Mobilization vs immobilization in treating wrist sprains
Immobilization is effective, but rapid mobilization improves functional outcomes, also in sprains or injuries. Post traumatic radial sided wrist pain is common and can represent a fracture or a ligament injury. However, other than wrist sprain in some patients after radiographs or MRI, no specific diagnosis were indicated due to normal reports.
No consensus were reported for the patient group following the ideal treatment. Studies were conducted to investigate that if patients with post traumatic radial sided wrist pain and MRI who were not showing the signs of fracture or SL- ligament injury, should be treated with immediate mobilization or immobilization casted for 2 weeks.
A randomized study was conducted with 43 patients of age 18-64 years. Among them, a dorsal wrist is casted for 2 weeks (n=21) or immediate mobilization was done (n=22) for the clinical examination, self assessment questionnaires (DASH, VAS), followed up at 2, 4 and 6 weeks. Days were also recorded on sick leave basis.
After 2 weeks of the randomized trial, patients treated in a cast had reduced wrist range of motion ROM (77% vs 96%, p=0.011) and higher DASH score (median 37 vs 18, p=0.009) compared to patients treated with immediate mobilization. After 4 weeks, DASH score was still higher in the group which was treated in a cast (median 14 vs 4, p= 0.01), but there was no difference in ROM. At 6 weeks of the trial, there were again no significant difference in any outcome measures between the groups and groups of sick leave (median 27 days vs 14 days, p= 0.077).
After the completion of randomized trials, patients with radial sided wrist pain where MRI does not demonstrate fracture or SL ligament injury does not showed any benefits from the cast immobilization and can be treated with early mobilization.