Rehabilitation Programmes for Scapholunate Instability

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

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

Conditions
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Wrist Strain, Wrist Sprain, Scaphoid-Lunate Instability

Intervention / Treatment
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* Other: Home exercise program


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: isometric training programme<br>'Home exercise programme' consisting of isometric exercises with participants followed up at week 1, 4, 6 and 8. | Other: Home exercise program<br>* Home exercise programme with participants followed up at week 1, 4, 6 and 8.<br>|
| Experimental: isotonic training programme<br>'Home exercise programme' consisting of isotonic exercises with participants followed up at week 1, 4, 6 and 8. | Other: Home exercise program<br>* Home exercise programme with participants followed up at week 1, 4, 6 and 8.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Grip strength using E-link dynamometer | change of grip strength from baseline change of 20% in kg considered signifcant | assessed at 0, 4 and 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| numerical rating scale | Pain scored on a numerical rating scale 0 (no pain) -10 (unbearable pain) Minimally Clinical Important Difference of 20mm | assessed at 0, 4 and 8 weeks | 
| Patient Rated Wrist Evaluation | Used Patient Rated Wrist Evaluation PRWE questionnaire (A score of 100 represents the worst functional score, whereas 0 represents no disability) with Minimally Clinical Important Difference of 14 points | assessed at 0, 4 and 8 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Scaphoid-Lunate, instability, wrist