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Expert Carpal Instability Treatment in Delhi

Carpal instability treatment at Arunalaya
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What is Carpal Instability ?

Carpal instability refers to the loss of normal alignment and mechanics of the eight small bones in the wrist, called carpal bones, and/or the radioulnar joint (the joint between the two forearm bones, the radius and ulna). This can lead to pain, swelling, changes in range of motion, weakness, and difficulty with grip, and if left untreated, can progress to arthritis and chronic disability.

Causes of Carpal Instability
The most common cause of carpal instability is trauma, such as a fall on an outstretched hand, which can injure the ligaments that connect the carpal bones. Ligaments are crucial for maintaining the stability of the wrist. Other causes include:
  • Degenerative changes: Wear and tear of cartilage leading to arthritis.
  • Congenital disorders: Conditions present at birth that affect the development of wrist bones and ligaments.
  • Connective tissue disorders: Such as Ehlers-Danlos syndrome, which can affect ligament strength.
Diagnosis of Carpal Instability

Medical history and symptom assessment: Including details of any trauma, pain characteristics (clicking, clunking, weakness), and functional limitations.

Physical examination

  • Inspection: Checking for visible deformities, swelling, or redness.
  • Palpation: Feeling for tenderness over specific carpal bones or ligaments.
  • Range of Motion (ROM) tests: Assessing wrist flexibility and identifying painful or limited movements.
  • Provocative tests: Specific maneuvers designed to reproduce symptoms and identify the unstable segment (e.g., Kirk-Watson test for scapholunate instability, midcarpal shift test).

Imaging studies

  • X-rays: Standard views (PA, lateral, oblique) are crucial, sometimes with stress views (e.g., clenched fist, ulnar deviation) to highlight instability. Specific angles like the scapholunate and capitolunate angles are measured.
  • MRI: Provides detailed images of ligaments and soft tissues.
  • CT scan: Useful for assessing dislocations and fractures, especially for surgical planning.
  • Fluoroscopy: Provides real-time dynamic imaging of wrist movement, which can be very helpful in identifying dynamic instability.
  • Diagnostic wrist arthroscopy: A minimally invasive surgical procedure that allows direct visualization of the joint and its structures.
Physiotherapy Management for Carpal Instability

Physiotherapy plays a crucial role in the conservative management of carpal instability, aiming to reduce pain, restore stability and range of motion, improve motor control, and strengthen the surrounding musculature. It is often the first line of treatment, especially if the instability is dynamic or if the patient still has good range of motion and grip strength. Physiotherapy can also be vital before and after surgery.

Pain Management and Protection:

  • Rest and activity modification: Avoiding activities that exacerbate pain.
  • Immobilization: Use of splints or braces to provide support and reduce stress on the unstable wrist.
  • Modalities: Ice therapy to reduce pain and inflammation. Manual therapy techniques may be used to reduce swelling.

Restoring Range of Motion

  • Gentle stretching and mobilization: Once pain is controlled, the focus shifts to restoring normal wrist flexibility. This may involve passive and active range of motion exercises.
  • Joint mobilization: Manual techniques by the therapist to restore normal joint play and movement.

Improving Motor Control and Proprioception:

  • Neuromuscular re-education: Exercises to enhance the wrist’s ability to sense its position and movement (proprioception) and improve coordinated muscle activation.
  • Wrist circles, finger taps, wrist rolls: Simple exercises to improve coordination.
  • Gyroball exercises, Slosh Pipes: Tools used to challenge and enhance proprioception.

Strengthening:

  • Targeted strengthening exercises: A personalized program will focus on strengthening the muscles that dynamically stabilize the wrist, particularly those of the forearm and hand.
  • Specific muscles often targeted
    • Radial instability: Abductor pollicis longus (APL), extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), flexor carpi radialis (FCR), pronator quadratus.
    • Ulnar instability: Extensor carpi ulnaris (ECU), pronator quadratus.
  • Progressive resistance: Exercises using therapy putty, hand grippers, resistance bands, or light weights (e.g., isometric exercises with up to 3 kg).
  • Functional exercises: Mimicking everyday activities like opening a door or turning a key.

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