Management of Wrist Injury with Improving Grasping Strength After 3 Months of Physical Therapy
Continue the home exercise program (HEP) independently without additional supervised physical therapy sessions, as evidence demonstrates that home-based rehabilitation is equally effective—and in some cases superior—to supervised therapy for wrist fracture recovery. 1, 2
Rationale for Independent Home Exercise Program
The American Academy of Orthopaedic Surgeons/American Society for Surgery of the Hand guidelines explicitly state that evidence for supervised hand therapy after distal radius fractures is inconsistent, with multiple studies showing no benefit over independent home exercise programs. 1 In fact, one high-quality study demonstrated that patients performing an unassisted home exercise program achieved significantly greater improvement in wrist functionality compared to those receiving supervised physical therapy—reaching 54% grip strength and 79% range of motion of the uninjured side versus only 32% and 52% respectively in the supervised group. 2
The patient should continue the current HEP with specific focus on exercises targeting joint mobility, muscle strength, and wrist stability, performed consistently for at least 4-6 months total from injury. 1, 3, 4
Critical Components of the Home Exercise Program
The HEP should include:
Grip strengthening exercises performed twice weekly, as these have been shown to significantly improve pain, function, grip strength, and muscle strength in patients with chronic wrist pain 4
Wrist stability training combined with grip exercises, which produces superior outcomes compared to conservative physical therapy alone 4
Range of motion exercises focusing on extension, flexion, and radial/ulnar deviation to prevent stiffness and maintain functional mobility 2, 3
Proprioception training to enhance neuromuscular control and prevent re-injury 3
Monitoring and Follow-Up Strategy
Schedule follow-up appointments every 4 weeks to monitor progress and adjust the exercise program as needed. 3 At each visit, assess:
- Grip strength using objective measurement (should progressively improve toward 80-100% of uninjured side) 2
- Pain levels during activities of daily living (should continue decreasing) 3, 4
- Range of motion in all planes (should approach near-normal values) 2, 3
- Functional performance with specific daily activities 3
Expected Timeline and Outcomes
The patient should continue rehabilitation for at least 6 months total from the initial injury, as most patients require this duration to achieve optimal functional recovery. 1 Evidence shows that a structured 16-week home-based program can effectively reduce wrist pain by an average of 5.1 cm on the visual analog scale and achieve near-normal wrist function. 3
Critical Pitfalls to Avoid
Do not discontinue the exercise program prematurely despite symptom improvement, as benefits are not sustained when patients stop exercising. 1 The most common reason for poor adherence to home exercise programs is change in health status, followed by lack of interest and low outcome expectations. 5
Ensure the patient maintains an exercise diary or log to track adherence, as this significantly improves outcomes in home-based rehabilitation programs. 2
When to Consider Additional Intervention
Return for reassessment if:
- Pain worsens or plateaus after 4 weeks of continued HEP 3
- Grip strength fails to improve beyond 50% of the uninjured side after 3 months 2
- New symptoms develop, including increased swelling, instability, or mechanical symptoms 1
- Functional limitations persist despite 6 months of appropriate conservative management 6
The current trajectory of improvement with independent home exercises indicates excellent prognosis, and additional supervised therapy would provide no added benefit while incurring unnecessary cost and time burden. 1, 2