13/10/2023
https://www.facebook.com/100038893911991/posts/1049464419693345/
Exercise-based intervention as a nonsurgical treatment for patients with (radial) carpal instability ✋🤚
https://pubmed.ncbi.nlm.nih.gov/37777444/
✋Carpal instability is one of the most common conditions affecting the hand and wrist region and is usually caused by ligamentous laxity, overuse due to sports or repetitive motion work, or secondary to trauma (eg, sprains or fractures of the wrist or carpal bones). https://pubmed.ncbi.nlm.nih.gov/27633260/, https://www.sciencedirect.com/science/article/pii/S0363502319314728
✋The cumulative incidence of carpal instability, as defined by radiological assessments and clinical provocation testing, can be as high as 44% in the second year after injury in people who have fallen on an outstretched hand. https://www.sciencedirect.com/science/article/pii/S0268089007000722
✋ Carpal instability can be classified into radial, ulnar, or midcarpal instability. https://pubmed.ncbi.nlm.nih.gov/33509029/
Radial instability is characterized by partial or complete injury to the scaphoid-lunate ligament, which may lead to carpal instability, that is, dorsal rotation of the triquetrum and lunate, while the scaphoid rotates in the volar direction. This deformity pattern is referred as dorsal intercalated segment instability (DISI). https://pubmed.ncbi.nlm.nih.gov/33509029/
✋The clinical presentation, which is sometimes delayed, is characterized by radial sided wrist pain, edema, sensation of instability, and loss of function. https://pubmed.ncbi.nlm.nih.gov/23678318/
✋In general, surgery is not indicated in cases of mild impairment with preserved range of motion and handgrip strength (eg, >80% of contralateral hand). Although the important role of proprioception and neuromuscular control in carpal instabilities and their potential implications for rehabilitation is well recognized, https://pubmed.ncbi.nlm.nih.gov/26115684/, only a few studies have transferred this knowledge in clinical practice. https://pubmed.ncbi.nlm.nih.gov/19963343/, https://pubmed.ncbi.nlm.nih.gov/27264903, https://pubmed.ncbi.nlm.nih.gov/29922497/, https://journals.sagepub.com/doi/10.1177/1758998316685469
👉 Cheuquelaf-Galaz and colleagues published a brand-new case series of an exercise-based intervention as a nonsurgical treatment for 39 adult patients with carpal instability, combining proprioceptive and strengthening exercises (s. figure, https://pubmed.ncbi.nlm.nih.gov/37777444/).
Patients with radial carpal instability performed strengthening exercises of the following muscles (s. figure):
1⃣ Abductor pollicis longus, using an elastic band to provide resistance to the thumb separation movement;
2⃣ Extensor carpi radialis longus (ECRL), by means of wrist extension movement with slight radial deviation favoring supination of the distal row of the carpus;
3⃣ Flexor carpi radialis (FCR): radial deviation with the forearm in neutral pronosupination position, which allows scaphoid supination; https://pubmed.ncbi.nlm.nih.gov/27264901/and
4⃣ Pronator quadratus: strengthening starting in neutral pronosupination position, advancing to supination and then returning to neutral position, in order to keep the distal radioulnar joint stable. https://pubmed.ncbi.nlm.nih.gov/1018088/, https://pubmed.ncbi.nlm.nih.gov/28751170/
👉 Training was initiated with small loads (0.25 and 1 kg, reps. only the weight of the hand if patiens experienced a feeling of instability with these loads). https://pubmed.ncbi.nlm.nih.gov/30905496/
👉 The exercise volume was 4 sets of 8-10 repetitions with emphasis on the eccentric phase, 1 min rest between the sets, with a progressive load increase of 20% every 1-2 weeks. All patients received treatment for 6-8 weeks, with 2-3 weekly sessions.
👉 Patients were asked to perform the exercise in a range of motion where a feeling of stability was perceived in the affected area or minimal pain (ie,
