Date Presented 04/05/19
Primary Author and Speaker: Jamie Bergner
Contributing Authors: Jennifer Farrar, Rogelio Coronado
PURPOSE: Dart thrower’s motion (DTM) is the primary movement pattern of the wrist during functional activity such as hammering and drinking from a cup (Brigstocke, Hearnden, Holt, & Whatling, 2014). The scapholunate interosseous ligament (SLIL) is a key stabilizing ligament of the wrist. If the SLIL becomes injured, progressive wrist instability and pain may occur interfering with occupational performance and participation. During DTM, stress to this important ligament is minimized, in comparison to orthogonal plane motion (flexion/extension/radial deviation/ulnar deviation) where the wrist motion primarily occurs at the radiocarpal joint, stressing the SLIL. After SLIL injury or surgical management, early controlled DTM may be appropriate for protecting SLIL integrity, while reducing the effects of prolonged immobilization. If deemed safe, early DTM could have a profound impact on early motion protocol development to allow earlier return to meaningful occupations after SLIL injury or repair. This scoping review summarizes the literature on 1.) the effects of DTM on the injured and surgically repaired SLIL and 2.) the extent to which dart thrower’s orthotic designs promote SLIL recovery.
DESIGN: A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines was conducted.
METHODS: A systematic literature search was conducted within six databases for articles published between 2003 and March 2018 (MEDLINE/PubMed, Ovid EMBASE, CINAHL, Cochrane Library, OTSeeker, PEDro, and ClinicalTrials.gov). A research librarian was consulted for developing a comprehensive search strategy. Studies were considered eligible if they were written in English and examined DTM in the context of SLIL injury or repair. Two independent reviewers conducted title and abstract screening. Grey literature was considered by reviewing conference postings and non-peer reviewed article sources.
RESULTS: Of 425 identified papers, 15 were eligible for inclusion. Five biomechanical studies examined the influence of DTM on the injured SLIL, while five articles described DTM orthotic designs. Five additional articles reported outcomes when DTM was used in the rehabilitation protocol and were included in the review. The results suggest limiting end-ranges of DTM in the injured/repaired SLIL while blocking orthogonal plane movements. Several custom orthotic designs described may accomplish this goal. DTM has been described as part of a comprehensive therapy program in small case studies and associated with positive clinical improvements in the short-term and intermediate follow-up.
CONCLUSIONS: Caution should be exercised with using DTM on the torn SLIL as gap increases, particularly at the end-ranges of motion (Garcia-Elias, Alomar Serrallach, & Monill Serra, 2014). Several orthosis designs have potential to limit this motion to midrange while allowing early movement after injury. This scoping review is important to occupational therapy clinical practice as it contributes to understanding biomechanical research and promotes safety and efficacy of rehabilitation protocol development after a client experiences an injury or surgical repair of the SLIL. Further higher-level research is needed to fully understand the influence of DTM on injured and post-surgical populations.
References
Brigstocke, G. H., Hearnden, A., Holt, C., & Whatling, G. (2014). In-vivo confirmation of the use of the dart thrower’s motion during activities of daily living. J Hand Surg Eur Vol, 39(4), 373–378. http://doi.org/10.1177/1753193412460149
Garcia-Elias, M., Alomar Serrallach, X., & Monill Serra, J. (2014). Dart-throwing motion in patients with scapholunate instability: A dynamic four-dimensional computed tomography study. J Hand Surg Eur Vol, 39(4), 346–352. http://doi.org/10.1177/1753193413484630
