Rehabilitation for Scapholunate Injury (II)
From previous article, we shared basic information about scapholunate injury, as well as interventions including orthosis protection and kinestio taping application. Nevertheless, in order to ensure the best outcome after this ligament injury, therapeutic exercise program is also an essential part of the rehabilitation program.
Below we will present evidence based exercising program for partial scapholunate injury (grade I). Although we can only confirm the degree of ligament tear through MRI, we can still utilize this program before considering surgical intervention.
* Please note, the affected wrist should be rested and protected with orthosis for at least 6 weeks, then initiate this program as tolerated.
* I also highly recommend utilizing kinesio taping to provide extra support when performing these exercises.
⭐ Stage I : Active Range of Motion (post injury 6-8 weeks)
The purpose of this stage is to move the injured wrist in a controlled pattern, to promote the healing of scapholunate ligament, also to help improving range of motion of the wrist. I usually recommend 10 reps x 3 sets / day.
1. Dart Throwing Motion Exercise
Have you ever threw a dart? Dart throwing motion (DTM) is one the best exercise to start when rehabilitating scapholunate injury! This motion is defined in mainly two steps:
Step 1: Wrist extended and towards the thumb side (wrist radial extension)
Step 2: Wrist flexed and towards the pinky side (wrist ulnar flexion)
2. Thumb Raise (Abductor Pollicis Longus, APL) Exercises
⭐ Stage II : Isometric Strengthening (post injury 8-10 weeks)
“Isometrics are exercises that do NOT move the joint when strengthening the muscles!”
For scapholunate injury, we should strengthen Extensor Carpi Radialis Longus (ECRL), Flexor Carpi Radialis (FCR) and Abductor Pollicis Longus (APL) muscles, which helps to promote dynamic stability of scapholunate joint.
* Theraband is one of the best exercising tool for isometric strengthening. Nevertheless, accurate positioning and holding is critical in this exercise.
1. ECRL strengthening with palm facing up (supination)
＊ Move wrist towards to your thumb side (radial deviation) then extend it down (wrist extension). (Hold 10 seconds for each repetition, 10 reps x 3 sets / day)
2. FCR strengthening with palm facing down (pronation)
＊ Move wrist towards to your thumb side (radial deviation) then flex it down (wrist flexion). (10 sec x 10 reps x 3 sets / day) 
3. APL Strengthening (10 sec x 10 reps x 3 sets / day)
⭐ Stage III: Dynamic Strengthening (post injury 10-12 weeks)
Compared to isometric strengthening, dynamic strengthening involves a rhythmic and continuous movement when performing the exercise.
For example, FlexBar® or Bodyblade® can be a great tool to perform dynamic strengthening exercises. (start with 1 min x 3 times / day, and gradually increase the time as tolerated)
* Medicine ball is also a great tool for more advanced dynamic strengthening, you can refer to the “throw down” exercise below!
⭐ Stage IV: Partial Weight Bearing (post injury 12-14 weeks)
At this stage, we can start loading the affected wrist with body weight. Make sure to begin with two hands partial weight bearing exercises (WBE) first, then proceed to one handed WBE.
The first exercise (left) bellow is using a yoga ball and press it against the wall (wall push up), a great way to partially bear weight on your affected wrist. The next one is more advanced, it only stress the affected hand, even with a multidirectional wobble board to challenge the balancing.
In summary, rehab exercises for partial scapholunate injuries consist of active range of motion, isometric strengthening, dynamic strengthening and weight bearing exercises. Please note, all these exercises should be pain free! You should always consult with the hand specialist or certified hand therapist before performing any exercise.
References:
* Anderson H and Hoy G. Orthotic intervention incorporating the dart-throwers motion as part of conservative management guidelines for treatment of scapholunate injury. J Hand Ther 2016; 29: 199–204.
* Karagiannopoulos, C., & Michlovitz, S. (2016). Rehabilitation strategies for wrist sensorimotor control impairment: From theory to practice. Journal of Hand Therapy, 29(2), 154-165.
* Holmes, M. K., Taylor, S., Miller, C., & Brewster, M. (2017). Early outcomes of ‘The Birmingham Wrist Instability Programme’: A pragmatic intervention for stage one scapholunate instability. Hand Therapy, 22(3), 90-100.
* Featured image credit: https://www.proxyclick.com
Andrew believes rehab-related knowledge should be easy to learn and follow at home, because "knowledge is power only when we can share it" !
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