Failure to Compensate: Patients With Nerve Injury Use Their Injured Dominant Hand, Even When Their Nondominant Is More Dexterous

Objective: To identify how individuals respond to unilateral upper extremity peripheral nerve injury via compensation (increased use of the nondominant hand). We hypothesized that injury to the dominant hand would have a greater effect on hand use (left vs right choices). We also hypothesized that compensation would not depend on current (postinjury) nondominant hand performance because many patients undergo rehabilitation that is not designed to alter hand use. Design: Observational survey, single-arm. Settings: Academic research institution and referral center. Participants: A total of 48 adults (N=48) with unilateral upper extremity peripheral nerve injury. Another 14 declined participation. Referred sample, including all eligible patients from 16 months at 1 nerve injury clinic and 1 hand therapy clinic. Interventions: Not applicable. Main Outcome Measures: Hand use (% of actions with each hand) via Block Building Task. Dexterity via Jebsen-Taylor Hand Function. Results: Participants preferred their dominant hand regardless of whether it was injured: hand usage (dominant/nondominant) did not differ from typical adults, regardless of injured side (P>.07), even though most participants (77%) were more dexterous with their uninjured nondominant hand (mean asymmetry index, −0.16±0.25). The Block Building Task was sensitive to hand dominance (P=2 × 10⁻⁴) and moderately correlated with Motor Activity Log amount scores (r²=0.33, P<.0001). Compensation was associated only with dominant hand dexterity (P=3.9 × 10⁻³), not on nondominant hand dexterity, rehabilitation, or other patient and/or injury factors (P>.1). Conclusions: Patients with peripheral nerve injury with dominant hand injury do not compensate with their unaffected nondominant hand, even if it is more dexterous. For the subset of patients unlikely to recover function with the injured hand, they could benefit from rehabilitation that encourages compensation with the nondominant hand.