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Brands M, Selles RW, van Kooij YE, Feitz R, Videler AJ, Slijper HP, Wouters RM. Outcomes of an exercise program in patients with dorsal or volar midcarpal laxity: a cohort study of 213 patients. Disabil Rehabil 2024; 46:1825-1831. [PMID: 37154580 DOI: 10.1080/09638288.2023.2207219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 04/08/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Describing the outcomes of an exercise program on wrist and hand function for patients with midcarpal instability (MCI). MATERIALS AND METHODS This study has a prospective cohort design. Two hundred and thirteen patients with MCI were included. The intervention was a 3-month exercise program consisting of hand therapy and home exercises. The primary outcome was perceived wrist and hand function evaluated with the Patient-Rated Wrist/Hand Evaluation (PRWHE) three months after treatment onset. Secondary outcomes were conversion to surgery, pain, and satisfaction with treatment results. RESULTS PRWHE total scores improved from 51 ± 19 (mean ± SD) to 33 ± 24 at 3 months (95% CI: 36-30, p < 0.001). All visual analog scales for pain demonstrated clinically relevant improvements at 6 weeks and 3 months (p < 0.001). At 3 months, 81% of the participants would undergo the treatment again. After a median follow-up of 2.8 years, 46 patients (22%) converted to surgery. CONCLUSIONS We found clinically relevant improvements in hand and wrist function and pain. Most participants would undergo treatment again and 78% of the participants did not convert to surgery. Hence, non-invasive treatment should be the primary treatment choice for patients with MCI.
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Affiliation(s)
- Mart Brands
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Yara E van Kooij
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
- Xpert Clinics Hand Therapy, Utrecht, The Netherlands
| | - Reinier Feitz
- Hand and Wrist Center, Xpert Clinics, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Annemieke J Videler
- Department of Plastic, Reconstructive and Hand Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
| | - Harm P Slijper
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Amsterdam, The Netherlands
| | - Robbert M Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
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Karagiannopoulos C, Griech SF. Impact of chronic wrist hypermobility on proprioception, strength, and functional performance in young adults. J Hand Ther 2024:S0894-1130(23)00161-8. [PMID: 38342640 DOI: 10.1016/j.jht.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND Chronic joint hypermobility has been attributed to repetitive ligamentous microtrauma, benign joint hypermobility syndrome (BJHS), or genetic connective tissue disorders that lead to pain and functional impairment, especially among females. Chronic wrist hypermobility (CWH) prevalence, etiology, and effects on proprioception, strength, and function have yet to be established. PURPOSE This pilot study aimed to determine the CWH prevalence among adults; its effects on proprioception, strength, and function; and whether these effects are gender based. STUDY DESIGN This was a quasi-experimental cross-sectional study. METHODS Ninety wrists (55 participants, mean age 27.46 years) with no wrist range of motion (ROM) restrictions or previous trauma for ≥6 months were screened for CWH based on an exploratory set of diagnostic criteria. Fifty-eight wrists (34 adults) were allocated to a CWH group, and 32 wrists (21 adults) were allocated to a healthy control group. Twenty-five CWH and 25 healthy control matched (gender, age, and handedness) participants were compared. Assessment included the active wrist joint position sense test, hand-held dynamometry for wrist extension and grip strength, and the patient-rated wrist evaluation for function. Testers were blinded to group allocation. RESULTS A 64.4% CWH prevalence existed among CWH participants, who were mostly asymptomatic females (74%). Frequent etiologic factors were midcarpal (96.5%) and scapholunate (39%) instabilities and BJHS (37%), which was higher among females (30%) than males (8%). Independent t-tests showed statistically significant (p < 0.05) group differences in wrist proprioception, wrist isometric extension, grip strength, and function with moderate-high (0.41-0.75) effect size. No significant gender differences existed in proprioception and function. CONCLUSIONS CWH is very prevalent among functional independent young adults with atraumatic midcarpal and intercarpal ligamentous laxities and BJHS. CWH prevails among women and adversely affects wrist proprioception, strength, and function. The study's specific CWH diagnostic criteria may be useful for clinicians to identify and timely manage impacted individuals by CWH.
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Affiliation(s)
- Christos Karagiannopoulos
- DeSales University Division of Healthcare, Doctor of Physical Therapy Program, Center Valley, PA, USA.
| | - Sean F Griech
- DeSales University Division of Healthcare, Doctor of Physical Therapy Program, Center Valley, PA, USA.
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Gomez-Sierra MA, Sandoval A. Palmar midcarpal instability a narrative review of the literature: Have we reached a consensus on a treatment? Injury 2023; 54 Suppl 6:110722. [PMID: 38143144 DOI: 10.1016/j.injury.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 12/26/2023]
Abstract
Palmar midcarpal instability (PMCI) is a wrist condition that requires treatment through non-surgical rehabilitation programs or surgical stabilization. This condition's natural history is poorly understood, and the optimal treatment approach remains unknown. Non-surgical treatments are initially implemented, followed by surgical stabilization if necessary. Arthrodesis and soft tissue stabilization are the two main surgical options for PMCI, with no established gold standard for treatment. A systematic review of 12 articles comparing arthrodesis and soft tissue stabilization was conducted to identify the optimal treatment approach for PMCI. Arthrodesis techniques, such as lunotriquetral arthrodesis, showed high functional outcomes but also high reintervention rates due to nonunion. Soft tissue stabilization techniques showed superior functional outcomes with less mobility loss and lower reintervention rates compared to arthrodesis. However, more studies are required to determine the optimal soft tissue technique. Based on this review we created a treatment algorithm for PMCI starting with non-surgical treatment first, followed by surgical stabilization if needed. Soft tissue stabilization techniques are preferred over arthrodesis due to better functional outcomes and lower reintervention rates. However, each patient's treatment approach should be individualized and evaluated independently to determine the best course of action. PMCI is a rare wrist condition, and further research is needed to better understand its natural history and establish a gold standard for treatment. The lack of literature comparing the two surgical options underscores the need for further research to determine the optimal treatment approach. Nonetheless, the current evidence suggests that soft tissue stabilization is a promising alternative to arthrodesis, providing superior functional outcomes and lower reintervention rates.
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Affiliation(s)
- Maria Antonia Gomez-Sierra
- Fundación Valle del Lili, Department of Orthopedics and Traumatology, Cra 98 No. 18-49Cali, Colombia Universidad ICESI, Calle 18 No. 122-135, Cali, Colombia.
| | - Alejandro Sandoval
- Fundación Valle del Lili, Department of Hand Surgery, Cra 98 No. 18-49, Cali, Colombia Universidad ICESI, Calle 18 No. 122-135, Cali, Colombia
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Cheuquelaf-Galaz C, Antúnez-Riveros MA, Lastra-Millán A, Canals A, Aguilera-Godoy A, Núñez-Cortés R. Exercise-based intervention as a nonsurgical treatment for patients with carpal instability: A case series. J Hand Ther 2023:S0894-1130(23)00123-0. [PMID: 37777444 DOI: 10.1016/j.jht.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/25/2023] [Accepted: 08/15/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Although the important roles of proprioception and neuromuscular control in carpal instabilities under laboratory conditions have been recognized, only a few studies have translated this knowledge into a routine clinical practice. PURPOSE This study aimed to evaluate the results of a personalized rehabilitation in patients with carpal instability on functionality and pain intensity. STUDY DESIGN This was a case series study. METHODS This case series included 39 adults (mean age: 38.2 ± 14.0 years; 16/23 females/males) diagnosed with carpal instability (radial or ulnar) with indication for orthopedic treatment. The disabilities of the arm, shoulder, and hand questionnaire was used to assess upper limb functionality. Pain perception was assessed using a visual analog scale. Exercise-based physiotherapy interventions were performed according to the clinical needs of the patients for at least 6 weeks (2-3 sessions per week). For the treatment of radial instability (n = 13), strengthening exercises of the abductor pollicis longus, extensor carpi radialis longus, flexor carpi radialis, and pronator quadratus muscles were prescribed. For the treatment of ulnar instability (n = 24), extensor carpi ulnaris and pronator quadratus were trained. All patients underwent proprioceptive training in open kinetic chain and closed kinetic chain, as well as strengthening of the unaffected hand. Changes before and after treatment were compared using the nonparametric Wilcoxon signed rank test. RESULTS A significant improvement with a large effect size in disabilities of the arm, shoulder, and hand (P < .001; d = 2.9) and visual analog scale (P < .001; d = 3.2) scores were obtained after treatment. Moreover, the changes were greater than the minimal clinically important difference of 10.8 and 1.4, respectively. Similar results were found when patients with radial instability and ulnar instability were analyzed separately. CONCLUSIONS Personalized training with specific proprioception and strengthening exercises produces improvements in functionality and pain perception in our cohort of people with carpal instability. These results highlight the importance of multicomponent exercise in the treatment of wrist instability. Future randomized clinical trials should further investigate the effectiveness of this protocol.
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Affiliation(s)
- Cristian Cheuquelaf-Galaz
- Servicio de Kinesiología, Hospital Clínico Universidad de Chile, Santiago, Chile; Servicio de Kinesiología, Clínica Santa María, Santiago, Chile
| | | | | | - Andrea Canals
- Escuela de Salud Pública, Universidad de Chile, Santiago, Chile
| | | | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.
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Lötters FJB, Schreuders TAR, Videler AJ. SMoC-Wrist: a sensorimotor control-based exercise program for patients with chronic wrist pain. J Hand Ther 2021; 33:607-615. [PMID: 30905496 DOI: 10.1016/j.jht.2018.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/09/2018] [Indexed: 02/08/2023]
Abstract
STUDY DESIGN This is a narrative review. INTRODUCTION Chronic wrist pain is a common disorder that can lead to considerable disability in performing activities in daily living and at work. Patients with nonspecific chronic wrist pain are regularly referred to a physiotherapist/hand therapist. Immobilization, avoiding excessive wrist load, steroid injections, and various physical therapy methods predominantly focus on the pain itself. However, these methods often do not result in a satisfactory long-term pain relief. PURPOSE OF THE STUDY In this article, we will describe the principles behind and content of a sensorimotor control-based exercise program as introduced by Videler et al., modified and substantiated by current insights into sensorimotor control training and wrist kinetics. METHODS Both structure and content of the modified exercise program (SMoC-wrist) are substantiated by recent scientific literature. RESULTS A clear 4-level exercise model based on sensorimotor principles is presented, that is, proprioceptive level, conscious static/isometric level, conscious dynamic level, and unconscious dynamic level. The content of each level and the transition toward the next level are described in detail. DISCUSSION Besides the substantiation of the exercise program, possible outcome measures for joint position sense and kinesthesia of the wrist are discussed. CONCLUSION We modified and substantiated a widely used exercise program for patients with nonspecific chronic wrist pain based on recent insights into sensorimotor control principles and wrist kinematics. The presented exercise program (SMoC-wrist) is not primarily focused on reducing pain but on functional reeducation and strengthening of the neuromusculoskeletal system on the basis of sensorimotor control principles.
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Affiliation(s)
| | - Ton A R Schreuders
- Hand and Wrist Rehabilitation, Goes, The Netherlands; Department of Rehabilitation Medicine, Rotterdam, The Netherlands
| | - Annemieke J Videler
- Hand and Wrist Rehabilitation, Goes, The Netherlands; Hand & Wrist Center Amsterdam/4hands, Amsterdam, The Netherlands
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Ricks M, Belward P, Hargreaves D. Long-Term Results of Arthroscopic Capsular Shrinkage for Palmar Midcarpal Instability of the Wrist. J Wrist Surg 2021; 10:224-228. [PMID: 34109065 PMCID: PMC8169170 DOI: 10.1055/s-0040-1722331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
Background Midcarpal instability is a term for a collection of poorly understood conditions where the proximal row of the carpus is unstable. The most common type of midcarpal instability is palmar midcarpal instability (PMCI). Treatment for PMCI includes nonoperative proprioceptive retraining of the wrist, splints, and strengthening. If this fails, various authors have suggested several different fusions, tenodesis procedures, or capsular shrinkage. There are no long-term case series in the literature. Objective The aim of this study is to assess the long-term results of arthroscopic capsular shrinkage when used for PMCI of the wrist. Methods A prospective cohort study of patients who underwent arthroscopic capsular shrinkage for PMCI was performed. Ethical board approval was given for this study. All patients were followed up and reviewed independently from the operating surgeon. Assessment included a structured questionnaire, disabilities of the arm, shoulder and hand (DASH) questionnaire, and clinical examination using a goniometer. PMCI was assessed objectively with the anterior drawer test and radiological imaging was only performed if clinically relevant to the residual symptoms. Results Thirteen patients (15 wrists) underwent arthroscopic capsular shrinkage for PMCI. Twelve patients (14 wrists) were available for clinical review with a follow-up rate of 92.3%. The mean time from index procedure to final review was 12 years (range: 10-14years). The symptoms of instability had completely resolved in nine wrists (7 patients). Only 2 of the 14 wrists had symptoms that were reproduced with a positive anterior drawer test. All other wrists were stable on objective assessment. The mean DASH score had improved from pre op of 34 to post op of 12.1 and at 12-year follow-up this had deteriorated minimally to 15.3. Assessment of the range of motion showed an average increase in range of flexion/extension by 22 degrees. Patient satisfaction was excellent. The patients rated that nine wrists were much better than presurgery, three as better, one unchanged, and one worse. Discussion/Conclusion There are no studies looking at the long-term natural history of treatments for PMCI. The lead author proposes a grading system for symptomatic PMCI that has been retrospectively applied to this cohort. It is a grading system from 1 to 4 and is based on a treatment algorithm. This is the first long-term study from any joint, where the results of capsular shrinkage have been maintained over time. In this series, we have not seen any deleterious effect from possible mechanoreceptor injury. We suspect that functioning mechanoreceptors are more relevant in the unstable joint, than the structurally stable joint. The authors propose that thermal capsular shrinkage is an effective and durable option for use in mild-to-moderate forms of PMCI.
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Affiliation(s)
- Matthew Ricks
- Upper Limb Unit, Wrightington Hospital, Lancashire, United Kingdom
| | - Peter Belward
- Department of Trauma & Orthopaedic Surgery, University Hospital Southampton, Southampton, Hampshire, United Kingdom
| | - David Hargreaves
- Department of Trauma & Orthopaedic Surgery, University Hospital Southampton, Southampton, Hampshire, United Kingdom
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Jing SS, Smith G, Deshmukh S. Demystifying Palmar Midcarpal Instability. J Wrist Surg 2021; 10:94-101. [PMID: 33815943 PMCID: PMC8012087 DOI: 10.1055/s-0040-1714688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
Palmar midcarpal instability is an uncommon condition diagnosed clinically with a painful pathognomonic clunk on terminal ulnar deviation of the wrist. Various causes have been described, but congenital laxity of the carpal ligaments is thought to be a key contributor. Treatment commences with conservative measures. This includes proprioceptive training based on more recent concepts on the sensorimotor function of the wrist. When these measures plateau, surgery is considered. The lack of high-level evidence and consensus on its cause continue to hamper our understanding and knowledge of this condition. The purpose of this review is to examine the current evidence to conceptualize this mysterious, yet infrequent phenomenon, and to provide an algorithm on its management.
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Affiliation(s)
- Shan Shan Jing
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, United Kingdom
| | - Gemma Smith
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, United Kingdom
| | - Subodh Deshmukh
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, United Kingdom
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Chen Z. A novel staged wrist sensorimotor rehabilitation program for a patient with triangular fibrocartilage complex injury: A case report. J Hand Ther 2020; 32:525-534. [PMID: 30017412 DOI: 10.1016/j.jht.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/07/2018] [Accepted: 04/01/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Case report. INTRODUCTION Studies have highlighted the sensory innervations and stabilizing role of forearm muscles on wrist joint and implications to wrist sensorimotor rehabilitation. This case explored the novel incorporation of dart-throwing motion and proprioceptive neuromuscular facilitation in wrist sensorimotor rehabilitation. PURPOSE OF THE STUDY To describe and evaluate a staged wrist sensorimotor rehabilitation program for a patient with triangular fibrocartilage complex (TFCC) injury. METHODS The patient participated in the staged program for 9 sessions over a 3-month period. Treatment involved neuromuscular strengthening at the wrist and movement normalization of the upper extremity. Outcome measures were grip strength, visual analog scale, joint position sense, Quick Disabilities of the Arm, Shoulder and Hand, and patient-rated wrist evaluation. RESULTS The patient showed improvement in all outcome measures. Most outcomes exceeded the established minimal clinically important difference values. DISCUSSION The results suggest that dart-throwing motion and proprioceptive neuromuscular facilitation are beneficial in rehabilitation of TFCC injury. CONCLUSIONS This is the first study that incorporated dart-throwing motion and proprioceptive neuromuscular facilitation in the sensorimotor rehabilitation of TFCC injury and yielded promising results. There is a need to further evaluate the program in prospective randomized controlled trial recruiting a larger group of patients with TFCC injury.
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Affiliation(s)
- Zhiqing Chen
- Occupational Therapy Department, Singapore General Hospital, Singapore.
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Bonhof-Jansen EDJ, Kroon GJ, Brink SM, van Uchelen JH. Rehabilitation with a stabilizing exercise program in triangular fibrocartilage complex lesions with distal radioulnar joint instability: A pilot intervention study. HAND THERAPY 2019. [DOI: 10.1177/1758998319861661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- EDJ Bonhof-Jansen
- Department of Hand Therapy, Isala Hand and Wrist Center, Zwolle, The Netherlands
| | - GJ Kroon
- Department of Hand Therapy, Isala Hand and Wrist Center, Zwolle, The Netherlands
| | - SM Brink
- Department of Rehabilitation Medicine, Isala Hand and Wrist Center, Zwolle, The Netherlands
| | - JH van Uchelen
- Handsurgeon, Xpert Clinic, Velp/Apeldoorn, The Netherlands
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Mulders MAM, Sulkers GSI, Videler AJ, Strackee SD, Smeulders MJC. Long-Term Functional Results of a Wrist Exercise Program for Patients with Palmar Midcarpal Instability. J Wrist Surg 2018; 7:211-218. [PMID: 29922497 PMCID: PMC6005774 DOI: 10.1055/s-0037-1612594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
Background Patients with palmar midcarpal instability have symptoms of pain, combined with clinical signs of abnormal mobility on stressing the joint, an unpredictable blockade feeling, and a noticeable clunk, in the absence of an underlying trauma. No data are available on the effect of conservative treatment for these patients. Purpose The purpose of this study was to evaluate the effect and the long-term functional outcomes of a wrist exercise program in patients with palmar midcarpal instability. Patients and Methods All patients diagnosed with palmar midcarpal instability between 2005 and 2011 were included. Patients completed the Patient-Rated Wrist and Hand Evaluation (PRWHE) and the Short Form-36 health (SF-36) questionnaires, scaled their perceived pain before and after treatment, and indicated the effect of the received treatment. Results A total of 119 patients diagnosed with palmar midcarpal instability were included. The median follow-up time was 6 years (IQR 4.5-7.0). The median PRWHE score after hand therapy was 35.5 and the median mental component of the SF-36 score was 53.9 and the physical component was 45.2. The median perceived pain reduced from eight to four and the median therapeutic effect of the wrist exercise program was five. Conclusion Although palmar midcarpal instability remains to be a chronic disease, the effectiveness of our wrist exercise program is promising with acceptable long-term functional results and a good quality of life. Level of Evidence Level IV, retrospective cohort study.
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Affiliation(s)
- M. A. M. Mulders
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - G. S. I. Sulkers
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - A. J. Videler
- Hand and Wrist Center Amsterdam, Amsterdam, The Netherlands
| | - S. D. Strackee
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - M. J. C. Smeulders
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Dorsal Wrist Plication for Midcarpal Instability. J Hand Surg Am 2018; 43:354-359. [PMID: 29241841 DOI: 10.1016/j.jhsa.2017.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/16/2017] [Accepted: 11/06/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Midcarpal instability (MCI) is a cause of chronic wrist pain for which treatment remains controversial. This study's purpose was to determine the outcome of a treatment algorithm for MCI that included immobilization and surgical interventions. METHODS We prospectively enrolled 23 consecutive patients (12 males, average age 27 years) with 27 symptomatic wrists. All had generalized wrist pain with an average duration of 22 months. All had MCI and a catch-up clunk that reproduced the symptoms. Initial treatment was full immobilization for 6 weeks. When necessary, recurrence after immobilization was treated with an anatomically based surgical procedure to plicate the dorsal capsule and extrinsic ligaments to stabilize the midcarpal joint. Failure of surgical plication was followed by 4-corner intercarpal arthrodesis when necessary. Patients were observed for instability, grip strength, wrist motion, and Patient-Rated Wrist Evaluation. RESULTS For 22 wrists there was partial relief of symptoms with full-time cast or orthosis immobilization; however, symptoms quickly returned with mobilization. The other wrists had previously been immobilized and patients refused further nonsurgical care. All patients underwent surgical plication of the dorsum of the wrists. Postoperative follow-up (35 months) showed statistically significant improvements in grip strength and Patient-Rated Wrist Evaluation scores. All patients had improved pain at final follow-up. Most improvement was in female patients aged under 25 years, with hypermobility and without major traumatic or work-related injuries. This contrasted with poorer outcomes in men aged over 25years who had moderate or severe trauma that was mostly work-related. Instability recurred in 2 patients who then had a 4-corner arthrodesis. CONCLUSIONS Immobilization was not successful in controlling pain and recurrence of instability in patients with MCI. Surgical midcarpal capsular plication was less effective in men with posttraumatic instability. The capsular plication procedure was successful in young female patients with ligament laxity and a history of only minor or repetitive trauma and no history of major trauma. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Abstract
The evidence behind management options for midcarpal instability (MCI) is scarce, relying solely on case series. Established treatments cause significant loss of wrist motion. As understanding of the condition has progressed, surgeons have been trying soft tissue techniques. The treatment option should be chosen for the appropriate type and grade of MCI. The Hargreaves grading system for palmar MCI aids treatment decision-making. A possible role for arthroscopy in treatment of MCI has been developed using arthroscopic thermal capsular shrinkage, appropriate for cases with dynamic instabilities. Static deformities require a soft tissue reconstruction or a partial wrist fusion.
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Mesplié G, Grelet V, Léger O, Lemoine S, Ricarrère D, Geoffroy C. Rehabilitation of distal radioulnar joint instability. HAND SURGERY & REHABILITATION 2017; 36:314-321. [PMID: 28751170 DOI: 10.1016/j.hansur.2017.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/16/2017] [Accepted: 02/24/2017] [Indexed: 11/15/2022]
Abstract
Distal radioulnar joint (DRUJ) instabilities are common and often combined with other injuries of the interosseous membrane and/or the proximal radioulnar joint. Once they are diagnosed and the treatment is chosen, physiotherapists have limited choices due to the lack of validated protocols. The benefits of proprioception and neuromuscular rehabilitation have been brought to light for the shoulder, knee and ankle joints, among others. However, no program has been described for the DRUJ. The purpose of this article is to study the muscular elements responsible for active DRUJ stability, and to propose a proprioceptive rehabilitation program suited to this condition.
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Affiliation(s)
- G Mesplié
- Institut Sud Aquitain de la Main et du Membre Supérieur, Clinique Aguiléra, 21, rue de l'Estagnas, 64200 Biarritz, France.
| | - V Grelet
- Institut Sud Aquitain de la Main et du Membre Supérieur, Clinique Aguiléra, 21, rue de l'Estagnas, 64200 Biarritz, France.
| | - O Léger
- Institut Sud Aquitain de la Main et du Membre Supérieur, Clinique Aguiléra, 21, rue de l'Estagnas, 64200 Biarritz, France.
| | - S Lemoine
- Institut Sud Aquitain de la Main et du Membre Supérieur, Clinique Aguiléra, 21, rue de l'Estagnas, 64200 Biarritz, France.
| | - D Ricarrère
- Institut Sud Aquitain de la Main et du Membre Supérieur, Clinique Aguiléra, 21, rue de l'Estagnas, 64200 Biarritz, France.
| | - C Geoffroy
- Institut Sud Aquitain de la Main et du Membre Supérieur, Clinique Aguiléra, 21, rue de l'Estagnas, 64200 Biarritz, France.
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Anderson H, Hoy G. Orthotic intervention incorporating the dart-thrower's motion as part of conservative management guidelines for treatment of scapholunate injury. J Hand Ther 2017; 29:199-204. [PMID: 27112271 DOI: 10.1016/j.jht.2016.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Case series. INTRODUCTION This paper describes conservative guidelines for the management of scapho-lunate interosseous ligament (SLIL) injury including fabrication of an orthosis that restricts active wrist movement to the dart-throwers (DTM) plane. PURPOSE OF THE STUDY The dart throwers' orthosis (DTO) was designed as a response to biomechanical studies suggesting that restraining motion to the DTM would off-load a deficient SLIL. METHODS After six weeks of wearing the DTO, the 5 patients in this case series initiated an exercise program that incorporated wrist proprioceptive training and specific muscle strengthening. DISCUSSION The DTO was designed to incorporate controlled movement in order to better integrate the secondary wrist stabilizers in wrists that had a deficient SLIL. The orthosis and the exercise program harnessed proprioceptive influences using active motion within the DTM plane, and stimulated mechanoreceptors so as to enhance stability. RESULTS All patients demonstrated improvement in subjective and objective outcomes including self-reported pain and function. CONCLUSIONS Orthotic intervention that controls motion within the DTM, combined with an appropriate proprioceptive rehabilitation program, may provide a viable conservative treatment option for patients with a similar clinical presentation. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Hamish Anderson
- Anderson Hand Therapy, The Avenue Physiotherapy Centre, Windsor, Victoria, Australia; Melbourne Orthopaedic Group, Windsor, Victoria, Australia.
| | - Greg Hoy
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
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