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This paper was awarded the ninth annual R. L. Petzoldt Prize for Innovations in Hand Therapy at the Sixteenth Annual Meeting of the American Society of Hand Therapists held in Kansas City, Missouri, October 1993. The R. L. Petzoldt Prize was endowed as a memorial by friends and family of Richard L. Petzoldt, MD. Its purpose is to recognize the paper presented at each ASHT meeting that best exemplifies an innovative and creative approach to hand therapy, thereby advancing clinical practice and research.