Improving an intrinsic-plus movement pattern with a reversed knitted hand function enhancement glove: a case report

This report describes a case in which orthotic therapy and the reversed application of a knitted hand function enhancement glove (Nigirukun®) were used to treat an intrinsic-plus-like movement pattern persisting after recovery from wrist drop secondary to radial nerve palsy. The patient was a man in his 20s who developed radial nerve palsy after a traffic accident. Although wrist drop and sensory disturbance improved during recovery, an intrinsic-plus-like movement pattern characterized by metacarpophalangeal joint flexion with proximal and distal interphalangeal joint extension persisted in the left hand, resulting in difficulty in grasping objects, particularly with the ring and little fingers. The intrinsic tightness test showed no evidence of structural shortening, suggesting that abnormal movement was mainly related to a fixed motor control strategy associated with intrinsic muscle overactivity. Initial treatment consisted of thermotherapy, range-of-motion exercises, and orthotic therapy designed to maintain the interphalangeal joints in flexion. To modify the flexion onset pattern during grasping, a knitted hand function enhancement glove was applied in a reversed orientation to assist interphalangeal joint flexion during the early phase of grasping, thereby reducing intrinsic muscle-dominant activation. Immediately after the introduction of the reversed glove, the patient reported improved ease of grasping, accompanied by increases in grip strength and active motion indices. By hospital day 59, total passive motion showed little change; however, improvements in finger flexor strength, active movement measures, and patient-reported outcomes were observed, suggesting that functional recovery may have been related more to changes in motor strategy than to structural joint changes. These findings suggest that the reversed use of a knitted hand function enhancement glove may support sensorimotor re-education and facilitate the relearning of coordinated flexion patterns in daily activities.