Therapy Considerations for Getting Athletes to Return to Play

Rehabilitation of stage-one scapholunate instability (ReSOS): An online survey of UK practice

Introduction

Scapholunate instability is one of the most frequent types of wrist instability, but optimal management is not established. This research aims to identify current conservative management strategies for stage-one scapholunate instability and how these interventions are evaluated in the UK.

Methods

A cross-sectional online survey of UK physiotherapists and occupational therapists with self-reported experience in the rehabilitation of stage-one scapholunate instability (ReSOS), was developed using the CROSS guideline and a clinical vignette. The frequency of treatment strategies was collated via a five-point Likert-type scale and evaluation strategies via fixed-response answers at three-to-six, seven-to-eleven and after 12 weeks post-injury. Data were analysed descriptively.

Results

Forty-three electronic surveys were completed and analysed. Thirty physiotherapists and 13 occupational therapists responded, with 90% working in the NHS. Activity advice and education was the most frequently used treatment at all time-points (100%, 98%, 98%). Quick-DASH was most frequently used region-specific patient reported outcome measure at all time-points (72%, 60%, 67%).

Discussion

Despite some identified themes, including neuromuscular rehabilitation strategies, the supporting evidence is limited in the ReSOS. It is unclear what rehabilitation and evaluation strategies are optimal and the development of a consensus on best practice is recommended.

Comparison of Wrist Motion and Grip Strength between Normal Caucasian, Southern Chinese and Japanese Populations

Background: Differences in structure and function of the hand and wrist between distinct populations affect our approach to treatment, expectations and functional outcomes. The aim of this study is to compare wrist motion and grip strength in Caucasian, Chinese and Japanese populations. Methods: A total of 424 normal wrists were evaluated that included 99 Japanese, 139 Caucasian and 186 Southern Chinese. Demographic information collected included age, gender, hand dominance and occupation. Evaluation included measurement of active motion and grip strength. Motion was measured using a goniometer. Grip strength was evaluated using a JAMAR dynamometer. Demographic information and evaluation was compared among the three cohorts using statistical tests. Multivariate mixed-effect model was further used to assess the racial impact on each evaluation controlling for demographic factors as well as two-hand measurements of everyone. Results: There was no difference in global wrist motion between the cohorts. We did find significant differences between the cohorts in all discrete measurements. Conclusions: Differences in wrist motion and grip strength between normal Japanese, Chinese and Caucasian populations may be due to bony structure rather than soft tissue properties. Knowledge of these disparities can provide references for personalised wrist examination, diagnosis, treatment and comparison of outcomes between different cohorts. Level of Evidence: Level III (Diagnostic).