Casting Protocol for PRP-Treated Scapholunate Ligament Tears
For PRP-treated scapholunate ligament tears, immobilize the wrist initially but strictly avoid complete immobilization beyond 6 weeks, then transition to progressive rehabilitation with range of motion exercises starting at 3-6 weeks. 1
Initial Immobilization Phase (0-6 Weeks)
- Immobilize the wrist during the acute healing phase, but this must be time-limited to prevent muscular atrophy and joint stiffness 1, 2
- Apply cryotherapy through a wet towel for 10-minute periods during the acute phase for short-term pain relief 1, 2
- Modify activities to reduce movements that provoke pain while maintaining some wrist motion 1
- The immobilization period should not exceed 6 weeks under any circumstances 1, 2
Transition Phase (3-6 Weeks)
- Begin gentle range of motion exercises once acute pain subsides, typically after 3-6 weeks of initial immobilization 1, 2
- Start with isometric exercises before progressing to more demanding strengthening 1, 2
- This early mobilization is critical to prevent the complications of prolonged immobilization 1
Progressive Rehabilitation Phase (6+ Weeks)
- Progress from isometric exercises to eccentric strengthening exercises 1, 2
- Incorporate tensile loading exercises to stimulate collagen production and guide normal alignment of newly formed collagen fibers 1, 2
- Gradual rehabilitation and physical therapy focusing on progressive strengthening is essential 2, 3
Critical Pitfalls to Avoid
- Never maintain complete immobilization beyond 6 weeks, as this leads to muscular atrophy and joint stiffness that can compromise outcomes 1, 2
- Never inject corticosteroids directly into the ligament substance during or after PRP treatment, as this inhibits healing, reduces tensile strength, and may predispose to spontaneous rupture 1, 2
Follow-Up Protocol
- Assess pain levels, range of motion, and functional improvement regularly to guide treatment progression 1, 2
- Re-evaluate at 3-6 months: if symptoms persist despite appropriate conservative management, obtain CT arthrography (gold standard with nearly 100% sensitivity) to evaluate for progression or associated injuries 1, 3
- Consider surgical consultation if conservative measures fail to achieve adequate outcomes by 6 months 1, 2
Important Context About PRP
Note that the evidence for PRP in ligamentous injuries is limited. The VA/DoD guidelines found inconsistent results for PRP in osteoarthritis, with mixed benefits and an inability to recommend for or against its use 4. However, when PRP is used for scapholunate ligament tears, the casting protocol should follow the conservative management principles outlined above, as these apply regardless of whether PRP is administered 1.