Static Progressive Stretch May Improve Motion in Wrist StiffnessAn occasional stiff wrist may not be too bothersome, but if it results in a loss of motion and decreased function, treatment is usually needed. There are several causes of wrist stiffness, including scarring in the soft tissues of the wrist or inflammation in the joint that could be caused by injury, trauma, paralysis, or even surgery.
While the usual treatment for wrist stiffness is physical therapy or surgery, researchers are looking for an alternative, less costly and less invasive (than surgery) treatment. Some doctors have used splints for treatment, but there have not been many studies that look at the splints' effectiveness and what type of splint would be best. For example, one type of splint uses springs or elastic bands to apply pressure, stretching the joint. But, there are several disadvantages to this type of treatment, ranging from pain to the risk of damaging the joint.
Another treatment is called stress relaxation, which - when researchers examined how it worked - is a stretching technique that looks like it breaks some of the tissue that is causing the wrist to contract, or become tighter and stiffer. In addition to the stretching, therapy can include static progressive stretching. Using a specially designed orthoses, or splint, the wrist is pulled to a straighter position. This technique has been studied for use knees, ankles, and elbows, but not in wrists.
The authors of this study assessed the use of static progressive stretching for patients who had wrist flexion, wrists that were bent inwards and unable to straighten, or extension, wrists that were stretched out and cannot be bent forward. Researchers followed 47 patients who were treated using the orthoses for static progressive stretching. All had tried other treatments without success. The average age of the patients was 49 years (ranging from 18 to 78 years). Some patients had stiff wrists from traumas while others developed following surgeries.
The patients first tried physical therapy for around 12 weeks on average, which involved conventional stretching, range of motion, ultrasounds, using ice (cryotherapy, and transcutaneous electrical nerve stimulation (TENS), which involves sending small shocks to stimulate the injured area.
All of the patients, upon entering the study, were given a wrist device made of a padded forearm cuff and padded hand plate, both attached to a metal base. An adjustable knob on the base would alter the angle of the wrist. The patients were told to adjust the angle of the orthoses until they felt their wrist pull, but without pain. This position was to be held for five minutes. They would then decide if they could tolerate another adjustment for a pain-free stretch for another five minutes. This program continued for 30 minutes at a time. The angle was then changed for the opposite direction and the process was repeated, for total session of 60 minutes. The sessions were to be done once a day at the beginning and then gradually increased up to a maximum of three times per day. The treatment was stopped when there was no change in angle after seven days of treatment in a row or when the physical therapist felt there would be no further improvement.
During and after the treatment, the patients were assessed for any injuries or problems that may have been caused by the treatment. The wrist's range of motion was also measured with each visit. The results showed that all patients experienced an increase in their arc of motion and their ability to move their wrists after follow up of between six and 24 months, depending on the patient. The arc of motion increased between 5 degrees to 100 degrees and the angles for bending or extending the wrist increased by between 3 degrees and 50 degrees.
There did not seem to be any connection between the age or sex of the patients and if they had good treatment results. When asked how satisfied with the treatment they were, the patients rated an average of 8.2 out of 10, with 10 being the best possible answer.
The authors concluded that the splinting device with static progressive stretch is a useful treatment for patients with wrist stiffness who have not been successful with physical therapy.
Mike S. McGrath, MD, et al. Evaluation of Static Progressive Stretch for the Treatment of Wrist Stiffness. n The Journal of Hand Surgery. November 2008. Vol. 33. No. 9. Pp. 1498-1504.
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