Postsurgical Rehabilitative Management of Avascular Necrosis in the Capitate
Received 21 January 2003; received in revised form 19 March 2003
Abstract
Objective
To discuss a case of avascular necrosis of the capitate and the follow-up postsurgical rehabilitation.
Clinical Features
A 41-year-old woman had severe left wrist pain. A short course of passive therapy was administered with no significant change. She was referred for additional diagnostic testing, including magnetic resonance imaging, which assisted in diagnosing the patient with avascular necrosis of the capitate. After undergoing surgical intervention, she was cleared to start an active rehabilitation program. She had significant loss of muscle strength and muscle atrophy and diminished active range of motion in the wrist and forearm.
Interaction and Outcome
The patient underwent surgical intervention consisting of an arthroplasty to the capitate. The follow-up rehabilitation techniques included the use of active and passive stretching, therapeutic putty, and light dumbbells. The patient was seen a total of 21 times during a 9-week time period. Outcome assessments were given intermittently during care to monitor progress. At the end of the program, she reported full function of the wrist with minimal to no pain. A 6-month follow-up showed improvements that were maintained with little pain.
Conclusion
Avascular necrosis of the capitate is relatively rare. Advanced imaging should be used for diagnostic purposes. Surgical intervention may be warranted; however, it is recommended a postsurgical rehabilitative procedure be implemented.
aClinic Director, Mahoning Valley Chiropractic and Rehabilitation Center, Canfield, Ohio
David P. DeSantis, DC, Clinic Director, Mahoning Valley Chiropractic and Rehabilitation Center, 6479 Raccoon Rd, Canfield, OH 44406
ABSTRACT