Case Report| Volume 32, ISSUE 4, P525-534, October 2019

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A novel staged wrist sensorimotor rehabilitation program for a patient with triangular fibrocartilage complex injury: A case report


      • Dart-throwing motion (DTM) assists in sensorimotor training of wrist injuries.
      • The wrist sensorimotor rehabilitation program is pioneer in incorporating DTM.
      • The program yielded promising results for triangular fibrocartilage complex injury.
      • Most outcomes showed modest improvement in scores.
      • The program also comprises clear criteria for progression at each stage.


      Study Design

      Case report.


      Studies have highlighted the sensory innervations and stabilizing role of forearm muscles on wrist joint and implications to wrist sensorimotor rehabilitation. This case explored the novel incorporation of dart-throwing motion and proprioceptive neuromuscular facilitation in wrist sensorimotor rehabilitation.

      Purpose of the Study

      To describe and evaluate a staged wrist sensorimotor rehabilitation program for a patient with triangular fibrocartilage complex (TFCC) injury.


      The patient participated in the staged program for 9 sessions over a 3-month period. Treatment involved neuromuscular strengthening at the wrist and movement normalization of the upper extremity. Outcome measures were grip strength, visual analog scale, joint position sense, Quick Disabilities of the Arm, Shoulder and Hand, and patient-rated wrist evaluation.


      The patient showed improvement in all outcome measures. Most outcomes exceeded the established minimal clinically important difference values.


      The results suggest that dart-throwing motion and proprioceptive neuromuscular facilitation are beneficial in rehabilitation of TFCC injury.


      This is the first study that incorporated dart-throwing motion and proprioceptive neuromuscular facilitation in the sensorimotor rehabilitation of TFCC injury and yielded promising results. There is a need to further evaluate the program in prospective randomized controlled trial recruiting a larger group of patients with TFCC injury.


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      JHT Read for Credit

      Quiz: # 649

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • # 1.
        The study design was
        • a.
        • b.
          prospective cohort
        • c.
          case series
        • d.
          case report
      • # 2.
        Results included improvement in
        • a.
          the DASH
        • b.
          the VAS
        • c.
          all outcome measures
        • d.
          the PRWE
      • # 3.
        Treatment consisted of
        • a.
          9 sessions over 3 months
        • b.
          3 sessions over 9 months
        • c.
          12 session over 4 weeks
        • d.
          4 sessions over 12 weeks
      • # 4.
        Many of the exercises consisted of
        • a.
          bouncing a variety of balls
        • b.
          weight bearing over an unstable base, often a ball
        • c.
          eccentric strengthening of the muscles of the wrist
        • d.
          grip strengthening
      • # 5.
        The author was encouraged with the result but recommended performing RCTs before completely endorsing the method
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.