Saba Kamal, OTR, CHT, Samir Sharma, MD, Foram Desai, OTR, Donna Breger Stanton, OTD,
OTR/L, FAOTA
Abstract
Study Design: Case report.
Introduction
One of the most common injuries to the wrist joint is often associated with “Scapholunate (S-L)
dissociation” due to the disruption or weakening of the SL interosseous ligament (SLIL)
complex.1 S-L instability can be described as static or dynamic.1 Static S-L injuries result in pain
at rest causing dysfunction with everyday activities.1 However, a large number of dynamic S-L
injuries can have a delayed diagnosis due to absence of symptoms as the S-L joint receives
stability from other surrounding structures.1 Based on this research, Salv- Coll et al1
proposed
that after dynamic S-L injury, it is essential to attend to normal joint surfaces, supporting
ligaments and muscles, and a complex network of neural pathways to attain the stability of the SL joint. This case report analyzes conservative management treatment for Grade I and Grade II
dynamic S-L injury using dynamic or leuko taping and neuromuscular strengthening to improve
functional capabilities.
Purpose of the Study
The purpose of this case report is to incorporate proprioceptive input using dynamic taping, in
combination with neuromuscular training to help with improving functional outcome in grade II
dynamic S-L instability cases. The hypothesis is that taping helps reduce the misalignment by
decreasing the gap between scaphoid and lunate. This decreases the pain which allows for
neuromuscular strengthening exercises to ensue sooner, resume functional activities, and prevent
further joint degeneration.
Methods
This article introduces a unique taping technique to treat grade I and II dynamic S-L injuries that
provides stability of the wrist through pisotriquetral joint, enhances proprioception, and improves
neuromuscular control. The taping method and functions are discussed in the paper (refer to the
figures and video). Fluoroscopy was performed at the surgeon’s office that provided us with
objective data of the S-L gap measurement with taping and without taping along with extensor
carpi radialis/longus (ECRB/L) isometric activation.
Results/Discussion
The patient subjectively reported decreased pain and increased function during daily activities. Objective
data presented with increased grip strength, decreased pain level on visual analogue scale (VAS), and
reduced S-L gap interval as measured on fluoroscopy. Please refer to table 1,2, and figures 8-13.
Conclusion
Wrist taping provides support by narrowing the gap between scaphoid and lunate. This reduces
pain allowing early initiation of isometric neuromuscular strengthening which helps stabilize the
wrist. Stabilization helps in faster return to ADLs and possibly prevents surgery in Grade I or
Grade II dynamic SL cases.
Level of Evidence: Level IV
Keywords: instability, neuromuscular control, proprioception, wrist, scapho-lunate, dart
throwing, splinting, dynamic taping, leuko taping
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