Early outcomes of ‘The Birmingham Wrist Instability Programme’: A pragmatic intervention for stage one scapholunate instability

Abstract

Introduction Scapholunate instability is commonly caused by a fall on an outstretched hand resulting in structural pathology and pain. In recent years, dynamic stability mechanisms have been described that may aid in the non-operative management of this patient group. Limited evidence exists regarding the clinical application of stability mechanisms for scapholunate instability, and there is a void of reproducible structured exercise regimes. Method A service evaluation was conducted over 16 months to assess patient outcomes following an evidence-based treatment protocol in the conservative management of stage one scapholunate instability. Pain-free grip, maximal grip, grip strength ratio, Euro-Qol five dimensions questionnaire (EQ-5D), Visual Analogue Scale (VAS) and Quick Disability of Arm, Shoulder and Hand questionnaire (Quick-DASH) scores were compared between baseline and final follow-up. Results Six consecutive patients (seven wrists) were included with five patients (six wrists) completing treatment. Mean grip strength ratio improved by 45%, mean VAS improved by 5.5 points, mean Quick-DASH improved by 33.96% and EQ-5D improved by 0.187 quality-adjusted life years. Where established, all outcomes exceeded minimal clinically important difference values. Discussion The Birmingham Wrist Instability Programme can yield clinically important results for patients with stage one scapholunate instability in the short term based on a small service evaluation. The findings support the need for further research to evaluate the rehabilitation programme in a larger group of patients over the longer term.