May 2009 No. 5
“SPLINT” SUGGESTION FOR THE HYPERMOBILE WRIST
Some years ago I presented an idea which may be of help for patients with generalized hypermobility of the wrist (no ligament injury) which is symptomatic either with weight bearing or repetitive activities at the end range of joint motion. Since these patients are not surgical candidates and exercise cannot strengthen the lax ligaments, an external constraint may be ideal.
I have seen mail sorters, assembly line workers, and musicians with painful symptoms who were helped by wearing a narrow wrist band applied snuggly just distal to the radius and ulna. This strap with square-ring and hook/loop closure is made of leather for maximum comfort. The square-ring or D-ring closure is important: The patient must be able to precisely adjust the tightness of the strap so functional range of motion remains but restraint is present at the position of pain onset.
Strap in place with trimmed area distal to ulna.
The snug strap prevents the patient from reaching the end range of wrist joint motion when the stress on the lax ligaments is maximal. The strap must be relatively narrow to accurately provide this support and I find it helpful to trim it slightly on the radial and ulnar aspects so it stays in place.
The challenge in constructing this strap is the required sewing skills and finding a small enough metal square-ring or D-ring for the closure. A ½ inch [or 12/13 mm] (inside dimension) square-ring or D-ring is ideal and available through some US splinting suppliers. You can construct a square ring by bending 1/16 inch [1.6mm] brass welding rod. Additionally, a 3/8 inch [9.5 mm] lingerie strap slide or ring available in the notions departments of some fabric stores may also be used. If sewing leather is not possible, a hook and loop wristwatch strap may be utilized, but in my experience they are generally too wide.
Patient sorting mail with strap in place; best to place closure on volar wrist area.
ADDITIONAL SUGGESTED READING
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Disclaimer: HandLab Clinical Pearls are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.