Loading Restrictions During Shock Wave Therapy and PRP for Chronic Wrist Injuries
Yes, you should implement modified loading restrictions during shock wave therapy and PRP treatment for your chronic nonunited ulnar styloid fracture and scapholunate ligament sprain, though complete immobilization is not necessary.
Rationale for Modified Loading
While the available guidelines do not directly address shock wave therapy or PRP protocols, the evidence strongly supports activity modification during healing of these specific injuries:
For the Chronic Scapholunate Ligament Sprain
Gradual rehabilitation with progressive strengthening is the recommended conservative approach for partial scapholunate ligament tears, which requires controlled loading rather than unrestricted use 1
The American College of Radiology emphasizes that your chronic sprain of the volar band represents an ongoing healing process that benefits from protection 1
Acute scapholunate ligament injuries treated surgically require 4 weeks of immobilization in neutral position, suggesting that even chronic injuries benefit from load protection during active treatment 2
Research demonstrates that judicious use of wrist splinting can be considered even for elite athletes during active treatment phases to prevent progression to static instability 3
For the Nonunited Ulnar Styloid Fracture
Your nonunion represents a Type 1 pattern (stable distal radioulnar joint based on your MRI showing intact TFCC) 4
The American Academy of Orthopaedic Surgeons guidelines indicate that ulnar styloid fractures associated with wrist injuries warrant consideration of protection, though they acknowledge limited evidence for specific protocols 5
The fact that this nonunion "occurred since the radiograph from [DATE]" suggests recent progression, making it more responsive to biological treatments but also more vulnerable to mechanical disruption 4
Practical Loading Protocol During Treatment
Recommended Restrictions
Avoid heavy gripping, lifting >5-10 pounds, and repetitive wrist loading during the active treatment phase (typically 6-12 weeks for combined shock wave and PRP protocols)
Use a removable wrist splint during high-demand activities and at night to limit extreme ranges of motion that stress the volar scapholunate band 3
Maintain gentle active range of motion exercises to prevent stiffness, as complete immobilization after stable injuries shows no benefit and may worsen outcomes 5
Activities to Continue
Light activities of daily living with the wrist in neutral to slight extension
Gentle active wrist motion exercises as tolerated, avoiding end-range positions
Non-impact cardiovascular exercise
Critical Pitfalls to Avoid
Do not continue unrestricted loading during biological treatment phases, as mechanical disruption can prevent the healing response that shock wave therapy and PRP are designed to stimulate 1, 2
Avoid complete rigid immobilization, as prolonged external fixation and complete immobilization are associated with poorer outcomes in wrist injuries 5
Do not rely solely on pain as a guide - your chronic injuries may have reduced pain sensitivity, and tissue damage can occur before pain signals adequate warning 3
Monitoring and Progression
Reassess clinically at 6-8 weeks to determine if loading can be gradually increased
Consider repeat imaging at 3 months if symptoms persist or worsen, as progression to static scapholunate instability (diastasis >4mm, lunate tilt >10°) would change management 1, 6
Progressive strengthening should begin only after pain-free active motion is achieved in the protected loading phase 1
The combination of your chronic scapholunate sprain and nonunited ulnar styloid fracture represents ongoing tissue injury that requires mechanical protection during biological augmentation with shock wave therapy and PRP to optimize healing potential.