Management of Left Wrist Pain Following Radial Bone Fracture
A directed home exercise program including active motion exercises is the best management approach for persistent left wrist pain and tightness following a historical radial bone fracture, particularly during weight-bearing exercises. 1
Assessment of Current Symptoms
The patient presents with:
- Left wrist pain during weight-bearing exercises and heavy lifting
- Tightness in thumb and hand area
- Inability to fully flatten hand
- History of radial bone fracture approximately 10 years ago
- Previous improvement with physical therapy (2018-2019)
Management Approach
1. Home Exercise Program
- Implement a structured home exercise program focusing on:
- Active finger and wrist range of motion exercises
- Thumb and hand stretching exercises
- Gradual strengthening exercises for the wrist and forearm
- Continuation of previously effective physical therapy exercises
The American Academy of Orthopaedic Surgeons (AAOS) guidelines strongly support home exercise programs for patients with distal radius fractures, noting they are as effective as supervised therapy for uncomplicated cases 1. Regular finger and hand motion is crucial to prevent stiffness and promote optimal outcomes.
2. Activity Modification
- Temporarily modify weight-bearing exercises that provoke symptoms
- Gradually reintroduce weight-bearing activities as symptoms improve
- Consider using wrist support during heavy lifting activities
3. Pain Management
- NSAIDs for pain and inflammation control as needed
- Application of ice after activities that provoke symptoms
- Heat therapy before exercises to improve tissue extensibility
4. Follow-up Evaluation
- If symptoms persist despite adherence to the home exercise program for 4-6 weeks, consider:
- Radiographic evaluation to assess for post-traumatic arthritis or other complications
- MRI without contrast if radiographs are negative but symptoms persist 1
- Referral to hand specialist for further evaluation
Rationale for Recommendation
The AAOS guidelines specifically state that "a home exercise program is an option for patients prescribed therapy after distal radius fracture" 1. This recommendation is supported by five randomized controlled trials comparing directed home exercise programs against various forms of supervised therapy, all showing comparable outcomes.
The guidelines emphasize that "finger motion does not have any adverse effects on an adequately stabilized distal radius fracture in regard to reduction or healing" and is "an extremely cost-effective intervention" 1. Additionally, they note that "hand stiffness is one of the most functionally disabling adverse effects" following distal radius fractures, making regular motion exercises essential.
Important Considerations
- Stiffness of the fingers and hand can result from a combination of factors including pain, swelling, and apprehension 1
- Finger and hand stiffness can be very difficult to treat after fracture healing, requiring multiple therapy visits and possibly additional surgical intervention 1
- Patients with unremitting pain during follow-up should be reevaluated to rule out complications 1
- Long-term continuation of balance training and multidimensional fall prevention may be beneficial for overall function 1
Potential Complications to Monitor
- Post-traumatic arthritis
- Chronic pain
- Joint stiffness
- Distal radioulnar joint (DRUJ) instability
By implementing this structured home exercise program and following the recommended management approach, the patient has the best chance of improving wrist function, reducing pain during weight-bearing activities, and addressing the tightness in the thumb and hand area.