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

Anderson, Hamish; Hoy, Greg

doi:10.1016/j.jht.2016.02.007

Cited by 24 publications

(14 citation statements)

References 30 publications

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“…A small study of five patients reviewed the non-operative management of SL instability with a Dart Throwing Motion (DTM) orthotic and proprioceptive exercise programme, with average follow-up of 48 months. 11 Although, a significant limitation of this study was lack of pre-treatment scores for comparison, post-treatment outcomes indicated minimal disability and close to normal function. This provides an indication that a structured rehabilitation programme and splinting can be successful in the conservative management of SL instability.…”

Section: Introductionmentioning

confidence: 86%

“…Proprioceptive rehabilitation, including joint position sense, kinaesthesia, conscious and unconscious neuromuscular control exercises are considered to help restore wrist stability. 11,22–26 Proprioceptive training has been shown to improve functional stability at other joints. 27,28 Powerball® (gyroscope) exercises have also been suggested to improve the dynamic control of the wrist.…”

Section: Introductionmentioning

confidence: 99%

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Early outcomes of ‘The Birmingham Wrist Instability Programme’: A pragmatic intervention for stage one scapholunate instability

et al. 2017

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Introduction: Scapholunate instability is commonly caused by a fall on an outstretched hand resulting in structural pathology and pain. In recent years, dynamic stability mechanisms have been described that may aid in the non-operative management of this patient group. Limited evidence exists regarding the clinical application of stability mechanisms for scapholunate instability, and there is a void of reproducible structured exercise regimes. Method: A service evaluation was conducted over 16 months to assess patient outcomes following an evidence-based treatment protocol in the conservative management of stage one scapholunate instability. Pain-free grip, maximal grip, grip strength ratio, Euro-Qol five dimensions questionnaire (EQ-5D), Visual Analogue Scale (VAS) and Quick Disability of Arm, Shoulder and Hand questionnaire (Quick-DASH) scores were compared between baseline and final follow-up. Results: Six consecutive patients (seven wrists) were included with five patients (six wrists) completing treatment. Mean grip strength ratio improved by 45%, mean VAS improved by 5.5 points, mean Quick-DASH improved by 33.96% and EQ-5D improved by 0.187 quality-adjusted life years. Where established, all outcomes exceeded minimal clinically important difference values. Discussion: The Birmingham Wrist Instability Programme can yield clinically important results for patients with stage one scapholunate instability in the short term based on a small service evaluation. The findings support the need for further research to evaluate the rehabilitation programme in a larger group of patients over the longer term.

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Section: Introductionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Early outcomes of ‘The Birmingham Wrist Instability Programme’: A pragmatic intervention for stage one scapholunate instability

et al. 2017

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“…Anderson and Hoy reported on a series of five patients with at least partial SL ligament tearing treated with an orthotic and rehabilitation program [25]. A custom splint was worn for a minimum 6 weeks limiting the patient to mid-range dartthrowers motion.…”

Section: Treatment Options Non-operative Managementmentioning

confidence: 99%

“…Dart-throwers motion is defined as the arc traveling from radial deviation with extension to ulnar deviation with flexion. It had been shown to place very little stress on the SL ligament and therefore allows earlier motion to improve function of secondary wrist stabilizers [24,25]. Rehabilitation afterward consisted of strengthening and proprioceptive exercises.…”

Section: Treatment Options Non-operative Managementmentioning

confidence: 99%

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Scapholunate and perilunate injuries in the athlete

Morrell

Moyer

Quinlan

et al. 2017

Curr Rev Musculoskelet Med

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Purpose of the review Scapholunate and perilunate injuries can be difficult to diagnose and treat in the athlete. In this review article, we present the mechanism of injury, evaluation, management, and outcomes of treatment for these injuries. Recent findings Acute repair of dynamic scapholunate ligament injuries remains the gold standard, but judicious use of a wrist splint can be considered for the elite athlete who is in season. The treatment of static scapholunate ligament injury remains controversial. Newer SL reconstructive techniques that aim to restore scapholunate function without compromising wrist mobility as much as tenodesis procedures show promise in athlete patients. Summary Acute injuries to the scapholunate ligament are best treated aggressively in order to prevent the sequelae of wrist arthritis associated with long-standing ligamentous injury. Acute repair is favored. Reconstructive surgical procedures to manage chronic scapholunate injury remain inferior to acute repair. The treatment of lunotriquetral ligament injuries is not well defined.

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