The constant challenge to restore sensory feedback in prosthetic hands has provided several research solutions, but virtually none has reached clinical fruition. A prosthetic hand with sensory feedback that closely imitates an intact hand and provides a natural feeling may induce the prosthetic hand to be included in the body image and also reinforces the control of the prosthesis. Areas covered: This review presents non-invasive sensory feedback systems such as mechanotactile, vibrotactile, electrotactile and combinational systems which combine the modalities; multi-haptic feedback. Invasive sensory feedback has been tried less, because of the inherent risk, but it has successfully shown to restore some afferent channels. In this review, invasive methods are also discussed, both extraneural and intraneural electrodes, such as cuff electrodes and transverse intrafascicular multichannel electrodes. The focus of the review is on non-invasive methods of providing sensory feedback to upper-limb amputees. Expert commentary: Invoking embodiment has shown to be of importance for the control of prosthesis and acceptance by the prosthetic wearers. It is a challenge to provide conscious feedback to cover the lost sensibility of a hand, not be overwhelming and confusing for the user, and to integrate technology within the constraint of a wearable prosthesis.

The cortical representation of body parts is constantly modulated in response to the afferent input, and acute deafferentation of a body part results in bilateral cortical reorganization. To study the effects on hand function of right forearm anaesthesia, we investigated ten human subjects (group 1) for perception of touch, tactile discrimination and grip strength in the right (ipsilateral) and left (contralateral) hand before, during and 24 h after forearm skin anaesthesia with a local anaesthetic cream (EMLAÒ). Ten agematched controls (group 2) were investigated in the same way but received placebo. In group 1 a significant improvement was seen in tactile discrimination in the ipsilateral hand compared to base line (P ¼ 0.009) and compared to group 2 (P ¼ 0.006). The improvement in tactile discrimination remained for at least 24 h after anaesthesia. Perception of touch, was improved during anaesthesia compared to baseline values in group 1 (P ¼ 0.046) and remained for at least 24 h. Grip strength did not change. These findings suggest that transient selective deafferentation of an extremity results in enhanced sensory functions of the functionally preserved parts of the same extremity, presumably as a result of expansion of adjacent cortical territories. Such rapid functional changes suggest unmasking of pre-existing synaptic connections as the mechanism underlying the acute modulation of sensory functions in the hand. Our findings open new perspectives for sensory re-education and rehabilitation following injury to the peripheral and central nervous system.

Although rupture of the extensor pollicis longus (EPL) tendon is a well-known complication of distal radial fractures, a number of patients rupture the EPL because of other conditions. We have retrospectively studied the aetiology of 27 ruptures of the EPL in 26 consecutive patients. Of 19 patients with injured wrists 12 had distal radial fractures, five had blunt trauma, and two had stab wounds that resulted in rupture. In the radial fractures operated on, the EPL rupture was caused by chafing against a dorsal plate (n = 2) or wear against the pins of an external fixator (n = 2). Six patients were taking steroids for systemic diseases and in two cases a local steroid injection was given just before the rupture. We conclude that previous injury is the most common cause of rupture of the EPL. but that rheumatoid arthritis or local or systemic steroids, or both, are also important aetiological factors. Seven patients had an iatrogenic cause for their rupture.

This simple sensory feedback system has the potential to restore sensory feedback in hand amputees and thus it could be a useful tool to enhance prosthesis use.

In cases of suspected scaphoid fracture where the initial radiographs are negative, a supplementary MRI, or alternatively CT, should be carried out within three to five days. Fracture classification, assessment of dislocation as well as evaluation of fracture healing is best done on CT with reconstructions in the coronal and sagittal planes, following the longitudinal axis of the scaphoid. After adequate conservative management, union is achieved at six weeks for approximately 90% of non-displaced or minimally displaced (≤ 0.5 mm) scaphoid waist fractures. Scaphoid waist fractures with moderate displacement (0.5–1.5 mm) can be treated conservatively, but require prolonged cast immobilization for approximately eight to ten weeks. Internal fixation is recommended for all scaphoid waist fractures with dislocation ≥ 1.5 mm. Distal scaphoid fractures can be treated conservatively. The majority heal uneventfully after four to six weeks of immobilization, depending on fracture type. In general, proximal scaphoid fractures should be treated with internal fixation. Cite this article: EFORT Open Rev 2020;5:96-103. DOI: 10.1302/2058-5241.5.190025