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Pain and VAS

Hand pain & complex regional pain syndrome: assessment, multimodal analgesia, and surgical considerations for vascular compromise.

Overview

Pain assessment in hand and upper-extremity surgery requires precise tool selection and interpretation. The digital Visual Analog Scale (VAS-D) is interchangeable with other scales, though scores may be slightly higher than VAS-P and lower than NRS-V [2]. For postoperative non–shoulder hand populations, a Numeric Rating Scale (NRS) value of 2.1 represents the Patient-Acceptable Symptom State (PASS) threshold [3]. Clinicians must use consistent anchors when utilizing the NRS, as the upper anchor of the 0-10 scale lacks universal standardization [12]. Furthermore, meaningful change in pain scores is more complex than current guidelines suggest, with important change not being consistent across the entire scale [12].

Effective pain management extends beyond intensity measurement to include psychological and functional factors. Addressing pain interference is critical for improving outcomes in wrist and hand pain, as patients with increased depressive symptoms, anxiety, and pain interference require more therapy with fewer achieving all goals [4, 17]. Mental health status may affect response to therapy in patients with hand conditions [17]. In chronic nerve injury, pain intensity should be considered only one component of pain, with the impact of pain in the context of disability also requiring consideration [5].

Interventional strategies and procedural techniques further influence pain outcomes. Injection approach does not affect patient pain perception scores or outcomes for trigger finger injection [1]. The ShotBlocker device effectively reduced the pain of injection versus controls when scores were adjusted to account for pain tolerance [11]. High-intensity laser therapy and mirror therapy offer conclusive evidence of pain reduction for complex regional pain syndrome type I in the hand area, even after the third treatment session [8]. Postoperative pain control should begin before surgery, and combining multiple strategies for pain treatment is beneficial for postoperative pain control in hand surgery [15].

Anatomy & Pathophysiology

Accurate diagnosis and management of hand and carpal fractures and dislocations rely on thorough physical examination and appropriate imaging to limit joint stiffness while preserving mobility and function [25]. Treatment principles emphasize balancing the restoration of function with the maintenance of aesthetic appearance [28]. Restoration of sensory and motor functions, alongside pain alleviation, remains the core objective of hand therapy [32].

Diagnostic Findings: Most patients with carpal tunnel syndrome do not exhibit notable weakness in thumb abduction strength [30]. Larger symptom markings on hand diagrams may indicate less effective coping strategies [37]. Unilateral musculoskeletal pain appears to delay grip initiation and relaxation bilaterally, potentially due to a centrally mediated mechanism [46]. Chronic upper limb pain is paralleled by reduced neuromuscular function of the shoulder and hand, along with impaired work ability, work disability, and general health [48].

Etiology and Risk Factors: The duration of smartphone use and the postures in which it is held contribute to the prevalence of discomfort in the thumb area and related muscles among right-handed students [31]. Factors contributing to thumb pain at work among hand therapists are related to manual therapy techniques and orthotic fabrication [36]. Posterior and posterior superior labral (PPS) injuries produce alterations in glenohumeral kinematics with implications for glenohumeral joint instability, increased glenohumeral joint loading, and potential joint damage [35].

Outcomes and Recovery: Significant differences in cold intolerance incidence after reverse digital artery flap are observed in age and specific digit involved, with a lower incidence in younger patients and the ring finger group [38]. The relative motion extension (RME) program supports safe earlier recovery of hand function and motion when compared to a continuous active motion (CAM) program following repair of zones V and VI extensor tendons [40]. Motivated and psychologically stable people are reported to do well irrespective of the severity of a hand injury [43].

Assessment Tools: For a hand surgery cohort, the Upper Extremity Computer Adaptive Test (UE CAT) demonstrated good to excellent test-retest reliability [42]. For a hand surgery cohort, the Pain Interference Computer Adaptive Test (PI CAT) demonstrated good reliability at the population level [42]. Clinical improvements after trigger digit treatments are reflected in improved PROMIS Pain Interference (PI) and Upper Extremity (UE) scores that reach previously accepted minimum clinically important difference values for hand patients [47].

Complications and Interventions: Major complications following trigger finger release are unlikely, whereas minor complications are prominent [44]. Both splinting and kinesiotaping are effective on pain, functional status, hand grip strength, and median nerve cross-sectional area in carpal tunnel syndrome, with greater effects observed in kinesiotaping [45].

Classification

Numeric Rating Scale (NRS): The upper anchor of the 0-10 Numeric Rating Scale lacks universal standardization, and meaningful change in pain scores is more complex than current guidelines suggest [12]. Important change in pain is not consistent across the entire Numeric Rating Scale, necessitating that clinicians use consistent anchors [12]. A value of 2.1 represents the Patient-Acceptable Symptom State (PASS) threshold for the NRS pain score in postoperative non-shoulder hand and upper-extremity populations [3].

Visual Analog Scale (VAS): Pain scores on the digital Visual Analog Scale (VAS-D) may be slightly higher than those on the paper VAS (VAS-P) [2]. Conversely, pain scores on the VAS-D may be slightly lower than those on the verbal Numeric Rating Scale (NRS-V) [2].

Complex Regional Pain Syndrome (CRPS): The IASP criteria and CRPS severity scores showed similar sensitivity in early diagnosis of complex regional pain syndrome following surgical treatment of distal radial fractures [14]. However, both IASP criteria and CRPS severity scores are poor indicators of the need for treatment in early diagnosis of complex regional pain syndrome [14]. Diagnosis and treatment of Complex Regional Pain Syndrome are challenging and often require a multidisciplinary approach [16].

Other Considerations: Injection approach does not affect patient pain perception scores or outcomes for trigger finger injections [1]. The ShotBlocker device effectively reduced the pain of injection versus controls when scores were adjusted to account for pain tolerance [11]. Pain intensity should be considered only one component of pain, and the impact of pain in the context of disability should be considered in patients with chronic nerve injury [5]. The Pain Interference domain has a larger correlation to physical function than numerical pain scores [6]. Demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores on numerous scoring systems for knee symptoms [34]. Therapists' definitions of painful sensitivity in the hand were consistent with an existing taxonomy for allodynia [39]. Experts recommend individually tailored programs to treat allodynia using a variety of physical/movement, sensory-based, and top-down approaches aligned with the Neuromatrix Model of Pain [41].

Clinical Presentation

Pain assessment in hand and upper-extremity pathology requires attention to both intensity and interference. While pain intensity is a component of chronic nerve injury, the impact of pain regarding disability must also be considered [5]. Pain interference serves as a critical link between pain severity, impairment, and self-reported disability in wrist/hand populations [4], with the Pain Interference domain correlating more strongly to physical function than numerical pain scores [6]. This association is significantly stronger in patients older than 11 years compared to those 11 years or younger [13].

Selection of pain measurement tools influences reported values and interpretation. Digital Visual Analog Scale (VAS-D) scores may be slightly higher than paper Visual Analog Scale (VAS-P) scores, yet slightly lower than Numeric Rating Scale-Verbal (NRS-V) scores [2]. A Numeric Rating Scale (NRS) score of 2.1 represents the Patient-Acceptable Symptom State (PASS) threshold in postoperative non–shoulder hand and upper-extremity populations [3]. However, the upper anchor of the 0-10 NRS lacks universal standardization, and meaningful or important changes in pain scores are not consistent across the entire scale [12]. Clinicians should use consistent anchors when utilizing the NRS, as meaningful change is more complex than current guidelines suggest [12].

Injection and Therapeutic Response: Injection approach does not affect patient pain perception scores or outcomes in trigger finger injection [1]. Patients respond to extra-articular steroid injections with gradual improvement over the course of the first week [10]. High-intensity laser therapy offers conclusive evidence of pain reduction in complex regional pain syndrome type I (CRPS-I) in the hand area, even after the third treatment session [8].

Complex Regional Pain Syndrome (CRPS): Diagnosis and treatment of CRPS are challenging and often require a multidisciplinary approach [16]. Both the IASP criteria and CRPS severity scores showed similar sensitivity in early diagnosis of CRPS following surgical treatment of distal radial fractures, yet both are poor indicators of the need for treatment in this setting [14].

Preoperative and Postoperative Management: Postoperative pain control should begin before surgery in hand surgery [15]. Combining multiple strategies for pain treatment is beneficial in hand surgery [15].

Associated Symptoms and Psychosocial Factors: Approximately one-third of patients with common shoulder disorders reported paresthesia and numbness in the ipsilateral hand, mostly of slight to moderate severity [18]. Greater pain intensity in the uninjured upper extremity is associated with greater unhelpful thinking regarding symptoms during recovery from upper-extremity injury [20]. Screening at 3 months after hand trauma may detect posttraumatic stress disorder, anxiety, depression, and chronic pain, and early intervention following such screening may improve treatment outcomes [27].

Investigations

Plain radiography: While often utilized in initial workups, plain radiography alone may not serve as the standard for accurate diagnosis in workers' compensation patients and can misdirect care [53]. In the context of thumb carpometacarpal arthritis, subjects with one stage of radiographic progression demonstrated a significantly higher intensity of pain on the PRWHE pain subscale at 36-month follow-up [24].

MRI: Magnetic resonance imaging scans may not be the standard for accurate diagnosis in workers' compensation patients and can misdirect care [53].

Other Considerations: Injection approach does not affect patient pain perception scores or outcomes in trigger finger injection [1]. Pain scores on the digital Visual Analog Scale (VAS-D) may be slightly higher than those on the paper Visual Analog Scale (VAS-P) [2] but slightly lower than those on the Numeric Rating Scale-Visual (NRS-V) [2]. A Numeric Rating Scale (NRS) pain score of 2.1 represents the Patient-Acceptable Symptom State (PASS) threshold in a postoperative non-shoulder hand and upper-extremity population [3]. Addressing pain interference may be important to improve outcomes in participants with wrist/hand pain [4], as the Pain Interference domain has a larger correlation to physical function than numerical pain scores [6]. The widest brief Michigan Hand Questionnaire score gap was seen across patients reporting the lowest pain scores after carpal tunnel release surgery [7]. High-intensity laser therapy (HILT) offers conclusive evidence of pain reduction in complex regional pain syndrome type I (CRPS-I) even after the third treatment session [8]. Patients respond to extra-articular steroid injections with gradual improvement over the course of the first week [10], and the ShotBlocker device effectively reduced the pain of injection versus controls when scores were adjusted to account for pain tolerance [11]. The upper anchor of the 0-10 Numeric Rating Scale lacks universal standardization [12], and meaningful change in pain scores is more complex than current guidelines suggest [12]; therefore, clinicians should use consistent anchors for the Numeric Rating Scale because important change is not consistent across the entire scale [12]. The association between greater pain interference and worse patient-reported upper extremity function is significantly stronger for patients older than 11 years than for those 11 years old or younger [13]. The IASP criteria and CRPS severity scores showed similar sensitivity in early diagnosis of complex regional pain syndrome following surgical treatment of distal radial fractures [14], yet both are poor indicators of the need for treatment in early detection of complex regional pain syndrome following surgical treatment of distal radial fractures [14]. Greater pain intensity in the uninjured upper extremity is associated with greater unhelpful thinking regarding symptoms during recovery from upper-extremity injury [20]. The causes of abnormality and severity in self-reported abnormal cold sensitivity suggest a multifactorial aetiology with bony, vascular, and neural components [57].

Treatment

Non-Operative

Injection Approach: The specific injection approach does not affect patient pain perception scores or outcomes in trigger finger injection [1]. Injection Response: Patients respond to extra-articular steroid injections with gradual improvement over the course of the first week [10]. Dosing: High-dose triamcinolone injections outperformed low-dose injections across most metrics including estimated time of relief, rate of repeat injection, and rate of surgery for soft tissue pathology of the hand [33]. Adjunctive Therapies: Combined intervention of vitamin D supplementation and physiotherapy had a better pain-relieving effect than physiotherapy alone in adult patients with musculoskeletal disorders [29]. High-intensity laser therapy offers conclusive evidence of pain reduction in complex regional pain syndrome type I in the hand area, even after the third treatment session [8]. Neural Mobilization: Perceptions of standardized thermal pain stimuli were not altered by neural mobilization techniques in individuals with carpal tunnel syndrome [54].

Operative

Pain Management: Postoperative pain control should begin before surgery [15]. Combining multiple strategies for pain treatment is beneficial for postoperative pain control in hand surgery [15]. Injection Pain Mitigation: The ShotBlocker device effectively reduced the pain of injection versus controls when scores were adjusted to account for pain tolerance [11]. Assessment Metrics: Pain scores on the digital Visual Analog Scale (VAS-D) may be slightly higher than those on the paper VAS (VAS-P) [2]. Pain scores on the digital Visual Analog Scale (VAS-D) may be slightly lower than those on the Numeric Rating Scale (NRS-V) [2]. A value of 2.1 represents the Patient-Acceptable Symptom State (PASS) threshold for the Numeric Rating Scale (NRS) pain score in a postoperative non–shoulder hand and upper-extremity population [3]. Outcome Correlation: The widest brief Michigan Hand Questionnaire score gap was seen across patients reporting the lowest pain scores after carpal tunnel release surgery [7]. Psychosocial Factors: Addressing pain interference may be important to improve outcomes in participants with wrist/hand pain [4]. Patients with increased depressive symptoms, anxiety, and pain interference require more therapy with fewer achieving all goals [17]. Chronic Pain Context: Pain intensity should be considered only one component of pain, and the impact of pain in the context of disability should be considered in patients with chronic nerve injury [5].

Complications

Pain and VAS: Injection approach does not affect patient pain perception scores or outcomes for trigger finger injection [1]. Pain scores on the digital Visual Analog Scale (VAS-D) may be slightly higher than the paper VAS (VAS-P) and slightly lower than the visual Numeric Rating Scale (NRS-V) [2]. A value of 2.1 represents the Patient-Acceptable Symptom State (PASS) threshold for the Numeric Rating Scale (NRS) pain score in a postoperative non–shoulder hand and upper-extremity population [3]. Addressing pain interference may be important to improve outcomes in participants with wrist/hand pain [4]. Pain intensity should be considered only one component of pain, and the impact of pain in the context of disability should be considered in patients with chronic nerve injury [5]. The Pain Interference domain had a larger correlation to physical function than did numerical pain scores [6]. The widest brief Michigan Hand Questionnaire score gap was seen across patients reporting lowest pain scores after carpal tunnel release surgery [7]. High-intensity laser therapy offers conclusive evidence of pain reduction in complex regional pain syndrome type I in the hand area, even after the third treatment session [8]. Patients respond to extra-articular steroid injections with gradual improvement over the course of the first week [10]. The association between greater pain interference and worse patient-reported upper extremity function was significantly stronger for pediatric patients older than 11 years than for those 11 years old or younger [13]. Approximately one-third of patients with common shoulder disorders reported paresthesia and numbness in the ipsilateral hand, mostly of slight to moderate severity [18]. Long-term outcomes for pelvic ring injury are complicated by posterior pelvic pain and are largely multifactorial [19]. Evidence of very low to low quality indicates that the effects of joint-protection programs on pain and hand function are too small to be clinically important at short-, intermediate-, and long-term follow-ups for people with hand arthritis [21]. Patients with a positive history of specific factors and in whom flexor tendon injury is found during A1 pulley release should be explained the possibility of prolonged postoperative symptoms [22]. None of the 26 patients who underwent Targeted Muscle Reinnervation (TMR) demonstrated evidence of new neuroma pain after the procedure [23]. All but one of the 15 patients who presented with preoperative neuroma pain experienced complete relief of pain in the distribution of the transferred nerves after TMR [23]. Psychosocial factors are the strongest correlates of pain with corticosteroid injection for idiopathic trigger finger, but a large portion of the variability remains unexplained [51].

Other Considerations: Donor site morbidity for contralateral C7 transfer is typically mild and transient [9].

Recovery

Light activity (weeks): While specific week ranges for light activity are not explicitly defined in the provided evidence, patients with idiopathic frozen shoulder can expect symptoms to subside and full shoulder movement to return within a maximum of two years from onset [56]. For patients undergoing A1 pulley release for trigger finger, those with a positive history of specific factors and flexor tendon injury found during surgery should be counseled regarding the possibility of prolonged postoperative symptoms [22].

Full activity (months): Long-term outcomes for pelvic ring injuries are largely multifactorial, dependent on the injury itself and associated injuries, and are often complicated by posterior pelvic pain [19]. In contrast, published clinical results for contralateral C7 transfer demonstrate significant improvements in upper limb function, with donor site morbidity typically being mild and transient [9]. Patients with early thumb carpometacarpal osteoarthritis who experience one stage of radiographic progression show significantly higher pain intensity on the PRWHE pain subscale at 36-month follow-up [24].

Complete recovery / outcome plateau (months): The association between greater pain interference and worse patient-reported upper extremity function is significantly stronger for patients older than 11 years compared to those 11 years old or younger [13]. Evidence of very low to low quality indicates that joint-protection programs compared with usual care or control have effects on pain and hand function that are too small to be clinically important at short-, intermediate-, and long-term follow-ups for people with hand arthritis [21].

Rehabilitation protocol: Patients respond to extra-articular steroid injections with gradual improvement over the course of the first week [10]. In the context of chronic nerve injury, pain intensity should be considered only one component of pain, and the impact of pain in the context of disability must also be considered [5]. Addressing pain interference may be important to improve outcomes in participants with wrist/hand pain [4].

Functional milestones: The Pain Interference domain had a larger correlation to physical function than numerical pain scores [6]. The widest brief Michigan Hand Questionnaire score gap was observed across patients reporting the lowest pain scores after carpal tunnel release surgery [7]. Longitudinal changes on the DASH of 11 points, Quick-DASH of 16 points, and PRWE of 14 points represent a minimally clinically important change [55]. The Musculoskeletal Function Assessment Questionnaire was found to be more responsive and more efficient than the SF-36 in measuring changes in function between baseline and follow-up values [49].

Other Considerations: Injection approach does not affect patient pain perception scores or outcomes [1]. Pain scores on the digital Visual Analog Scale (VAS-D) may be slightly higher than the paper VAS (VAS-P) and slightly lower than the verbal Numerical Rating Scale (NRS-V) [2]. None of the 26 patients who underwent Targeted Muscle Reinnervation (TMR) demonstrated evidence of new neuroma pain after the procedure, and all but one of the 15 patients who presented with preoperative neuroma pain experienced complete relief of pain in the distribution of the transferred nerves [23]. Mobile-bearing and fixed-bearing all-polyethylene tibial component total knee arthroplasty designs functioned equivalently at the time of early follow-up in a low-to-moderate-demand patient group [58]. Further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time after autologous matrix-induced chondrogenesis for focal cartilage defects in the knee [50].

Key Evidence

  • [L3] Our data suggest that injection approach does not affect patient pain perception scores or outcomes. (10.1177/1558944717703134)
  • [L3] Therefore, the VAS-D may be used interchangeably with the other two scales but therapists must be aware that pain scores on the VAS-D may be slightly higher than the VAS-P and slightly lower than the NRS-V. (10.1016/j.jht.2011.07.017)
  • [L3] The authors propose a value of 2.1 to represent the Patient-Acceptable Symptom State (PASS) threshold for the Numeric Rating Scale (NRS) pain score in this population. (10.1016/j.jhsa.2024.07.020)
  • [L4] Addressing pain interference may be important to improve outcomes in this population. (10.1016/j.jht.2019.06.001)
  • [L4] Pain intensity should be considered only one component of pain, and the impact of pain in the context of disability should be considered in patients with chronic nerve injury. (10.1016/j.jhsa.2010.07.018)
  • [L3] The Pain Interference domain had a larger correlation to physical function than did numerical pain scores. (10.1016/j.jhsa.2017.06.004)
  • [L3] Unexpectedly, the widest brief Michigan Hand Questionnaire score gap was seen across patients reporting lowest pain scores. (10.1177/15589447211064365)
  • [L1] The study results offer conclusive evidence of pain reduction, a highly debilitating symptom in CRPS-I, even after the third HILT treatment session. (10.1016/j.jht.2025.02.009)
  • [L5] Published clinical results have demonstrated significant improvements in upper limb function, confirming the procedure's safety and efficacy, with donor site morbidity that is typically mild and transient. (10.1177/17531934251314640)
  • [L1] Patients respond to extra-articular steroid injections with gradual improvement over the course of the first week. (10.1016/j.jhsa.2007.08.002)
  • [L1] The ShotBlocker device effectively reduced the pain of injection versus controls when scores were adjusted to account for pain tolerance. (10.1177/1558944719884655)
  • [L5] The authors argue that the upper anchor of the 0-10 Numeric Rating Scale lacks universal standardization and that meaningful change is more complex than current guidelines suggest, urging clinicians to use consistent anchors and recognize that important change is not consistent across the entire scale. (10.1016/j.jht.2017.12.008)
  • [L3] The association between greater pain interference and worse patient-reported upper extremity function was significantly stronger for patients older than 11 years than those 11 years old or younger. (10.1016/j.jhsa.2020.05.011)
  • [L3] The IASP criteria and CRPS severity scores showed similar sensitivity in early diagnosis, but both are poor indicators of the need for treatment. (10.1177/1753193412469142)
  • [L3] The evidence available suggests that postoperative pain control should begin before surgery and that combining multiple strategies for pain treatment is beneficial. (10.1016/j.jhsa.2015.05.024)
  • [L4] This review elucidates the recent advances in the knowledge of the aetiology, classification and treatment of Complex Regional Pain Syndrome, highlighting that diagnosis and treatment are challenging and often require a multidisciplinary approach. (10.1177/1753193412471021)
  • [L3] There is some indication that patients with increased depressive symptoms, anxiety, and pain interference require more therapy with fewer achieving all goals, suggesting that mental health status may affect response to therapy. (10.1016/j.jht.2020.10.006)
  • [L3] Approximately one-third of patients with common shoulder disorders also reported paresthesia and numbness in the ipsilateral hand, mostly of slight to moderate severity. (10.1016/j.jse.2025.02.033)
  • [L2] Given that greater pain intensity in the uninjured upper extremity is associated with greater unhelpful thinking, clinicians can be attuned to patient concerns about contralateral pain. (10.1016/j.jhsa.2023.03.019)
  • [L1] Evidence of very low to low quality indicates that the effects of JP programs compared with usual care/control on pain and hand function are too small to be clinically important at short-, intermediate-, and long-term follow-ups for people with hand arthritis. (10.1016/j.jht.2018.09.012)
  • [L4] In addition, they should explain to patients with a positive history of these factors and in whom flexor tendon injury is found during surgery about the possibility of prolonged postoperative symptoms. (10.1016/j.jhsa.2018.06.023)
  • [L4] None of the 26 patients who underwent TMR demonstrated evidence of new neuroma pain after the procedure, and all but one of the 15 patients who presented with preoperative neuroma pain experienced complete relief of pain in the distribution of the transferred nerves. (10.1007/s11999-014-3528-7)
  • [L2] However, subjects with early CMC OA who had 1 stage of radiographic progression were found to have a significantly higher intensity of pain on the PRWHE pain subscale at 36-month follow-up. (10.1177/1558944720928489)
  • [L4] Despite a limited evidence base, screening at 3 months may detect posttraumatic stress disorder, anxiety, depression, and chronic pain, potentially allowing for early intervention and improved treatment outcomes. (10.1016/j.jht.2016.11.006)
  • [L3] Combined intervention (vitamin D with physiotherapy) had a better pain-relieving effect than physiotherapy alone. (10.3389/fnut.2021.717473)
  • [L3] Most patients with CTS do not appear to have notable weakness of thumb abduction strength. (10.1016/j.jhsa.2007.04.007)
  • [L4] The duration of smartphone use and the postures in which it is held contribute to the prevalence of discomfort in the thumb area and related muscles among right-handed students. (10.1186/s12891-024-07685-7)
  • [L5] Restoration of sensory and motor functions as well as alleviating pain is at the core of hand therapy. (10.1016/j.jht.2017.12.009)
  • [L4] High-dose triamcinolone injections outperformed low-dose injections across most metrics including estimated time of relief, rate of repeat injection, and rate of surgery. (10.1016/j.jhsa.2025.09.014)
  • [L4] Numerous scoring systems have been devised to evaluate patients who have symptoms related to the knee, but demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores. (10.2106/00004623-199706000-00009)
  • [L5] The PPS injury produces alterations in GH kinematics with implications for GH joint instability, increased GH joint loading, and potential joint damage. (10.1016/j.jse.2024.12.023)
  • [L4] Factors that were identified as contributing to thumb pain at work were related to manual therapy techniques and orthotic fabrication. (10.1016/j.jht.2024.08.019)
  • [L3] This suggests that larger symptom markings on hand diagrams may indicate less effective coping strategies. (10.1016/j.jhsa.2015.07.031)
  • [L4] Significant differences were observed in age and specific digit involved, with a lower incidence in younger patients and the ring finger group. (10.1177/1753193415596438)
  • [L5] Therapists' definitions were consistent with an existing taxonomy for allodynia. (10.1016/j.jht.2023.08.012)
  • [L1] The RME program supports safe earlier recovery of hand function and motion when compared to a CAM program following repair of zones V and VI extensor tendons. (10.1016/j.jht.2018.10.003)
  • [L5] Experts recommend individually tailored programs to treat allodynia using a variety of physical/movement, sensory-based, and top-down approaches aligned with the Neuromatrix Model of Pain. (10.1016/j.jht.2023.08.003)
  • [L2] For a hand surgery cohort, the UE CAT demonstrated good to excellent test-retest reliability and the PI CAT demonstrated good reliability at the population level. (10.1016/j.jhsa.2025.03.006)
  • [L4] Motivated and psychologically stable people are reported to do well irrespective of the severity of a hand injury. (10.1177/1753193407087026)
  • [L3] Major complications following trigger finger release are unlikely; however, minor complications are prominent. (10.1177/15589447221081869)
  • [L1] Both splinting and kinesiotaping are effective on pain, functional status, hand grip strength and median nerve cross-sectional area, with greater effects in kinesiotaping. (10.1016/j.jht.2024.12.001)
  • [L4] Unilateral musculoskeletal pain appears to delay grip initiation and relaxation bilaterally, perhaps due to a centrally mediated mechanism. (10.1016/j.jht.2011.06.004)
  • [L3] Clinical improvements after trigger digit treatments are reflected in improved PROMIS PI and UE scores that reach previously accepted minimum clinically important difference values for hand patients. (10.1016/j.jhsa.2022.03.015)
  • [L4] Chronic upper limb pain was paralleled by reduced neuromuscular function of the shoulder and hand along with impaired work ability, work disability and general health. (10.1186/s12891-016-0953-7)
  • [L3] It was more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values. (10.2106/00004623-199709000-00006)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L2] Psychosocial factors are the strongest correlates of pain with corticosteroid injection, but a large portion of the variability remains unexplained. (10.1016/j.jhsa.2011.10.055)
  • [L3] Magnetic resonance imaging scans may not be the standard for accurate diagnosis and can misdirect care. (10.1016/j.jhsa.2011.12.008)
  • [L2] Longitudinal changes on the DASH of 11 points, the Quick-DASH of 16 points, and the PRWE of 14 points represent minimally clinically important changes. (10.1016/s0363-5023(12)60023-9)
  • [L4] In the great majority of patients idiopathic frozen shoulder is a self-limiting condition, in which symptoms subside and full shoulder movement returns within a maximum of two years from the onset of symptoms. (10.2106/00004623-197860040-00030)
  • [L4] The causes of abnormality and severity suggest a multifactorial aetiology with bony, vascular and neural components. (10.1177/1753193409354184)
  • [L1] The two designs functioned equivalently at the time of early follow-up in this low-to-moderate-demand patient group. (10.2106/jbjs.j.00157)

See Also

References

[1] The Effect of Trigger Finger Injection Site on Injection-Related Pain. HAND. 2017. DOI: 10.1177/1558944717703134

[2] Validity, Reliability, and Responsiveness of a Digital Version of the Visual Analog Scale for Measuring Pain Intensity. Journal of Hand Therapy. 2011. DOI: 10.1016/j.jht.2011.07.017

[3] Establishing the Patient-Acceptable Symptom State for the Numeric Rating Scale-Pain Score in a Postoperative Non–Shoulder Hand and Upper-Extremity Population. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.07.020

[4] Pain interference may be an important link between pain severity, impairment, and self-reported disability in participants with wrist/hand pain. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2019.06.001

[5] Relationships Among Pain Disability, Pain Intensity, Illness Intrusiveness, and Upper Extremity Disability in Patients With Traumatic Peripheral Nerve Injury. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.07.018

[6] Efficacy of PROMIS Pain Interference and Likert Pain Scores to Assess Physical Function. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.004

[7] Prescription Opioids and Patient-Reported Outcomes and Satisfaction After Carpal Tunnel Release Surgery. HAND. 2022. DOI: 10.1177/15589447211064365

[8] Effect of high-intensity laser therapy and mirror therapy on complex regional pain syndrome type I in the hand area: A randomized controlled trial. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.009

[9] Harnessing the uninjured hemisphere for treatment of the stroke or brain-injured patient – evolution of the contralateral C7 transfer. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251314640

[10] Extra-Articular Steroid Injection: Early Patient Response and the Incidence of Flare Reaction. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.08.002

[11] The Effectiveness of a Non-Invasive Shot Blocking Device for Reducing Pain of In-office Injections in Hand Surgery. HAND. 2019. DOI: 10.1177/1558944719884655

[12] A reconceptualization of the pain numeric rating scale: Anchors and clinically important differences. Journal of Hand Therapy. 2018. DOI: 10.1016/j.jht.2017.12.008

[13] Upper Extremity Function, Peer Relationships, and Pain Interference: Evaluating the Biopsychosocial Model in a Pediatric Hand Surgery Population Using PROMIS. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2020.05.011

[14] A comparison of the accuracy of two sets of diagnostic criteria in the early detection of complex regional pain syndrome following surgical treatment of distal radial fractures. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412469142

[15] Management of Acute Postoperative Pain in Hand Surgery: A Systematic Review. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.05.024

[16] Complex Regional Pain Syndrome: a review. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193412471021

[17] The relationship between depression, anxiety, and pain interference with therapy referral and utilization among patients with hand conditions. Journal of Hand Therapy. 2022. DOI: 10.1016/j.jht.2020.10.006

[18] Shoulder pain and dysesthesia of the hand: a prospective evaluation of 1201 consecutive patients presenting for shoulder surgery. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.033

[19] Chapter 32 Pelvic Fractures: Definitive Treatment and Outcomes. 2021.

[20] Is Pain in the Uninjured Arm Associated With Unhelpful Thoughts and Distress Regarding Symptoms During Recovery From Upper-Extremity Injury?. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.03.019

[21] The effectiveness of joint-protection programs on pain, hand function, and grip strength levels in patients with hand arthritis: A systematic review and meta-analysis. Journal of Hand Therapy. 2019. DOI: 10.1016/j.jht.2018.09.012

[22] Factors Causing Prolonged Postoperative Symptoms Despite Absence of Complications After A1 Pulley Release for Trigger Finger. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.06.023

[23] Targeted Muscle Reinnervation: A Novel Approach to Postamputation Neuroma Pain. Clinical Orthopaedics & Related Research. 2014. DOI: 10.1007/s11999-014-3528-7

[24] The Association of AUSCAN and PRWHE Patient-reported Outcome Measures With Radiographic Progression of Early Thumb Carpometacarpal Arthritis at 36-Month Follow-up Is Limited to Subtle Changes in the Pain Subscale. HAND. 2020. DOI: 10.1177/1558944720928489

[25] Chapter 29 Hand/Carpal Fractures and Dislocations. 2021.

[27] Systematic review: Predicting adverse psychological outcomes after hand trauma. Journal of Hand Therapy. 2017. DOI: 10.1016/j.jht.2016.11.006

[28] 9. Hand Surgery. 2013.

[29] Combined Effect of Vitamin D Supplementation and Physiotherapy on Reducing Pain Among Adult Patients With Musculoskeletal Disorders: A Quasi-Experimental Clinical Trial. Frontiers in Nutrition. 2021. DOI: 10.3389/fnut.2021.717473

[30] Thumb Abduction Strength Measurement in Carpal Tunnel Syndrome. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.04.007

[31] The impact of smartphone use duration and posture on the prevalence of hand pain among college students. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07685-7

[32] Pain-related psychological issues in hand therapy. Journal of Hand Therapy. 2018. DOI: 10.1016/j.jht.2017.12.009

[33] Efficacy of Low-Dose Versus High-Dose Corticosteroid Injections for Soft Tissue Pathology of the Hand. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.09.014

[34] Demographic Biases of Scoring Instruments for the Results of Total Knee Arthroplasty. The Journal of Bone & Joint Surgery*. 1997. DOI: 10.2106/00004623-199706000-00009

[35] 2025 Basic Science Neer Award Winner: The impact of posterior and posterior superior labral injuries and the effect of their treatment on glenohumeral kinematics in the deceleration and follow-through phase of throwing: a biomechanical study. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.12.023

[36] THUMB PAIN EXPERIENCED IN HAND THERAPISTS. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.08.019

[37] The Relationship Between Catastrophic Thinking and Hand Diagram Areas. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.07.031

[38] Prevalence, characteristics and natural history of cold intolerance after the reverse digital artery flap. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415596438

[39] How should we define and assess painful sensitivity in the hand? An international e-Delphi study. Journal of Hand Therapy. 2024. DOI: 10.1016/j.jht.2023.08.012

[40] A randomized clinical trial comparing early active motion programs: Earlier hand function, TAM, and orthotic satisfaction with a relative motion extension program for zones V and VI extensor tendon repairs. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2018.10.003

[41] How should we treat painful sensitivity in the hand? An international e-Delphi study. Journal of Hand Therapy. 2024. DOI: 10.1016/j.jht.2023.08.003

[42] Evaluation of Test–Retest Reliability for the Patient-Reported Outcomes Measurement Information System Upper Extremity and Pain Interference Computer Adaptive Tests in a Hand Surgery Population. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.03.006

[43] The Psychological Impact of Severe Hand Injury. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193407087026

[44] Complications Following Endoscopic and Open Trigger Finger Release: A Retrospective Comparative Study. HAND. 2022. DOI: 10.1177/15589447221081869

[45] Effect of splinting and kinesiotaping treatments on functional status, sleep quality and median nerve cross-sectional area in carpal tunnel syndrome: A single blind prospective randomized controlled study. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.12.001

[46] Influence of Pain Associated with Musculoskeletal Disorders on Grip Force Timing. Journal of Hand Therapy. 2011. DOI: 10.1016/j.jht.2011.06.004

[47] Responsiveness of PROMIS Instruments for Trigger Digit After Corticosteroid Injection or A1 Pulley Release. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.03.015

[48] Associations between biopsychosocial factors and chronic upper limb pain among slaughterhouse workers: cross sectional study. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-0953-7

[49] Comparison of the Musculoskeletal Function Assessment Questionnaire with the Short Form-36, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Sickness Impact Profile Health-Status Measures. The Journal of Bone and Joint Surgery (American Volume)*. 1997. DOI: 10.2106/00004623-199709000-00006

[50] Mid‐term results of Autologous Matrix‐Induced Chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1042-3

[51] Predictors of Pain During and the Day After Corticosteroid Injection for Idiopathic Trigger Finger. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.10.055

[53] Magnetic Resonance Imaging in Evaluating Workers' Compensation Patients. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.12.008

[54] Effects_of_Manual_Therapy_on_Pain_Perception_in_Individuals_with_Carpal_Tunnel_S_S0894113008001415. n.d..

[55] Minimal Clinically Important Differences on the DASH, Quick-DASH and PRWE. The Journal of Hand Surgery. 2012. DOI: 10.1016/s0363-5023(12)60023-9

[56] Brief Note The Natural History of 'Idiopathic' Frozen Shoulder. The Journal of Bone & Joint Surgery. 1978. DOI: 10.2106/00004623-197860040-00030

[57] Cut-Off Value for Self-Reported Abnormal Cold Sensitivity and Predictors for Abnormality and Severity in Hand Injuries. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193409354184

[58] Mobile and Fixed-Bearing (All-Polyethylene Tibial Component) Total Knee Arthroplasty Designs. Journal of Bone and Joint Surgery. 2010. DOI: 10.2106/jbjs.j.00157

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