Tratamiento rehabilitador en las inestabilidades mediocarpianas palmares

Resumen

Las inestabilidades mediocarpianas son una patología provocada por la descoordinación en el movimiento entre la hilera proximal y distal del carpo. Las más frecuentes son las inestabilidades palmares (PMCI) y suelen ocasionar un dolor y un clunk muy característico con determinados movimientos de la muñeca. Su diagnóstico en ocasiones no es fácil ya que no existen pruebas de imagen diagnósticas específicas. La primera opción de su tratamiento siempre será conservadora a través de rehabilitación. Actualmente no existen estudios randomizados con series amplias en cuanto a resultados de los tratamientos propuestos dado que no es una patología muy frecuente. En este artículo, se propone un protocolo de trabajo en base a la revisión de los estudios biomecánicos existentes hasta el momento actual.

Abstract

Midcarpal instabilities are a pathology caused by the uncoordination on the move between proximal and distal carpal rows. The most frequent are palmar instabilities ( PMCI) and usually cause pain and clunk very characteristic with certain movements of the wrist. Sometimes their diagnosis aren't easy because there aren't specific diagnosed imaging tests. The first option of their treatment will always be conservative through rehabilitation. Currently there are no randomized studies with large series with results of the proposed treatments because is not a frequent pathology. In this article a work protocol is proposed based on the review of existing biomechanical studies up to the present time.

Palabras clave

inestabilidad mediocarpiana palmar - muñeca - ortesis - propiocepción - fortalecimiento

Keywords

palmar midcarpal instability - wrist - splint - propioception - strengthening

• Bibliografía

• 1 Lichtman DM, Wroten ES. Understanding midcarpal instability. J Hand Surg Am 2006; 31 (03) 491-498
• 2 Lichtman DM, Schneider JR, Swafford AR, Mack GR. Ulnar midcarpal instability-clinical and laboratory analysis. J Hand Surg Am 1981; 6 (05) 515-523
• 3 Lichtman DM, Bruckner JD, Culp RW, Alexander CE. Palmar midcarpal instability: results of surgical reconstruction. J Hand Surg Am 1993; 18 (02) 307-315
• 4 Moritomo H, Murase T, Goto A, Oka K, Sugamoto K, Yoshikawa H. In vivo three-dimensional kinematics of the midcarpal joint of the wrist. J Bone Joint Surg Am 2006; 88 (03) 611-621
• 5 Esplugas M, Garcia-Elias M, Lluch A, Llusá Pérez M. Role of muscles in the stabilization of ligament-deficient wrists. J Hand Ther 2016; 29 (02) 166-174
• 6 A. Lluch et al. El papel de la propiocepción y el control neuromuscular en las inestabilidades del carpo. Rev Iberoam Cir mano 2015; 43 (01) 70-78
• 7 Garcia-Elías M. The non-dissociative clunking wrist: a personal view. J Hand Surg Eur Vol 2008; 33 (06) 698-711
• 8 Petrie S, Collins J, Solomonow M, Wink C, Chuinard R. Mechanoreceptors in the palmar wrist ligaments. J Bone Joint Surg Br 1997; 79 (03) 494-496
• 9 Hagert E, García-Elías M, Forsgren S, Ljung BO. Immunohistochemical analysis of wrist ligament innervation in relation to their structural composition. J Hand Surg Am 2007; 32 (01) 30-36
• 10 Hagert E. Proprioception of the wrist joint: a review of current concepts and possible implications on the rehabilitation of the wrist. J Hand Ther 2010; 23 (01) 2-17
• 11 Ho PC, Tse WL, Wong CW. Palmer Midcarpal Instability: An algorithm of diagnosis and surgical management. J Wrist Surg 2017; 6 (04) 262-275
• 12 von Schroeder HP. Dorsal wrist plication for midcarpal instability. J Hand Surg Am 2018; 43 (04) 354-359
• 13 Higgin RPC, Hargreaves DG. Midcarpal instability: the role of wrist arthroscopy. Hand Clin 2017; 33 (04) 717-726
• 14 Atzei A, Braidotti F, Hagert E, Luchetti R. Arthroscopic Ligament Plication for Palmar Midcarpal Instability. J Wrist Surg 2015; 04 (10) 1055
• 15 Chinchalkar S, Yong SA. An ulnar boost splint for midcarpal instability. J Hand Ther 2004; 17 (03) 377-379
• 16 O'Brien MT. An innovative orthotic design for midcarpal instability, non-dissociative: mobility with stability. J Hand Ther 2013; 26 (04) 363-364
• 17 Braidotti F. , et al. J Hand Ther 2015; xxx: 1-6
• 18 Rosén B, Lundborg G. Training with a mirror in rehabilitation of the hand. Scand J Plast Reconstr Surg Hand Surg 2005; 39 (02) 104-108
• 19 Mulders MA. , et al. Long-Term Functional Results of a wrist exercise programme. J Wrist Surg 2017
• 20 Harwood C, Turner L. Conservative management of midcarpal instability. J Hand Surg Am 2015; •••: 1-8
• 21 Lichtman DM, Wroten ES. Understanding midcarpal instability. J Hand Surg Am 2006; 31 (03) 491-498
• 22 Wright TW, Dobyns JH, Linscheid RL, Macksoud W, Siegert J. Carpal instability non-dissociative. J Hand Surg [Br] 1994; 19 (06) 763-773