Is Splinting better than Early Mobilisation in the Treatment of Wrist Sprains?
Date First Published:
January 31, 2010
Last Updated:
June 16, 2010
Report by:
Dr Shalini Panchal, ST3 Emergency Medicine (St Helier Hospital)
Three-Part Question:
In [adult patients with wrist sprains] is [immediate mobilisation better than immobilisation in a splint] at [decreasing pain and reducing time to full recovery].
Clinical Scenario:
A 30 year old female presents to the emergency department with a swollen, bruised and painful wrist following a hyperextension injury. After examination and appropriate investigation you diagnose a wrist sprain. She asks you if she can have a splint to wear. You are unsure whether a period of immobilisation in a splint or early mobilisation is the best option.
Search Strategy:
Medline 1966-11/10 using the OVID interface.
Search Details:
1. EMBASE, MEDLINE; exp SOFT TISSUE INJURIES/; 5697 results.
2. EMBASE, MEDLINE; exp SPLINTS/; 8455 results.
3. EMBASE, MEDLINE; exp IMMOBILIZATION/; 48481 results.
4. EMBASE, MEDLINE; 1 and (2 or 3); 90 results.
Search expanded to include keyword search.
Internet search using google scholar.
2. EMBASE, MEDLINE; exp SPLINTS/; 8455 results.
3. EMBASE, MEDLINE; exp IMMOBILIZATION/; 48481 results.
4. EMBASE, MEDLINE; 1 and (2 or 3); 90 results.
Search expanded to include keyword search.
Internet search using google scholar.
Outcome:
Altogether 90 papers were found in Medline and Embase all of which were not relevant to the topic or were of insufficient quality.
Author Commentary:
There is no specific literature on the use of splints or immobilisation in the management of wrist sprains. There were two review articles[1],[2] that looked at a combination of experimental and clinical studies relating to a variety of other soft tissue injuries that found in favour of early, controlled mobilisation to decrease pain, stiffness and swelling.
References:
1. Immobilization or early mobilization after an acute soft-tissue injury?
Physician and Sportsmedicine, 200, vol./is 28/3 (55-63), 0091-3847 (2000)
Kannus P.
2. Resting injured limbs delays recovery: A systematic review
Journal of Family Practice, September 2004, vol./is. 53/9(706-712), 0094-3509 (Sep 2004)
Nash C.E., Mickan S.M., Del Mar C.B., Glasziou P.P.
References:
1. Immobilization or early mobilization after an acute soft-tissue injury?
Physician and Sportsmedicine, 200, vol./is 28/3 (55-63), 0091-3847 (2000)
Kannus P.
2. Resting injured limbs delays recovery: A systematic review
Journal of Family Practice, September 2004, vol./is. 53/9(706-712), 0094-3509 (Sep 2004)
Nash C.E., Mickan S.M., Del Mar C.B., Glasziou P.P.
Bottom Line:
No published evidence was found to answer the 3-part question. Local/National advice should be followed.