What is the best treatment approach for a patient with a wrist injury who experiences no pain, has good extension of the wrist and fingers, and some remaining strength, and is able to move completely after resting?

Treatment Approach for Wrist Injury with Complete Movement After Rest

For a patient with a wrist injury who has no pain, good extension, remaining strength, and complete movement after resting, active finger motion exercises should be initiated immediately while avoiding early wrist motion and immobilization. 1

Immediate Management Strategy

Finger Motion Protocol (Critical Priority)

• Begin active finger motion exercises immediately following diagnosis to prevent the most functionally disabling complication of hand stiffness 1
• Instruct the patient to move fingers regularly through complete range of motion at the first encounter 1
• This intervention is extremely cost-effective, requires no pharmaceutical intervention or additional visits, and provides significant impact on patient outcome 1
• Finger motion does not adversely affect an adequately stabilized distal radius fracture regarding reduction or healing 1

Wrist Motion Approach

• Do not begin early wrist motion routinely following stable fracture fixation, as studies show no significant difference in pain, function (DASH scores), or complications between early and late motion 1
• Allow patients to continue activities that do not worsen pain 1

Critical Avoidance Strategies

• Avoid complete immobilization and splinting, as this prevents restoration of normal movement and function, causes muscular atrophy and deconditioning, and promotes learned non-use 1, 2, 3, 4
• Avoid prolonged positioning of the wrist at end ranges, as this may exacerbate symptoms 2, 3, 4

Structured Rehabilitation Program

Task-Specific Practice (Core Strategy)

• Implement task-specific practice focusing on wrist extension movements as the primary rehabilitation strategy 2, 4
• Progress with repetitive, goal-oriented functional activities that gradually increase in difficulty and resistance 3
• Emphasize normal movement patterns with good alignment during functional tasks 3

Exercise Prescription

• Flexibility training: Perform 2-3 times per week, holding static stretches for 10-30 seconds with 3-4 repetitions for each stretch 2, 3, 4
• Resistance training progression: 2, 3, 4
  • 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 as strength improves
  • Increase resistance when 15 repetitions become only somewhat difficult (Borg RPE 12-14)

Duration and Monitoring

• Continue rehabilitation for 9-12 months depending on return-to-work goals for optimal functional recovery 2, 3, 4
• Monitor for development of unremitting pain during follow-up, which would warrant reevaluation 3

Adjunctive Treatment Options

Pain Management (If Needed)

• Ice applications through a wet towel for 10-minute periods are effective for short-term pain relief and reducing swelling 1
• NSAIDs effectively relieve tendinopathy pain; topical NSAIDs eliminate gastrointestinal hemorrhage risk 1

Advanced Interventions (For Persistent Weakness)

• Functional Electrical Stimulation (FES) may be considered as an adjunct to motor practice for patients with demonstrated impaired muscle contraction, promoting neural reorganization and facilitating more complete muscle contractions 3, 4

Common Pitfalls to Avoid

The most critical error is applying immobilization or splinting when the patient demonstrates good movement capability, as this directly contradicts the evidence showing that finger stiffness is one of the most functionally disabling adverse effects and can require multiple therapy visits and possibly additional surgical intervention after fracture healing 1. The presence of voluntary finger and wrist extension is a positive prognostic indicator, and active use should be encouraged rather than restricted 3.