• Mike S McGrath, Slif D Ulrich, Peter M Bonutti, Jonathan M Smith, Thorsten M Seyler, and Michael A Mont.
• Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA.
• J Hand Surg Am. 2008 Nov 1;33(9):1498-504.

PurposeDecreased wrist flexion and/or extension after trauma or surgery can be a challenging problem. Physical therapy, orthoses, and additional surgical interventions may not restore the desired range of motion or functionality. The purpose of this study was to assess the total arc of motion and the satisfaction scores of patients who had wrist stiffness and who were treated with a bidirectional, patient-directed orthosis that used the principles of static progressive stretch.MethodsForty-seven patients who experienced posttraumatic or postsurgical wrist stiffness were treated with a patient-directed orthosis. Treatment consisted of a 30- to 60-minute stretching protocol performed 1 to 3 times per day. Compliance with the device, treatment duration, mean total arc of motion, patient satisfaction, and complications were evaluated.ResultsThe total arc of motion increased by a mean of 35 degrees (range, 5 degrees to 100 degrees ) after a mean of 10 weeks of treatment (range, 5 to 26 weeks). The mean flexion and extension increased by 18 degrees (range, 1 degrees to 50 degrees ) and 17 degrees (range, 3 degrees to 50 degrees ), respectively. Assessment of age, gender, and time before commencement of treatment showed that these factors did not significantly affect the magnitude of improvement or the final arc of motion. The mean patient satisfaction score was 8.2 points on a scale of 0 to 10 points. All patients completed the treatment, and there were no complications reported with use of the device.ConclusionsAll of the patients who used this protocol improved their total arc of motion. A splinting device that uses the principles of static progressive stretch is a useful treatment for patients who have posttraumatic or postsurgical wrist stiffness and whose progress has plateaued after a course of conventional physical therapy.Type Of Study/Level Of EvidenceTherapeutic IV.

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