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….
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.