Comparison of Strength, Weight Bearing, Proprioception, Reaction Time and Function in Scapholunate Instability

Condition(s) studied

Investigational drug(s) / intervention(s)

Baseline Assessments: Evaluation of isokinetic muscle strength, grip strength, upper extremity weight-bearing capacity, proprioceptive sense, reaction time, and functional performance in both groups

Study summary

Scapholunate (SL) instability is the most common type of instability seen in the wrist, resulting from SLI injury or excessive mobility \[1,2\]. It usually occurs after trauma and can range from mild injury to severe malalignment \[3\]. Symptoms include dorsal pain, clicking sound, limited movement, increased pain with weight-bearing, and weakness \[4,5\]. Pain reduces joint movement and grip strength, limiting daily activities \[6\]. If there is no dislocation, conservative treatment (education, exercise, splinting) is applied \[7\].

The wrist absorbs and transfers load through ligaments. During flexion-extension, the scaphoid and lunate follow the capitate \[10\]. SLIL injuries alter forearm muscle activation. EKRL, EKRB, APL, and FKR are "scapholunate-friendly" muscles; EKU is not recommended due to its pronator effect \[12-15\]. SLIL mechanoreceptors enhance dynamic stability \[11,19\]. There are no studies objectively measuring the strength of these muscles.

Isokinetic muscle assessment has not been performed in SL instability. These measurements objectively determine muscle strength and imbalances, personalizing treatment. Weight transfer capacity, reaction time, and proprioception have also not been studied. However, weight transfer is an indicator of stability, proprioception is critical for functionality, and reaction time reflects neuromuscular response speed \[23-27\].

The aim of this study is to compare forearm isokinetic muscle strength, grip strength, weight transfer, proprioception, reaction time, and functionality in individuals with SL instability with those in healthy individuals.

Eligibility

Primary outcome measure(s)

• Isokinetic Muscle Strength Evaluation — Baseline
  It will be evaluated with the Isokinetic Cybex device. At 60/90/ angular velocities, the extensor-flexor peak torque force / work produced by the muscle will be evaluated concentrically.
• Weight-Bearing Test — Baseline
  Test protocol: The subject will be asked to apply as much pressure as possible with the extended elbow and wrist on a digital scale. The subjects will perform 3 trials and the average value will be recorded in kilograms and will be compared with the weight transfer test of the unaffected hand, which is determined as a normative value for maximum weight-bearing capacity.
• Grip Strength Evaluation — Baseline
  It will be evaluated with the JAMAR hand held dynamometer
• Wrist Proprioception Evaluation — Baseline
  t will be evaluated with the Isokinetic Cybex Device device The hand will be brought to the target angle value of 30 degrees extension or 30 degrees flexion with the help of a physiotherapist and will be waited for approximately 5 seconds. After the patient learns, he/she will be asked to do it himself/herself with his/her eyes closed. After the movement is repeated 3 times in a row, the participant will be asked to actively apply the determined target extension movement to the same extremity. The difference between the target angle and the measured angle.The difference between the target angle and the measured angle will be recorded as the margin of error.
• Reaction Time Evaluation — Baseline
  Upper extremity reaction time evaluation will be performed with the reaction speed measurement and exercise set Blazepod Trainer (Blazepod Trainer Device, Play Coyotta Ltd. Tel Aviv Israel) device. Individuals will be asked to turn off the 5 LEDs placed on the table in front of them as quickly as possible with one hand in the sitting position. Both hands will be evaluated. The number of LEDs extinguished in 30 seconds (number), the unit extinguishing time (msec) and the number of LEDs missed when the LEDs extinguished after a 5-second waiting period will be recorded. Measurements will be made on both hands.
• Pain Evaluation — Baseline
  It contains 10 cm line that should be assigned according to perceived pain intensity at rest, during activity and while exercising.
• Quick DASH — Baseline
  The QuickDASH is a subset of 11 items from the 30-item DASH and is a self-reported questionnaire in which the response options are presented as 5-point Likert scales. At least 10 of the 11 items must be completed for a score to be calculated and the scores range from 0 (no disability) to 100 (most severe disability). This score was designed be useful in patients with any musculoskeletal disorder of the upper limb.

Trial sites (1)

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