Rehabilitation Programmes for Scapholunate Instability

University of Bradford2 enrolled

Overview

Two different exercises approaches were tested in patients with Scapho-Lunate (SL) instability; one to strengthen the tendons in static positions and the other to strengthen the tendons whilst the wrist is moving.

Scapho-Lunate (SL) instability is the most common form of wrist instability, but is complex to diagnose and is often missed entirely. The natural progression of SL instability has been suggested to lead to osteoarthritis. The management of SL instability can be broadly divided into conservative and surgical, with the former being the first option taken by most medical professionals, which primarily involves physiotherapy. The evidence base for physiotherapy management of SL instability is limited; however cadaver research has identified loading some of the wrist tendons may stabilise the scaphoid and lunate.There is currently no research as to whether this clinically makes any difference to the patients symptoms, or how to do it. This research therefore aimed to test the protocol and methods, and act as a platform for larger studies, to investigate this. Two different exercises approaches were tested; one to strengthen the tendons in static positions and the other to strengthen the tendons whilst the wrist is moving.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Wrist Strain Wrist Sprain Scaphoid-Lunate Instability

Interventions

Home exercise programOTHER

Home exercise programme with participants followed up at week 1, 4, 6 and 8.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Ages eighteen to sixty, * wrist pain, * confirmed scapholunate ligament disruption on MRA or XR (partial or full), * referred from orthopaedic wrist specialist, * for conservative management, * consent to trial. Exclusion Criteria: * Under eighteen or over sixty years, * previous fracture, * degenerative changes in the wrist, * previous surgery, * complex regional pain syndrome or diagnosis of rheumatological conditions, * no wrist injection in preceding twelve months or other wrist conditions.

Locations (1)

Bradford Royal Infirmary

Bradford, West Yorkshire, United Kingdom

Outcomes

Primary Outcomes

Grip strength using E-link dynamometer

change of grip strength from baseline change of 20% in kg considered signifcant

Time frame: assessed at 0, 4 and 8 weeks

Secondary Outcomes

numerical rating scale

Pain scored on a numerical rating scale 0 (no pain) -10 (unbearable pain) Minimally Clinical Important Difference of 20mm

Time frame: assessed at 0, 4 and 8 weeks

Patient Rated Wrist Evaluation

Used Patient Rated Wrist Evaluation PRWE questionnaire (A score of 100 represents the worst functional score, whereas 0 represents no disability) with Minimally Clinical Important Difference of 14 points

Time frame: assessed at 0, 4 and 8 weeks

Data from ClinicalTrials.gov

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