Milliken Research in Journal of Hand Surgery

Milliken Hand Rehabilitation Center Hand Therapists, Macy Stonner, OTD, OTR/L, CHT & Logan Berlet, OTD, OTR/L were recently published in The Journal of Hand Surgery for their paper, “The Impact of Social Deprivation and Hand Therapy Attendance on Range of Motion After Flexor Tendon Repair.” The purpose of the paper was to examine the influence of social deprivation and hand therapy attendance on active range of motion (AROM) outcomes following flexor tendon repair.

Below is information about the Milliken research that was included in the paper. It discusses how the study was performed and the overall team conclusions.


We performed a retrospective analysis of patients who underwent primary zone I–III flexor tendon repair between November 2016 and November 2020. Area deprivation index (ADI) was used to quantify social deprivation. Medical record review determined each patient’s demographic characteristics, injury details, total hand therapy visits, and final AROM outcome. Active range of motion was converted to Strickland’s percentage for analysis. Spearman correlation and simple and multivariable linear regression models were used to assess relationships between explanatory variables and outcomes.


There were a total of 109 patients, with a mean ADI of 53 and mean therapy attendance of 13 visits. Higher ADI and lower therapy attendance were correlated, and each was associated with significantly decreased Strickland’s percentage. In the multivariable model, therapy attendance, ADI, zone 2 injury, and age maintained significant associations with Strickland’s percentage.


Socially deprived patients attend fewer therapy sessions and obtain poorer AROM after flexor tendon repair. Social deprivation is likely to contribute to poor outcomes both by its association with decreased therapy attendance and by other potential pathways that make it difficult for deprived patients to achieve good surgical outcomes.

Access The Publication and Paper


Summer Hand Injuries

We all love summer as it brings warm weather and outdoor fun. Summer hand injuries can put a damper on the good times we look forward to. With proper caution and planning, you can save yourself a trip to the emergency room and a medically created setback!

  • Wrist fractures: Sports-related activities increase fall risk. Biking, rollerblading, skateboarding, and scootering tend often lead to wrist fractures or sprains. Be aware of uneven sidewalks and other pedestrians, and wear wrist guards for protection.
  • Burns: Bonfires, barbeques, and fireworks pose danger around open flames. Keep your distance from the fire, and use long-handled tongs when grilling to protect your hands. Keep your children safe by keeping them aware of the fire.
  • Tendonitis: Golf, tennis, and baseball become more popular in warmer weather, which is often accompanied by elbow tendonitis and pain. Prior to play, consider stretching your wrists to prevent tendon tearing and inflammation. Check your racket/club/bat to ensure proper fit and that it’s not causing unnecessary strain.
  • Lawnmower accidents: 25% of yearly lawnmower summer hand injuries lead to finger or toe amputation. Always use the proper safety guards/precautions when cleaning out lawnmower blades. Keep children away from the lawnmower.
  • ATV accidents. Every year, ATVs cause 135,000 injuries and 700 deaths. 30% of deaths are among children below age 16. If you choose to ride an ATV, please consider the following precautions:
    • Wear a helmet and protective eyewear
    • Limit the number of riders
    • Only ride during daylight hours
    • Never operate an ATV under the influence of alcohol or drugs

Have fun this summer, but keep yourself and others away from summer injuries. If you sustain an upper-extremity injury, don’t hesitate to call the Milliken Hand Rehabilitation Center!

Fireworks & Hand Safety

As we approach the 4th of July, it is important to keep in mind that the use of even the smallest fireworks can result in devastating injuries. Sparklers reach temperatures over 1000 degrees and can easily burn skin or ignite clothing. Larger fireworks can fracture fingers or amputate portions of the hand.  While these injuries may seem extreme, they are injuries that the Hand Therapists at the Milliken Hand Rehabilitation Center commonly see in their clinics every July.  According to the U.S. Consumer Product Safety Commission 2020 Fireworks Annual Report, hands and fingers were the most frequently injured body parts, accounting for 30% of the injuries sustained by fireworks.

The safest way to enjoy fireworks is at a public display conducted by professionals. But, if you choose to use fireworks, the Consumer Product Safety Commission has the following tips:

  • Never allow young children to hold or ignite fireworks.
  • Never place any part of your body directly over a firework device. Back up to a safe distance immediately after lighting the fuse, and only light one at a time.
  • Never try to re-light or pick up fireworks that have not ignited fully.
  • Never point or throw fireworks at another person.
  • Keep a bucket of water or a garden hose handy.
  • Never carry fireworks in a pocket or shoot them off in metal or glass containers.
  • After fireworks complete their burning, wait 20 minutes, and then douse them with plenty of water before discarding in a trash can.

Our team at the Milliken Hand Rehabilitation Center wishes everyone a Safe and Happy 4th of July Holiday! If you do experience a hand or upper extremity injury, we are here to help!

Firework & Hand Safety Tip Sheet pdf (Download)











Chronic Condition Spring Safety Tips

Spring is a time of awakening.  As we wake up from our winter slumber, we are eager to be more active.  This could mean getting back to recreational activities such as hiking, biking, or participating in an outdoor sport.  Or it could mean doing housekeeping activities such as spring cleaning or gardening.  Returning at full force may lead to an injury or a flare-up of a chronic condition.  Here are some tips to consider should you reengage a chronic condition: 

  • It is always a good idea to warm up before and cool down after an activity. 
  • Gentle stretching prior to an activity can prevent a muscle strain while gentle stretching after can decrease soreness. 
  • While it may be tough to slow down, breaking down the activities into short intervals can prevent fatigue. 
  • Eating a healthy diet of lean proteins and vegetables can improve your endurance. 
  • Even when the weather is mild, be sure to drink plenty of fluids to prevent dehydration. 
  • To boost your confidence and enjoyment, set realistic goals. 
  • To improve your performance, seek professional tips from a tennis or golf coach.  
  • Maintaining your equipment and tools in proper condition can decrease stress on your joints. 
  • Building up the handles on your tools will lessen hand pain. 
  • Wearing sunscreen will not only protect your skin from harmful UV rays; it will preserve its youthfulness.  

Following these tips will help you to enjoy the cool spring weather but if you do encounter a chronic condition in your hands or upper extremity our team at The Milliken Hand Rehabilitation Center is here to help!

Good Form With Exercise Apps

For many people, the start of the new year symbolizes a time to take on new challenges and adopt new practices to improve physical health and overall well-being and we want to ensure that good form is being practiced. With the rise in popularity of fitness apps and online workout programs since the start of the Covid-19 pandemic, people now more than ever, are deciding to make exercise a part of their daily routine. While fitness apps can be a very powerful tool by providing motivation, accountability, and a fun experience for those new to exercise, a few basic guidelines should be followed to avoid injury and a possible premature end to your new year’s resolution.
  1. Always warm up and stretch prior to starting any workout – When you warm-up and stretch your body temperature rises, blood flow is elevated, and more oxygen is carried to the muscles. Increased blood circulation and higher oxygen levels boost energy, increase muscle stamina, improve range of motion, and decrease the likelihood of strains or sprains by preparing soft tissues for the exertion of exercise.
  2. Practice good form – Proper form is essential to avoiding injury when beginning any new training program. This is especially true if you’re new to working out. Some basic tips for performing the exercise with good form include:

-Perform the exercise slowly through a full range of motion. For example, if performing weighted bicep curls you should start with an appropriate weight that allows you to fully extend and flex your elbow. If weight is appropriate, but you are still unable to move through a  full range of motion, you may need to focus on stretching tight muscles that are preventing full-motion prior to lifting.

-Perform resistance exercises with a neutral spine. To achieve a correct neutral position stand with your chest high, chin gently tucked, feet shoulder-width apart, and abdominals and glutes activated. This position protects your spine and provides a solid platform from which to safely perform resistance training.

-Use a mirror to monitor form throughout the course of your workout. Whether you are lifting weights or doing yoga, you will likely fatigue as your workout progresses and form may suffer as a result. Using a mirror that allows you to periodically check your form will assist with maintaining good posture and symmetry throughout the course of your workout.

  1. Listen to your body – Whether you’re a seasoned fitness veteran or brand new to working out, it is normal to feel some soreness 1-2 days after performing a strenuous workout or trying a new exercise. This sensation is usually spread out over a larger area of the body and can be alleviated through gentle stretching, resting sore areas, and maintaining good hydration.  If pain is sharp, focused in a specific area,  or returns quickly with exercise, the activity that is causing pain should be discontinued or modified. Rest, ice, and elevation may also be helpful. If the pain does not resolve and begins to impact daily function you may need to see a doctor or consider contacting our team at the Milliken Hand Rehabilitation Center.

Safety Tips for Holiday Gathering

The holidays are shaping up to look different again this year from traditional gatherings of the past with recommendations of continued social distancing, masks, and possible outdoor meals. During these times, our annual celebrations with family and friends are so important for our mental health, but it is equally important to stay safe. As indoor dinner parties and social get-togethers are still risky this holiday season due to the COVID-19 pandemic, many people will likely be cooking and gathering outside. It is important to keep safety in mind when using a grill or turkey fryer (especially if it is for the first time) while cooking in the kitchen, and while gathering.  Below are some tips to help you and your family and friends enjoy Thanksgiving safely!

Social Holiday Safety Tips:

  • Cook and eat outdoors. Consider cooking a turkey on the grill or in an outdoor turkey fryer and having dinner outside to avoid being inside with other individuals for long periods of time.
  • Wear a mask. Remember that even outside it is important to maintain physical distance and wear face coverings when gathering.
  • Serve safer. Use single-use cutlery to decrease the transmission across surfaces and choose one person to do the serving to avoid everyone touching the serving utensils.
  • Wash your hands often.

*Refer to the CDC’s guideline to Holiday Celebrations and Small Gatherings for more information.*

Outdoor cooking safety tips:

  • Be prepared. Follow the manufacturer’s instructions and familiarize yourself with the operations, especially if you are a first-time user of a deep-fryer.
  • Use only on a safe surface. Use the deep-fryer on a stable, non-combustible surface outside.
  • Never leave a deep-fryer unattended.
  • Ensure turkey is dry. Dry turkey before placing in a deep fryer to avoid water/oil interaction that could lead to a grease fire.
  • Have a fire extinguisher nearby in case of emergency.

Kitchen Holiday Safety Tips:

  • Wear a mask while preparing food.
  • Minimize distractions. Pay attention while using a knife, removing hot items from the oven, and carrying a heavy object, to prevent injury as these are often prime times to have an accident.
  • Cut away from yourself. Always keep both hands and your body out of the path of your sharp knife to avoid injury.
  • Use a sharp knife when carving. Dull tools require more force to cut through the turkey and you are more likely to cut yourself.
  • Dry workspace. Keep the workspace in the kitchen, tools, cutting boards, and your hands clean and dry to help prevent any injuries that may occur from slipping.
  • DO NOT put water on a grease fire. Instead, smother it by placing a lid on top of the pan.

An additional safety measure has been created by the

From the Milliken team, we hope you have a safe and Happy Thanksgiving! If you do find yourself needing assistance for an injury related to your hands, wrist, or upper extremity, The Milliken Hand Rehabilitation Center is here to help!

Hand Safety When Pumpkin Carving

With Halloween being this weekend, we know pumpkins are being carved in preparation for display.  While usually not thought of as a dangerous activity, injuries from knives or other tools used for carving can require surgical repair and sometimes take multiple months to rehabilitate. Here are a few safety tips to help keep you away from our clinic!
  • Be sure that the tools you plan to use, as well as your hands, are dry before you begin carving. This will help prevent any injuries that may occur from slipping.
  • Purchase a pumpkin carving kit that includes a small serrated knife. This is safer than using a large sharp knife.
  • Cut away from yourself and use small, controlled strokes.
  • Be sure that the hand you are using to stabilize the pumpkin is not in a location that the knife could contact if it slips or pierces through both sides of the pumpkin.
  • Find appropriate ways for children to help. They can scoop the seeds and draw the pattern on the pumpkin, but in most cases should not be handling the carving knife.   You can also consider painting or applying stickers to your pumpkins instead of carving them.
  • If you plan to put a lit candle inside your pumpkin, consider cutting a hole in the bottom of the pumpkin. This way you can place your pumpkin on top of the candle, rather than reaching into the pumpkin to light the candle (which may result in a burn).
  • If you cut your hand or finger, apply direct pressure to the wound with a clean cloth. If the bleeding doesn’t stop or slow after 15 minutes of continuous pressure, head to the emergency room.

If you do sustain a hand injury this Halloween season our team at the Milliken Hand Rehabilitation Center is here to help!

4th of July Hand & Firework Safety

Summer 2021 is looking a little brighter than the summer of 2020 as neighborhood and community gatherings, parades, and summer celebrations are returning in a safe way. This means that large firework displays may return, but also people are excited to safely gather to celebrate the holidays with friends and family. With large gatherings returning, more people may be looking to create a bigger and more exciting firework display at home. While fireworks are beautiful and entertaining, they can be very dangerous. For this reason, fireworks and hand safety should be a top priority. Below are some tips to help you and your family and friends enjoy the summer holiday safely!

It is recommended to go watch your local fireworks display that is likely run by your local fire department. However, if you decide to set off fireworks at home, here are some safety tips to follow:

  • Never let young children play or ignite fireworks. If older children are playing with fireworks, always have adult supervision.
  • Never place any part of your body directly over a fireworks device when lighting the fuse.
  • Back up to a safe distance immediately after lighting the firework.
  • Never try to re-light or pick up fireworks that have not ignited fully.
  • Keep a bucket of water or a garden hose nearby in the case of fire.
  • After fireworks complete their burning, douse it with plenty of water from a bucket or hose before discarding it to prevent a trash fire.

Typical fireworks injuries can be caused by firecrackers, bottle rockets, sparklers, and more. In fact, sparklers may seem very safe, but they can burn at about 2,000 degrees, hot enough to melt metal! Below is a list of common firework injuries and what to do in case of an accident:

Burns: This is the most common firework injury. A minor burn causes redness and pain, but a more serious burn can cause blisters and more damage beneath the skin. Minor burns can be treated at home by cleaning the burn with cool running water, but all other burns should be handled by the emergency department.

Hand fractures and lacerations: Fireworks can cause severe hand injuries including broken bones, deep cuts, and torn or cut tendons. These hand injuries require immediate care by the emergency department. Before you receive emergency care, it is recommended to remove all jewelry, cover the hand with a clean cloth, place ice over it, and elevate the hand above the heart.

Amputations: This is one of the most severe firework injuries and requires immediate care by the emergency department. You should follow the pre-emergency department steps mentioned earlier.  However, if a lost finger(s) can be located, clean it with saline (saltwater), wrap it in gauze, put it in an air and water-tight bag, place it on ice, and bring it to the emergency department with you.

From the Milliken team, we hope you have a safe and happy summer holiday! If you do find yourself needing assistance for an injury related to your hands, wrist, or upper extremity, the Milliken Hand Rehabilitation Center is here to help!

Let’s Give Them A Hand

June 7th – 13th we will recognize our Hand Therapists during the American Society of Hand Therapists (ASHT) Hand Therapy Week. This highly specialized group of therapists provide patient care at the Milliken Hand Rehabilitation Center.

The Milliken Hand Rehabilitation Center was one of the first three hand rehabilitation facilities established in the U.S. With over 60 years of experience treating complex and common injuries, Milliken’s occupational, physical and certified hand therapists assist Washington University plastic surgeons, orthopedic surgeons, and community physicians in providing treatment for patients with hand and upper extremity injuries. Some specific conditions that are treated:

  • Arthritis of the hand and wrist
  • Brachial plexus injuries: affecting nerves in the shoulder, elbow, forearm, wrist, and fingers
  • Congenital Hand and Upper Extremity differences
  • Dupuytren’s Contracture
  • Fractures/crush injuries
  • Nerve Compression Syndromes/Peripheral nerve injuries
  • Pre & Post-Operative care for Breast Cancer
    Pre-Operative evaluation and education includes:
     Baseline measurements of upper extremity function, A home program to complete pre-surgery to improve the recovery process post-operatively, Activity of daily living demands and anticipated needs
    Post-Operative care includes: Wound and scar management, Ensure full motion of arms is achieved, Home program personalized to your situation, Activities of daily living deficits, Work demands addressed, Pain management techniques
  • Sports-related injuries of the elbow, hand or wrist
  • Tendon lacerations
  • Tendonitis
  • Work-related injuries and conditions

Pre and Post Operation Services

Milliken therapists are able to work with injuries that both require an operation and provide hand therapy for those that don’t. We provide therapy techniques and services to help optimize your function.

Continue reading about who we are…

Fireworks & Hand Safety

View our Firework Safety Tip Sheet

The summer of 2020 is different from any we have known before.  Covid-19 has affected our ability to celebrate with the normal parades, gatherings, and summer celebrations.  Large firework displays have been canceled this year.  This may lead to more inexperienced people handling fireworks meaning Fireworks & Hand Safety should be a priority!  Although they are beautiful and entertaining, fireworks can be very dangerous.

It is important to be aware of these common firework injuries and what to do in case of an accident.

BURNS:  Burns to the fingers/hand are the most common firework injury.  A minor burn causes redness and pain.  A more serious burn can cause blisters and the most serious burn causes the skin to take on a white, leathery look but the damage is beneath the skin.  Minor burns can be treated by cleaning the burn with clean running cool water and over the counter medication.  All other burns should be handled by emergency treatment.

EYE INJURIES:  Fireworks can send dangerous particles into the air.  These can cause minor irritation, burns to the eye, and at worst complete loss of vision.  Leave an eye injury alone and seek emergency medical care.

HAND FRACTURES AND LACERATIONS:  Besides burns, fireworks can cause severe hand injuries that can include, broken bones, deep cuts, and torn tendons.  Severe hand injuries require emergency treatment.  Before the arrival of emergency personnel, the following first aid is recommended: -remove all jewelry;  – cover the hand with a clean cloth; – place ice over it;- elevate the hand above the heart.

FACIAL INJURIES:  Besides burning the eyes, fireworks can burn the face.  Severe injuries also include broken facial bones and loss of facial tissue.  If injured, keep your head/face above heart level, put a clean cloth over the injury, apply ice, and seek emergency medical care as soon as possible.

AMPUTATIONS:  One of the most severe of all firework injuries is that of amputation.  First aid for this includes cleansing with a saline (saltwater) solution, covering with a clean cloth, elevating above heart level, and applying ice until you can get emergency care.  If a lost finger/s can be located, clean it with saline (saltwater), wrap it in gauze, put it in an air and watertight bag, and place it on ice.  Take it to the emergency room with you.

Additional safety tips from the National Council on Firework Safety.

Common sense can do a lot to reduce/prevent injuries and other fire hazards.  Remember, if you choose to use fireworks this season, be safe and prepared. If you do experience a hand injury from fireworks, the Milliken Hand Rehabilitation Center is here to help.

Hand Safety Tips While Walking Your Dog

Walking your dog is seen as a good way to reach your weight loss goals, keep in shape, and decrease stress, but it could also increase your risk of injury.  Every year people are hurt while walking their dog, and the majority of these are women. In 2017 a study of ER visits found that injuries had increased to 4400 a year. NBC News did an additional story regarding seniors and injuries resulting from dog walking. The injuries seen by incidence are hip fractures, wrist fractures, and injuries of the upper arm.  The mechanism of injury is usually due to a tangled or wrapped leash, trying not to step on the dog, or pulling of the dog.

Here are some key points to remember when taking your dog for a walk:

  1. Do not wrap the leash around your hand or wrist. Most trainers say that you should place the leash loop on your thumb and let it dangle down past your hand then bring it up loosely and around your thumb again and through the palm, then make a fist to hold onto the lease.
  2. Wear appropriate shoes when walking your dog.
  3. Pay attention to your dog and your surroundings. No phone use, no zoning out.
  4. Do not use a long leash. It is best to keep the dog next to you on either side.
  5. Don’t put fingers under the collar, they can get caught in the collar or leash.
  6. Keep your dog by your side, to decrease pulling.

Walking your dog should be an enjoyable activity for both of you.  So be safe and have fun!

In case you do sustain an injury while walking your dog, our team at Milliken Hand Rehabilitation Center is here to help!