Postsurgical rehabilitative management of avascular necrosis in the capitate

To discuss a case of avascular necrosis of the capitate and the follow-up postsurgical rehabilitation.

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.

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.