Rehabilitation Programmes for Scapholunate Instability

A Pilot Study to Investigate Two Different Physiotherapy Rehabilitation Programmes, to Treat the Conservatively Managed Scapholunate Instability.

Two different exercises approaches were tested in patients with Scapho-Lunate (SL) instability; one to strengthen the tendons in static positions and the other to strengthen the tendons whilst the wrist is moving.

Scapho-Lunate (SL) instability is the most common form of wrist instability, but is complex to diagnose and is often missed entirely. The natural progression of SL instability has been suggested to lead to osteoarthritis. The management of SL instability can be broadly divided into conservative and surgical, with the former being the first option taken by most medical professionals, which primarily involves physiotherapy. The evidence base for physiotherapy management of SL instability is limited; however cadaver research has identified loading some of the wrist tendons may stabilise the scaphoid and lunate.There is currently no research as to whether this clinically makes any difference to the patients symptoms, or how to do it. This research therefore aimed to test the protocol and methods, and act as a platform for larger studies, to investigate this.

Two different exercises approaches were tested; one to strengthen the tendons in static positions and the other to strengthen the tendons whilst the wrist is moving.

Inclusion Criteria:

• Ages eighteen to sixty,
• wrist pain,
• confirmed scapholunate ligament disruption on MRA or XR (partial or full),
• referred from orthopaedic wrist specialist,
• for conservative management,
• consent to trial.

Exclusion Criteria:

• Under eighteen or over sixty years,
• previous fracture,
• degenerative changes in the wrist,
• previous surgery,
• complex regional pain syndrome or diagnosis of rheumatological conditions,
• no wrist injection in preceding twelve months or other wrist conditions.