The wrist is the location at which the two forearm bones — the ulna and radius — make contact with the various carpal bones of the hand. A break or fracture is caused by a large fall or excessive force against the bone. It is most common in the wrist end of the radius and occurs less often in the ulna and the scaphoid of the carpal bones. Symptoms include severe pain, swelling, tenderness, stiffness, numbness, deformity of the hand and loss of grip strength. Surgery may be needed to repair and realign the bone, followed by months of physical therapy to rebuild lost function.
Start of Physical Therapy
Physical therapy, if the doctor feels it's needed, usually begins once the cast is removed about six weeks after the fracture has occurred. At this point the pain should be diminished and the wrist is well into the healing process. The doctor will evaluate whether the bone is safe enough to begin physical therapy. If therapy is started too soon, then you can risk injuring the wrist again.
Wrist exercises are used to restore muscle strength, mobility and function lost after the injury. Therapy cannot heal the initial fracture, but repeated load-bearing activities can work to build stronger, denser bones. This is an important factor in preventing future injuries. Since wrist fractures often occur in the elderly, therapy may be ongoing to improve bone density. In this case, low impact exercises such as swimming are usually recommended.
The wrist joint operates like a hinge, and the most common exercise, known as an extension/flexion, involves bending the wrist up and down on that hinge. As healing develops, you can perform this exercise with a weight in hand to further strengthen the muscles. The wrist also has a limited movement side to side, which is known as a wrist deviation. A third movement, the supination/pronation, involves flipping the forearm up and down. Other exercises include extending your fingers, squeezing a tennis ball/hand grip or a prayer stretch. You can also perform isometric exercises, which are exercises without muscle contractions, by simply pushing against your stationary hand. Each of these movements is a vital part of the nascent stages of physical therapy. However, a medical professional is needed to make exercise recommendations and demonstrate proper mechanics. Physical therapy is usually done in an out-patient setting and should be supervised. You may be able to start a home program once you have learned proper form and routine.
Therapy is usually completed once you have achieved a full restoration of mobility and strength, after which time you can continue a regular exercise routine on your own. It may take as long as a year to fully recover from a wrist fracture. However, the precise duration of the therapy depends on the extent of the injury, the kind of treatment received and your body's response to the treatment. Rehabilitation may be delayed from persistent stiffness, nerve or blood vessel damage and osteoarthritis, which is either caused by fractures that extend into the joint or a pre-existing problem. Residual wrist problems can be permanent.