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Manipulation under Anesthesia: An Effective Treatment for Stiffness After Proximal Row Carpectomy
Devan Griner, MD; Clay Spitler, MD; Chris Pankiw, MD; D.Marshal Jemison, MD; University of Tennessee College of Medicine
University of Tennessee College of Medicine, Chattanooga, TN, USA


Introduction: Proximal row carpectomy (PRC) is a salvage procedure for significant arthritis of the carpus that preserves some motion and provides pain relief. The classic indications for PRC include scapholunate advanced collapse, end stage Keinbock’s disease, and scaphoid-nonunion advanced collapse. One of the most common complications is significant wrist stiffness in spite of aggressive hand therapy. Little is written about the treatment options for stiffness after PRC. If patients have limited range of motion after PRC (< 60 degree arc of flexion/extension), our routine is to perform manipulation under anesthesia to improve their range of motion. We hypothesize that in patients with less than expected wrist range of motion after proximal row carpectomy, wrist manipulation under anesthesia increases range of motion compared to pre-operative values.

Materials & Methods: Patients with limited range of motion after PRC were offered manipulation under anesthesia. The majority of manipulations were done with an axillary block with a few patients requiring MAC or general anesthesia. After manipulation, the patient continued in therapy until their range of motion plateaued again. A retrospective review of the medical record was performed. Pre and post manipulation ranges of motion were recorded. Other information obtained included age, gender, race, associated trauma, pre and post-operative pain, and cases associated with workers compensation. Changes in range of motion values pre-manipulation to post-manipulation were calculated using a Paired Samples t-test.

Results: A total of 20 patients were identified and their data reviewed. There were 12 men (60%) and 8 (40%) women. Mean age was 53 with a range of 25-73yrs. Trauma preceded the PRC in 17(85%). All patients (100%) complained of pain prior to their manipulation and post operatively, 11 (55%) were pain free. Mean preoperative wrist extension was 32.2 degrees with a postoperative mean of 41.6 degrees, an increase in 7.38 degrees (p<0.001). Mean preoperative wrist flexion was 24.3degrees with a postoperative mean of 38.5 degrees, an increase in 14.6 degrees (p<0.001) Overall preoperative range of motion was 58.2 degrees and postoperatively 79.8 degrees, a gain of 20.7 degrees (p<0.001).

Conclusions: Patients with less than expected range of motion after proximal row carpectomy can be safely and effectively treated with manipulation under anesthesia. These patients can expect to improve their range of motion by an average of 20 degrees.

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