Midcarpal Instability: From Testing to Treatment (Recorded Webinar)

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Video Runtime: 63 Minutes; Learning Assessment Time: 18 Minutes

What is one of the most challenging wrist conditions we see in the hand therapy clinic? Is it a patient with a crush injury involving multiple fractures and tendon lacerations, or is it the young girl involved in gymnastics who presents with progressive onset of wrist pain? Wrist instability can be a difficult condition to treat. This webinar will be covering the intricate mechanics of midcarpal instability and the two types of clinical presentations: midcarpal VISI (volar intercalated segmental instability) and the less common midcarpal DISI (dorsal intercalated segmental instability). Clinical testing for each of these conditions will be covered as well as evidence-supported treatment interventions including orthotic management, muscular engagement, and the progression with proprioceptive training. Develop tools to systematically address midcarpal instability that you can readily apply in the clinic

Learning Objectives

Through clinical testing, distinguish between the two types of midcarpal instability: VISI and DISI
Determine which type of orthosis will be beneficial for a midcarpal VISI versus a midcarpal DISI to promote stability with daily activities
Formulate a treatment program for a patient with a midcarpal VISI and midcarpal DISI to promote joint stability based on evidence-supported understanding of muscle groups
Implement proprioceptive training to optimize stability for higher-level tasks, such as gripping and weight bearing, to facilitate the patient returning to previous occupations

Meet your instructor

Ann Porretto-Loehrke

Ann Porretto-Loehrke is a skilled clinician with a passion for teaching and clinical treatment of upper extremity disorders. She has been practicing for 30 years and teaching continuing education courses for the past 20. She is the Clinical Development Coordinator at the Hand to Shoulder Center in Appleton, Wisconsin. Ann is…

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Chapters & learning objectives

1. Introduction: Understanding Midcarpal Instability From Testing to Treatment

This chapter covers midcarpal pathomechanics and clinical testing to determine which type of instability is present. Orthotic management for support, muscles to emphasize, and proprioceptive training principles will be covered to address both midcarpal VISI (most common) and midcarpal DISI conditions.

2. Case #1: Midcarpal VISI

This chapter presents a clinical case of a 15-year-old male with a midcarpal VISI. Orthotic management with a pisiform boost, exercise, and proprioceptive training will be covered.

3. Case #2: Midcarpal DISI

This chapter presents a clinical case of a 46-year-old female with a midcarpal VISI. Orthotic management to block wrist ulnar deviation, exercise, and proprioceptive training will be covered.

4. Question and Answer Session

In this chapter, we’ll review and answer the questions asked during the webinar.

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