Posttraumatic radial sided wrist pain is common and can represent a fracture or a ligament injury.
Wrist sprains
arise commonly due to the stretching or tearing of tissues (ligaments)
connecting bones and joints in the wrist. The early mobilisation technique has
been depicted as beneficial for radial sided wrist pain where MRI does not
manifest fracture or SL ligament injury.
Posttraumatic
radial sided wrist pain is common and can represent a fracture or a ligament
injury. However, in some patients radiographs and MRI are normal, indicating no
specific diagnosis other than a wrist sprain. There is no consensus on the
ideal treatment for this patient group. The aim was to investigate if patients
with posttraumatic radial sided wrist pain and MRI not showing signs of
fracture or SL-ligament injury should be treated with immediate mobilisation or
2 weeks cast immobilisation.
Forty-three
patients, aged 18–64 years, were randomised to either a dorsal wrist cast for 2
weeks (n = 21), or immediate mobilisation (n = 22). Follow-up at 2, 4, and 6
weeks included clinical examination, self-assessment questionnaires (DASH, VAS)
and recording of days on sick-leave.
At 2 weeks’
patients treated in a cast had reduced wrist range of motion, ROM (77% vs 96%,
p = 0.011), and higher DASH score (median 37 vs 18, p = 0.009) compared to
patients treated with immediate mobilisation. At 4 weeks, DASH score was still
higher in the group treated in a cast (median 14 vs 4, p = 0.01), but there was
no difference in ROM. At 6 weeks there were no differences in any outcome
measure between the groups. Furthermore, there was no significant difference in
sick-leave between the groups (median 27 days’ vs 14 days, p = 0.077).
Patients with
radial sided wrist pain where MRI does not demonstrate fracture or SL ligament
injury do not benefit from cast immobilisation and can be treated with early
mobilisation.
J Plast Surg Hand Surg. 2016 Jun;50(3):156-60
Is early mobilisation better than immobilisation in the treatment of wrist sprains?
Martin Clementson et al.
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