Outcomes of an exercise program in patients with dorsal or volar midcarpal laxity: a cohort study of 213 patients

Abstract

Purpose

Describing the outcomes of an exercise program on wrist and hand function for patients with midcarpal instability (MCI).

Materials and methods

This study has a prospective cohort design. Two hundred and thirteen patients with MCI were included. The intervention was a 3-month exercise program consisting of hand therapy and home exercises. The primary outcome was perceived wrist and hand function evaluated with the Patient-Rated Wrist/Hand Evaluation (PRWHE) three months after treatment onset. Secondary outcomes were conversion to surgery, pain, and satisfaction with treatment results.

Results

PRWHE total scores improved from 51 ± 19 (mean ± SD) to 33 ± 24 at 3 months (95% CI: 36–30, p < 0.001). All visual analog scales for pain demonstrated clinically relevant improvements at 6 weeks and 3 months (p < 0.001). At 3 months, 81% of the participants would undergo the treatment again. After a median follow-up of 2.8 years, 46 patients (22%) converted to surgery.

Conclusions

We found clinically relevant improvements in hand and wrist function and pain. Most participants would undergo treatment again and 78% of the participants did not convert to surgery. Hence, non-invasive treatment should be the primary treatment choice for patients with MCI.

IMPLICATIONS FOR REHABILITATION

• Midcarpal instability (MCI) is a disabling condition and treatment options are limited.

• Patients with MCI can benefit from an exercise program aiming to improve the strength and coordination of the wrist muscles.

• Participants improved in hand/wrist function and 78% did not convert to surgery.

• Non-invasive treatment should be the primary treatment choice for these patients.

Keywords:

• Hand
• wrist injuries
• conservative treatment
• surgical procedures
• physical therapy modalities

Disclosure statement

Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.