Early mobilization similar to cast immobilization for non-fracture radial-sided wrist pain

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Synopsis
43 patients with posttraumatic radial-sided wrist pain, without fracture or scapholunate ligament injury, were randomized to either immediate mobilization of the wrist or 2 weeks of cast immobilization. The purpose of this study was to compare the two treatment modalities with regards to the total range of motion in the wrist, wrist radio-ulnar deviation, grip strength, pinch strength, pain, and disability. Outcomes were assessed Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
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Why was this study needed now?
Wrist fractures or scapholunate (SL) ligament injuries are often concerns for patients who underwent trauma with resulting radial wrist pain symptoms. Computed tomography scans or magnetic resonance imaging is often used to detect these fractures and injuries, and a positive diagnosis of one or both usually results in cast immobilization as the standard treatment. However, for patients with traumatic wrist pain, but no fracture or SL ligament injury, it remains uncertain whether cast immobilization is necessary compared to early mobilization treatment for pain relief, range of motion, and functionality outcomes.
What was the principal research question?
In the treatment of posttraumatic radial-sided wrist pain in the absence of fracture or scapholunate ligament injury, does early mobilization improve pain and function outcomes when compared to immobilization, assessed over a 6-week period?
Population: 43 patients, over the age of 18 years, with posttraumatic radial-sided wrist pain were included. Eligible patients did not have a fracture in the wrist or a scapholunate ligament injury as demonstrated via magnetic resonance imaging.
Intervention: Early mobilization group: patients were allowed immediate mobilization after radiographic assessment (n=22; Median age: 31 [18-64]; 12F/10M)
Comparison: Cast immobilization group: a standard below elbow cast was implemented for two weeks to treat posttraumatic radial-sided wrist pain (n=21; Median age: 31 [18-57]; 12F/9M)
Outcomes: Outcomes included total wrist range of motion (ROM), assessing flexion and extension using a goniometer (% motion compared to unaffected wrist); wrist radio-ulnar deviation; grip strength assessed using an Exacta Hydraulic Hand Dynamometer (North Coast Medical, Gilroy, CA); pinch strength assessed using a pinch gauge (B&L Engineering, Santa Ana, CA); pain as measured using a visual analogue scale (VAS; 0-10 from no pain to worst pain); and the Disability of Arm, Shoulder, and Hand (DASH; 0-100 from no disability to greatest disability) Questionnaire to assess function and symptoms of the affected wrist. Duration of sick leave was also documented (days).
Methods: RCT; single-center
Time: Outcomes were measured at weeks 2, 4, and 6.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.