International Journal of Physical Medicine & Rehabilitation
Open Access
ISSN: 2329-9096
+44 1300 500008
ISSN: 2329-9096
+44 1300 500008
Indulekha S
Senior Resident, Department of Physical Medicine and Rehabilitation,All India Institute of Medical Sciences, Rishikesh
Scientific Tracks Abstracts: Int J Phys Med Rehabil
Case: A 23-year-old right-handed female weight lifter presented with pain in left wrist following a 100kg shoulder press since 1 year. She had felt no "crack'' or “giving away feel” at wrist during the onset of pain. During first week, mild pain was present only during heavy weight lifting which was relieved with icing and rest. After 1 month, pain worsened and required occasional oral medications. During a span of next 10 months pain gradually progressed and became severe (NPRS-7/10) along with movement restriction of wrist which mandated her to seek medical expertise. Examination revealed grade 2 tenderness over mid carpal region over dorsum of left wrist without any swelling. Left wrist showed loss of 20° of extension and 10° of flexion than right. Imaging revealed stage 2 Kienbock's disease. Although surgery was suggested in view of her future athletic training, she was managed conservatively due to patient’s unwillingness to surgery. Discussion A wrist immobiliser at neutral position, activity restriction and NSAIDs (SOS) were given for 4 weeks. After which Low intensity Pulsed ultrasound of 1.5MHz for 10 mins was given for 7 days. Fluidotherapy (20-30 min) for dart throwing movement alternating with gentle fisting in sets of 20 repetitions in several sessions 5 times a day for 10 min each in a pain free range followed by icing was initiated along with gentle AROM of wrist, supination and pronation of forearm preceded by hot water fomentation. This protocol was followed for six weeks. On completion, NPRS was 2/10 on lifting weights more than 10 kg. After 6 weeks, grip strengthening exercises and intrinsic hand muscle strengthening activities along with wrist extensor and flexor strengthening exercises and wrist circle exercises were started and was continued. After 6 months her pain resolved and wrist ROM improved by 5° in both flexion and extension. Conclusion This case highlights that early diagnosis and nonoperative management can yield favorable functional outcomes in early-stage Kienböck's disease in young individuals when instituted promptly.
Dr. Indulekha S. completed her MBBS from Jubilee Mission Medical College and Research Institute, Kerala, and earned her MD in Physical Medicine and Rehabilitation from AIIMS Rishikesh. She currently serves as a Senior Resident at AIIMS Rishikesh. Her clinical interests include spinal cord injury rehabilitation, neurorehabilitation, and musculoskeletal rehabilitation. She has published three research articles, with four more under review, and has presented her work at national and international conferences. She is trained in musculoskeletal ultrasonography, pain intervention techniques, and gait analysis, and is actively involved in clinical research.