Dysfunctional movement patterning in the hand: an unrecognized entity?

Following injury or surgery to the hand, most patients undergo an uneventful recovery, with or without the need for hand therapy. Those that do not, usually display common and predictable patterns of stiffness, caused by intrinsic or extrinsic soft tissue tightness, or weakness caused by either neuromuscular pathology or disuse. A smaller group may develop complex regional pain syndrome (CRPS). Finally, there are a small number of patients that do not follow any of these recognized paths and present instead with painless (usually), abnormal patterns of movement that can have significant effects on hand function. Although this abnormal ‘patterning’ is not well recognized or described in the hand literature, it has been described as a cause of chronic functional problems in the cervical spine, lumbar spine and knee (Hodges and Tucker, 2011; Sterling et al., 2001); and in the shoulder where it is known to be one of the causes of instability (Lewis et al., 2004).