Submit articles to The Journal of Hand Surgery at http://ees.elsevier.com/jhs/

Aims and scope: The Journal of Hand Surgery publishesoriginal, peer-reviewed articles related to the pathophysiology,diagnosis, and treatment of diseases and conditions ofthe upper extremity; these include both clinical and basicscience studies along with case reports. Special featuresinclude History of Hand Surgery, A Touch of Humanity,Current Concepts, Surgical Techniques, Evidence-BasedMedicine, In Brief, Review of Books and Media, andLetters to the Editor. Accepted submissions will be publishedin the print journal as well as in the online version.Supplemental materials may be published in the onlineversion with reference to it in the print version. Beforebeginning to write for the Journal of Hand Surgery, prospectiveauthors should read these Instructions completely.Authors will also benefit from reading

• Manske PR. Structures and format of peer-reviewed scientificmanuscripts. J Hand Surg Am. 2006;31(7):1051-1055.
• Flatt AE. Words. J Hand Surg 2000;25(2):201-210.

Roy A. Meals, MD, Editor-in-Chief
Ghazi M. Rayan, MD, Review Editor
The Journal of Hand Surgery
American Society for Surgery of the Hand
822 West Washington Boulevard
Chicago, IL 60607
Phone: (312) 880-1900
Fax: (847) 384-1435
Email: jhs@assh.org

Editorial policies: Statements and opinions expressed in the Journal of Hand Surgery are those of the author(s) and notnecessarily those of the Editor or Publisher. The Editor andPublisher disclaim any responsibility or liability for suchmaterial. Neither the Editor nor the Publisher guarantees,warrants, or endorses any product or service advertised inthis publication; nor do they guarantee any claims made bythe manufacturer of such product or service.

Copyright: All material published in the Journal of Hand Surgery isvested in the American Society for Surgery of the Hand. In accordance with the Copyright Act of 1976, thecorresponding author of each manuscript will be required tocomplete a copyright assignment form on acceptance of themanuscript. When submitting a paper the author(s) mustmake a full statement to the Editor about all submissions andprevious reports that might be regarded as prior or duplicatepublication of the same or similar work. Copies of suchmaterial should be included with the submitted paper tohelp the Editor decide how to deal with the matter. The Journal of Hand Surgery may use and permit others to use data generated from the initiation to the completion of manuscript review, eg, race, sex, and nationality of authors; time from submission to decision(s); time to receipt of revision(s); times to publication; and final decisions.

Financial interest: The Conflict of Interest Statement, signedby all listed authors, is required on submission of the manuscript.This form requires disclosure from each author indicatingthat (a) no financial conflict of interest exists with anycommercial entity whose products are described, reviewed,evaluated, or compared in the manuscript, except for thatdisclosed under 'Acknowledgments' or (b) a potential conflictof interest exists with one or more commercial entities whoseproducts are described, reviewed, evaluated, or compared inthe manuscript.

Ethical standards: The Journal of Hand Surgery adheres tothe ethical standards described by the Committee on PublicationEthics (http://publicationethics.org) and the InternationalCommittee of Medical Journal Editors (http://www.icmje.org/urm_main.html). Authors are expected toadhere to these standards.

Human subjects: Articles involving research conducted inhuman subjects must include a statement in the Materialsand Methods section indicating approval by the institutionalreview board and noting that informed consent, as well asany necessary HIPAA consent, was obtained from eachpatient. For reports of research using human subjects, provideassurance that (a) necessary and appropriate consentwas obtained from each patient and (b) the study protocolconformed to the ethical guidelines of the 1975 Declarationof Helsinki as reflected in a prior approval by the appropriateinstitutional review committee. Identify patients bynumber, not by initials. Clinical trials must be registered ina public trials registry. Denote the registry and registrynumber. Articles emanating from a particular institutionmust have approval by the requisite authority.

Animal experimentation: Manuscripts reporting animal experimentsmust include a statement in the Materials and Methodssection that animal care complied with the guidelines ofthe authors' institution and the National Institutes of Healthand any national law on the care and use of laboratory animals.

Systematic reviews and meta-analyses: Authors shouldadhere to the Preferred Reporting Items for SystematicReviews and Meta-Analyses (PRISMA) guidelines (www.prisma-statement.org) and indicate in the Materials and Methodssection of the manuscript that they have done so.

Permissions: Obtain and submit written permission for usefrom the original copyright holder for any lengthy directquotations, tables, or illustrations taken from copyrightedmaterial. Include the permission in the text, table footnote,or figure legend and provide complete information as tosource. Photographs of identifiable persons must be accompaniedby a signed release that indicates informed consent.

Units of measurement: Use Système International (SI) measurements. For clarity, nonmetric equivalents may be includedin parentheses following the SI measurements.

Abbreviations and acronyms: If an abbreviation or acronymappears more than three times in the abstract or morethan three times in the article, spell out an abbreviation oracronym the first time it is used, followed by the shortenedversion in parentheses. Spell out all abbreviations and acronymsat the beginning of sentences.

Drug names: Use generic names. You may cite proprietarynames in parentheses along with the name and location ofthe manufacturer.

Language editing: Authors lacking facility with English syntaxshould seek editorial assistance prior to submitting their manuscripts.Material requiring major editorial work for clarity ofmeaning will be returned without review. To obtain the assistanceof an English-language editor prior to submitting amanuscript, goto http://www.elsevier.com/locate/languagepolishing. Authorsare responsible for the cost associated with using an editingservice. Use of an editing service does not guarantee acceptanceof the manuscript.

Style: When not otherwise specified in these Instructions toAuthors or in the Journal of Hand Surgery Style Guide,defer to the guidelines specified in the latest edition of theAmerican Medical Association's Manual of Style (www.amamanualofstyle.com).

As a final step before submitting your manuscript, turn on the "Display Readability Statistics" function in Microsoft Word. Instructions to do so are in the Help Menu. Then subject the manuscript to Microsoft Word's Spelling and Grammar checker and consider making the changes it recommends. For instance, JHS encourages active verb forms. On completion of the spelling and grammar check, Word will give you the percentage of sentences with passive verb forms, the Flesch Reading Ease score, and the Flesch-Kincaid Grade Level. Please indicate these 3 scores in your cover letter. Going through this process and reporting the results will make the writing stronger and will facilitate the review process.

Organization of the manuscript: Manuscripts not complyingwith these requirements will be returned to the author(s) forappropriate formatting modifications prior to review. Since theauthors' identities are withheld from the reviewers, include theauthors' names only on the title page. For blinding purposes,submit the manuscript as two separate files: the title page as onefile and the manuscript, without author names, as another file.Double space lines throughout (including the list of references,tables, and figure legends) with 2.5-cm margins all around. Usecontinuous numbering to number each line in the margin.Arrange the manuscript as follows: title page, abstract, body ofthe manuscript, references, figure legends, tables, figures. Organizethe body of the manuscript as follows. For peerreviewedscientific studies, the sections are introduction, materialsand methods, results, and discussion. JHS scientific articlesdo not include a conclusion section. For review articles,include historical background (introduction), specific subheadingsfor the main body of the text, and a summary.

Title page: The title should be a concise and informativedescription of the study. Include the authors' highest academic degrees, both abbreviated and spelled out (maximumtwo). Exclude professional certifications such as CHT, RN,and RPT. Include the department and institution where thework was done. The sequence of the authors' names is of theauthors' choosing. Designate one author as the correspondentand supply his or her complete mailing address, telephonenumber, fax number, and e-mail address. Every person listed asan author should have materially participated in the design,execution, and analysis of the study and should verify theaccuracy of the entire manuscript before its submission. Lessercontributions are appropriately noted in an acknowledgmentsection on the title page. The person(s) receiving the proposed acknowledgement must give approval to the author for the publication of their name(s). Manuscripts should have no morethan 6 authors. A greater number requires justification.

On the title page, provide a short title of no greater than 45characters, including spaces, for the running head. List inalphabetical order key words for coding and indexing purposes.Include disclaimers, if any, and a brief acknowledgmentof grants or other assistance. Note: If you received agrant from the American Foundation for Surgery of the Hand,then please acknowledge that grant on your Title Page.

Abstract: Do not include footnotes, statistical results, or referencesin the abstract. Type the abstract on a separate page. Forpeer-reviewed clinical studies, submit a structured abstractlimited to 300 words and divided into 5 sections: Purpose,Methods, Results, Discussion, and Level of Evidence (seetable). For peer-reviewed basic science studies, submit a structuredabstract limited to 300 words divided into 5 sections:Purpose, Methods, Results, Discussion, and Clinical Relevance.For review articles and case reports, submit a briefone-paragraph description of the manuscript contents.

Manuscript body: Restrict the manuscript to fewer than3,000 words. In both the abstract and in the main body,avoid claiming priority of findings. For example, avoidstatements such as, "This paper is the first to report..."Formatting, such as Greek letters, italics, superscripts, andsubscripts, may be used. The coding scheme for such elementsmust be consistent throughout.

Articles may use section subheadings within the followingheadings to clarify content.

Introduction: In fewer than 500 words and in 3 to 4paragraphs, include the study's background, rationale, questionsor hypotheses posed, and novelty. Each of the questionsor hypotheses should be sufficiently important toappear in the abstract.

Materials and methods: Present the study design clearly.Identify and describe the measurement parameters. Describestatistical methods with enough detail to enable a knowledgeablereader with access to the original data to verify thereported results. When possible, quantify findings and presentthem with appropriate indicators of measurement error oruncertainty (such as confidence intervals). Avoid sole relianceon statistical hypothesis testing, such as the use of P values,which fails to convey important quantitative information. Donot identify the statistical software used unless the analysis wasdependent on a particular software program.

Results: In less than 500 words, present the findings in thesame order that you pose the questions or hypotheses in the Introduction. Data should be presented only once, in a text,table, or graph.

Discussion: In fewer than 1,000 words, briefly restate therationale and the questions, then explore major limitations andcompare and contrast the study's results with previous work.Include one paragraph for each question or hypothesis. Synthesizethe current results with those previously published. It isthe Journal of Hand Surgery's style not to include a Conclusionsection since this is typically redundant with the abstract.

References: Authors are responsible for verifying the accuracyand completeness of references. Referencesshould not be merely a listing of the results of a computerizedliterature search but should have been read bythe author and deemed pertinent to the manuscript.Type references double-spaced on pages separate fromthe text and number them consecutively by the order oftheir citation in the text. Identify references in the textby Arabic numerals within parentheses. Do not use anautomated end notes system or automatic list numberingbecause these features are lost when converting themanuscript into the form necessary for publication.

As of October, 2012, the Journal of Hand Surgery requires references to be formatted according to the latest edition of the American Medical Association's Manual of Style (www.amamanualofstyle.com). If a referencesource is not yet published but has been accepted forpublication, include the source in the reference list andsubmit the letter of acceptance along with the manuscript.

Do not cite meeting abstracts, personal communications, orunpublished material (including oral and poster presentations,correspondence club letters, and manuscripts not yetaccepted for publication) in the reference list. If critical tothe manuscript's message, cite this material in the textwithin parentheses. Please note the following examples ofreference style.

Journal article
Elfar JC, Yaseen Z, Stern PJ, et al. Individual finger sensibility in carpal tunnel syndrome. J Hand Surg Am. 2010;35(11):1807-1812

Book
Taleisnik J. The Wrist. New York, NY: Churchill Livingstone;1985: 25-32.

Chapter in edited book
Bowers WH. The distal radioulnar joint. In: Green DP, ed. Operative Hand Surgery. 3rd ed. New York, NY: ChurchillLivingstone; 1993:973-1020.

Tables: Double-space table data with the table number andtitle centered above the table and with explanatory notesbelow the table. Each table should be on a separate page. Donot duplicate material in tables with material in the text orfigures. Submit lengthy tables and extended data for publicationas supplementary material in the online journal.

Figure legends: Number the figures with Arabic numeralsin the order cited in the text. Provide sufficient explanation to render the figure intelligible without reference to thetext. Define all symbols and all abbreviations not yet spelledout in the text. For reproduction of any copyrighted material,include written permission from the copyright holder(see Permissions, above). On a page separate from the bodyof the manuscript, type figure legends double-spaced.

Figures: Apply any digital manipulation of an image (e.g.,brightness, color, contrast) to the whole image in order notto misrepresent the original image Enhancement or maskingof a portion of an image is unacceptable unless clearly andcompletely explained in the legend. Use professionally producedarrows or other markers placed directly on the figureto identify important features. Do not write on the illustrations.Crop figures as necessary to emphasize the subjectmaterial. All figures and illustrations should be oriented sothe distal component (e.g., the fingertip) is at the top. Thenames of the subject, author, or institution must not appearanywhere on the figure. The figure title and caption materialappear in the legend, not on the figure. Figure numbersmust correspond with the order in which figures occur inthe text. Do not include photographs or x-rays of normalfindings. Submit line art with no gradations of shading, asthey will not reproduce well. Use cross-hatching or patternswhere shading is necessary. Artwork and photographs submittedin color will be reproduced in full color in theJournal at no charge to the authors. Obscure the identity ofany person included in a photograph or include the person'swritten permission to be identified. If a figure has beenpublished, acknowledge the original source and submitwritten permission from the original copyright holder toreproduce the material (see Permissions, above). Authorsare responsible for applying for permission for both printand electronic rights for all borrowed materials and areresponsible for paying any fees related to the applications ofthese permissions.

Please see instructions for submitting digital art at http://ees.elsevier.com/jhs. Provide images in EPS or TIF format. Tocreate the art, use graphics software such as Photoshop andIllustrator, not presentation software such as PowerPoint,Corel-Draw, or Harvard Graphics. Color images must beCMYK, at least 300 DPI. Gray scale images should be at least300 DPI. Combinations of gray scale and line art should be atleast 1,200 DPI. Line art (black and white or color) should beat least 1,200 DPI and be accompanied by a proof.

Special features:

Review Articles

• The Current Concepts section is designed to provide reviewarticles focusing on up-to-date information covering 60 essentialtopics on a three-year rotation. Current Concepts authorsare invited based upon their expertise. Contact Ghazi Rayan atjhs@assh.org with suggestions or questions.
• The Surgical Techniques section complements the Current Concepts section and provides step-by-step details of varioussurgical procedures relevant to clinical practice. Surgicaltechnique articles are open for submission and will also be solicited from experts. Interested authors shouldcontact David Netscher at netscher@bcm.tmc.edu.
• The Evidence-Based Medicine section uses case-based learningand applies this concept to all aspects of the managementof a particular disease including etiology, diagnosis,nonsurgical and surgical treatment, aftercare, and outcomes.Cases can be submitted and will serve as the basisfor a review of the best scientific evidence available tomanage the patient. Volunteers interested in reviewingthe evidence and writing a full article should contactDavid Ring at dring@partners.org.
• In Brief articles are short summaries that focus on the relevant, recent peer-review literature pertaining to specific hand and upper extremity surgical conditions or medical problems relevant to our medical practices. Contact Dawn LaPorte at dlaport1@jhmi.edu with a brief outline of the proposed topic, suggestions or questions.

If you would like to submit a review article, please email the appropriate review editor to receive detailed instructions.

Case Reports: The Journal receives far more case reportsthan space allows for publication. To be worthy of publication,a case report must have extraordinary teaching valueto the readers. Typically we do not accept cases where twofindings are associated since the findings are often coincidentallyrather than causally related. Restrict the abstract to150 words and highlight the unique features of the case. Insections identified as Introduction, Case Report, and Discussionand in fewer than 1,500 words, introduce the topic,present the case, and discuss its novelty and educationalvalue. Limit references to 10 citations.

History of Hand Surgery: Include a brief unstructured abstract,limit the manuscript length to 3,000 words, andfollow the guidelines for original science submissions.

A Touch of Humanity: As space allows, the Journal willpublish selected submissions in the following categories:

• First Hand: Original essays or poetry that relate to theauthor's experience and insight as a health care provider orpatient. If the description could be used to identify thepatient, his signed authorization must accompany the submission.Omitting or generalizing information to mask apatient's identity is acceptable; changing information is not.Restrict essays to 1,500 words, poetry to 40 lines.
• The Hand in Art: Original, previously unpublished photographsof hands represented in established works of art suchas paintings, sculpture, stamps, and coins. Follow the standardsof photography cited above in the section on Figures.A legend of no more than 150 words should describe thework, its materials, creator, location, date of creation, andcontext.
• Hand Crafted: Original, previously unpublished photographsof work created by readers. Possible objects includebut are not limited to wood turning, cabinetry,painting, sculpture, car restoration, needle craft, jewelrymaking. Follow the standards of photography cited abovein the section on Figures. Include a legend of no morethan 150 words describing the work, its materials, andtime required for completion.

We encourage readers to submit unsolicited reviews ofbooks and media that they think would be of interest toother readers. Limit reviews to 800 words and include thework's title, publisher, city and date of publication, andretail price. Such submissions will go through the samereview and selection process as unsolicited scientific manuscripts.

Letters: Letters to the editor are encouraged. They may beindependent observations, or they may relate to a previouslypublished article. Letters must not duplicate informationsubmitted elsewhere for publication or previously published.Letters are subject to editing and abridgement withoutthe author's review. Limit the body of the letter to 300words, authors to three, references to five, and tables orfigures to one. We are more likely to publish a letter relatingto a previously published article when we receive itpromptly after the article is published. We will forward theletter to the author(s) for comment (maximum 300 wordsand 5 references). The policies regarding conflicts and disclosuresfor full manuscripts apply to letters as well.

Video clips: The Journal of Hand Surgery invites authors tosubmit video clips for publication on the Journal's website.All video clips will be subject to peer review. The AmericanSociety for Surgery of the Hand will hold the copyright onall video clips published on the Journal's website. Eachcoauthor of a video clip must sign a form, obtainable fromthe Editorial Office, expressly transferring copyright in theevent that we publish the video clip on the Journal's website.Peer review will proceed when the Editorial Office hasreceived the signed copyright releases.

Video clips must be no more than 1 minute in length andno more than 5 MB in file size. QuickTime or MPEGformats are acceptable. Authors who want their videosaccessible in a streaming format must also provide either asingle SureStream file or 3 uniquely named single-rate clips(28.8, 56, T1) with a SMIL file to list the bandwidthchoices. Video clips must meet production quality standardswithout modifications or editing by the Editorial Office.The Journal can accept only video submissions that meetthe Journal's formatting and image quality requirements.Authors will be notified if there are any problems withsubmitted files and asked to resubmit modified files. Imageediting and correct formatting are the author's responsibility. Authors may supply a still shot from the clip to beposted next to the link to the video clip on the website;guidelines for figure submission should be followed.

For detailed instructions on capturing, digitizing, saving,and submitting videos by ftp, please see the Guidelines forVideo Submission available at www.jhandsurg.org.

Reprints: We will send a reprint order form to the authorwith the page proofs. Reprints ordered at that time aremore economical than those ordered after publication.Questions regarding reprints should be directed to the Publisher(212) 462-1966.

Updated February 2013

SUBMIT MANUSCRIPTS ONLINE AT HTTP://EES.ELSEVIER.COM/JHS

Updated June 2013