Rehabilitation Protocol for Peripheral Nerve Injury with Resolved Wrist Drop
You should discontinue the arm sling immediately and begin an intensive structured rehabilitation program combining resistance training with task-specific wrist practice. 1, 2
Why Stop Using the Sling
The American Academy of Physical Medicine and Rehabilitation explicitly advises against splinting or prolonged immobilization during the recovery phase, as it prevents restoration of normal movement patterns and may impede functional recovery. 1, 2 Your resolved wrist drop indicates significant motor recovery has already occurred—this is the primary clinical goal and a positive prognostic indicator. 1
Core Rehabilitation Program
Resistance Training Protocol
Start with low-intensity resistance at 40% of your 1-repetition maximum (the maximum weight you can lift once) with 10-15 repetitions per exercise. 1, 2
Progress to moderate intensity (41-60% of 1-RM) with 8-10 repetitions as your strength improves. 1, 2
Perform resistance training 2-3 times per week to allow adequate recovery between sessions—do not train daily as this prevents muscle adaptation. 1
Critical warning: Start with very low intensity during initial sessions to avoid muscle damage from progressing resistance too quickly. 1
Flexibility Training
Implement static stretches held for 10-30 seconds with 3-4 repetitions for each stretch targeting wrist and forearm muscles. 1, 2
Continue flexibility training 2-3 times per week in conjunction with resistance work. 1, 2
Task-Specific Practice
The American Heart Association recommends intensive task-specific training focusing on wrist extension and flexion movements, practicing functional activities that progressively challenge wrist control with graded difficulty. 1, 3
Progress from supported (table-based) to unsupported wrist movements as motor control improves, incorporating activities requiring normal movement patterns with good alignment during functional tasks. 1
Advanced Treatment Option: Functional Electrical Stimulation
Consider adding Functional Electrical Stimulation (FES) to the wrist and forearm extensor muscles as an adjunct to your motor practice—not as standalone treatment. 1, 3, 2 The World Stroke Organization and American Heart Association specifically recommend FES for patients with demonstrated impaired muscle contraction and wrist motor impairment, which produces short-term increases in motor strength and control. 3, 2
FES should be used within the first 6 months post-injury for optimal outcomes. 3
Expected Timeline and Prognosis
Optimal functional recovery requires 9-12 months of continued rehabilitation depending on your return-to-work goals. 1, 2 Most motor recovery gains occur within the first 6 months, making this a critical window for intensive rehabilitation. 1
Rapid relief of symptoms typically occurs within 3-4 months with structured rehabilitation, with maintenance of gains over 12 months. 1
Critical Pitfall to Avoid
The absence of motor function outside extension represents incomplete recovery that will not spontaneously improve without structured resistance training and task-specific practice. 1 Passive range of motion alone is insufficient—active motor practice is essential. 1
Avoid prolonged positioning of the wrist at end ranges, which exacerbates symptoms and may impede recovery. 1, 2