What is the best course of treatment for a 29-year-old male patient with a left wrist injury, who has been working on a computer (CI) for the last three months, showing improvement but still experiencing limited range of motion (ROM), particularly with extension?

Treatment Plan for Left Wrist Injury with Limited Extension

For a 29-year-old male with a left wrist injury showing improvement but limited range of motion (particularly extension), the most effective treatment approach is task-specific practice combined with joint mobilization techniques to restore normal wrist function.

Assessment Findings

• Patient has been working at a computer for three months following injury
• Shows improvement but still has problems with range of motion, primarily with extension
• Demonstrates good grasping strength

Recommended Treatment Plan

Primary Interventions

• Task-specific practice focusing on wrist extension movements should be implemented as the core rehabilitation strategy 1

  • Engage in repetitive, purposeful activities that specifically target wrist extension
  • Practice should be progressive and goal-oriented to improve motor function

• Joint mobilization techniques combined with thermal ultrasound therapy 2

  • Apply 3-MHz continuous ultrasound to dorsal and volar aspects of wrist for approximately 6 minutes
  • Follow immediately with 10 minutes of joint mobilizations
  • This combination has shown effectiveness in restoring active range of motion in wrists after injury

Exercise Prescription (FITT-PRO Approach)

• Flexibility Training 1

  • Perform 2-3 times per week
  • Hold static stretches for 10-30 seconds
  • Complete 3-4 repetitions for each stretch with brief rest periods (30-60 seconds)
  • Focus on both static and dynamic techniques to stretch all major wrist muscle groups

• Resistance Training 1

  • Begin with low-intensity exercises (40% of 1-RM) with 10-15 repetitions
  • Progress to moderate intensity (41-60% of 1-RM) with 8-10 repetitions
  • Advance to higher intensity (>60% of 1-RM) with 6-8 repetitions
  • Perform 2-3 times per week with proper breathing techniques

• Mirror therapy 1

  • Implement as an adjunct intervention to improve motor outcomes
  • Use visual feedback to enhance motor learning and neuroplasticity

Progression Guidelines

• Gradually increase resistance when 15 repetitions become only somewhat difficult (Borg RPE 12-14) 1
• Advance from static stretches to dynamic movements as range improves 1
• Progress exercise intensity while maintaining proper form and technique 1

Clinical Considerations

• Limited wrist motion directly correlates with functional disability - research shows a direct relationship between restriction of wrist motion and decreased functional ability 3
• Wrist movements in flexion-extension and radial-ulnar deviation are naturally coupled - maximal wrist range of motion occurs near the neutral position 4
• Avoid prolonged positioning of the wrist at end ranges as this may exacerbate symptoms 1
• Consider the relationship between wrist and shoulder function - thoracic alignment may influence upper extremity function 5

Treatment Duration and Monitoring

• Continue rehabilitation for 9-12 months depending on the patient's return-to-work goals 1
• Monitor progress by regularly measuring active range of motion 2
• Discharge from therapy when patient achieves full range of motion or plateaus for two consecutive visits 2

Cautions and Contraindications

• Avoid splinting if possible as it may prevent restoration of normal movement and function 1
• Ensure proper weight distribution and alignment during exercises to normalize movement patterns 1
• Discourage cocontraction or tensing of muscles as this is unlikely to be a helpful long-term strategy 1