 |
| Simon "The Wiz" Whitlock showing how the DTM should be done! |
If there’s a subject close to my hand therapy heart, it is
the “Dart-thrower’s motion” or DTM. For the uninitiated, the DTM was coined in
an attempt to describe a pattern of wrist movement that most limits motion
between two important bones in the wrist, the scaphoid and the lunate. The
reason my ears prick up when DTM is mentioned is that when hand surgeons and
therapists first started talking about it in the late 2000’s, I started to
integrate it into the management of my patients.
 |
| My DTM splint |
I created a splint that was designed to limit movement to
the DTM. I wrote a paper about it for the Australian Sports Physiotherapy
magazine, and was an invited speaker at the International Hand Therapy
conference in 2010. I also presented my splinting concept and some preliminary
results at a couple of conferences in Australia.
I’ve had some great success with applying these principles, especially with those patients who were prepared to stick with the program I devised. The program involved wearing a splint that restricted motion to the DTM plane, and a progressive series of exercises and proprioceptive activities. One patient in particular stands out. I’ll call him Markos.
 |
| Markos "the Glassman" Moya (not his real name or picture!) |
Markos had diagnosed mid-carpal instability. He didn’t want
surgery because typically the surgery restricts wrist motion. Markos had dreams
of joining the world senior’s tennis tour in 18 months’ time. He wore the
splint, and was religious with his exercises. Importantly, he also addressed
aspects of his tennis game, hitting flatter through the ball. I just googled
him to find his is now ranked just outside the top fifty in the world for his
age group. He’s living the dream, and is proof the principles work… or is he?
 |
| Classic SL dissociation. Not that easy! |
It was the IFSSH scientific committee’s report on wrist
biomechanics in 2007 that focussed on the DTM. Since that time, research on the
DTM has succeeded spectacularly on muddying the waters. In 2013 they updated
their report. What appeared to be so
clear cut, and so useful, is now confused with definitions of different planes
of DTM; of functional DTM vs pure DTM, and of potential problems with the movement.
We aren’t nearly as convinced now that there is any merit in using it in rehabilitation
to protect a dysfunctional joint. Questions have been asked, and answers are
still being sought. Memo to self; when you think you know it all, you don’t. It’s
that’s simple.
Look after those fingers,
Hamish
