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What's New — Hand — August 2026

66 new articles published this month.

Themes: Thumb CMC Arthritis & Arthroplasty · AI & Digital Innovation · Nerve Surgery & TMR · Distal Radius & Wrist Fractures · Wrist & Finger OA Solutions · Health Services & Education

Digest generated 2026-09-14 07:52:46+00:00.

Highlights

Thumb CMC Arthritis & Arthroplasty

Basal joint disease dominates this month's hand literature, spanning novel implants, joint preservation, and complications. A commentary urges disciplined surveillance as trapeziometacarpal arthroplasty adoption accelerates [10], while a single-surgeon CUSUM analysis defines the learning curve for dual-mobility arthroplasty with 2-year outcomes [58]. Meniscal allograft interposition ('Taco Technique') shows promising pain and function results in 90 patients [24], and cadaveric testing clarifies how drill-hole trajectory in suture-button suspensionplasty affects index metacarpal fracture risk [64]. Extension osteotomy with ligamentoplasty alters CMC1 contact patterns on 4D CT [7], suture-button stabilisation is reported for CMC instability and dislocation [35], and an international survey highlights persistent disagreement over terminology and treatment of thumb CMC instability [17].

AI & Digital Innovation

Artificial intelligence and digital tools feature prominently across diagnosis, assessment, and decision-making. Multimodal LLMs show variable ability to apply LaFontaine criteria for distal radius fracture stability [38], and four commercial AI platforms demonstrate imperfect concordance with fellowship-trained hand surgeons on case vignettes [63]. ChatGPT largely preserves diagnostic accuracy despite patient self-diagnosis and framing bias in upper-extremity vignettes [57]. AI-based 3D hand models with virtual goniometry agree well with manual ROM measurement [53]. Complementing these, a dedicated axial fluoroscopic view validated against CT improves intraoperative scaphoid screw centrality assessment [14], and a scoping review examines intraoperative electrodiagnostics for neonatal brachial plexus palsy decision-making [6].

Nerve Surgery & TMR

Peripheral nerve reconstruction and compression neuropathy form a strong cluster. Acute targeted muscle reinnervation at upper-extremity amputation yields better pain and patient-reported outcomes than delayed TMR [13]. Ten minutes of intraoperative electrical stimulation may improve motor grades after end-to-end nerve transfers [48], and an anatomical feasibility study supports FCU-to-ECRB/ECRL nerve transfers for spastic wrist flexion deformities [55]. A case series details operative findings and reconstruction of civilian ballistic nerve injuries [43]. On the compression side, concomitant carpal and cubital tunnel syndromes show greater motor impairment than isolated entrapments [26], surgeon expectations align variably with PROMIS outcomes after open carpal tunnel release [2], and plastic building-block rehabilitation was associated with earlier recovery after carpal tunnel release [61].

Distal Radius & Wrist Fractures

Distal radius and wrist trauma generate several practice-informing studies. A case-control study identifies capitate-to-axis-of-radius distance as the key radiographic predictor of flexor tendon rupture after volar plating [44]. A systematic review concludes untreated ulnar styloid fractures do not compromise wrist function after distal radius fractures [60], while an ASSH survey characterises surgeon management preferences for geriatric distal radius fractures [62]. Social determinants of health and therapy attendance influence early recovery after operative fixation [27], and LLM-based assessment of fracture stability adds a digital angle [38]. Relatedly, a meta-analysis addresses the controversial management of the pink pulseless hand in paediatric supracondylar fractures [59].

Wrist & Finger OA Solutions

Degenerative conditions of the wrist and fingers are addressed with both established and motion-preserving options. A systematic review compares proximal row carpectomy and four-corner fusion for wrist osteoarthritis, outlining indications and complications [30]. A 4+5 extensor compartment pedicled vascularized bone graft shows mid-term clinical and MRI-documented revascularisation benefits in Lichtman II, IIIa Kienböck's disease [29]. For PIP osteoarthritis, multicentre data suggest joint denervation is a reasonably durable, motion-preserving alternative to arthroplasty or arthrodesis [47]. A randomised trial finds a self-management exercise regimen non-inferior to supervised hand therapy for PIP volar plate injuries [20], and a review standardises assessment of first web space contracture [56].

Health Services & Education

Care delivery, equity, training, and sustainability round out the month. No-show patterns at a rural academic hand clinic differ from prior urban data, informing access interventions [3]. Socioeconomic status shapes trigger finger management [34] and paediatric hand injury incidence [36]. Sustainability efforts show reduced drapes and trays cut carbon emissions and costs in minor hand trauma surgery [5], while absorbable sutures reduce pain without compromising healing in open clinic surgery [12]. Surgeon-therapist collaboration is framed as central to outcomes [54], tattoo preservation algorithms address patient-centred incision planning [40], and spaced simulator training with fNIRS evidence favours 2-day intervals for arthroscopic skill retention [1].

Articles by Theme

Thumb CMC Arthritis & Arthroplasty (7)

7. Guebeli A, Honigmann P, Dobbe JGG, et al. Pre- and postoperative 4D CT analysis of thumb CMC joint kinematics after first metacarpal extension osteotomy. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06455-5

In a prospective single-center study, six adults with early thumb carpometacarpal osteoarthritis underwent pre- and postoperative 4D CT during active opposition-retroposition to quantify changes in joint contact and kinematics after first metacarpal extension (Wilson) osteotomy with modified Brunelli ligamentoplasty, with five healthy volunteers as references. The analysis tested whether the procedure reduces cumulative palmar contact and normalizes kinematic patterns toward those of healthy thumbs. These in vivo kinematic data provide biomechanical rationale for the combined procedure in early CMC1 arthritis.

10. McEachan JE, Talwalkar S. Trapeziometacarpal joint arthroplasty: enthusiasm, resilience and responsibility. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261467231

This editorial commentary discusses the rapid uptake of trapeziometacarpal joint arthroplasty as an alternative to trapeziectomy, prompted by a letter from hip surgeons urging hand surgeons to 'learn from Charnley.' The authors argue that enthusiasm for implants that preserve thumb length and strength must be balanced with responsibility. Clinically, they call for formal explant surveillance protocols and implant retrieval analysis systems before widespread adoption outpaces evidence.

17. Nieuwdorp NJ, Mayrhofer-Schmid M, Hundepool CA, et al. Thumb Carpometacarpal Instability: An International Survey on Terminology, Diagnostic Workup, and Treatment. HAND 2026. doi:10.1177/15589447261469600

An international cross-sectional survey of 208 hand surgeons from 38 countries examined terminology, diagnostic workup, and treatment of thumb carpometacarpal instability, with responses analyzed by region and specialty. The study revealed substantial variation in practice patterns worldwide. The findings highlight the need for standardised definitions and consensus-based diagnostic and treatment guidelines for this controversial condition.

24. Eng EM, Rakauskas T, Vieira L, et al. “The Taco Technique”: A Basal Joint Reconstruction Case Series Using a Meniscal Allograft. HAND 2026. doi:10.1177/15589447261463821

A case series of 30 patients (mean age 70 years) undergoing thumb basal joint reconstruction with a meniscal allograft using the novel 'Taco Technique' reported outcomes via pain scales, range of motion, and telephone surveys. Preoperative daily pain averaged 8.76/10 with substantial improvement postoperatively. Meniscal allograft arthroplasty appears promising for basal joint arthritis, though larger comparative studies are needed to validate this technique.

35. Gao D, Sungaran J, McCarron L, et al. Suture-Button Stabilisation for Thumb Carpometacarpal Joint Instability and Dislocation: A Retrospective Case Series. HAND 2026. doi:10.1177/15589447261469607

This retrospective case series of 13 patients, including 4 adolescents, evaluated suture-button stabilisation for thumb carpometacarpal joint instability and dislocation, with most cases being chronic instability and mean follow-up of 11.8 months. The technique avoids the morbidity of tendon graft harvest and large bone tunnels required in traditional ligament reconstruction. The findings support suture-button fixation as a less morbid alternative for CMC1 instability, though the evidence base remains limited.

58. Froschauer SM, Gotterbarm T, Holzbauer M. Learning Curve Analysis of Dual-Mobility Trapeziometacarpal Arthroplasty: A Single-Surgeon Series With 2-Year Follow-up. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.015

A prospective single-surgeon series of 113 dual-mobility trapeziometacarpal arthroplasties used CUSUM analysis to define the learning curve, with 2-year clinical outcomes. Surgical-time CUSUM peaked at case 28, indicating proficiency stabilisation, and all clinical outcomes improved significantly postoperatively. Surgeons adopting this implant should anticipate roughly 28 cases before surgical efficiency plateaus.

64. Kretzmann ID, Judge E, Baldini T, et al. Index Metacarpal Fracture Risk in Suture Button Suspensionplasty and the Effects of Drill Hole Position: A Cadaveric Study. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.009

In 43 fresh-frozen cadaveric hands, suture button suspensionplasty was performed with three K-wire trajectories (central bicortical, dorsal unicortical-plus-bicortical, volar unicortical-plus-bicortical) and index metacarpals were cantilever bend-tested to failure against native controls. Maximum load to failure and peak stress were compared across groups. The results define how drill hole position affects iatrogenic index metacarpal fracture risk, guiding safer surgical technique for thumb basilar joint suspensionplasty.

AI & Digital Innovation (6)

6. Albdewi MJ, Malessy MJ, Saadeh YS. Intraoperative electrodiagnostic testing as a decision-making tool for neonatal brachial plexus palsy: a scoping review. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261478357

This PRISMA-guided scoping review synthesized nine studies (eight retrospective, one prospective) evaluating intraoperative electrodiagnostic techniques, nerve action potentials, somatosensory and motor evoked potentials, compound muscle action potentials, and electromyography, in neonatal brachial palsy surgery. Substantial heterogeneity existed in how these modalities were used to distinguish patients suitable for neurolysis versus nerve reconstruction. The evidence base is too inconsistent to support standardised intraoperative electrodiagnostic decision-making, highlighting the need for prospective studies and consensus protocols.

14. Tzaytlin I, Benkovich V, Abialevich A, et al. Assessment of Scaphoid Screw Centrality Using a Dedicated Axial Fluoroscopic View: A CT-Validated Study. HAND 2026. doi:10.1177/15589447261476241

In 54 patients undergoing scaphoid fixation, the authors validated a dedicated axial fluoroscopic view against postoperative CT measurements of screw deviation from the geometric center of the scaphoid waist. Agreement was assessed by Spearman correlation and Bland-Altman analysis, with subgroup analyses. The technique may improve intraoperative assessment of near-central screw placement within the narrow scaphoid corridor.

38. Newson C, Bailey V, Chappell A, et al. Can Artificial Intelligence Assess Distal Radius Fracture Stability?. HAND 2026. doi:10.1177/15589447261465836

This cross-sectional diagnostic accuracy study tested whether a multimodal large language model could assess distal radius fracture stability using the 5 LaFontaine criteria, comparing its performance against the majority assessment of five hand surgeons on 20 radiographs. The study addresses whether AI image interpretation can serve as an adjunctive diagnostic tool for fracture triage and referral. The clinical implication concerns the real-world reliability of AI for structured radiographic assessment in hand surgery.

53. Değerli Yİ, Güngör S, Oskay D, et al. Observer-Blinded Comparison of Virtual and Manual Finger ROM in AI-Based 3-Dimensional Hand Models. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.06.009

In this observer-blinded cross-sectional validation study, finger joint ROM measured with an AI-based 3-dimensional hand modeling system using virtual goniometry was compared with manual goniometry in patients with postinjury ROM limitations. AI-based measurements showed strong agreement with manual goniometry for MCP, PIP, and DIP flexion with no systematic bias and high intra- and inter-rater reliability, supporting virtual goniometry as a valid, reliable alternative for clinical finger ROM assessment.

57. Jaarsma EH, Ring D, Wickman J, et al. Can Large Language Models Preserve Diagnostic Accuracy Despite Patient Self-Diagnosis and Framing Bias in Hypothetical Upper-Extremity Scenarios?. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.014

ChatGPT (GPT-5) was tested on 180 randomised upper-extremity clinical vignettes varying symptom specificity and patient self-diagnosis accuracy. The LLM identified the intended diagnosis in 165/180 cases and largely avoided anchoring on incorrect self-diagnoses. This suggests LLMs may remain diagnostically reliable despite vague patient descriptions and framing bias, supporting their potential role in online health triage.

63. Donnelley CA, Lee CJ, Halim A, et al. AI Clinical Decision Making Compared with Fellowship-Trained Hand Surgeons: A Case-Based Study. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.06.010

Nine hand surgery case vignettes (four easy, five complex) with radiographs and clinical images were distributed to fellowship-trained hand surgeons and four AI platforms (ChatGPT-4, Claude Opus 4.6, Gemini, Open Evidence) queried once per case. Concordance between AI recommendations and surgeon management was compared across case complexity. The study quantifies how reliably commercial AI platforms replicate expert hand surgeon decision-making, informing their suitability as clinical adjuncts.

Nerve Surgery & TMR (7)

2. Cullom ME, Hajj JP, Ahmed S, et al. Comparison of Surgeon Expectations to Patient-Reported Outcomes Following Open Carpal Tunnel Release. HAND 2026. doi:10.1177/15589447261476240

This study compared hand surgeons' expectations of recovery after open carpal tunnel release with patient-reported PROMIS pain-interference and upper-extremity outcomes at 2 weeks, 6 weeks, and 3 months postoperatively across five surgeons (2021-2024). The findings reveal the degree of alignment or discordance between surgeon predictions and actual patient-reported recovery trajectories. Recognizing these gaps can help surgeons calibrate postoperative counseling and set more accurate recovery expectations for carpal tunnel patients.

13. Posey SL, Geary MB, Pierrie SN, et al. Acute Versus Delayed Targeted Muscle Reinnervation for Upper-Extremity Amputations—Why Wait?. HAND 2026. doi:10.1177/15589447261475383

Using a single-center prospective registry of transradial and transhumeral amputation patients, the authors compared targeted muscle reinnervation performed acutely (within 30 days) versus delayed (beyond 30 days) relative to amputation. The hypothesis was that acute TMR improves pain and patient-reported outcomes without added complications. The findings inform surgical timing decisions for neuroma prophylaxis in upper-extremity amputees.

26. Lee KK, Sadeh O, Barrientos A, et al. Clinical Characteristics of Concomitant Versus Isolated Carpal and Cubital Tunnel Syndromes: A Prospective Cohort Study. HAND 2026. doi:10.1177/15589447261475385

In a prospective cohort of 86 adults, patients with isolated carpal tunnel syndrome (n=32), isolated cubital tunnel syndrome (n=26), and concomitant CTS/CuTS (n=28) underwent standardised sensory and motor examinations. Concomitant dual compression represented a distinct clinical subgroup with greater objective motor impairment than either isolated entrapment syndrome. Clinicians should evaluate for coexisting median and ulnar nerve compression, as combined disease portends more severe presentation and may influence surgical decision-making.

43. Ghosh K, Aggarwal S, Blum E, et al. Operative Evaluation and Treatment of Civilian Ballistic Nerve Injuries: A Case Series. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.003

A retrospective review of 49 patients (57 nerves) with low-velocity civilian gunshot wound nerve injuries at two academic centers examined indications for nerve exploration, intraoperative findings, and reconstruction methods. The cohort was predominantly young men (mean age ~29 years) with motor or mixed nerve injuries, and the median time from injury to surgery was 99 days, with most patients undergoing exploration (61.2%). The study provides civilian data on the operative status of ballistic nerve injuries to guide surgical decision-making regarding exploration timing and reconstruction strategy.

48. Rieker M, Choo S, Snipes K, et al. Ten Minutes of Intraoperative Nerve Stimulation May Improve Outcomes Following End-to-End Nerve Transfer. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.005

This retrospective cohort study of 60 end-to-end nerve transfers (radial-to-axillary or median/ulnar-to-musculocutaneous) in 46 patients compared outcomes between patients receiving 10 minutes of continuous intraoperative electrical stimulation (2 mA, 100 μs) and those who did not. Among stimulated patients, 88% achieved M4-M5 motor recovery versus 61% in the non-stimulated group, with groups otherwise similar in age, timing, and transfer type. Brief intraoperative electrical stimulation is a low-burden technique that may meaningfully improve motor outcomes after nerve transfer and warrants prospective confirmation.

55. Wu KY, Stephens T, Shahriarirad R, et al. Nerve Transfers to Rebalance the Spastic Wrist: An Anatomical Feasibility Study. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.004

This anatomical feasibility study in 10 fresh-frozen cadaveric upper extremities evaluated transferring a motor branch from the flexor carpi ulnaris to the extensor carpi radialis brevis and/or longus to rebalance spastic wrist flexion deformity. The study mapped the number, entry points, and available lengths of motor branches relative to the interepicondylar line, providing anatomical data supporting the feasibility of nerve transfers as an alternative to tendon transfers for spastic wrist imbalance.

61. Brenac C, de Villeneuve Bargemon JB, Merlini L. Rehabilitation using plastic building-block toys was associated with early recovery following carpal tunnel release: a prospective comparative observational pilot study. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104823

This item is a letter to the editor commenting on a pilot study of plastic building-block toy rehabilitation after carpal tunnel release, not the original study itself. The commentary appears in Orthopaedics & Traumatology: Surgery & Research as a journal pre-proof. Its content is a peer commentary rather than primary evidence, so no independent clinical finding can be abstracted from this document.

Distal Radius & Wrist Fractures (6)

27. Jiang EX, MacAlpine EM, Abouljoud MM, et al. The Associations Between Social Determinants of Health and Therapy Attendance With Early Recovery After Operative Distal Radius Fractures. HAND 2026. doi:10.1177/15589447261441340

This study analyzed adults undergoing operative distal radius fracture fixation at a tertiary center (2020-2023), using the Area Deprivation Index and Social Vulnerability Index to examine which demographic and socioeconomic factors predict lack of formal hand therapy and whether therapy affects early outcomes. Social determinants of health were associated with reduced therapy attendance, and formal postoperative therapy was linked to differences in patient-reported function, range of motion, and complications. Findings highlight the need to identify socially vulnerable patients and improve access to hand therapy after distal radius fixation.

38. Newson C, Bailey V, Chappell A, et al. Can Artificial Intelligence Assess Distal Radius Fracture Stability?. HAND 2026. doi:10.1177/15589447261465836

This cross-sectional diagnostic accuracy study tested whether a multimodal large language model could assess distal radius fracture stability using the 5 LaFontaine criteria, comparing its performance against the majority assessment of five hand surgeons on 20 radiographs. The study addresses whether AI image interpretation can serve as an adjunctive diagnostic tool for fracture triage and referral. The clinical implication concerns the real-world reliability of AI for structured radiographic assessment in hand surgery.

44. Bachoura A, Matzon J, Ghayyad K, et al. Radiographic Risk Factors for Flexor Tendon Ruptures Following Distal Radius Volar Plating. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.04.021

This case-control study compared 27 patients with flexor tendon rupture after volar plating of distal radius fractures against 73 controls without rupture, evaluating radiographic parameters including radial inclination, Soong class, volar tilt, and capitate-to-axis-of-radius distance (CARD). Multivariable analysis identified CARD as the only significant independent predictor of rupture when the plate was prominent, with mean CARD of 9.8 mm in the rupture group versus 3.5 mm in controls. Measuring CARD on lateral radiographs may help identify patients at elevated risk of attritional flexor tendon rupture after volar plating and inform plate positioning and follow-up.

59. Itte VN, Cowie J, Ali Yusuf Y, et al. The management of pink pulseless hands in paediatric supracondylar humerus fractures: A systematic review and meta-analysis. Injury 2026. doi:10.1016/j.injury.2026.113461

This systematic review and meta-analysis of 25 retrospective studies (591 children) compared closed reduction and percutaneous pinning alone versus brachial artery exploration for pink pulseless hands after paediatric supracondylar humerus fractures. Pooled pulse return within 24 hours after CRPP alone was 0.61 (95% CI 0.48-0.74) with high heterogeneity. The evidence remains inconclusive, underscoring the need for individualized monitoring and further prospective study of this controversial management decision.

60. Li C, Gao W, Yang C, et al. Untreated ulnar styloid fractures do not compromise wrist function in patients with distal radius fractures: A systematic review and meta-analysis. Injury 2026. doi:10.1016/j.injury.2026.113479

This meta-analysis of 11 studies (1383 patients) compared wrist outcomes after distal radius fracture with untreated ulnar styloid fracture versus isolated distal radius fracture. A small, likely clinically insignificant deficit in patient-reported wrist function was seen only at short-term (≤6 months) follow-up, with no differences in medium- to long-term outcomes. Routine treatment of ulnar styloid fractures accompanying distal radius fractures appears unnecessary.

62. Zaidi Z, Dbeis A, Lee Y, et al. Management Preferences of Geriatric Distal Radius Fractures: Insights From an American Society for Surgery of the Hand Surgeon Survey. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.04.007

A survey of American Society for Surgery of the Hand members presented a 72-year-old distal radius fracture scenario across six fracture patterns to characterize management preferences for geriatric patients. Treatment choices varied by fracture pattern and surgeon factors, despite guideline support for nonsurgical management. The findings highlight substantial practice variation and the tension between guideline recommendations and patient-centered operative decision-making in elderly distal radius fractures.

Wrist & Finger OA Solutions (5)

20. Salentijn DA, Jawahier P, van Barreveld M, et al. Self-Management Exercise Regimen Versus Supervised Hand Therapy in Patients With Dorsal Dislocation or Hyperextension Injury With a Volar Plate Avulsion of the Proximal Interphalangeal Joint: The Randomized Controlled PINOT Study. HAND 2026. doi:10.1177/15589447261469595

The multicenter randomised controlled PINOT trial tested noninferiority of a self-management exercise regimen versus supervised hand therapy with dorsal block splinting for stable, congruent PIP joints after dorsal dislocation or hyperextension injury with volar plate avulsion. The study addressed whether therapist-supervised care could be safely replaced by a self-directed program. If noninferiority is confirmed, self-management could reduce therapy burden while maintaining outcomes for this common injury.

29. Önel Y, Ancar C. Clinical outcomes of using 4 + 5 extensor compartment pedicled vascularized bone graft in Kienböck’s disease. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10347-5

Thirty patients (31 wrists) with Lichtman stage II or IIIa Kienböck's disease underwent a 4th-5th extensor compartment artery pedicled vascularized distal radius bone graft, with retrospective mid-term follow-up (mean 27.5 months) including VAS, Mayo Wrist Score, motion, grip strength, radiographs, and MRI. Pain decreased significantly (VAS 6.1 to 2.6) and Mayo scores improved, with MRI evidence of lunate revascularization and differences between disease stages. This joint-preserving vascularized graft appears effective for early-stage Kienböck's disease, particularly before lunate collapse.

30. Boever J, Unglaub F, Wulf J, et al. Conservative and surgical treatment of wrist osteoarthritis: a systematic review. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06423-z

This systematic review following PRISMA guidelines searched PubMed, Cochrane, and Embase (2010-2025) and included eight studies comparing proximal row carpectomy (PRC) and four-corner fusion (4CF) for wrist osteoarthritis. Both procedures significantly reduced pain and improved function; PRC offered better range of motion and fewer complications, while 4CF yielded greater grip strength. These findings support individualized selection between PRC and 4CF based on patient priorities regarding motion, strength, and complication risk.

47. Kwee E, Nieuwdorp NJ, Blaaker C, et al. Is PIP Denervation for Osteoarthritis a Durable Solution? Results from a Multicenter Outcome Study. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.06.006

This multicenter prospective study of 87 patients (105 joints) with symptomatic PIP osteoarthritis evaluated the durability of PIP joint denervation, defining procedural success as avoidance of subsequent arthroplasty or arthrodesis. At a median follow-up of 43 months, 81% of joints had not required conversion to arthroplasty or arthrodesis, with secondary outcomes including pain, function, satisfaction, and willingness to repeat the procedure. The results support PIP denervation as a reasonably durable, less invasive, motion-preserving alternative to arthroplasty or arthrodesis for PIP osteoarthritis.

56. Miller EA, Boe CC, Crowe CS. Assessment Strategies for First Web Space Contracture. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.012

This review synthesizes current strategies for assessing and measuring outcomes in first web space contracture, a debilitating condition impairing thumb positioning, pinch, and grasp, and highlights the lack of a universally accepted framework for defining, classifying, or measuring it. By clarifying methodologies and identifying gaps and inconsistencies, it lays groundwork for standardised, clinically meaningful evaluation and management of this condition.

Health Services & Education (8)

1. Li W, Ye Y, Zhou J, et al. Two‐Day Spacing Outperforms 1‐Hour and 1‐Week Spacing in Arthroscopic Training: A Simulation‐Based Randomized Controlled Trial With Functional Near‐Infrared Spectroscopy Evidence. Arthroscopy 2026. doi:10.1002/arj.70503

In a randomised controlled trial of 30 novice orthopaedic residents learning knee arthroscopy on simulators, spacing intervals of 1 hour, 2 days, and 1 week were compared using behavioural scores and functional near-infrared spectroscopy of cortical activation. The 2-day spacing group achieved the highest immediate and 1-week retention scores with the most favourable cortical activation patterns. Curricula for arthroscopic skills training should schedule practice sessions approximately 2 days apart rather than same-day or weekly intervals.

3. Ardizzone CA, Cheesman JS, Shaver TL, et al. Factors Affecting Clinic Visit No-Shows at an Academic Medical Center in the American Southwest. HAND 2026. doi:10.1177/15589447261480385

A retrospective cross-sectional analysis of 6539 hand clinic visits by 3586 patients at a southwestern academic safety-net hospital (2022-2023) used multivariable logistic mixed-effects modeling to identify predictors of no-show appointments. The study tested whether risk factors identified in an urban Boston cohort, such as younger age, race/ethnicity, appointment day, and proximity to clinic, apply in a predominantly rural catchment area. Identifying locally relevant no-show risk factors enables targeted interventions such as reminder systems to improve clinic efficiency and reduce lost revenue.

5. Kiely A, Macdonald K, Lees V. Reducing the carbon footprint of hand trauma surgery under local anaesthetic. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261468591

A retrospective cohort study of 100 minor hand trauma procedures compared carbon emissions and costs between standard care and a reduced-waste protocol using smaller drapes and streamlined instrument trays. Smaller drapes cut CO2 emissions per procedure by 71% and streamlined trays by 20%, yielding 236 kg of carbon saved over 4 months and approximately 40% cost savings per procedure without compromising safety or infection rates. Simple waste-reduction measures can substantially shrink the environmental and financial footprint of hand surgery and merit broader adoption.

12. Hägg M, Mellstrand Navarro C, von Kieseritzky J. Absorbable sutures reduce pain without compromising wound healing in open clinic hand surgery. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-07159-7

In this prospective cohort of 270 adults undergoing minor open clinic hand surgery, patients alternately received 5-0 Vicryl Rapid or 5-0 Ethilon skin closure, with wound outcomes and pain assessed at two weeks. Infection rates were equivalent between suture types, and absorbable sutures reduced pain during dressing changes while avoiding suture removal. Absorbable sutures appear preferable in outpatient hand surgery, saving healthcare time without compromising wound healing.

34. Stadelmeier LF, Hilbig-Vlatten L, Asschenfeldt J, et al. Socioeconomic and Demographic Influences on Trigger Finger Management: A Retrospective Cohort study. HAND 2026. doi:10.1177/15589447261467938

This retrospective cohort study examined how race, socioeconomic factors, and insurance status influence the management of trigger finger, one of the most common hand conditions in the United States. It addresses whether disparities in surgical care stem from social determinants rather than underlying pathology. The clinical implication is that recognition of these socioeconomic and demographic influences may help reduce inequities in trigger finger treatment.

36. Rydman N, Wilcke M, Pettersson HJ, et al. The impact of socioeconomic factors on the incidence of paediatric hand and forearm injuries in Sweden. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261472348

This registry-based cohort study analyzed all children aged 0-18 years with hand or forearm injuries in Stockholm County from 2014 to 2019, using Poisson regression to compare incidence across socioeconomic groups. The overall incidence was 345 per 10,000 person-years, paradoxically highest in high-socioeconomic-status areas, with injury type varying by both age and socioeconomic status, burns and crush injuries predominated in low-SES toddlers while fractures and sprains were more common in older children from average/high-SES areas. The results suggest injury prevention strategies should be tailored to both age and socioeconomic context.

40. Eze DL, Benjamin-Laing H, Naji S, et al. Tattoo preservation in upper limb surgery: current practice and a patient-centred decision algorithm. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261467229

This survey of 225 hand and upper limb surgeons assessed practice when tattoos overlie preferred surgical incisions, using a standardised scenario of a tattoo over the anterior distal forearm approach for distal radius fixation. Most respondents (77%) would incise directly through the tattoo, with tattoo-preserving alternatives chosen less frequently. The authors propose a patient-centred decision algorithm, highlighting the need for shared decision-making around tattoo preservation in upper limb surgery.

54. Naughton N, Gift HJ, Stern BZ. Through the Eyes of a Therapist: Ten Things a Hand Surgeon Should Know. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.06.012

This perspective article outlines ten key insights from the hand therapist's viewpoint that hand surgeons should know, emphasizing that outcomes depend on interdisciplinary collaboration rather than operative technique alone. It highlights therapists' expertise in tissue healing, motion management, oedema control, orthotics, and graded return to function, and encourages surgeon-therapist partnership to improve outcomes, efficiency, and patient satisfaction.

4. Roccaforte E, Choy J, Scambler W, et al. Clinical Outcomes and Complications of Intramedullary Proximal Phalanx Fixation. HAND 2026. doi:10.1177/15589447261478333

This retrospective single-center study evaluated clinical, radiographic, and functional outcomes of proximal phalanx fracture fixation using a single intramedullary headless screw device (ExsoMed InFrame). Outcomes assessed included operative time, alignment, time to union, return to activity, range of motion, and complications. The results inform the growing evidence base supporting minimally invasive intramedullary fixation as an option that permits early mobilization of hand fractures.

8. Peszek A, Richman EH, Rakowski DR, et al. Proximal Phalanx Intramedullary Fixation Configurations: A Comparative Biomechanical Cadaveric Study. HAND 2026. doi:10.1177/15589447261476242

This cadaveric biomechanical study randomised 40 proximal phalanges with simulated transverse fractures to intramedullary threaded nail fixation in 'I,' 'Y,' or 'X' configurations versus two crossed Kirschner wires, then compared fixation strength. The results quantify how nail configuration affects construct stability relative to conventional K-wire fixation. Findings guide surgeons in selecting intramedullary configurations that permit immediate mobilization without sacrificing mechanical strength.

9. Woo SJ, Park KH, Woo SH, et al. Non–General Anesthesia Techniques for Pediatric Trigger Thumb Release: An Institutional Experience With Audiovisual Distraction- and Sedation-Assisted Local Anesthesia. HAND 2026. doi:10.1177/15589447261475392

In 296 paediatric trigger thumb releases in children under 12, the authors compared sedation-assisted local anaesthesia (ketamine) with audiovisual distraction-assisted local anaesthesia using caregiver-provided smartphones, with caregivers present at the bedside. Both non, general anaesthesia protocols were feasible, with technique selected by the child's cooperativeness. This offers an alternative for families hesitant about general anaesthesia, potentially reducing delays in surgical correction.

11. Shenqiang Q, Jun S, Zengtao W. Four-finger reconstruction with ten toes preservation: 5-year follow-up. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261476751

A 25-year-old man with multi-digit defects underwent staged four-finger reconstruction using composite flaps and iliac bone grafts, with all toes preserved. At 5-year follow-up, good functional and aesthetic outcomes were achieved. This case suggests a viable strategy for multi-digit reconstruction that avoids toe harvest morbidity.

15. Williams E, Emin A, Pinder R. Incidental finding of a reversed variant (type V) palmaris profundus during forearm surgery. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261474410

The authors report incidental intraoperative identification of a reversed type V palmaris profundus, a rare accessory flexor muscle variant, during forearm surgery. This variant may carry different clinical implications than more common subtypes. Surgeons should be aware of such anomalies to avoid misidentification and complications during forearm procedures.

16. Daliri M, Khosravi F, Jamali J, et al. What clusters exist among the health care personnel screened for upper extremity musculoskeletal conditions?. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-025-09107-8

In a cross-sectional study of 4,635 healthcare personnel screened by interview and physical examination, latent class analyses identified subgroups of common upper extremity musculoskeletal conditions (including CTS, lateral epicondylitis, trapeziometacarpal OA, DeQuervain tendinopathy, trigger digit, ganglion cyst, and rotator cuff tendinopathy) among both all screened individuals and the 713 with at least one condition. The analysis revealed latent clusters based on biopsychosocial factors among individuals who often do not seek care. These patterns can inform personalized, comprehensive care strategies for patients presenting with musculoskeletal complaints.

18. Sutter N, Wanivenhaus C, Götschi T, et al. Computed tomography based three-dimensional analysis of side-to-side differences between metacarpals. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261470219

Three-dimensional CT models of metacarpals from 20 healthy adults were mirrored and compared side-to-side to quantify normal left-right asymmetry relevant to fracture planning. Mean differences were small (0.6 mm length; 1.8-3° in rotation and deviation), but pronation/supination outliers reached 10°. Surgeons using contralateral metacarpals for CT-based alignment guidance should recognize that side-to-side differences, particularly in pronation/supination, may exceed clinically relevant thresholds.

19. Rojer LA, Juttmann JY, Schep NW. Arthroscopic treatment of scapholunate interosseous ligament injuries: a systematic review and meta-analysis. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261472361

A systematic review and random-effects meta-analysis of 16 studies (434 patients) evaluated patient-reported outcomes after arthroscopic treatment of scapholunate interosseous ligament injuries with at least 12 months follow-up, covering capsulodesis, electrothermal treatment, debridement with percutaneous pinning, and scapholunate reduction-association. Meta-analysis of six capsulodesis studies (N = 250) showed significant improvement in patient-reported outcomes versus baseline. Arthroscopic capsulodesis appears to offer a reliable option, though the optimal approach for different injury grades remains unresolved.

21. Holzbauer M, Diepold J, Mihalic JA, et al. Screening for amyloidosis in trigger finger release and Dupuytren’s fasciectomy. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261476753

In a prospective exploratory study, surgical specimens from 100 trigger finger releases and 100 Dupuytren limited fasciectomies in older adults were screened for amyloid using Congo red staining, with immunohistochemical subtyping and cardiological referral for positives. Ten trigger finger and eight Dupuytren specimens were Congo red positive, but amyloid was immunohistochemically confirmed in only five trigger finger cases (four transthyretin), with no clinical cardiac amyloidosis detected. Routine screening for cardiac amyloidosis via these common hand procedures appears to have limited yield, though incidental transthyretin deposition may correlate with pre-existing heart failure.

22. Gordon AM, Nian PP, Said M, et al. Association Between Cannabis Use and Tobacco Use With Nonunion of Nonoperative Management of Scaphoid Fractures. HAND 2026. doi:10.1177/15589447261472087

This study evaluated whether cannabis use, alone or combined with tobacco, is independently associated with nonunion and subsequent surgery after nonoperative management of scaphoid fractures, extending beyond the established risk of tobacco use. It addresses a gap, as cannabis-related fracture healing risk is poorly defined. Results inform risk counseling and surveillance decisions for conservatively managed scaphoid fractures in patients using these substances.

23. Piotuch B, Kuryha I, Fliciński F, et al. A prospective pilot study of two new clinical tests for the presence of the palmaris longus tendon. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261474769

In a prospective pilot study of 370 wrists, two new clinical tests (Szczecin 1 and Szczecin 2) for detecting the palmaris longus tendon were compared with Schaeffer's and AIIMS tests using ultrasonography as the reference standard. The Szczecin tests showed higher sensitivity (87-91%) than Schaeffer's (71-72%) or AIIMS (63-65%). These new tests may improve preoperative identification of the palmaris longus, particularly in patients where tendon visibility is difficult.

25. Adeodato SC, de Oliveira NSP, Favorito LA, et al. Asymmetry of the Intrinsic Scapholunate Articular Facets: A Cadaveric Morphometric Analysis. HAND 2026. doi:10.1177/15589447261469596

In 26 cadaveric wrists, investigators exposed the scaphoid and lunate intrinsic articular facets after dividing the scapholunate interosseous ligament and performed linear and area morphometry using calipers and ImageJ analysis. The study demonstrated asymmetry between the paired scapholunate articular facets, filling a gap in the anatomic characterization of the intrinsic joint interface. These normative morphometric data may guide implant design, arthroscopic assessment, and reconstruction of the scapholunate interval.

28. Engmann TF, Asschenfeldt J, Stearns SA, et al. A Retrospective Cohort Study of Extensor Pollicis Longus Reconstruction Using Palmaris Longus Tendon Graft or Extensor Indicis Proprius Transfer. HAND 2026. doi:10.1177/15589447261472088

This single-institution retrospective cohort compared functional outcomes and complications of extensor pollicis longus reconstruction using palmaris longus tendon graft versus extensor indicis proprius transfer, including delayed presentations. Both techniques provided functional thumb extension with comparable outcomes, addressing the limited comparative data between the two methods. Results support either approach for EPL reconstruction, with technique selection individualized to patient factors and timing of reconstruction.

31. Laurell T, Kruit AS, Winge MI. PULPe Best Paper Award 2025. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261468480

This correspondence announces the 2025 Paediatric Upper Limb Project Europe (PULPe) Best Paper Awards, which recognize excellence in congenital and miscellaneous paediatric upper limb research published across leading hand surgery journals. Award-winning work included a within-subject controlled trial of syndactyly release with skin graft versus skin graft substitute. The initiative aims to foster collaboration and promote high-quality evidence in the rare and heterogeneous field of paediatric upper limb conditions.

32. Kong C, Liu J, Zhang C, et al. Anatomical variations of blood supply to the island flap in modified Bilhaut-Cloquet procedure for thumb duplication. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261470282

In 190 patients with Wassel type II-IV thumb duplication treated with the modified Bilhaut-Cloquet procedure, the blood supply to the island flap harvested from the radial thumb was assessed and classified by the relative calibers of the proper digital artery and communicating branches. Three patterns were identified, fine communicating branch (n=134), equal caliber (n=43), and coarse communicating branch (n=16), with the coarse type showing the lowest flap success rate and the fine type achieving 100% success. Intraoperative recognition of these vascular patterns can improve flap outcomes and reduce complications in thumb duplication correction.

33. Bojovic M, Hagert E. Bone stress fractures and injuries of the upper limb in athletes. International Orthopaedics 2026. doi:10.1007/s00264-026-06978-x

This narrative review synthesizes the mechanisms, risk factors, diagnosis, and management of upper-limb bone stress injuries in athletes, covering injuries from the scapula to the metacarpals. It emphasizes that plain radiographs are often normal early, making MRI the key tool for detecting early stress reactions, and that subtle, non-specific symptoms frequently delay diagnosis. Clinically, it guides sport-specific recognition of anatomical patterns, graded loading management, and return-to-sport decision-making.

37. Jain NS, Weiss K, Bregman DE. Reconstruction of a Base of Fifth Metacarpal Tumor Using the Dubert Procedure: A Case Report. HAND 2026. doi:10.1177/15589447261469602

This case report describes reconstruction after resection of the fifth metacarpal base for a recurrent myopericytic neoplasm in a 63-year-old man, using the Dubert procedure, fusion of the fourth and fifth metacarpal shafts with autogenous bone graft. At 6 months, the fusion had united with good motion and grip strength. The technique demonstrates that stability can be maintained without sacrificing hand function after tumour excision of the metacarpal base.

39. Raeker-Jordan E, Nahhas C, Mzeihem M, et al. Fingertip Forces and Thenar Pressure During Instrument Use in Simulated Meniscectomy: A Comparative Study of Rongeur and Forceps. HAND 2026. doi:10.1177/15589447261468032

This study used TekScan pressure sensors to quantify fingertip forces and thenar pressure in 13 orthopaedic residents performing simulated meniscectomies with a pistol-grip pituitary rongeur versus pincer-grip Ferris-Smith forceps. The rongeur produced significantly higher forces in the fingers (50.10 vs 30.62 N) and thenar region (40.69 vs 3.34 N), with similar thumb-tip forces. These findings suggest instrument design substantially affects hand loading, with implications for surgeon ergonomics and prevention of overuse injury.

41. Aggag AM. Dual-pedicle FDMA flap with intraoperative perfusion testing: a decision-making strategy for reliable thumb reconstruction. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261473410

Thirty patients with complex thumb defects were reconstructed with a dual-pedicle modification of the first dorsal metacarpal artery (FDMA) flap, adding a secondary fasciocutaneous pedicle from the radial index finger and using an intraoperative axial pedicle stress test with temporary tourniquet occlusion to guide whether the secondary pedicle could be divided. Most patients (27/30) tolerated immediate division of the secondary pedicle, while three required temporary retention due to inadequate perfusion. This perfusion-testing strategy offers a practical intraoperative decision-making tool to enhance the reliability of FDMA flap thumb reconstruction and reduce ischemic complications.

42. Unknown Author. Journal CME Instructions. The Journal of Hand Surgery 2026. doi:10.1016/s0363-5023(26)00459-4

This document outlines the Journal of Hand Surgery continuing medical education (CME) program, describing its objectives of affirming or increasing hand surgeons' knowledge and their ability to apply clinical data to patient care. Participants must read selected clinically relevant articles per issue and correctly answer all online examination questions to earn credit, per AMA policy. It is administrative program information rather than a research study, with no clinical findings or implications.

45. Monhollen AA, Kolb ND, Hark G, et al. Single Institution Validation Study of the Mangled Digit Severity Score for Predicting Salvageability of Severe Digital Injuries. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.06.001

A single-institution external validation study at a level 1 trauma center assessed the Mangled Digit Severity Score (MDSS) in 40 patients with 85 mangled digits treated between 2019 and 2025, testing its ability to predict amputation versus successful salvage. Using the originally published cutoffs, the MDSS achieved 76.2% overall accuracy with sensitivity of 74%, and receiver operating characteristic analysis was used to derive institution-specific optimised cutoffs for salvage versus revision amputation. The findings support the MDSS as a reasonably discriminating decision-support tool for severe digital injuries while suggesting cutoff refinement may improve its predictive performance.

46. Norman-Puim E, Lalone E, Kadar A, et al. Reverse Total Wrist Arthroplasty: New Design and Biomechanical Advantages. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.06.005

In eight cadaveric specimens, investigators compared a novel reverse total wrist arthroplasty (RTWA), which shifts the center of rotation, against a custom load-sensing fourth-generation total wrist arthroplasty (TWA) using an active motion simulator during flexion-extension and radial-ulnar deviation. The RTWA generally required lower muscle force magnitudes, with four of five muscles examined needing less force during flexion-extension, though radial-ulnar deviation results were underpowered and descriptive only. These biomechanical findings suggest the reverse design may reduce muscular demand and offer kinematic advantages that could address persistent failure rates of current TWA designs.

49. Zhang W, Wu T, Wang C, et al. The Efficacy of Transosseous Foveal Repair Combined With Dorsal Reinforcement in the Treatment of Chronic Triangular Fibrocartilage Complex Injury With Severe Distal Radioulnar Joint Instability. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.007

In a case series of 21 patients with chronic TFCC injury and severe DRUJ instability treated with arthroscopic transosseous foveal repair plus allogeneic tendon graft dorsal reinforcement, substantial improvements were seen at ~44.5 months follow-up: VAS pain fell from 5.5 to 0.7, Mayo wrist score rose from 68.9 to 90.3, and PRWE dropped from 50.4 to 8.9, with all patients achieving clinically meaningful improvement. This suggests that augmenting foveal repair with dorsal reinforcement may address instability that foveal repair alone cannot, though the uncontrolled design limits causal inference.

50. Yasui Y, Tsukada K, Yonezawa K, et al. Paper 58. Pitch Count Alone Is Not Enough: Age-Dependent Pinch Strength Change and Associated Factors in Youth Baseball Pitchers. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00315

This prospective study examined age-dependent changes in pulp and tip pinch strength (reflecting flexor digitorum superficialis function as a dynamic medial elbow stabilizer) across a single pitching bout in youth baseball pitchers, and identified associated physical and pitching-related factors. It challenges the adequacy of pitch counts alone as a workload metric, suggesting pinch strength change could serve as an objective fatigue marker to complement pitch-count rules in UCL injury prevention.

51. MacLeay C, Murphy J, Giglio V, et al. In older adults undergoing surgical fixation or arthroplasty following upper limb fractures, does frailty predict post-operative complications and mortality? A systematic review and meta-analysis. JSES Reviews, Reports, and Techniques 2026. doi:10.1016/j.xrrt.2026.100764

This systematic review and meta-analysis evaluated whether pre-operative frailty predicts post-operative mortality and complications in older adults undergoing surgical fixation or arthroplasty for upper limb fractures, with secondary outcomes including reoperation, discharge destination, and length of stay. Quantifying frailty's prognostic value in this population can inform preoperative risk stratification and shared decision-making for upper limb fracture surgery in the elderly.

52. Isi S, Dowling B, Shen A, et al. Relationship Between Grip and Three-Point Pinch Strength to Ball Velocity and Elbow Varus Torque in High School Pitchers. JSES Reviews, Reports, and Techniques 2026. doi:10.1016/j.xrrt.2026.100853

This cross-sectional study of high school pitchers assessed the relationship between grip and three-point pinch strength and both ball velocity and elbow varus torque. The findings help clarify whether these simple strength measures correlate with performance and medial elbow loading, potentially offering practical screening markers for pitching performance and UCL injury risk in adolescent athletes.

65. Kinnair A, Lädermann A, Daniel C, et al. Reliability of the Classification for Assessing Hand Behind the Back Following Reverse Shoulder Arthroplasty.. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.08.005

In a prospective cohort of 116 postoperative reverse shoulder arthroplasty shoulders, two blinded observers independently classified hand-behind-back function using both the traditional vertebral-level method and a new three-type HBB Classification (unable, assisted/non-fluent, fluent unassisted). The study compared interobserver reliability between the two systems. If the HBB Classification proves more reliable, it offers a simpler bedside tool for tracking functional recovery and guiding rehabilitation goals after reverse shoulder arthroplasty.

66. Sato R, Ishigaki T, Okochi T, et al. Effects of grip contraction with different finger recruitment and different wrist positions on dynamic medial elbow joint stability. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.08.008

Using ultrasonographic measurement of medial elbow joint space under valgus stress in 20 healthy men, this study tested how grip contraction with selective exclusion of the second or third digit and different wrist positions affects dynamic medial ulnar collateral ligament stability. The findings clarify which finger flexors and wrist positions contribute most to dynamic medial elbow stability. Results can inform injury-prevention and rehabilitation strategies for baseball players by targeting specific flexor-pronator muscle recruitment and pitch-specific wrist positioning.

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