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Three Part Question

In [adult patients with wrist sprains] is [immediate mobilisation better than immobilisation in a splint] at [decreasing pain and reducing time to full recovery].

Clinical Scenario

A 30 year old female presents to the emergency department with a swollen, bruised and painful wrist following a hyperextension injury. After examination and appropriate investigation you diagnose a wrist sprain. She asks you if she can have a splint to wear. You are unsure whether a period of immobilisation in a splint or early mobilisation is the best option.

Search Strategy

Medline 1966-11/10 using the OVID interface.

1. EMBASE, MEDLINE; exp SOFT TISSUE INJURIES/; 5697 results.
2. EMBASE, MEDLINE; exp SPLINTS/; 8455 results.
3. EMBASE, MEDLINE; exp IMMOBILIZATION/; 48481 results.
4. EMBASE, MEDLINE; 1 and (2 or 3); 90 results.

Search expanded to include keyword search.

Internet search using google scholar.

Search Outcome

Altogether 90 papers were found in Medline and Embase all of which were not relevant to the topic or were of insufficient quality.

Comment(s)

There is no specific literature on the use of splints or immobilisation in the management of wrist sprains. There were two review articles[1],[2] that looked at a combination of experimental and clinical studies relating to a variety of other soft tissue injuries that found in favour of early, controlled mobilisation to decrease pain, stiffness and swelling. References: 1. Immobilization or early mobilization after an acute soft-tissue injury? Physician and Sportsmedicine, 200, vol./is 28/3 (55-63), 0091-3847 (2000) Kannus P. 2. Resting injured limbs delays recovery: A systematic review Journal of Family Practice, September 2004, vol./is. 53/9(706-712), 0094-3509 (Sep 2004) Nash C.E., Mickan S.M., Del Mar C.B., Glasziou P.P.

Clinical Bottom Line

No published evidence was found to answer the 3-part question. Local/National advice should be followed.