Broken Wrist Complications After Cast Removal and Physical Therapy

A broken wrist can be treated with a splint or cast.
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The wrist is a complex joint made up of eight bones, plus the radius and ulna, the two bones in the forearm. "Broken wrist" can refer to a fracture of any, some or all of these bones. Complications after a fractured wrist can include continued aching or stiffness, nerve or blood vessel damage, arthritis, infection, nonunion, avascular necrosis and carpal tunnel syndrome.


Treatment of a broken wrist might include the use of a brace, splint or cast. Surgery and the insertion of metal plates or devices called external fixators might also be necessary. If surgery or external fixators are used, infection is a possible complication. Surgery, external fixators, splints, casts and braces can cause damage to nerves or blood vessels. The wrist area can experience pain, numbness or tingling after your wrist is healed. In some cases, nerve damage can be permanent.


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Wrist Stiffness

Once the cast or other immobilization device is removed, you can expect that the wrist will be stiff. The purpose of a cast is to keep the bones in position while they heal, but a cast also prevents movement, which causes muscles, tendons and ligaments to become tight. Physical therapy is necessary to stretch and loosen the wrist joint. It might take several months to regain full function in the wrist, even with physical therapy.


Other Complications

A fractured wrist, like any injured joint, can develop arthritis, sometimes years after the initial injury. Arthritis secondary to a fracture is similar to most types of arthritis, with stiffness and pain as the most likely symptoms. Other complications after a fractured wrist include nonunion, in which the bones do not knit back together properly, and avascular necrosis, in which the bone dies because of inadequate blood supply. Arthritis, nonunion and avascular necrosis are not usually related to treatment.


Carpal Tunnel Syndrome

The radial nerve runs through a band of tissue called the carpal tunnel on the inside of the wrist below the thumb. A wrist fracture can damage the nerve or cause scarring of the carpal tunnel during the healing process. The result is called carpal tunnel syndrome. One study in the October 2008 "Journal of Hand Surgery" reported that if your radius and ulna move more than 35 percent when the wrist fracture occurs, you are more likely to develop carpal tunnel syndrome.


Healing Takes Time

You should expect that full recovery from a fractured wrist will take at least a year, according to the American Academy of Orthopaedic Surgeons. You might continue to have some residual stiffness or ache for two years, especially for high-impact injuries such as a motorcycle crash or if you are over 50 years old. If your injury was severe – multiple fractured bones or bones that were crushed – recovery will take longer. Sometimes even with the best of treatment, your wrist will always be stiff and sore.




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