Dart-Splint: An innovative orthosis that can be integrated into a scapho-lunate and palmar midcarpal instability re-education protocol

Scaphoid tuberosity excursion is minimized during a dart-throwing motion: A biomechanical study

“…Although studies 4-6 have previously demonstrated that a dart-throwing motion minimizes scaphoid motion, these results could serve as a basis to clinically assess scaphoid tuberosity excursion and could help determine which type of a dart-throwing motion is optimal during rehabilitation. These results support the work by Braidotti et al 14 who developed an orthosis based on patient specific anatomical landmarks (radio-palmar aspect of the scaphoid tuberosity and the ulno-dorsal aspect of the hamate) to guide the patient through a dart-throwing motion. The current study supports the use of their selection of the scaphoid tuberosity.…”

“…Although not addressed by this study, once that motion is found a patient might be educated to use this best dart-throwing motion. Possibly a brace similar to that developed by Braidotti et al 14 could be used initially to train a patient and continued to be used until healing has occurred. Lastly, this study does not address how to determine this ideal dart-throwing motion in a patient with injured or healing structures.…”

Functional kinematics of the wrist

“…Further research has demonstrated that the mechanical axis of the skeletal ligamentous wrist is oriented along the dart-thrower’s plane (Crisco et al, 2011) and demonstrated that it is fundamental to all ballistic (throwing, hammering) motions, as well as many occupational and household activities (Garg et al, 2014; Palmer et al, 1985). Further evidence that the wrist is pre-disposed to a dart thrower’s motion is the orientation of the muscle insertions – the extensor carpi radialis longus and brevis, and flexor carpi ulnaris insert at an oblique axis that is oriented in the transverse view to the dart-throwing motion (DTM) plane (Braidotti, 2015). In addition to generating motion along the DTM plane, the muscles serve to supinate the scaphoid, thus stabilizing the scapho-lunate joint, and further protecting the dorsal scapho-lunate ligament (Salva-Coll et al, 2011).…”

Orthotic intervention incorporating the dart-thrower's motion as part of conservative management guidelines for treatment of scapholunate injury

“…15 These articles emphasize the use of static and controlled motion orthoses, patient education to avoid weightbearing and forceful gripping, proprioceptive training, and specific muscle strengthening without reporting clinical results. 3,[15][16][17][18] Over the past decade, there has been an increasing amount of scientific study and discussion regarding the use of dart-thrower's movement (DTM) for rehabilitation of SLIL injury. 2,[19][20][21][22] This multiplanar movement of radialeextension to ulnareflexion is most commonly seen in functional activities, such as bouncing or throwing a ball, hitting a nail with a hammer, pouring water from a jug, or drinking from a cup.…”

“…Other previously described orthoses use different mechanisms to restrict movement to the DTM plane. 18,27,28 The DTO was worn in conjunction with a rehabilitative program designed to increase proprioceptive input and maximize the activation of secondary stabilizers in the absence of an intact SLIL. The program is a modification of previously reported protocols 26,29,30 and includes additional strategies based on the authors' clinical experience.…”