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Physical Therapy Management of the Subluxated Wrist in Children With Arthritis

W Barden, BSc(PT), HBHK, is Physical Therapist, Department of Rehabilitation Services, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8.
D Brooks, MSc, BSc(PT), was Clinical Specialist in Research, Education, and Practice, The Hospital for Sick Children, at the time of this study. She is currently Lecturer, Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada M5T 1W5.
A Ayling-Campos, BSc(PT), BPHE, is Physical Therapist, Department of Rehabilitation Services, The Hospital for Sick Children.

Arthritis commonly affects the hand and wrist in children and may contribute to loss of range of motion and force of the muscles surrounding the involved joints. The purpose of this case report is to describe a physical therapy protocol for managing a subluxated wrist in children with arthritis. Measures of range of motion and force of the wrist observed in two patients up to 2 years after the implementation of this protocol are also reported. The initial phase of the physical therapy program focused on realigning the subluxated wrist. Heat was used to manage flexor muscle tightness and increase tissue extensibility. The carpal bones were then realigned manually and supported in position with a cast for a period of 72 hours. Once alignment of the wrist was achieved, the emphasis of physical therapy was placed on increasing range of motion and force at the wrist joint through visits to the physical therapist and an extensive home program. Measurements of passive range of motion and active range of motion using a goniometer, grip forces using a modified sphygmomanometer, and peak torque of the wrist extensors using a dynamometer (measured in one patient) were recorded before and up to 2 years following the implementation of the protocol. There was an increase in wrist extension passive range of motion (35° in both patients) and active range of motion (15° in patient 1 and 25° in patient 2) between the measurements obtained before and 1 to 2 years following the implementation of the protocol. Measures of grip force also increased (50 mm Hg in patient 1 and 80 mm Hg in patient 2). Increases in range of motion and force at the wrist in two patients with subluxated joints appear to demonstrate the potential benefits of this physical therapy protocol. Research is needed to determine the effectiveness of this protocol.

Key Words: Arthritis • Hand • Pediatrics • Physical therapy

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