Mobilization With Movement in Distal Radial Fractures
Condition: Pain; Acute Pain; Mobility Limitation
MeSH terms: Acute Pain; Mobility Limitation; Radius Fractures
Study type: Interventional

Summary: 
      Distal radius fractures (DRF) are the most common upper extremity disorders encountered in
      clinical practice. With an understanding of the mechanics of distal radius fractures,
      surgical intervention, and bone healing, the therapist can modify the therapy program
      according to the patient's individual needs. The therapeutic process is begun in the crucial
      stage of bone healing during fracture immobilization. By addressing edema reduction and early
      range of motion of the uninvolved joints, most problems can be avoided before cast or fixator
      removal. Rehabilitation following the immobilization period should focus on regaining wrist
      movements provided that earlier problems have been addressed properly. During the
      rehabilitative process, the therapist can incorporate scar management, modalities, joint
      mobilization, active and passive range of motion, splinting, and strengthening to maximize
      the patient's functional result.

      Massage and mobilization techniques are used in the treatment of DRF due to their analgesic
      effects. The painless mobilization with movement technique (MWM, developed by Brian Mulligan)
      is a manual therapy method applies to correct the limitation of movement in the joint and to
      relieve pain and functional disorders. Many studies have shown that MWM technique provides
      faster and momentary painless joint movement compared to other physical therapy modalities.
      The patient group with DRF has a large place in the general population and long treatment
      processes cause both labour loss and economic loss. Therefore, this study aimed to examine
      the effectiveness of MWM technique in cases with distal radius fractures.
    

Detailed description: 
      In this study, 42 DRF patients with age range 18-65 who applied to Kırşehir Ahi Evran
      University Training and Research Hospital were examined. The individuals included in the
      study were divided into two groups according to the paired randomization method. These groups
      were control and intervention groups. Traditional physiotherapy methods were applied to the
      control group, traditional physiotherapy and MWM techniques were applied to the intervention
      group. Traditional physiotherapy methods were included; Transcutaneous Electrical Nerve
      Stimulation (TENS), stretching and strengthening exercises.

      For the evaluation of patients; Visual Analogue Scale (VAS), wrist goniometric measurements,
      grip strength measurement, pinch strength measurement, edema measurement and Munich Wrist
      Questionnaire (MWQ) were used.
    

Intervention name(s): TENS, exercise; Mulligan mobilisation
Intervention type(s): Other; Other
Intervention description(s): TENS: The patients were sat in a chair positioned next to a treatment table. The hand to be treated was placed on the treatment table with the forearm in the supine position. Electrodes were then placed on the transverse carpal ligament and palmar surface of the hand. Conventional TENS was applied, with the current transition time set to 50-100 µs, and performed at a frequency of 100 Hz for a period of 20 minutes at an amplitude that did not cause muscle contraction or any feeling of numbness or tingling.
The supervised exercises were performed by the patients in a seated position. Strengthening exercises were performed with both hands by means of Digi-Flex hand exerciser (IMC Products Corp, Hicksville, New York), modeling mass and elastics. The patients were tasked with performing these exercises 10 times in each session and three times daily.; Each participant was tested with sustained manual glides in each of the possible directions during active wrist flexion and extension from the seated position. For the lateral glide, the therapist stabilises the lateral aspect of the distal radius using the first web-space. And glides the proximal row of carpal bones laterally (towards the thumb) using the first web-space of the other hand, following the joint line. For the medial glide, the therapist stabilises the medial aspect of the distal ulna using the first web-space. And glides the proximal row of carpal bones medially (away from the thumb) using the first web-space of the other hand, following the joint line.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized Controlled Trial
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Pain; Range of motion