Journal of Hand Therapy RSS feed: Articles in Press. 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//inpress?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. Journal of Hand Therapy0894-11302010-03-02 © 2010 Published by Elsevier Inc. healthpermissions@elsevier.comhttp://www.jhandtherapy.org/article/PIIS0894113009001537/abstract?rss=yesAbstract: The relationship between the flexor and extensor systems of the digits is both intricate and balanced, such that disruption of one system can affect the entire dynamics of the finger. The imbalance may be obvious, whereas the precipitating factor may be less obvious. These authors describe a case and provide a detailed biomechanical analysis of how a flexion contracture of the distal interphalangeal joint led to a swan neck deformity in one of their patients.—Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum EditorSwan Neck Deformity after Distal Interphalangeal Joint Flexion Contractures: A Biomechanical Analysis - Corrected ProofShrikant J. Chinchalkar, Brent A. Lanting, Douglas Ross10.1016/j.jht.2009.11.005Journal of Hand Therapy (2010)2010-03-02Journal of Hand Therapy2010-03-02PRACTICE FORUMhttp://www.jhandtherapy.org/article/PIIS0894113009001550/abstract?rss=yesAbstract: Narrative Review: Myopathy, fracture, tendon rupture, and neuropathy are severe physical adverse effects associated with commonly prescribed medications. Recognition of and exercise adjustment for these medication-induced effects by the therapist is essential to providing adequate care. The normal structure and function of muscle, tendon, cartilage, or bone may be altered by medications, leading to significant disability. The number of patients presenting to therapists with medication-induced physical complaints is rising with increases in medication utilization. Therapists should be involved in adverse effect risk reduction by 1) identification and reporting of potential adverse medication reactions, 2) adjustment of exercise regimen when the patient is on a medication with potential damaging effects on tendon, muscle, or cartilage, and 3) vigilant screening for medication-induced myopathies, fractures, neuropathies, and tendinopathies. Although many medications induce physical adverse effects, understanding the most serious musculoskeletal effects of commonly prescribed medications is critical for therapists.Level of Evidence: 5.Medication-induced Adverse Effects: Important Concepts for the Hand Therapist - Corrected ProofDaniel M. Riche, John D. Cleary, S. Travis King10.1016/j.jht.2009.12.001Journal of Hand Therapy (2010)2010-03-02Journal of Hand Therapy2010-03-02SPECIAL ISSUEhttp://www.jhandtherapy.org/article/PIIS0894113009001513/abstract?rss=yesAbstract: Narrative Review. In general, nervous system disorders present with changes in sensation, strength, and cognitive function that must be recognized early for the timely referral often needed for optimal outcome. This article summarizes screening for nervous system disorders in patients who present to the hand therapist and the typical findings associated with common neurologic disorders. Recommendations for referral by the hand therapist of patients with a screening examination consistent with a nervous system disorder are also presented. Central nervous system (CNS) disorders discussed in this article include stroke, traumatic brain and spinal cord injury, CNS tumors, Parkinson disease, dementia, epilepsy, and multiple sclerosis. This is followed by a discussion of the peripheral nervous system (PNS) disorders of acquired and hereditary polyneuropathies, Guillain–Barré syndrome and myasthenia gravis. Lastly, there is a brief discussion of amyotrophic lateral sclerosis, a disorder affecting both the CNS and PNS.Level of Evidence: 5.Screening for Medical Disease—Nervous System Disorders - Corrected ProofMichelle H. Cameron, Eve L. Klein10.1016/j.jht.2009.11.003Journal of Hand Therapy (2010)2010-02-15Journal of Hand Therapy2010-02-15SPECIAL ISSUEhttp://www.jhandtherapy.org/article/PIIS0894113009001525/abstract?rss=yesAbstract: Narrative Review. Conditions of the head, neck, thorax, and shoulder may occur simultaneously with arm pathology or produce symptoms perceived by the patient to originate in the elbow, wrist, or hand. Identification of the tissue disorder and associated impairments, followed by matching the rehabilitative intervention to address these issues, leads to optimal outcomes. With this goal in mind, the hand therapist needs to recognize clinical findings that signal potentially serious medical conditions of the brain, cervical region, chest, or shoulder. Additionally, less serious but potentially debilitating, musculoskeletal or neurogenic pain from proximal sources must also be differentiated from somatic pain originating in the elbow, wrist, or hand so that the clinician can decide to further examine and intervene or refer to an appropriate health care provider. This article describes clinical findings that suggest the presence of serious medical pathology in the head, neck, or thorax and presents a screening algorithm to assist in discriminating pain derived from local structures in the distal arm from referred pain originating in the more proximal regions of the shoulder, thorax, neck, or brain.Level of Evidence: 5.Screening for Head, Neck, and Shoulder Pathology in Patients with Upper Extremity Signs and Symptoms - Corrected ProofEmmanuel Yung, Skulpan Asavasopon, Joseph J. Godges10.1016/j.jht.2009.11.004Journal of Hand Therapy (2010)2010-02-12Journal of Hand Therapy2010-02-12SPECIAL ISSUEhttp://www.jhandtherapy.org/article/PIIS0894113009001021/abstract?rss=yesAbstract: Narrative Review: Pain is considered a fundamental ramification of hand injury and has been identified as one of the most acutely stressful aspects of traumatic injuries and their treatment. Both comorbid psychiatric conditions and psychosocial factors have been shown to affect medical treatment outcome in patients with hand disorders and pain, further complicating recovery and potentially leading to significant psychological, social, and economic consequences for the individual. The purpose of this article was to assist hand therapists in developing a greater understanding of psychological constructs, psychosocial variables, and comorbid psychiatric conditions and thereby facilitate the more effective identification of such factors. A case study is included to illustrate these concepts. Circumstances in which referral for a comprehensive psychological evaluation is necessary are discussed. Many of the principles reviewed are also applicable to other upper extremity and musculoskeletal conditions.Psychological Perspective on Hand Injury and Pain - Corrected ProofAngela J. Koestler10.1016/j.jht.2009.09.001Journal of Hand Therapy (2010)2010-02-11Journal of Hand Therapy2010-02-11SPECIAL ISSUEhttp://www.jhandtherapy.org/article/PIIS0894113009001549/abstract?rss=yesTherapists are continually modifying tendon protocols as part of the quest to create the perfect balance between tendon protection and tendon glide. Although much literature exists on the rehabilitation of the long flexor and extensor tendons to the digits, little literature exists on the rehabilitation of the extensor pollicis longus (EPL) tendon. This author used concepts related to tendon glide, tendon tethering, and early active mobilization to create a new splint and subsequent protocol for patients after an EPL laceration near the extensor retinaculum.—Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum EditorPostoperative Management of Extensor Pollicis Longus Repairs within Close Vicinity to or within the Extensor Retinaculum - Corrected ProofShrikant J. Chinchalkar, Joey G. Pipicelli, Joan Laxamana, Leslie von Dehn10.1016/j.jht.2009.11.006Journal of Hand Therapy (2010)2010-02-11Journal of Hand Therapy2010-02-11PRACTICE FORUMhttp://www.jhandtherapy.org/article/PIIS0894113009001501/abstract?rss=yesAssessing outcomes is vital in any hand therapy practice setting, as it is the primary method of determining whether or not a treatment program is working. In the pediatric population, determining improvements in hand function can be challenging. The author describes using a developmental perspective to evaluate hand function for infants and young children. The utilization of a consistent approach to play along with standard toys is described in this article as a method to evaluate the quality of hand function throughout developmental grasp patterns.—Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum EditorMeasuring Hand Function in the Young Child - Corrected ProofEmily S. Ho10.1016/j.jht.2009.11.002Journal of Hand Therapy (2010)2010-01-18Journal of Hand Therapy2010-01-18PRACTICE FORUMhttp://www.jhandtherapy.org/article/PIIS0894113009001495/abstract?rss=yesAbstract: Fractures of the upper extremity are considered a hallmark of underlying osteopenia or osteoporosis and strong predictors of subsequent fractures. Falling is the strongest single risk factor for fractures in older adults. Studies have shown that interventions to prevent falls can significantly reduce this risk factor. Hand therapists working with patients with an upper extremity injury from a fall cannot assume that screening for osteoporosis or the likelihood of falls has been addressed by other health care professionals. The purposes of this article are to 1) summarize osteoporosis and falls risk screening, 2) describe how fall prevention strategies can be integrated into hand therapy practice, and 3) present evidence for federal and professional organizational support of prevention practice.Screening for Falls and Osteoporosis: Prevention Practice for the Hand Therapist - Corrected ProofMary Thompson, Celinda P. Evitt, Mirtha Montejo Whaley10.1016/j.jht.2009.11.001Journal of Hand Therapy (2010)2010-01-08Journal of Hand Therapy2010-01-08SPECIAL ISSUEhttp://www.jhandtherapy.org/article/PIIS0894113009001355/abstract?rss=yesAbstract: Narrative Review: Many organ systems in the body can demonstrate signs and symptoms of impairment that mimic integumentary, musculoskeletal, and/or neuromuscular conditions commonly evaluated and treated by the hand therapist. In this review, diseases and disorders affecting the gastrointestinal (GI), hepatic/biliary, and renal/urologic systems capable of referring pain and other symptoms to the upper quadrant are presented. Specifically, these organ systems can refer pain to the sternum, neck, shoulder, scapulae, and subscapular and interscapular regions. Symptom referral from the viscera to the elbow and hand is extremely rare. Symptoms of carpal tunnel syndrome/paresthesias can occur in renal disorders and with hepatic/biliary problems. Following the screening model proposed by Goodman and Snyder, potential origins from the GI, hepatic/biliary, and renal/urologic systems are discussed. The goal is to identify patients with referred pain patterns and associated signs and symptoms of conditions that require referral to a physician or other appropriate health care professional. The alert hand therapist will recognize red flag histories, clinical presentation, and risk factors suggesting the need for a more thorough examination to ensure that the patient/client has a condition requiring intervention that is within the scope of the therapist's practice. Screening principles and tips for physician referral are offered.Level of Evidence: 5.Screening for Gastrointestinal, Hepatic/Biliary, and Renal/Urologic Disease - Corrected ProofCatherine C. Goodman10.1016/j.jht.2009.10.005Journal of Hand Therapy (2009)2009-12-28Journal of Hand Therapy2009-12-28SPECIAL ISSUEhttp://www.jhandtherapy.org/article/PIIS0894113009001483/abstract?rss=yesAlthough protocols provide therapists with the scaffolding with which to build a treatment program, it is the judgment, knowledge, and skills of the therapist, and how the one uses such information that allows for modification of a protocol when deemed necessary. This therapist outlines how she modified a postsurgical protocol by using anatomy, biomechanics, the literature, and clinical judgment. This article describes the methodical approach used to successfully modify a standard postsurgical protocol after a PIP joint arthroplasty.—Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum EditorPostoperative Management for PIP Joint Pyrocarbon Arthroplasty - Corrected ProofSheri B. Feldscher10.1016/j.jht.2009.10.011Journal of Hand Therapy (2009)2009-12-28Journal of Hand Therapy2009-12-28PRACTICE FORUMhttp://www.jhandtherapy.org/article/PIIS0894113009001252/abstract?rss=yesAbstract: Narrative review: Hand therapists must be able to identify signs and symptoms of systemic disease that can mimic integumentary, neuromuscular, or musculoskeletal dysfunction evaluated and treated within their scope of practice. Pneumonia, complications of pacemakers, liver disease, kidney stones, ectopic pregnancy, and myocardial ischemia are only a few examples of problems and systemic diseases that can cause shoulder or upper extremity signs or symptoms. A screening model is presented for use by therapists in all practice settings. Information gathered is combined with results from the objective evaluation in making a treatment-versus-referral decision. Knowing the risk factors for various illnesses, diseases, and conditions will help guide the therapist in knowing when to screen for specific problems. Recognizing red flag histories, signs, and symptoms will also alert the therapist to the need for additional questions. Clues to screening and tips for physician referral are offered. Level of Evidence: 5.Screening for Medical Problems in Patients with Upper Extremity Signs and Symptoms - Corrected ProofCatherine C. Goodman10.1016/j.jht.2009.09.005Journal of Hand Therapy (2009)2009-11-30Journal of Hand Therapy2009-11-30SPECIAL ISSUE