Orthotic intervention incorporating the dart-thrower's motion as part of conservative management guidelines for treatment of scapholunate injury.

STUDY DESIGN: Case series.

INTRODUCTION: This paper describes conservative guidelines for the management of scapho-lunate interosseous ligament (SLIL) injury including fabrication of an orthosis that restricts active wrist movement to the dart-throwers (DTM) plane.

PURPOSE OF THE STUDY: The dart throwers' orthosis (DTO) was designed as a response to biomechanical studies suggesting that restraining motion to the DTM would off-load a deficient SLIL.

METHODS: After six weeks of wearing the DTO, the 5 patients in this case series initiated an exercise program that incorporated wrist proprioceptive training and specific muscle strengthening.

DISCUSSION: The DTO was designed to incorporate controlled movement in order to better integrate the secondary wrist stabilizers in wrists that had a deficient SLIL. The orthosis and the exercise program harnessed proprioceptive influences using active motion within the DTM plane, and stimulated mechanoreceptors so as to enhance stability.

RESULTS: All patients demonstrated improvement in subjective and objective outcomes including self-reported pain and function.

CONCLUSIONS: Orthotic intervention that controls motion within the DTM, combined with an appropriate proprioceptive rehabilitation program, may provide a viable conservative treatment option for patients with a similar clinical presentation.

LEVEL OF EVIDENCE: 4.