From the Guidelines
Treatment for laxity with carpal movement after a wrist injury should prioritize conservative approaches, including immobilization and physical therapy, before considering surgical intervention. The initial management involves immobilizing the wrist with a brace or splint for 4-6 weeks to allow healing and stabilize the joint.
Conservative Management
- Physical therapy should focus on strengthening exercises for the wrist flexors, extensors, and grip muscles, performed 3-4 times weekly for 6-8 weeks.
- Specific exercises include wrist curls, reverse wrist curls, and grip strengthening with therapy putty or hand exercisers.
- Pain management may include NSAIDs like ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks.
Surgical Intervention
For persistent laxity, corticosteroid injections might be considered, though limited to 2-3 injections spaced at least 6 weeks apart. If conservative measures fail after 3-6 months, surgical options such as ligament reconstruction or arthrodesis may be necessary, targeting the specific ligaments damaged, with the scapholunate and lunotriquetral ligaments being common culprits 1.
Importance of Proper Treatment
Proper treatment is essential as untreated wrist laxity can lead to chronic instability, progressive arthritis, and decreased function over time. The American College of Radiology Appropriateness Criteria suggest that radiographs are usually appropriate for the initial imaging of adults with acute blunt or penetrating trauma to the hand or wrist 1. However, for suspected wrist tendon or ligament trauma, next imaging studies may include MRI without IV contrast, CT without IV contrast, or MR arthrography of the wrist, which are equivalent alternatives 1.
Additional Considerations
In cases of functional movement symptoms, strategies that encourage normal movement patterns and resting postures should be tried before considering splinting, as splinting may prevent restoration of normal movement and function 1. Overall, a comprehensive approach addressing the specific needs of the patient, including immobilization, physical therapy, pain management, and potentially surgical intervention, is crucial for optimal outcomes in treating laxity with carpal movement after a wrist injury.
From the Research
Treatment Options for Laxity with Carpal Movement
Laxity with carpal movement after a wrist injury can be a challenging condition to treat. The following are some treatment options that have been studied:
- Immobilization: Immobilization with a cast can be used to treat wrist sprains, but studies have shown that early mobilization may be a better option for some patients 2.
- Early Mobilisation: Early mobilisation has been shown to be effective in treating wrist sprains, with patients experiencing reduced wrist range of motion and higher DASH scores when treated with immobilization compared to early mobilisation 2.
- Surgical Repair: In some cases, surgical repair may be necessary to treat underlying conditions such as scaphoid fractures, scapholunate dissociation, or ligamentous injuries 3.
- Arthrodesis: Arthrodesis, or the fusion of bones, can be used to treat carpal instability and arthrosis of the wrist joint. Different types of arthrodesis, such as scapho-capitatum and lunato-capitatum arthrodeses, have been shown to be effective in treating these conditions 4.
Diagnostic Techniques
Diagnostic techniques such as radiography and MRI can be used to evaluate the extent of the injury and determine the best course of treatment 5. A short MR imaging examination with a low-field-strength MR imaging system has been shown to have additional value in predicting the need for treatment in patients with acute wrist trauma 5.
Rehabilitation
Rehabilitation is an important part of treating laxity with carpal movement. A thorough field evaluation is mandatory to ensure prompt recognition of a potentially debilitating injury, and early diagnosis, treatment, and rehabilitation can help to maintain functional healthy wrists for future athletic endeavors 6.