The Journal of hand surgery
June 6, 2026 · via Europe PMC
Timeline of Functional Recovery Following Hand and Upper-Extremity Transplantation.
Mordukhovich I, Roncagli C, Hoffner N, Barclay K, Rampazzo A, Bassiri Gharb B.
AI summary — for doctors, generated from the abstract only
A systematic review of 97 hand and upper-extremity transplant patients over 10 years found that while grip strength and finger range of motion stabilized after the first year, other measures like thumb opposition and overall hand transplant scores continued improving for years, with more distal transplants generally recovering better than proximal ones.
What was studied
A systematic review (PubMed, Embase, Cochrane, Medline; 2104 records screened, 118 articles included) of hand and upper-extremity transplantation (HUET) outcomes over the first 10 years post-transplant, comparing proximal (above mid-forearm) versus distal transplants across multiple functional and psychosocial measures (sensory testing, grip strength, thumb opposition, range of motion, quality of life, disability scores, and a hand transplant-specific scoring system).
Key findings
- 97 patients were identified across studies from 1998-2025; distal transplant sensory testing (Semmes-Weinstein Monofilament) improved from postoperative year 1 to year 2.
- Power grip strength remained relatively constant over time for both groups, but proximal transplants recovered less overall strength than distal transplants (4.51 vs. 7.33 kg).
- Hand Transplantation Score System scores showed significant improvement in distal transplants from year 1 (65) to year 3 (76), while proximal transplants only showed comparable improvement much later, from year 1 (61) to years 8-10 (82.5).
- Bilateral transplant patients had higher quality-of-life (SF-36) scores than unilateral transplant patients across years 1-10, though disability (DASH) scores did not differ between bilateral and unilateral patients.
Clinical relevance
The findings provide clinicians and patients considering hand/arm transplantation with realistic timelines for different aspects of functional recovery, showing that proximal transplants take substantially longer to reach comparable functional scores than distal transplants, which is important for counseling and setting expectations about the multi-year recovery trajectory.
Who should care
Limitations
This review synthesizes data from a relatively small total number of patients (97) across nearly three decades of evolving surgical technique and rehabilitation practice, which introduces heterogeneity that could affect the precision of the reported recovery timelines.
Hand and arm transplant patients can expect grip strength to plateau within the first year, but other functional measures continue improving for several years, with transplants performed higher up the arm taking much longer to reach comparable functional scores than those performed lower down.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Purpose
The degree to which motor and psychosocial functions may recover following hand and upper-extremity transplantation (HUET) remains unclear. This study quantifies HUET outcome changes in the first 10 years post-transplantation to provide insight into this question.
Methods
A systematic review of PubMed, Embase, Cochrane, and Medline yielded 2104 records; 118 articles were included in the final review. HUETs above the proximal third of the forearm were designated as proximal and the remaining distal. Semmes-Weinstein Monofilament (SWMF) test, grip strength, Kapandji, finger and thumb total active range of motions (TAROMs), Carroll, Short Form 36 (SF-36), Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), and Hand Transplantation Score System (HTSS) were recorded according to patient and postoperative year (POY).
Results
Ninety-seven patients were identified between 1998 and 2025. Distal HUETs' SWMF improved from POY1 (4 [4-4]) to POY2 (5 [4-6]). Power grip remained constant for distal and proximal HUETs, but proximal HUETs recovered less than distal HUETs (4.51 ± 1.49 kg vs 7.33 ± 0.71 kg). Lateral pinch strengths did not differ between groups. Proximal HUETs' lateral grips demonstrated sustained improvement after POY3. Bilateral HUETs demonstrated higher SF-36 scores than unilateral HUETs across POY1-10. HTSS measured significant improvements in distal HUETs increasing from 65 (57-79.5) (POY1) to 76 (71-85) by POY3, while proximal HUET only improved from POY1 (61 [45-70.5]) at POY8-10 (82.5 [72-91.5]). Finger TAROMs remained largely unchanged after POY1 while distal and proximal Kapandji thumb opposition scores improved at POY3-6 and POY8-10, respectively.
Conclusions
Transplant level influenced recovery of power grip and HTSS. HUET power grip strength and finger TAROM stabilized after POY1 while lateral grip, Kapandji scores, HTSS, and SWMF showed improvements in the decade following transplantation, mostly for distal HUETs. Bilateral HUETs had better psychosocial (SF-36) outcomes than unilateral HUETs, but no difference in DASH scores.
Type of study/level of evidence
Therapeutic IV.
DOI
10.1016/j.jhsa.2026.05.003
PMID
42249869
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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