Orthotic intervention is an essential component of hand rehabilitation, addressing biological factors that affect activity and participation. Functional, pain-free joint mobility requires skeletal stability, healthy articular cartilage, and appropriate extensibility of periarticular dense connective tissues (DCTs). This article addresses basic science underlying clinical reasoning when considering orthoses to maintain or restore structural integrity, mobility and function of DCT structures, and articular cartilage. However, these tissues often have different and sometimes conflicting requirements for the maintenance and restoration of integrity and health. The duration of immobilization, especially at end range, should be carefully considered, as it impairs nutrition of tissues and adversely compresses articular cartilage, causing injury that may not be reversible. Immobilization also reduces extensibility of DCT. Thus, an intermittent orthotic wearing schedule is suggested, allowing movement wherever possible to promote tissue health. To optimize benefits and minimize harmful effects of orthotic intervention, further research on physiological responses of human tissues to immobilization and tension is needed.Orthotic Considerations for Dense Connective Tissue and Articular Cartilage—The Need for Optimal Movement and StressPat McKee, Susan Hannah, Victoria W. Priganc10.1016/j.jht.2011.12.002Journal of Hand Therapy 25, 2 (2012)2012-04-01Journal of Hand Therapy2012-04-01252S0894-1130(12)X0002-4Clinical Section233243http://www.jhandtherapy.org/article/PIIS0894113012000282/abstract?rss=yesTable of Contents10.1016/S0894-1130(12)00028-2Journal of Hand Therapy 25, 2 (2012)2012-04-01Journal of Hand Therapy2012-04-01252S0894-1130(12)X0002-4FrontmatterA3A3http://www.jhandtherapy.org/article/PIIS0894113012000294/abstract?rss=yesEditorial Board / Masthead / ASHT Officers10.1016/S0894-1130(12)00029-4Journal of Hand Therapy 25, 2 (2012)2012-04-01Journal of Hand Therapy2012-04-01252S0894-1130(12)X0002-4FrontmatterA4A5http://www.jhandtherapy.org/article/PIIS0894113012000142/abstract?rss=yesJeanine Beasley, EdD, OTR, CHT, lives in Rockford, Michigan and is an associate professor in Grand Valley State University’s Occupational Therapy Department. She also works as a hand therapist at Mary Free Bed Rehabilitation Hospital in Grand Rapids, Michigan. Dr Beasley has authored a number of publications dealing with arthritis, splinting, and the use of simulation in occupational therapy programs. Her current research interests include the use of pressure sensors to determine forces involved in various daily activities.Contributors10.1016/j.jht.2012.01.001Journal of Hand Therapy 25, 2 (2012)2012-04-01Journal of Hand Therapy2012-04-01252S0894-1130(12)X0002-4FrontmatterA6A8http://www.jhandtherapy.org/article/PIIS0894113012000312/abstract?rss=yesInstructions for authors10.1016/S0894-1130(12)00031-2Journal of Hand Therapy 25, 2 (2012)2012-04-01Journal of Hand Therapy2012-04-01252S0894-1130(12)X0002-4FrontmatterA9A10