Evaluating the effectiveness of sensory re-education in adults with median and ulnar nerve injuries: A systematic review.

Authors

Coral Katave, Noor Elfaki, Stephen Gbekor, Lourdes Filippi, Stella Seal, Ala Elhelali

Published in

Journal of hand therapy : official journal of the American Society of Hand Therapists. Sep 23, 2026. Epub Sep 23, 2026.

Abstract

Median and ulnar nerve injuries disrupt tactile discrimination and dexterity, yet postoperative rehabilitation remains largely motor-centric. Sensory re-education (SR) strategies aim to leverage cortical plasticity for functional recovery. This study aims to appraise the effectiveness of SR interventions and elucidate their neuroplastic rationale.
Following PRISMA guidelines (PROSPERO CRD42024534679), we searched PubMed, Embase, Cochrane, PEDro, and Web of Science from inception to May 2024. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) involving adults (≥18 years) with surgically repaired median or ulnar nerves were eligible. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2 (RCTs) and ROBINS-I (CCTs). Findings were synthesized narratively due to heterogeneity in interventions, outcomes, and follow-up.
The search yielded 23,296 records; 8992 unique titles/abstracts were screened and 12 trials were included (9 RCTs, 3 CCTs; n=269). Mean age was 32 years (range 24-45) and 82.5% (n=222) were male. Early, therapist-supervised SR produced the largest improvements. Grip strength was assessed in 6 trials: 2 showed a significant between-group benefit (p<0.05 and p=0.035) and 4 showed no between-group difference (p=0.796, 0.34-0.43, 0.54, 0.94). Dexterity was assessed in 5 studies: 2 reported significant between-group differences for at least one measure/subtest (p=0.004-0.029; p=0.035), 2 were nonsignificant (p=0.12; p=0.34-0.43), and 1 reported results without between-group testing. Two-point discrimination was evaluated in 10 studies: 9 reported between-group statistics (5 favored the intervention, p=0.05 to <0.001; 4 showed no difference, p=0.112-0.86), and 1 study reported sensory grades only. Semmes-Weinstein thresholds favored the intervention in 3 studies (p=0.04, 0.003, <0.001), and 3 studies showed no between-group difference (p=0.77, 0.796, 0.22), and were qualitative-only in 1 study. Tactile gnosis (STI) improved in 2 of 3 trials (p=0.03; p=0.008). Cold intolerance was assessed in 4 studies, and none demonstrated a between-group benefit (p=0.75-0.99; one reported p>0.05).
Across 12 controlled trials (n=269), sensory re-education (SR) was associated with inconsistent between-group benefits. The clearest signals were short-term improvements in selected sensory outcomes and tactile gnosis in some protocols (notably anesthesia-facilitated SR and sensor-glove-augmented SR), while motor strength, pain, and cold intolerance generally did not show reliable between-group advantages. Standardized outcome metrics, mechanistic neuroimaging, and digitally delivered SR platforms are needed to define optimal dosing and long-term benefit.

PMID:
42778436
Bibliographic data and abstract were imported from PubMed on 24 Sep 2026.

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