What's the best course of treatment for my nerve injury, given I have good control and strength on the ventral (front) side, no motor function on the dorsal (back) side, and can still carry a 10 lb weight two weeks after the injury?

Nerve Injury Rehabilitation at Two Weeks Post-Injury

Based on your presentation—preserved ventral (flexor) strength allowing 10 lb weight carrying but absent dorsal (extensor) motor function at two weeks—you should immediately begin intensive task-specific wrist extension practice combined with functional electrical stimulation (FES) to the wrist and forearm extensors, while avoiding any splinting or immobilization. 1, 2

Your Current Clinical Picture and Prognosis

Your ability to carry 10 lbs indicates preserved flexor function, which is a positive prognostic sign, but the complete absence of extensor motor function represents incomplete recovery that will not spontaneously improve without structured intervention. 1, 2 The specific deficit pattern you describe—preserved finger/grip function with wrist extensor weakness—requires active rehabilitation rather than observation alone. 2

Immediate Rehabilitation Protocol (Starting Now at 2 Weeks)

Primary Treatment: Task-Specific Wrist Extension Practice

• Begin with supported wrist movements on a table surface, then progress to unsupported movements as wrist control improves. 2
• Practice functional activities that progressively challenge wrist extension with graded difficulty, focusing on normal movement patterns with good alignment. 1, 2
• Perform repetitive, goal-oriented activities that require active wrist use to promote neural reorganization and motor recovery. 2
• Gradually increase resistance and complexity as the wrist demonstrates improved control. 2

Essential Adjunctive Therapy: Functional Electrical Stimulation

• Apply FES to your wrist and forearm extensor muscles specifically to address the absent motor function you're experiencing. 3, 1, 2
• Use FES in combination with task-specific training, not as standalone treatment, to enhance motor control and provide sensory input that facilitates more complete muscle contractions. 1, 2
• FES leads to short-term increases in motor strength and motor control when combined with active practice. 2

Structured Resistance Training (When Extensor Function Begins to Return)

• Start with low-intensity resistance at 40% of 1-repetition maximum (1-RM) with 10-15 repetitions. 1, 2
• Progress to moderate intensity (41-60% of 1-RM) with 8-10 repetitions as tolerated. 1, 2
• Increase resistance when 15 repetitions become only somewhat difficult (Borg RPE 12-14). 2
• Perform resistance training 2-3 times per week to allow adequate recovery between sessions. 1, 2

Flexibility and Range of Motion Work

• Perform static stretches held for 10-30 seconds with 3-4 repetitions for each stretch. 1, 2
• Implement flexibility training 2-3 times per week in conjunction with resistance work. 1, 2

Critical Management Principles: What You Must NOT Do

• Do NOT use splinting or immobilization—this prevents restoration of normal movement and function and may promote learned non-use. 1, 2, 4
• Avoid prolonged positioning of the wrist at end ranges, which exacerbates symptoms and may impede recovery. 1, 2, 4
• Do not rely on passive range of motion alone—active motor practice is essential for recovery. 1, 2
• Do not progress resistance too quickly—start with very low intensity during initial sessions to avoid muscle damage. 1

Expected Timeline and Recovery Window

• Continue rehabilitation for 9-12 months depending on functional goals for optimal recovery. 1, 2, 4
• Most motor recovery gains occur within the first 6 months, making this a critical window for intensive rehabilitation—you are currently in this optimal window at 2 weeks. 1, 2
• Nerve regeneration occurs at approximately one inch per month, and recovery is possible for up to 18 months following injury. 5
• Rapid relief of symptoms typically occurs within 3-4 months with appropriate structured rehabilitation, with maintenance of gains over 12 months. 1

Why Your Two-Week Assessment Is Correct

Your clinical observation aligns with the expected pattern: at two weeks post-injury, you have sufficient time to assess which muscle groups have preserved function (your ventral/flexor muscles allowing 10 lb weight carrying) versus those with complete motor loss (your dorsal/extensor muscles). 1, 2 This specific deficit pattern will not spontaneously improve without the structured resistance training and task-specific practice outlined above. 1, 2

Common Pitfall to Avoid

The absence of motor function in your extensors represents incomplete recovery that requires active intervention. 1 Many patients and clinicians mistakenly wait for "spontaneous recovery" beyond the initial weeks, but the evidence clearly shows that structured rehabilitation must begin immediately to maximize the critical 6-month recovery window. 1, 2