Proximal Strengthening for the Management of Wrist Pain

Mitchell Selhorst

Status: Completed

Conditions: Wrist Injuries

Treatments: Other: Proximal Strengthening; Other: hand therapy

Study type: Interventional

Funder types: Other

Identifiers

NCT02435979

IRB15-00251

Details and patient eligibility

About

This study will be a randomized controlled trial comparing proximal strengthening vs. traditional hand therapy for patients with wrist pain. Patients will attend 2 hand therapy sessions per week for 4 weeks. Change in patient function and pain as measured by the patient rated wrist evaluation will be the primary outcome of interest

Full description

This will be a non-blinded randomized controlled trial using a sample of consecutive patients with wrist pain. Patients who are referred to Nationwide Children's Hospital Hand therapy clinics with a primary complaint of wrist pain will be considered for this study.

Patients will be randomly assigned to one of two treatment groups; The proximal strengthening group or Traditional Hand Therapy Group. Both treatment groups will be evaluated and treated by the certified hand therapists for 2 sessions per week for 4 weeks. Both groups will receive similar treatment durations of 45-60 minutes per session based on each patient's individual needs.

Proximal strengthening group-The experimental proximal strengthening group consists of treatment where the hand therapist address specific impairments at the wrist and hand for 20-30 minutes at each treatment session. Patients allocated to this treatment group will also perform a standardized proximal strengthening protocol consisting of cervical, periscapular, and shoulder strengthening exercises. Depending on the pace and guidance needed for these exercises 25-30 minutes will be spent on proximal strengthening exercises. As the patients endurance and strength increased the repetitions and/or resistance of these exercises will increase.

Traditional Hand Therapy Group This active comparator group consists of treatment where the hand therapist address specific impairments at the wrist and hand for 45-60 minutes at each treatment session. Treatment can include stretching, motion, and strengthening exercises. As the patients endurance and strength increased the repetitions and/or resistance of these exercises will increase. Modalities for pain control and tissue mobility, and bracing or splinting if necessary. All treatments for the traditional hand therapy treatment group will occur seated at the hand therapy treatment table.

Enrollment: 38 patients

Sex: All

Ages: 8+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Wrist pain

Exclusion criteria

• <8 years of age
• any neurological disorder
• Juvenile rheumatoid arthritis
• juvenile idiopathic arthritis
• Wrist fractures < 16 weeks from date of injury or surgery
• Tendon repair
• Nerve injury or repair
• Inability to follow directions
• Inability to attend follow-up appointments

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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38 participants in 2 patient groups

Proximal strengthening + hand therapy

Experimental group

Description:

Patients in this group will perform traditional hand therapy for 30 minutes and proximal strengthening of the core, cervical spine, and shoulder complex for up to 30 minutes

Treatment:

Other: hand therapy

Other: Proximal Strengthening

Traditional hand therapy

Active Comparator group

Description:

This group will receive traditional hand therapy for 45-60 minutes each session.

Treatment:

Other: hand therapy