Functional Recovery, Quality of Life, and Return to Work After Surgical Repair of Traumatic Hand Nerve Injuries: A 6-Month Prospective Study

Functional Recovery, Quality of Life, and Return to Work After Surgical Repair of Traumatic Hand Nerve Injuries: A 6-Month Prospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Functional Recovery, Quality of Life, and Return to Work After Surgical Repair of Traumatic Hand Nerve Injuries: A 6-Month Prospective Study Mitra Niazi, Shahram Mohseni, Dana İtani This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7149013/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Traumatic injuries to the peripheral nerves of the hand can result in significant functional impairment, reduced quality of life (QoL), and delayed or unsuccessful return to work (RTW). Despite advances in microsurgical techniques, recovery remains challenging for many patients. Objective: This prospective study aimed to evaluate the functional recovery, QoL outcomes, and RTW rates of patients undergoing surgical repair for hand nerve injuries over a six-month period. Methods: A total of 100 patients aged 18–48 years underwent surgical intervention within 48 hours following hand nerve injury. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and QoL was measured with the Short Form-36 (SF-36). RTW data were collected through interviews at 6-month follow-up. Statistical analyses were performed using paired t-tests and chi-square tests. Results: The mean DASH score improved from 74.6 at baseline to 42.3 and 26.1 at 3 and 6 months, respectively (p < 0.001). The total SF-36 score increased from 42.8 to 71.4 over the same period (p < 0.001), with significant gains in the physical function, social engagement, and pain domains. At 6 months, 34% of patients had returned to work, with higher RTW rates among individuals with stable employment and isolated nerve injury. Conclusion: Early surgical intervention after traumatic hand nerve injury leads to notable improvements in function and quality of life. However, the RTW remains suboptimal, especially among those in physically demanding jobs. Comprehensive rehabilitation strategies that incorporate vocational support are required to enhance occupational outcomes. Peripheral nerve injury Hand function Quality of life Return to work Introduction Hand injuries are among the most frequently reported traumatic injuries worldwide and are especially prevalent in occupational settings [ 2 , 4 , 9 ]. They account for a significant proportion of emergency admissions and work-related disabilities, with over 3 million upper extremity injuries occurring annually in the United States [ 2 ]. A substantial portion of these injuries involves trauma to the peripheral nerves, particularly the median and ulnar nerves, which play critical roles in hand motor and sensory functions [ 1 , 5 , 11 ]. Peripheral nerve injuries (PNI) can result in serious impairments, including pain, weakness, paresthesia, cold intolerance, and decreased dexterity [ 5 , 8 ]. These deficits can severely affect an individual's capacity to perform essential activities of daily living, such as self-care, household responsibilities, and occupational tasks [ 5 , 7 , 10 ]. Importantly, these limitations often lead to a decline in the overall quality of life (QoL), as patients experience increased dependency, reduced social participation, and emotional distress [ 3 , 4 , 10 ]. Therefore, quality of life has emerged as a critical outcome measure in both clinical and occupational rehabilitation following nerve injury [ 3 , 10 , 14 ]. Although microsurgical techniques have significantly improved in recent decades, recovery following nerve repair is often slow, incomplete, and unpredictable [ 11 , 12 ]. Several factors influence recovery trajectories, including injury severity, number of nerves involved, surgical timing, presence of comorbid injuries, and patient occupation [ 6 , 11 , 13 ]. Individuals engaged in manual labor face greater challenges in regaining full function and returning to their previous jobs [ 6 , 9 , 13 ]. Failure or delay in return to work (RTW) following traumatic hand nerve injury can lead to long-term socioeconomic consequences, including job loss, reduced income, and loss of identity within the workforce [ 9 , 13 ]. This disruption negatively affects psychological well-being and QoL, making occupational reintegration a core component of rehabilitation [ 3 , 9 , 14 ]. Despite the importance of this issue, longitudinal studies examining functional recovery, quality of life, and RTW after the surgical repair of hand nerve injuries remain limited. The existing literature tends to focus on either clinical or psychological outcomes, with fewer studies integrating both functional and occupational dimensions [ 6 , 10 , 11 ]. This prospective study aimed to address this gap by evaluating changes in upper extremity function, quality of life, and return-to-work status in patients undergoing surgical repair for traumatic hand nerve injuries. Using validated instruments, including the DASH and SF-36, outcomes were assessed at baseline, 3 months, and 6 months postoperatively to provide a comprehensive view of the rehabilitation process in this vulnerable patient population. Methods This prospective descriptive study was conducted between 2023 and 2025 at the Istanbul Hand Surgery Clinic in Turkey. The study population comprised patients aged 18–50 years who sustained traumatic peripheral nerve injuries in the hand and underwent surgical repair within 72 h of injury. Patients with isolated digital nerve injuries or significant comorbidities, such as cardiovascular diseases, diabetes mellitus, thyroid disorders, neuropsychiatric illnesses, or connective tissue diseases, were excluded. Patients who were unwilling to participate were also excluded. Sampling was performed using consecutive convenience sampling. All participants provided written informed consent prior to their inclusion in the study. The study protocol was approved by the Ethics Committee of Uskudar University, Turkey (Approval Number: 2023/124, Date: December 14, 2023). Data Collection Instruments Data were collected at three time points: pre-surgery (baseline) and at 3 and 6 months post-surgery, using the following tools: Demographic and Injury Characteristics Questionnaire: Collected data on patient demographics (age, sex, occupation), injury specifics (type, cause, time, associated injuries), and employment status prior to the injury. Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire: The validated Turkish version of the DASH questionnaire was used to assess upper extremity function and disability. The questionnaire includes 30 items scored on a 0–100 scale, with higher scores indicating greater disabilities [ 15 ]. Short Form-36 Health Survey (SF-36): This generic, multidimensional tool assesses health-related quality of life across eight domains: physical functioning, social functioning, role limitations due to physical or emotional problems, mental health, vitality, pain, and general health perception. The scores range from 0 to 100, with higher scores reflecting a better quality of life [ 16 ]. Return to Work (RTW) Assessment Return to Work status was evaluated at 3 and 6 months post-surgery through structured interviews conducted by trained nurses, alongside a review of medical and occupational health records. RTW was defined as the resumption of any paid employment, either full-time or part-time, including modified or accommodated tasks. The duration from surgery to RTW was recorded in days. Additional data on factors potentially influencing RTW were collected, including occupational type (manual, clerical, professional), physical demands of the job, workplace accommodations or modifications, patient-perceived barriers to RTW, and employer support or involvement in the rehabilitation process. This comprehensive approach aimed to capture both the timing and quality of occupational reintegration. Statistical Analysis Descriptive statistics were used to summarize the demographic, clinical, and occupational variables. Changes in the DASH and SF-36 scores over time were analyzed using repeated measures analysis of variance (ANOVA). Associations between RTW and relevant clinical and demographic factors were examined using chi-square tests and logistic regression analyses. Statistical analyses were performed using SPSS version 26 (IBM Corp., Armonk, NY, USA). Statistical significance was set at p < 0.05. Results Of the 100 participants included in the study, the mean age was 30.4 years (range: 18–48 years), and 88% were male. All patients underwent surgical repair within 48 h of injury. Regarding occupational background, 54% of the participants were employed in physically demanding, manual dexterity requiring jobs, such as construction work, welding, carpentry, and cargo handling. An additional 22% were engaged in service-related fields, including food preparation, cleaning, tailoring, and hairdressing. The remaining 14% were office workers or technicians, and 10% were unemployed or students at the time of the injury (Table 1 ). Functional recovery was assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire at baseline (pre-surgery) and at 3 and 6 months postoperatively. The mean DASH score was 74.6 ± 10.8 before surgery, indicating severe functional limitations. At the 3-month follow-up, the mean score improved to 42.3 ± 11.5, and further declined to 26.1 ± 9.4 at 6 months, indicating a statistically significant improvement over time (p < 0.001). The greatest functional gains were observed in patients with isolated nerve injuries, whereas recovery was slower in patients with combined injuries (nerve + tendon or vascular involvement). Health-related quality of life was evaluated using the SF-36 questionnaire. The total mean score increased from 42.8 ± 9.7 at baseline to 60.3 ± 10.2 at 3 months, and reached 71.4 ± 11.6 at 6 months (p < 0.001). Improvements were particularly notable in the physical, social, and bodily pain domains. Patients who returned to work reported significantly higher SF-36 scores across all subdomains at 6 months than those who remained unemployed (p < 0.05). At the 6-month follow-up, 34 patients (34%) returned to paid employment. Among them, 28 (82.4%) resumed their previous job roles and 6 (17.6%) transitioned to alternative or modified work. The average time to RTW was 67.2 days (range, 30–120 days). Return-to-work rates were higher among patients in stable job sectors (e.g., office workers and technicians) at 66.7%, compared to only 29.3% among those in seasonal or freelance occupations (p < 0.05). Additionally, patients with isolated nerve injuries had a significantly higher RTW rate than those with combined injuries (p < 0.01) (Table 2 ). Table 1 Demographic and Clinical Characteristics of the Participants (n = 100) Variable n (%) or Mean ± SD Age (years) 30.4 ± 6.2 Gender • Male 88 (88%) • Female 12 (12%) Injury to Surgery Interval ≤ 48 hours for all patients Side of Injury • Right 56 (56%) • Left 44 (44%) Type of Nerve Injury • Median nerve only 42 (42%) • Ulnar nerve only 36 (36%) • Combined nerve injury 22 (22%) Associated Injuries • Nerve only 58 (58%) • Nerve + Tendon 28 (28%) • Nerve + Vessel 14 (14%) Occupational Status at Injury • Manual labor (construction, welding, cargo, carpentry) 54 (54%) • Service sector (food, cleaning, tailoring, hairdressing) 22 (22%) • Office/technical work 14 (14%) • Unemployed/student 10 (10%) Dominant Hand Affected 63 (63%) Table 2 Functional Outcomes, Quality of Life Scores, and Return to Work Status (n = 100) Outcome Measure Baseline 3 Months 6 Months DASH Score (mean ± SD) 74.6 ± 10.8 42.3 ± 11.5 26.1 ± 9.4 SF-36 Total Score (mean ± SD) 42.8 ± 9.7 60.3 ± 10.2 71.4 ± 11.6 • Physical Functioning 38.5 ± 10.3 56.2 ± 11.1 66.8 ± 10.9 • Bodily Pain 36.2 ± 9.5 54.9 ± 10.6 63.1 ± 9.8 • Social Functioning 44.7 ± 8.8 61.3 ± 9.4 72.6 ± 10.2 Return to Work (RTW) - - 34 patients (34%) • Returned to previous job - - 28 (82.4% of RTW) • Modified or new job - - 6 (17.6% of RTW) Mean time to RTW (days) - - 67.2 ± 18.4 Discussion Traumatic hand nerve injuries are among the most disabling conditions affecting young working-age populations, with significant implications for physical function, quality of life, and return-to-work. In the present study, a 6-month prospective analysis of patients undergoing surgical repair of peripheral hand nerve injuries demonstrated marked improvements in upper limb function and health-related quality of life, along with a limited but meaningful rate of return to paid employment after surgery. These findings reflected both the potential for functional recovery and persistent barriers to occupational reintegration, consistent with the literature. The progressive reduction in DASH scores over time in our cohort confirmed the expected trend of functional recovery following early nerve repair, particularly in cases with isolated injuries. However, patients with combined injuries involving tendons or vascular structures showed slower improvement and greater residual disability, findings supported by other studies emphasizing the impact of injury severity on function and recovery trajectory [4, 21]. Sensory re-education and early occupational therapy are essential for facilitating fine motor recovery and reducing long-term disability, although evidence remains mixed on the most effective protocols [ 17 , 20 ]. Parallel to functional improvement, our patients also showed a notable increase in SF-36 scores over time, with the most significant gains seen in the physical functioning and social participation domains. These outcomes are in line with previous studies emphasizing that functional reconstruction of the hand leads to substantial gains in quality of life, especially when combined with a multidisciplinary rehabilitation approach [ 1 , 3 , 5 , 18 ]. Nonetheless, a subset of patients continues to report persistent limitations, which may reflect psychosocial challenges, chronic pain, or socioeconomic pressures post-injury [ 3 , 8 , 19 ]. Return to work (RTW) is a central indicator of successful rehabilitation and societal reintegration. In our study, 34% of patients returned to work by six months post-surgery, with only 28% returning to their previous job. This finding is comparable with previous research, which has reported early RTW rates ranging from 30–50%, highly dependent on occupational demands, injury severity, and availability of vocational support [ 2 , 4 , 9 , 13 ]. Patients with stable, less physically demanding jobs had significantly higher RTW rates, highlighting the importance of job type and workplace accommodation. This aligns with the findings of Izadi et al., who demonstrated that RTW is significantly delayed in patients with higher HISS scores and physically intensive jobs [ 9 ]. Furthermore, psychosocial factors such as financial stress, lack of employer support, and limited access to worksite assessments have been identified as major barriers [ 2 , 8 , 13 ]. A key strength of our study is its multidimensional outcome assessment, combining objective functional data (DASH), subjective quality of life measures (SF-36), and real-world occupational outcomes (RTW). This triangulated approach allows for a more holistic evaluation of recovery, as emphasized by Akbari et al. and Stonner et al., who advocated for integrated models of patient monitoring in upper limb nerve injury [ 5 , 8 ]. Despite these insights, several limitations of this study should be acknowledged. First, our RTW assessment was limited to a 6-month follow-up, whereas some patients may require longer periods for complete reintegration. Second, psychosocial factors such as depression, anxiety, and pain perception were not directly measured, although prior studies have shown their strong influence on both functional and vocational outcomes [ 4 , 8 , 13 ]. Finally, the relatively small number of patients returning to their exact previous roles underscores the need for improved vocational rehabilitation services tailored to the hand injury population. In conclusion, surgical repair of peripheral hand nerve injuries is associated with a significant improvement in upper limb function and quality of life. However, the rate of return to work remains suboptimal, particularly among individuals with physically demanding jobs or complex injury. Comprehensive rehabilitation programs that address not only physical recovery but also workplace adaptation and psychosocial support are essential to enhance outcomes and long-term participation in the workplace and society [2, 9, 13, 21]. Moreover, advanced surgical approaches, such as upper extremity transplantation, have also demonstrated positive impacts on functional reintegration and QoL in selected cases [22]. Conclusion This study demonstrates that early surgical repair of traumatic hand nerve injuries leads to meaningful improvements in upper-limb function and quality of life over a 6-month period. However, return to work remains limited, particularly among individuals in physically demanding jobs. Comprehensive rehabilitation strategies that address both physical recovery and workplace reintegration are necessary to improve long-term outcomes. Declarations Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing Interests The authors have no relevant financial or non-financial interests to disclose. Author Contributions M.N. designed the study, collected and analyzed the data, and wrote the first draft of the manuscript. D.I. contributed to manuscript preparation, literature review, and critical revisions. S.M. contributed to study design, clinical supervision, and manuscript editing. All authors reviewed and approved the final version of the manuscript. Data Availability The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Consent to Participate Informed consent was obtained from all individual participants included in the study. Consent to Publish The authors affirm that human research participants provided informed consent for the publication of anonymized data. References Alawi, S. A., Werner, D., Könneker, S., Vogt, P. M., & Jokuszies, A. (2018). Quality of life and reconstructive surgery efforts in severe hand injuries. Innovative Surgical Sciences, 3(2), 147-156. DOI: 10.1515/iss-2018-0002 Uys, M. E., Buchanan, H., & van Niekerk, L. (2020). Return to work for people with hand injuries in South Africa: Occupational therapy strategies. South African Journal of Occupational Therapy, 50(2), 52-61. https://doi.org/10.17159/2310-3833/2020/vol50no2a7 Bismak, O. (2019). 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DOI: 10.1097/PRS.0000000000000892 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7149013","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":488556872,"identity":"21329543-14d1-4f90-b43e-abe2b871f1e0","order_by":0,"name":"Mitra Niazi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYDACZgjFw8DA2PiAgSGBgeEAiM+GTwszXEuzAYoWHkLWgJRJEKVFt53/2IcfDHdk+PsPt1Xz/ElL7Dt+9gHDh7LDDPbSB7BqMTvMzDyzh+EZj8SBg223edtyEmeeSTdgnHHuMAMPXwJOLUAnHOZhONgI1NJQkbjhQBoDM28bUAsOl4G0MP4BapE/zNhWzPMHqOX8MwbmvwS0MINsMTjG2MbMw5aTuOEG0BZG/FqMmWUMDvMYnmFslpzblmY888YzhoM959J5eM7g0HL+4GPGNxWH7eXOH3/44c2fZNm+82mMD36UWcux92DXAgEGaPwDDPhichSMglEwCkYBQQAAeA1ZMII5WTQAAAAASUVORK5CYII=","orcid":"","institution":"Uskudar University","correspondingAuthor":true,"prefix":"","firstName":"Mitra","middleName":"","lastName":"Niazi","suffix":""},{"id":488556874,"identity":"b672a6f9-b0b4-4f1c-bd3c-a5252f030096","order_by":1,"name":"Shahram Mohseni","email":"","orcid":"","institution":"Uskudar University","correspondingAuthor":false,"prefix":"","firstName":"Shahram","middleName":"","lastName":"Mohseni","suffix":""},{"id":488556876,"identity":"58863d84-a089-4977-a728-79f53aa270a4","order_by":2,"name":"Dana İtani","email":"","orcid":"","institution":"Uskudar University","correspondingAuthor":false,"prefix":"","firstName":"Dana","middleName":"","lastName":"İtani","suffix":""}],"badges":[],"createdAt":"2025-07-17 12:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7149013/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7149013/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90675731,"identity":"3f210884-0347-4fc5-8ffe-a4c46443dd35","added_by":"auto","created_at":"2025-09-05 14:32:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":455489,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7149013/v1/d497b6b4-f971-40f7-8627-01d53eb33bf3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Functional Recovery, Quality of Life, and Return to Work After Surgical Repair of Traumatic Hand Nerve Injuries: A 6-Month Prospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHand injuries are among the most frequently reported traumatic injuries worldwide and are especially prevalent in occupational settings [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. They account for a significant proportion of emergency admissions and work-related disabilities, with over 3\u0026nbsp;million upper extremity injuries occurring annually in the United States [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A substantial portion of these injuries involves trauma to the peripheral nerves, particularly the median and ulnar nerves, which play critical roles in hand motor and sensory functions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePeripheral nerve injuries (PNI) can result in serious impairments, including pain, weakness, paresthesia, cold intolerance, and decreased dexterity [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These deficits can severely affect an individual's capacity to perform essential activities of daily living, such as self-care, household responsibilities, and occupational tasks [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Importantly, these limitations often lead to a decline in the overall quality of life (QoL), as patients experience increased dependency, reduced social participation, and emotional distress [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Therefore, quality of life has emerged as a critical outcome measure in both clinical and occupational rehabilitation following nerve injury [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough microsurgical techniques have significantly improved in recent decades, recovery following nerve repair is often slow, incomplete, and unpredictable [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Several factors influence recovery trajectories, including injury severity, number of nerves involved, surgical timing, presence of comorbid injuries, and patient occupation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Individuals engaged in manual labor face greater challenges in regaining full function and returning to their previous jobs [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFailure or delay in return to work (RTW) following traumatic hand nerve injury can lead to long-term socioeconomic consequences, including job loss, reduced income, and loss of identity within the workforce [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This disruption negatively affects psychological well-being and QoL, making occupational reintegration a core component of rehabilitation [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite the importance of this issue, longitudinal studies examining functional recovery, quality of life, and RTW after the surgical repair of hand nerve injuries remain limited. The existing literature tends to focus on either clinical or psychological outcomes, with fewer studies integrating both functional and occupational dimensions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis prospective study aimed to address this gap by evaluating changes in upper extremity function, quality of life, and return-to-work status in patients undergoing surgical repair for traumatic hand nerve injuries. Using validated instruments, including the DASH and SF-36, outcomes were assessed at baseline, 3 months, and 6 months postoperatively to provide a comprehensive view of the rehabilitation process in this vulnerable patient population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis prospective descriptive study was conducted between 2023 and 2025 at the Istanbul Hand Surgery Clinic in Turkey. The study population comprised patients aged 18–50 years who sustained traumatic peripheral nerve injuries in the hand and underwent surgical repair within 72 h of injury. Patients with isolated digital nerve injuries or significant comorbidities, such as cardiovascular diseases, diabetes mellitus, thyroid disorders, neuropsychiatric illnesses, or connective tissue diseases, were excluded. Patients who were unwilling to participate were also excluded.\u003c/p\u003e\u003cp\u003eSampling was performed using consecutive convenience sampling. All participants provided written informed consent prior to their inclusion in the study. The study protocol was approved by the Ethics Committee of Uskudar University, Turkey (Approval Number: 2023/124, Date: December 14, 2023).\u003c/p\u003e\u003cp\u003eData Collection Instruments\u003c/p\u003e\u003cp\u003eData were collected at three time points: pre-surgery (baseline) and at 3 and 6 months post-surgery, using the following tools:\u003c/p\u003e\u003cp\u003eDemographic and Injury Characteristics Questionnaire: Collected data on patient demographics (age, sex, occupation), injury specifics (type, cause, time, associated injuries), and employment status prior to the injury.\u003c/p\u003e\u003cp\u003eDisabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire: The validated Turkish version of the DASH questionnaire was used to assess upper extremity function and disability. The questionnaire includes 30 items scored on a 0–100 scale, with higher scores indicating greater disabilities [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eShort Form-36 Health Survey (SF-36): This generic, multidimensional tool assesses health-related quality of life across eight domains: physical functioning, social functioning, role limitations due to physical or emotional problems, mental health, vitality, pain, and general health perception. The scores range from 0 to 100, with higher scores reflecting a better quality of life [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eReturn to Work (RTW) Assessment\u003c/p\u003e\u003cp\u003eReturn to Work status was evaluated at 3 and 6 months post-surgery through structured interviews conducted by trained nurses, alongside a review of medical and occupational health records. RTW was defined as the resumption of any paid employment, either full-time or part-time, including modified or accommodated tasks. The duration from surgery to RTW was recorded in days.\u003c/p\u003e\u003cp\u003eAdditional data on factors potentially influencing RTW were collected, including occupational type (manual, clerical, professional), physical demands of the job, workplace accommodations or modifications, patient-perceived barriers to RTW, and employer support or involvement in the rehabilitation process. This comprehensive approach aimed to capture both the timing and quality of occupational reintegration.\u003c/p\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eDescriptive statistics were used to summarize the demographic, clinical, and occupational variables. Changes in the DASH and SF-36 scores over time were analyzed using repeated measures analysis of variance (ANOVA). Associations between RTW and relevant clinical and demographic factors were examined using chi-square tests and logistic regression analyses. Statistical analyses were performed using SPSS version 26 (IBM Corp., Armonk, NY, USA). Statistical significance was set at p \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 100 participants included in the study, the mean age was 30.4 years (range: 18\u0026ndash;48 years), and 88% were male. All patients underwent surgical repair within 48 h of injury. Regarding occupational background, 54% of the participants were employed in physically demanding, manual dexterity requiring jobs, such as construction work, welding, carpentry, and cargo handling. An additional 22% were engaged in service-related fields, including food preparation, cleaning, tailoring, and hairdressing. The remaining 14% were office workers or technicians, and 10% were unemployed or students at the time of the injury (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFunctional recovery was assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire at baseline (pre-surgery) and at 3 and 6 months postoperatively. The mean DASH score was 74.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8 before surgery, indicating severe functional limitations. At the 3-month follow-up, the mean score improved to 42.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5, and further declined to 26.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4 at 6 months, indicating a statistically significant improvement over time (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The greatest functional gains were observed in patients with isolated nerve injuries, whereas recovery was slower in patients with combined injuries (nerve\u0026thinsp;+\u0026thinsp;tendon or vascular involvement).\u003c/p\u003e\u003cp\u003eHealth-related quality of life was evaluated using the SF-36 questionnaire. The total mean score increased from 42.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7 at baseline to 60.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2 at 3 months, and reached 71.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.6 at 6 months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Improvements were particularly notable in the physical, social, and bodily pain domains. Patients who returned to work reported significantly higher SF-36 scores across all subdomains at 6 months than those who remained unemployed (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eAt the 6-month follow-up, 34 patients (34%) returned to paid employment. Among them, 28 (82.4%) resumed their previous job roles and 6 (17.6%) transitioned to alternative or modified work. The average time to RTW was 67.2 days (range, 30\u0026ndash;120 days). Return-to-work rates were higher among patients in stable job sectors (e.g., office workers and technicians) at 66.7%, compared to only 29.3% among those in seasonal or freelance occupations (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, patients with isolated nerve injuries had a significantly higher RTW rate than those with combined injuries (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic and Clinical Characteristics of the Participants (n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%) or Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Male\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e88 (88%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Female\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (12%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInjury to Surgery Interval\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;48 hours for all patients\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSide of Injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Right\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56 (56%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Left\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44 (44%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of Nerve Injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Median nerve only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42 (42%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Ulnar nerve only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (36%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Combined nerve injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (22%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssociated Injuries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Nerve only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58 (58%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Nerve\u0026thinsp;+\u0026thinsp;Tendon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (28%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Nerve\u0026thinsp;+\u0026thinsp;Vessel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (14%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupational Status at Injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Manual labor (construction, welding, cargo, carpentry)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54 (54%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Service sector (food, cleaning, tailoring, hairdressing)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (22%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Office/technical work\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (14%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Unemployed/student\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (10%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDominant Hand Affected\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63 (63%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFunctional Outcomes, Quality of Life Scores, and Return to Work Status (n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcome Measure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 Months\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 Months\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDASH Score (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSF-36 Total Score (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Physical Functioning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Bodily Pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Social Functioning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReturn to Work (RTW)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34 patients (34%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Returned to previous job\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28 (82.4% of RTW)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Modified or new job\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (17.6% of RTW)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean time to RTW (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67.2\u0026thinsp;\u0026plusmn;\u0026thinsp;18.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTraumatic hand nerve injuries are among the most disabling conditions affecting young working-age populations, with significant implications for physical function, quality of life, and return-to-work. In the present study, a 6-month prospective analysis of patients undergoing surgical repair of peripheral hand nerve injuries demonstrated marked improvements in upper limb function and health-related quality of life, along with a limited but meaningful rate of return to paid employment after surgery. These findings reflected both the potential for functional recovery and persistent barriers to occupational reintegration, consistent with the literature.\u003c/p\u003e\u003cp\u003eThe progressive reduction in DASH scores over time in our cohort confirmed the expected trend of functional recovery following early nerve repair, particularly in cases with isolated injuries. However, patients with combined injuries involving tendons or vascular structures showed slower improvement and greater residual disability, findings supported by other studies emphasizing the impact of injury severity on function and recovery trajectory [4, 21]. Sensory re-education and early occupational therapy are essential for facilitating fine motor recovery and reducing long-term disability, although evidence remains mixed on the most effective protocols [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e Parallel to functional improvement, our patients also showed a notable increase in SF-36 scores over time, with the most significant gains seen in the physical functioning and social participation domains. These outcomes are in line with previous studies emphasizing that functional reconstruction of the hand leads to substantial gains in quality of life, especially when combined with a multidisciplinary rehabilitation approach [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Nonetheless, a subset of patients continues to report persistent limitations, which may reflect psychosocial challenges, chronic pain, or socioeconomic pressures post-injury [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eReturn to work (RTW) is a central indicator of successful rehabilitation and societal reintegration. In our study, 34% of patients returned to work by six months post-surgery, with only 28% returning to their previous job. This finding is comparable with previous research, which has reported early RTW rates ranging from 30\u0026ndash;50%, highly dependent on occupational demands, injury severity, and availability of vocational support [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Patients with stable, less physically demanding jobs had significantly higher RTW rates, highlighting the importance of job type and workplace accommodation. This aligns with the findings of Izadi et al., who demonstrated that RTW is significantly delayed in patients with higher HISS scores and physically intensive jobs [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Furthermore, psychosocial factors such as financial stress, lack of employer support, and limited access to worksite assessments have been identified as major barriers [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA key strength of our study is its multidimensional outcome assessment, combining objective functional data (DASH), subjective quality of life measures (SF-36), and real-world occupational outcomes (RTW). This triangulated approach allows for a more holistic evaluation of recovery, as emphasized by Akbari et al. and Stonner et al., who advocated for integrated models of patient monitoring in upper limb nerve injury [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite these insights, several limitations of this study should be acknowledged. First, our RTW assessment was limited to a 6-month follow-up, whereas some patients may require longer periods for complete reintegration. Second, psychosocial factors such as depression, anxiety, and pain perception were not directly measured, although prior studies have shown their strong influence on both functional and vocational outcomes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Finally, the relatively small number of patients returning to their exact previous roles underscores the need for improved vocational rehabilitation services tailored to the hand injury population.\u003c/p\u003e\u003cp\u003eIn conclusion, surgical repair of peripheral hand nerve injuries is associated with a significant improvement in upper limb function and quality of life. However, the rate of return to work remains suboptimal, particularly among individuals with physically demanding jobs or complex injury. Comprehensive rehabilitation programs that address not only physical recovery but also workplace adaptation and psychosocial support are essential to enhance outcomes and long-term participation in the workplace and society [2, 9, 13, 21]. Moreover, advanced surgical approaches, such as upper extremity transplantation, have also demonstrated positive impacts on functional reintegration and QoL in selected cases [22].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that early surgical repair of traumatic hand nerve injuries leads to meaningful improvements in upper-limb function and quality of life over a 6-month period. However, return to work remains limited, particularly among individuals in physically demanding jobs. Comprehensive rehabilitation strategies that address both physical recovery and workplace reintegration are necessary to improve long-term outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eM.N. designed the study, collected and analyzed the data, and wrote the first draft of the manuscript. D.I. contributed to manuscript preparation, literature review, and critical revisions. S.M. contributed to study design, clinical supervision, and manuscript editing. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirm that human research participants provided informed consent for the publication of anonymized data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlawi, S. A., Werner, D., K\u0026ouml;nneker, S., Vogt, P. M., \u0026amp; Jokuszies, A. (2018). 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DOI: 10.3233/NRE-201612\u003c/li\u003e\n\u003cli\u003eVan Bekkum, S., De Jong, T., Zuidam, M., \u0026amp; Mureau, M. A. (2020). Long-term quality of life after free flap upper extremity reconstruction for traumatic injuries. Journal of Reconstructive Microsurgery, 36(03), 213-222. DOI: 10.1055/s-0039-3400515\u003c/li\u003e\n\u003cli\u003eNavarro, X. (2016). Functional evaluation of peripheral nerve regeneration and target reinnervation in animal models: a critical overview. European Journal of Neuroscience, 43(3), 271-286. DOI: 10.1111/ejn.13033\u003c/li\u003e\n\u003cli\u003eChen, L., Ogalo, E., Haldane, C., Bristol, S. G., \u0026amp; Berger, M. J. (2021). Relationship between sensibility tests and functional outcomes in patients with traumatic upper limb nerve injuries: a systematic review. Archives of Rehabilitation Research and Clinical Translation, 3(4), 100159. DOI: 10.1016/j.arrct.2021.100159\u003c/li\u003e\n\u003cli\u003eCzarnecki, P., G\u0026oacute;recki, M., \u0026amp; Romanowski, L. (2020). Factors affecting the final outcomes after reconstruction of the median and ulnar nerve at the level of the forearm: Analysis of 41 patients. Injury, 51(12), 2910-2915. DOI: 10.1016/j.injury.2020.02.117\u003c/li\u003e\n\u003cli\u003eShores, J. T., Brandacher, G., \u0026amp; Lee, W. A. (2015). Hand and upper extremity transplantation: an update of outcomes in the worldwide experience. Plastic and reconstructive surgery, 135(2), 351e-360e. DOI: 10.1097/PRS.0000000000000892\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Peripheral nerve injury, Hand function, Quality of life, Return to work","lastPublishedDoi":"10.21203/rs.3.rs-7149013/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7149013/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eTraumatic injuries to the peripheral nerves of the hand can result in significant functional impairment, reduced quality of life (QoL), and delayed or unsuccessful return to work (RTW). Despite advances in microsurgical techniques, recovery remains challenging for many patients.\u003c/p\u003e\u003ch2\u003eObjective:\u003c/h2\u003e\u003cp\u003eThis prospective study aimed to evaluate the functional recovery, QoL outcomes, and RTW rates of patients undergoing surgical repair for hand nerve injuries over a six-month period.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eA total of 100 patients aged 18\u0026ndash;48 years underwent surgical intervention within 48 hours following hand nerve injury. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and QoL was measured with the Short Form-36 (SF-36). RTW data were collected through interviews at 6-month follow-up. Statistical analyses were performed using paired t-tests and chi-square tests.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eThe mean DASH score improved from 74.6 at baseline to 42.3 and 26.1 at 3 and 6 months, respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The total SF-36 score increased from 42.8 to 71.4 over the same period (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with significant gains in the physical function, social engagement, and pain domains. At 6 months, 34% of patients had returned to work, with higher RTW rates among individuals with stable employment and isolated nerve injury.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e\u003cp\u003eEarly surgical intervention after traumatic hand nerve injury leads to notable improvements in function and quality of life. However, the RTW remains suboptimal, especially among those in physically demanding jobs. Comprehensive rehabilitation strategies that incorporate vocational support are required to enhance occupational outcomes.\u003c/p\u003e","manuscriptTitle":"Functional Recovery, Quality of Life, and Return to Work After Surgical Repair of Traumatic Hand Nerve Injuries: A 6-Month Prospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-22 15:36:34","doi":"10.21203/rs.3.rs-7149013/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6f96912e-d195-4f69-8786-86d8ffca366b","owner":[],"postedDate":"July 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-18T09:53:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-22 15:36:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7149013","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7149013","identity":"rs-7149013","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}