Case Study: 2 Types of Distal Radius Fracture Treatments
After a distal radius fracture (DRF) or surgery, patients lose wrist and hand proprioceptive ability. This may be due to immobilization, lack of sensory input to the sensorimotor cortex, or associated injuries to the wrist joint capsule, ligaments, and possibly other soft tissues, such as tendons and muscles. Damage to these structures may impede sensory input from these structures and ail motor output.
What is the best way to help patients regain mobilization? Let’s look at a study that tests two different treatments.
Sensorimotor Rehabilitation
A study compared the outcomes of patients following surgery for distal radius fractures treated using either a sensorimotor treatment protocol or the postoperative standard of care.1
The evaluation of all patients included a comprehensive sensorimotor panel. The panel included blinded sensory testing with Semmes–Weinstein monofilaments, static and moving two-point discrimination, vibration, temperature, the timed Moberg’s pick-up test, stereognosis, and proprioception. Proprioception can be tested using the joint position test with the patients’ eyes closed.2
The most pronounced deficiencies at baseline included the results of the Moberg’s pick-up test, stereognosis, and proprioception.
Therapeutic Interventions
In therapy, the patients in the sensorimotor group worked on movement, activities of daily living (ADL), and edema control as well as orthosis adjustment as necessary. After six weeks, following removal of the orthosis, the patients commenced work on the wrist with motion, both active and passive, and gradual strengthening, as well as continuing work on ADL. Check out their home protocol below.
Home Program for the Sensorimotor Group
| Home Protocol 15 min x 2 each day |
|---|
| Sensory stimulation—each finger from distal to proximal with and without cream |
| Flexion and extension—each finger active and passive using the uninjured hand—eyes open and eyes closed |
| Adduction and abduction fingers—eyes open and closed |
| Mirror imaging of finger movement 1–5 flexion/extension abduction—eyes open and eyes closed |
| Stimulation of each finger with different textures (for example, cotton, steel wool, toothbrush)—eyes open and eyes closed |
| Imagination with eyes closed wrist flexion/extension, radio–ulnar deviation, and pro-supination |
| Same movement—both wrists |
| Activities of daily living—eyes open and eyes closed |
| Dominant hand involved: write, eat, dress |
| Non-dominant hand: eat, dress, grooming |
Conclusion
Proprioception deficits were pronounced at initial evaluation and remained high at six weeks and even at the three-month follow-up. The clinical results were better in the group treated with the sensorimotor-proprioception protocol; however, not all the differences between the groups were statistically significant. Provision of this HEP program to patients following DRF may improve sensorimotor deficits and function.
- Wollstein, R., Harel, H., Lavi, I., Allon, R., & Michael, D. (2019). Postoperative treatment of distal radius fractures using sensorimotor rehabilitation. Journal of Wrist Surgery, 8(1), 2–9. https://doi.org/10.1055/s-0038-1672151
- Karagiannopoulos, C., & Michlovitz, S. (2016). Rehabilitation strategies for wrist sensorimotor control impairment: From theory to practice. Journal of Hand Therapy, 29(2), 154–165. https://doi.org/10.1016/j.jht.2015.12.003
