Rehabilitation for Carpal Ligament Injury and Instability

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

“…26,36 This orthosis was designed as a response to biomechanical studies suggesting that restraining motion to the DTM would offload a deficient SLIL and more readily permit healing and recovery. 2,15,26 The development of a dynamic orthosis that permits movement in a specific plane is in line with established ligament rehabilitation protocols, [15][16][17] including those for the lower limb. 33 This case series comprises patients diagnosed with an SLIL injury, who were deemed not appropriate for surgical intervention.…”

“…26 Rehabilitation guidelines that incorporate intercarpal motion control with proprioceptive input have been proposed for safe mobilization of an injured or repaired SLIL. 2,15,22,24,26 Although a recent biomechanical study of patients with SLIL injuries demonstrated increased gapping at the SL interval, the study did not identify at which point along the DTM plane the gapping occurred. 25 Thus, the potential for protected early DTM remains.…”

“…15,26,30,33 The DTO consisted of two parts joined by a 0.2-mm piece of steel wire attached to the dorsal and palmar aspects of the forearm piece. The wire ran through a guide hole created in the first web space ( Fig.…”

“…6,9,[12][13][14] Conservative management of SLIL injuries is not as well understood, and most published reports describe a treatment that is primarily based on the hand therapist's experience and preference. 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.…”

“…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.…”