Therapists at Gold Coast Hand Therapy were lucky to be involved in creating a new type of wrist support for Distal Radio-Ulna joint instability (DRUJ instability). A local Gold Coast Orthopeadic Upper limb surgeon requested an alternative to surgery for one of our lovely clients by providing her with a new design in forearm rotational support bracing.
Our client, Ms J, had proven DRUJ instability on dynamic CT scan and was functionally significantly impaired by pain and weakness in her dominant right arm/ wrist. This had arisen following a MVA causing a distal radius and ulna fracture which was managed with ORIF surgery. She underwent significant rehabilitation without improvement in the DRUJ instability symptoms.
The Brace was described in the referral by the surgeon as “complex – call me”. We phoned the surgeon where he described the concept of:
“A forearm splint designed to stabilise the radius and ulna in 3-dimensional space by means of pressure on the interosseous space, reducing the sensation of DRUJ instability in motion and load.”
“This splint was originally described by Prof JK Stanley in 1998 but the article was never published. The need for trialling or use of this splint is rare and reserved for those who have failed surgical intervention and wish to try and avoid surgery.”
The therapist got onto making a prototype with the guide being 2 pieces of dowel positioned volarly and dorsally over the interosseous membrane and secured in place by a bandage.
Neoprene was chosen to be the base material due to its compressive, elastic and warmth factors and thermoplastic bars would replace the dowel to customise for conformity.
A pattern of Ms J forearm was measured and cut out. The neoprene length was 2/3 up the forearm to accommodate the thermoplastic bars and circumferential in design to provide even pressure and support. Velcro was fitted to help secure the neoprene brace in place.
The location of the interosseous membrane both volarly and dorsally was then stenciled onto the brace and 2 internal pockets were sewn into the neoprene sleeve. The thermoplastic pieces were measured and rolled so that they could slide into the internal pockets. This involved a little bit of tweaking to get the best position of comfort for Ms J to allow for supination and pronation without restriction.
The ‘in clinic prototype’ was worn by Ms J for 2 weeks during the day for everyday function. On her return to GCHT she reported such relief of pain from the brace as well as improved confidence in the use of the right arm particularly tasks involving forearm rotation.
So with this initial success the Therapist organised a meeting with a professional manufacturer TSL Australia to replicate the brace with superior products and professional sewers. This involved the forearm neoprene brace to be fabricated with a zip and velcro and the therapist moulding the thermoplastic pieces into the internal pockets for custom fitting support in the interosseous membrane.
The final product is pictured below. Ms J now uses the brace every day for the past 18 months and she is satisfied enough to avoid any DRUJ stabilisation surgery. It has brought her increased confidence, improved daily function and reduced pain
Benefits reported by Ms J included:
- Stability and Support: the brace prevents excessive movement at the DRUJ, which can reduce pain and improve functional stability.
- Enhanced Functionality: Improved joint stability can lead to better functional outcomes, allowing individuals to engage in activities that require wrist and forearm motion without fear of exacerbating their condition.
- Facilitates Rehabilitation: A brace can be an integral part of a rehabilitation program, allowing for controlled movement while promoting healing and strengthening of surrounding muscles.
- Psychological Comfort: Knowing that there is support in place can help reduce anxiety about performing activities, fostering a more positive mindset during recovery.
Initial prototype fabricated in GCHT rooms:
TSL prototype and final brace, with thanks to TSL Australia:
Author:
Taryn Lester – Physiotherapyist – Gold Coast Hand Therapy