Wrist Sprain or Something More

A friendly patient is referred to you from a general Dr. with the diagnosis of wrist sprain. His script says strengthing program for wrist sprain. You do a detailed wrist exam and you find the following: Tenderness in the scapho-lunate region, positive Watson’s shiift test, ROM is about 50% of opposite side, strength is about 50% of opposite side and he has no numbness or tingling. Pain is significant when gripping or pushing up out of a chair. What is the best treatment plan for the patient at this time? A strengthening program per Dr.’s orders or something else? Let us know what you think….
Moderator's Response
Aggressive strengthening would not be the best call in my opinion as if the patient has a tear of the SL ligament you can make this situation worse tear or completely tear a partial tear. Strengthening would not be my first line of attack for this patient. I would first see if I could get the Dr. to investigate for a potential wrist ligament injury and if this Dr. was not receptive to this I would try a wrist orthosis and work on ROM only in a pain free range. Very often general doctors do not detect these type of injuries and aggressive therapy can make them worse and NOT better.

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