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

Published:October 30, 2021DOI:



      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.


      Observational survey, single-arm.


      Academic research institution and referral center.


      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.


      Not applicable.

      Main Outcome Measures

      Hand use (% of actions with each hand) via Block Building Task. Dexterity via Jebsen-Taylor Hand Function.


      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).


      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.


      List of abbreviations:

      ANOVA (analysis of variance), DH (dominant hand), JTHF (Jebsen-Taylor Hand Function Test), MAL (Motor Activity Log), NDH (nondominant hand), PNI (peripheral nerve injury)
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        • Philip BA
        • Kaskutas V
        • Mackinnon SE.
        Impact of handedness on disability after unilateral upper-extremity peripheral nerve disorder.
        HAND (N Y). 2020; 15: 327-334
        • Rajan P
        • Premkumar R
        • Rajkumar P
        • Richard J.
        The impact of hand dominance and ulnar and median nerve impairment on strength and basic daily activities.
        J Hand Ther. 2005; 18: 40-45
        • Beaulé PE
        • Dervin GF
        • Giachino AA
        • Rody K
        • Grabowski J
        • Fazekas A.
        Self-reported disability following distal radius fractures: the influence of hand dominance.
        J Hand Surg. 2000; 25: 476-482
        • Gonzalez CL
        • Whitwell RL
        • Morrissey B
        • Ganel T
        • Goodale MA.
        Left handedness does not extend to visually guided precision grasping.
        Exp Brain Res. 2007; 182: 275-279
        • Oldfield RC.
        The assessment and analysis of handedness: the Edinburgh Inventory.
        Neuropsychologia. 1971; 9: 97-113
        • Sainburg RL.
        Evidence for a dynamic-dominance hypothesis of handedness.
        Exp Brain Res. 2002; 142: 241-258
      1. Brattain K. Analysis of the peripheral nerve repair market in the United States. Minneapolis: Magellan Medical Technology Consultants Inc; 2013.

        • Kouyoumdjian JA
        • Graça CR
        • Ferreira VF.
        Peripheral nerve injuries: a retrospective survey of 1124 cases.
        Neurol India. 2017; 65: 551
        • Taylor CA
        • Braza D
        • Rice JB
        • Dillingham T.
        The incidence of peripheral nerve injury in extremity trauma.
        Am J Phys Med Rehabil. 2008; 87: 381-385
        • Philip BA
        • Kaskutas V
        • Mackinnon SE.
        Handedness has a narrow impact on disability after unilateral peripheral nerve disorder.
        American Society for Neurorehabilitation, Baltimore2017
        • Dyck PJ
        • Boes CJ
        • Mulder D
        • et al.
        History of standard scoring, notation, and summation of neuromuscular signs. A current survey and recommendation.
        J Peripher Nerv Syst. 2005; 10: 158-173
      2. Medical Research Council. Aids to the investigation of the peripheral nervous system. London: Her Majesty's Stationary Office; 1943.

        • He B
        • Zhu Z
        • Zhu Q
        • et al.
        Factors predicting sensory and motor recovery after the repair of upper limb peripheral nerve injuries.
        Neural Regen Res. 2014; 9: 661-672
        • Gonzalez CLR
        • Ganel T
        • Goodale MA.
        Hemispheric specialization for the visual control of action is independent of handedness.
        J Neurophysiol. 2006; 95: 3496-3501
        • Stone KD
        • Bryant DC
        • Gonzalez CL.
        Hand use for grasping in a bimanual task: evidence for different roles?.
        Exp Brain Res. 2013; 224: 455-467
        • Christopoulos V
        • Bonaiuto J
        • Andersen RA
        A biologically plausible computational theory for value integration and action selection in decisions with competing alternatives.
        PLoS Comput Biol. 2015; 11e1004104
        • Fitzpatrick AM
        • Dundon NM
        • Valyear KF
        The neural basis of hand choice: an fMRI investigation of the posterior parietal interhemispheric competition model.
        NeuroImage. 2019; 185: 208-221
        • Uswatte G
        • Taub E
        • Morris D
        • Light K
        • Thompson P.
        The Motor Activity Log-28 assessing daily use of the hemiparetic arm after stroke.
        Neurology. 2006; 67: 1189-1194
        • Taylor C
        • Coffey T
        • Berra K
        • Iaffaldano R
        • Casey K
        • Haskell W.
        Seven-day activity and self-report compared to a direct measure of physical activity.
        Am J Epidemiol. 1984; 120: 818-824
        • Klesges RC
        • Eck LH
        • Mellon MW
        • Fulliton W
        • Somes GW
        • Hanson CL.
        The accuracy of self-reports of physical activity.
        Med Sci Sports Exerc. 1990; 22: 690-697
        • Harris PA
        • Taylor R
        • Thielke R
        • Payne J
        • Gonzalez N
        • Conde JG.
        Research Electronic Data Capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Beaton DE
        • Wright JG
        • Katz JN
        • Group UEC.
        Development of the QuickDASH: comparison of three item-reduction approaches.
        J Bone Joint Surg Am. 2005; 87: 1038-1046
        • Franchignoni F
        • Vercelli S
        • Giordano A
        • Sartorio F
        • Bravini E
        • Ferriero G.
        Minimal clinically important difference of the Disabilities of the Arm, Shoulder and Hand outcome measure (DASH) and its shortened version (QuickDASH).
        J Orthop Sports Phys Ther. 2014; 44: 30-39
        • Gummesson C
        • Ward MM
        • Atroshi I.
        The shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH.
        BMC Musculoskelet Disord. 2006; 7: 44
        • Friard O
        • Gamba M.
        BORIS: a free, versatile open-source event-logging software for video/audio coding and live observations.
        Methods Ecol Evol. 2016; 7: 1325-1330
        • Stone KD
        • Gonzalez CL.
        Manual preferences for visually- and haptically-guided grasping.
        Acta Psychol (Amst). 2015; 160: 1-10
        • Jebsen RH
        • Taylor N
        • Trieschmann RB
        • Trotter MJ
        • Howard LA.
        An objective and standardized test of hand function.
        Arch Phys Med Rehabil. 1969; 50: 311-319
        • Jarus T
        • Poremba R.
        Hand function evaluation: a factor analysis study.
        Am J Occup Ther. 1993; 47: 439-443
      3. U.S. Department of Labor. O*NET OnLine. Available at: Accessed March 6, 2017.

        • Sigirtmac IC
        • Oksuz C.
        Investigation of reliability, validity, and cutoff value of the Jebsen-Taylor Hand Function Test.
        J Hand Ther. 2021; 34: 396-403
        • Cook KF
        • Dunn W
        • Griffith JW
        • et al.
        Pain assessment using the NIH Toolbox.
        Neurology. 2013; 80 (11 Suppl): S49-S53
        • Armijo-Olivo S
        • Woodhouse LJ
        • Steenstra IA
        • Gross DP.
        Predictive value of the DASH tool for predicting return to work of injured workers with musculoskeletal disorders of the upper extremity.
        Occup Environ Med. 2016; 73: 807-815
        • Lang CE
        • Strube MJ
        • Bland MD
        • et al.
        Dose response of task-specific upper limb training in people at least 6 months poststroke: a phase II, single-blind, randomized, controlled trial.
        Ann Neurol. 2016; 80: 342-354
        • Waddell KJ
        • Strube MJ
        • Bailey RR
        • et al.
        Does task-specific training improve upper limb performance in daily life poststroke?.
        Neurorehabil Neural Repair. 2017; 31: 290-300
        • Klöppel S
        • Vongerichten A
        • van Eimeren T
        • Frackowiak RSJ
        • Siebner HR.
        Can left-handedness be switched? Insights from an early switch of handwriting.
        J Neurosci. 2007; 27: 7847-7853
        • Taub E.
        Somatosensory deafferentation research with monkeys: implications for rehabilitation medicine.
        (editor)in: Ince L Behavioral psychology and rehabilitation medicine. Williams & Wilkins, Baltimore1980
        • Wolf SL
        • Lecraw DE
        • Barton LA
        • BB Jann
        Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients.
        Exp Neurol. 1989; 104: 125-132
        • Nudo RJ
        • Wise BM
        • SiFuentes F
        • Milliken GW.
        Neural substrates for the effects of rehabilitative training on motor recovery after ischemic infarct.
        Science. 1996; 272: 1791-1794
        • Yancosek KE
        • Calderhead WJ.
        Efficacy of Handwriting for Heroes, a novel hand dominance transfer intervention.
        Hand Therapy. 2012; 17: 15-24
        • Dunn AM.
        Non-dominant arm training improves functional performance and modifies spontaneous arm selection.
        Pennsylvania State University, University Park, PA2017
        • Smurr LM
        • Gulick K
        • Yancosek K
        • Ganz O.
        Managing the upper extremity amputee: a protocol for success.
        J Hand Ther. 2008; 21: 160-176
        • Flindall JW
        • Gonzalez CL.
        Wait wait, don't tell me: handedness questionnaires do not predict hand preference for grasping.
        Laterality. 2019; 24: 176-196
        • Yancosek K
        • Daugherty SE
        • Cancio L.
        Treatment for the service member: a description of innovative interventions.
        J Hand Ther. 2008; 21 ([quiz: 195]): 189-194
        • Sabari JS.
        Motor learning concepts applied to activity-based intervention with adults with hemiplegia.
        Am J Occup Ther. 1991; 45: 523-530
        • Yancosek KE
        • Mullineaux DR.
        Stability of handwriting performance following injury-induced hand-dominance transfer in adults: a pilot study.
        J Rehabil Res Dev. 2011; 48: 59-68