Proximal row carpectomy: Is early postoperative mobilisation the right rehabilitation protocol? - 25/08/10

Doi : 10.1016/j.otsr.2010.02.011

P. Edouard ^a,^b,^⁎ , D. Vernay ^b, S. Martin ^b, P. Hirsch ^b, S. Bardoux ^b, C. Grange ^a, D. Claus ^b, J.-M. Claise ^b,^c
^a Department of Physical Medicine and Rehabilitation, LPE EA 4338, Bellevue Hospital, University Hospital of Saint-Etienne, 42055 Saint-Etienne cedex 2, France
^b Rehabilitation and Physical therapy Department, Cébaza Hospital, Clermont-Ferrand Teaching Hospital Center, BP 30056, 63, rue de Chateaugay, 63118 Cébazat, France
^c Hand Surgery Unit, La Chataigneraie Private Hospital, 63110 Beaumont, France

Corresponding author. Tel.: +33 4 77 12 77 57; fax: +33 4 77 12 77 72.

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Summary

Purpose of the study

To determine the feasibility and interest of an early rehabilitation protocol with no initial immobilisation after proximal row carpectomy.

Material and methods

Thirteen patients were included in this retrospective study. Range of motion (ROM) and wrist strength (grip strength and grasp strength) were evaluated 3 and 6weeks after surgery on the both wrists (operated and non-operated). Postoperatively, patients had no immobilisation of the wrist, and began a rehabilitation program immediately after surgery in the department of Physical Therapy and Rehabilitation under multidisciplinary team supervision. The same surgical technique was used for all patients by the same surgeon.

Results

Six weeks after PRC, there was a 25–51% deficit in passive ROM and 54–64% deficit in active ROM compared to the corresponding non-operated wrist. Six weeks after PRC, mean overall grip strength was nearly 55% and Jamar dynamometer grip strength was 51% of the contralateral side.

Discussion

This study shows that immediate immobilisation following PRC is unnecessary, and that early rehabilitation is of the essence. Early rehabilitation could reduce the delay necessary to recover range of motion and strength, and probably the time to return to work.