Transitioning Out of Wrist Brace After Scapholunate Ligament Injury
Gradually wean from the brace over 2-3 weeks while simultaneously initiating a progressive exercise program, prioritizing functional support during activities and removing the brace for controlled range of motion exercises.
Weaning Protocol (Weeks 4-6)
The evidence from ankle ligament injuries provides the most relevant guidance, as wrist-specific protocols are not well-established in the literature. Functional support for 4-6 weeks total is the evidence-based standard for ligamentous injuries 1. Since you're at week 4, continue some level of support through week 6.
Week 4-5: Partial Weaning
- Remove brace for 2-3 hours daily during low-demand activities (desk work, light ADLs) 1
- Keep brace on during sleep and any activities requiring grip or wrist loading 1
- Begin gentle range of motion exercises when brace is off (see below) 1
- Monitor for pain, swelling, or instability - if these occur, increase brace use 2
Week 5-6: Progressive Independence
- Extend brace-free periods to 4-6 hours daily 1
- Continue bracing during higher-demand activities and sleep 1
- Progress to strengthening exercises (see below) 1
- By end of week 6, transition to activity-based bracing only 1
Week 6+: Activity-Based Support
- Use brace only during high-demand activities (sports, heavy lifting, prolonged gripping) 1
- Discontinue nighttime bracing if no morning stiffness or pain 1
- Consider taping as an alternative to bracing for return to activities 1
Exercise Progression During Transition
Early Phase (Week 4-5): Range of Motion
- Initiate gentle wrist flexion/extension, radial/ulnar deviation within pain-free range 2, 3
- Perform 10-15 repetitions, 3 times daily 3
- Gentle wrist circles in both directions 3
- These exercises should be done with brace removed 1
Intermediate Phase (Week 5-6): Strengthening
- Begin isometric wrist exercises (static contractions without movement) 2
- Progress to light resistance exercises using therapy putty or light weights 2
- Towel curls and grip strengthening exercises 3
- Closed kinetic chain exercises are preferred initially (weight-bearing on hands in quadruped position) 2
Advanced Phase (Week 6+): Functional Activities
- Progress resistance and complexity based on pain-free performance 2
- Return to sport-specific or work-specific activities gradually 1
- Achieve >90% symmetry with opposite wrist before full return to demanding activities 2
Critical Pitfalls to Avoid
Do not abruptly discontinue the brace - the evidence strongly supports gradual weaning over 2-3 weeks rather than immediate cessation 1. Scapholunate ligament injuries are prone to recurrence even after optimal healing 4.
Monitor for signs of instability - increased pain with grip, wrist extension, or clicking/clunking sensations suggest inadequate healing 5, 6. If these occur, return to more consistent bracing and contact your surgeon 7.
Avoid high-load activities prematurely - scapholunate injuries can progress to carpal instability and degenerative changes if stressed before adequate healing 7, 8, 6. The 4-6 week timeframe is for beginning the transition, not completing it 1.
Early mobilization is critical but must be balanced with protection - stiffness is a concern, but so is re-injury 2. The key is controlled motion during brace-free periods while maintaining protection during loaded activities 1.