Physical rehabilitation interventions for hand function in people with systemic sclerosis

Systemic sclerosis (SSc) is a complex systemic autoimmune rheumatic disease with marked clinical heterogeneity. Cutaneous manifestations affecting the hands and wrists include vascular insufficiency, early edema (puffy fingers), followed by progressive skin fibrosis and atrophy (sclerodactyly). This progressive skin tightening results in joint stiffness, deformity, functional impairment and reduced quality of life. Beyond skin changes, hand involvement may also include inflammatory arthritis, joint contractures, tendon friction rubs, Raynaud phenomenon, digital ulcers, acro-osteolysis, and calcinosis, all of which can further impair hand function, significantly affecting individuals' ability to perform routine occupational and daily tasks requiring grasping, gripping, and fine motor dexterity. In this article, we synthesize the evidence evaluating manual therapy, prescribed hand exercises, self-administered hand exercise protocols, telerehabilitation, paraffin wax, therapeutic ultrasound, manual lymphatic drainage, and dynamic splinting to improve hand function in people with SSc.