Proprioception retraining for a patient with chronic wrist pain secondary to ligament injury with no structural instability

• Published in: Journal of hand therapy Vol. 29; no. 2; pp. 183 - 190
• Main Authors: Hincapie, Olga L., PT, DPT, CHT, Elkins, Jeananne S., PhD, DPT, MPH, Vasquez-Welsh, Laura, MsOT, CHT
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2016; Elsevier Limited
• Subjects: Adult; Carpal ligaments; Chronic Pain - diagnosis; Chronic Pain - rehabilitation; Dart-throwing motion; Female; Follow-Up Studies; Hand Strength - physiology; Humans; Injuries; Injury Severity Score; Joint Instability - physiopathology; Knee; Ligaments; Ligaments, Articular - injuries; Medicine; Naturopathy; NMR; Nuclear magnetic resonance; Pain; Pain Measurement; Patients; Physical Medicine and Rehabilitation; Proprioception - physiology; Proprioception retraining; Range of Motion, Articular - physiology; Rehabilitation; Risk Assessment; Sensorimotor; Sprains and Strains - diagnosis; Sprains and Strains - rehabilitation; Time Factors; Treatment Outcome; Wrist; Wrist Injuries - diagnosis; Wrist Injuries - rehabilitation; Wrist; Dart-throwing motion; Carpal ligaments; Proprioception retraining; Sensorimotor
• ISSN: 0894-1130; 1545-004X
• DOI: 10.1016/j.jht.2016.03.008

Abstract Study Design Case report. Introduction Previously published studies demonstrate the importance of the sensory innervation of the carpal ligaments and the implication for the sensorimotor control of the wrist. In addition, this case considers key rehabilitation concepts to include the dart-throwing motion and the stabilizing effect of the forearm muscles. Purpose of the Study To describe the rehabilitation program for a patient with chronic wrist pain, diagnosed with a partial tear of the dorsal intercarpal ligament and a sprain of the scapholunate ligament of the right wrist. Methods The patient participated in a staged treatment plan over a 3-month period (20 sessions), which began with a focus on proprioceptive awareness and joint position sense retraining. The treatment progressed to strengthening of specific muscles to enhance stability of the wrist joint. The patient completed the Quick Disabilities of the Arm, Shoulder and Hand and the patient-rated wrist evaluation on initial evaluation, re-evaluation at ninth session, and discharge at 20th session. Results Raw scores in the Quick Disabilities of the Arm, Shoulder and Hand and the patient-rated wrist evaluation improved from 33 and 61.5 on initial evaluation to 18 and 17.5 on discharge, respectively. Conclusions Sensorimotor techniques including proprioceptive retraining may improve pain, neuromuscular control, and functional outcomes in patients with chronic wrist pain due to ligament injury. The effectiveness of proprioceptive retraining needs to be evaluated in a well-designed randomized controlled trial recruiting this patient population. Level of evidence 5.