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Patients undergoing scapholunate ligament reconstruction at Balgrist University Hospital are divided into two groups and receive two different types of mobilisation postoperatively. The investigators will compare the outcome (pain, strength, mobility) between the two groups 1 year after the operation.
The so-called 'dart-throwing motion' (DTM) plane of movement, from radial extension to ulnar flexion, has gained attention as it has been shown to be an important axis of wrist movement during activities of daily living. Further studies have shown that during movement of the intact wrist in the dart throwing plane, most of the movement occurs in the mediocarpal joint, while the proximal row remains relatively immobile.
In scapholunate (SL) ligament reconstruction using the flexor carpi radialis tendon, the SL interval is immobilised using 2 Kirschner wires for 8-10 weeks to relieve the strain on the ligament and allow it to heal. From the 2nd postoperative week, mobilisation is started using DTM mobilisation or mobilisation in the anatomical plane. The aim of the study is to investigate in a randomised trial whether mobilisation in the anatomical plane produces the same postoperative results.
In this project, the investigators will compare two types of mobilisation in the rehabilitation of SL ligament reconstruction. The participants will be randomised to two treatment groups. This procedure therefore corresponds to a risk category A in 'other' clinical trials according to Chapter 4 ClinO.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Early dart throwing motion | Experimental | From the 2nd postoperative week, the 'Dart-Throwing Motion' is started, from radial extension to ulnar flexion. |
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| Mobilisation in anatomical planes | Active Comparator | From the 2nd postoperative week, movements are started in the anatomical plane of the hand (standard rehabilitation) |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Early dart throwing motion-mobilization | Other | We compare two different mobilisations in the rehabilitation of patients following scapholunate ligament reconstruction |
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| Measure | Description | Time Frame |
|---|---|---|
| Pain in resting position | Assessment of resting pain using the VAS Score (Visual Analog Scale), where 0 indicates no pain and 10 indicates the worst pain. | Before surgery, 7 weeks after surgery, 11 weeks after surgery, 6 months after surgery, 12 months after surgery |
| Pain during activity | Assessment of pain during activity using the VAS (Visual Analog Scale), where 0 indicates no pain and 10 indicates the worst pain | Before surgery, 7 weeks after surgery, 11 weeks after surgery, 6 months after surgery, 12 months after surgery |
| Mobility of the wrist: Flexion | Assessment of wrist flexion by measuring the range of motion in degrees. | Before surgery, 7 weeks after surgery, 11 weeks after surgery, 6 months after surgery, 12 months after surgery |
| Mobility of the wrist: Extension | Assessment of wrist extension by measuring the range of motion in degrees. | Before surgery, 7 weeks after surgery, 11 weeks after surgery, 6 months after surgery, 12 months after surgery |
| Mobility of the wrist: Ulnar deviation | Assessment of wrist ulnar deviation by measuring the range of motion in degrees. | Before surgery, 7 weeks after surgery, 11 weeks after surgery, 6 months after surgery, 12 months after surgery |
| Mobility of the wrist: Pronation | Assessment of wrist pronation by measuring the range of motion in degrees. | Before surgery, 7 weeks after surgery, 11 weeks after surgery, 6 months after surgery, 12 months after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Recording ability to work | Degree of employment in per cent (from 0 to a maximum of 100 per cent) is recorded | Before surgery, 7 weeks after surgery, 11 weeks after surgery, 6 months after surgery, 12 months after surgery |
| Recording of physical limitations |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Lisa Reissner, PD | Contact | 044 386 57 47 | lisa.reissner@balgrist.ch | |
| Andreas Schweizer, Prof | Contact | 044 386 11 11 | andreas.schweizer@balgrist.ch |
| Name | Affiliation | Role |
|---|---|---|
| Lisa Reissner, PD | Balgrist University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Balgrist University Hospital | Recruiting | Zurich | Canton of Zurich | 8008 | Switzerland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 21872862 | Result | Crisco JJ, Wilcox BJ, Beckwith JG, Chu JJ, Duhaime AC, Rowson S, Duma SM, Maerlender AC, McAllister TW, Greenwald RM. Head impact exposure in collegiate football players. J Biomech. 2011 Oct 13;44(15):2673-8. doi: 10.1016/j.jbiomech.2011.08.003. Epub 2011 Aug 27. | |
| 15140483 | Result | Werner FW, Green JK, Short WH, Masaoka S. Scaphoid and lunate motion during a wrist dart throw motion. J Hand Surg Am. 2004 May;29(3):418-22. doi: 10.1016/j.jhsa.2004.01.018. |
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| Mobility of the wrist: Supination | Assessment of wrist supination by measuring the range of motion in degrees. | Before surgery, 7 weeks after surgery, 11 weeks after surgery, 6 months after surgery, 12 months after surgery |
| Strength Assessment: Grip Strength | Using the Jamar Hydraulic Hand Dynamometer which displays isometric grip force from 0-90 kg, grip strength will be assessed. | Before surgery, 11 weeks after surgery, 6 months after surgery, 12 months after surgery |
Using the DASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire, physical limitation will be recorded. This 30-item questionnaire allows patients to rate difficulty and interference with daily life on a 5-point Likert scale. The scores are then used to calculate a scale score ranging from 0 (no disability) to 100 (most severe disability). |
| Before surgery, 11 weeks after surgery, 6 months after surgery, 12 months after surgery |
| Recording wrist pain and restrictions | Using the PRWE (Patient-Rated Wrist Evaluation) questionnaire, specific wrist pain and restrictions will be recorded. This 15-item questionnaire measures wrist pain and disability in daily activities. Patients rate their wrist pain and disability from 0 (no pain) to 10 (worst pain).
| Before surgery, 11 weeks after surgery, 6 months after surgery, 12 months after surgery |
| 16322624 | Result | Crisco JJ, Coburn JC, Moore DC, Akelman E, Weiss AC, Wolfe SW. In vivo radiocarpal kinematics and the dart thrower's motion. J Bone Joint Surg Am. 2005 Dec;87(12):2729-2740. doi: 10.2106/JBJS.D.03058. |
| 17996783 | Result | Moritomo H, Apergis EP, Herzberg G, Werner FW, Wolfe SW, Garcia-Elias M. 2007 IFSSH committee report of wrist biomechanics committee: biomechanics of the so-called dart-throwing motion of the wrist. J Hand Surg Am. 2007 Nov;32(9):1447-53. doi: 10.1016/j.jhsa.2007.08.014. |