Functional Disability of the Wrist: Direct Correlation with Decreased Wrist Motion

Purpose

There are multiple surgical procedures to alleviate wrist pain. Some degree of wrist range of motion loss is expected with surgery. Patients generally prefer motion sparring procedures, assuming increased motion will carry over to increased function. There are no studies that clearly demonstrate the correlation between motion and function. Studies that do exist show a wide variation in ranges needed for activities of daily living (ADL). This is due to the differences in tasks assessed and an assumption that the observed maximum range used for the activity is the minimum needed.

Methods

Forty-two subjects participated in three assessments over a 48-hour period. Assessments consisted of range of motion testing, three subjective surveys: Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), Modern Activity Subjectivity Survey (MASS), and a timed functional test (Modern Activity Timed Test [MATT]). One assessment was a baseline with no splint, one was after wearing a partially restricted splint for 24 hours, and one was after wearing a highly restricted splint for 24 hours. Splint order was randomized, as was timing of baseline testing (before splinting, between splints, after both splints).

Each splint was a customized static wrist splint and of comparable form, shape, and weight. Partially restricted splint was made of hypoallergenic close-celled foam and highly restricted splint of heat sensitive moldable plastic. They were applied with Velcro straps and circumferentially taped and signed by a researcher to verify compliance. Participants were instructed not to remove the splint for 24 hours.

Results

The differences in range of motion for wrist flexion/extension, deviation, and circumduction were statistically significant. Scores on the DASH, PRWE, and MASS were also found to be significantly different. The MATT matched the perceived difficulties from the subjective surveys.

Discussion

The use of low profile splints to limit wrist range of motion did demonstrate a correlation between restricted wrist motion and functional ability.

Implications for hand therapy: As therapists, it is important that we be able to give our patients realistic expectations. Though limited, the information from this study provides additional information on the effects of limited wrist range of motion on functional ability. Of further interest is the development of new measurement tools. The MASS and the MATT cover common activities most of which are not addressed in the other measures. With further study and validation, they have the potential for providing important further functional information both for treatment planning and outcome evaluation.