Management of Wrist Drop with Preserved Finger Flexion
You should continue exercising all finger movements immediately and aggressively while initiating a structured occupational therapy program with dynamic wrist extension splinting—never use static immobilization, as this worsens outcomes and causes muscle deconditioning. 1
Immediate Action: Continue and Intensify Finger Exercises
Perform active finger motion exercises regularly and through complete range of motion starting now. 2, 3 This is extremely cost-effective and provides significant impact on outcomes, as finger stiffness is one of the most functionally disabling complications following any upper extremity weakness. 2
Maintain active motion of all fingers to prevent stiffness, which becomes very difficult to treat after it develops and may require multiple therapy visits or surgical intervention. 2, 4 Finger motion does not adversely affect adequately stabilized conditions and should never be delayed. 2, 4
Exercise unaffected joints immediately and aggressively, as delayed motion dramatically increases the risk of hand stiffness that can be nearly impossible to reverse. 4
Primary Treatment Strategy: Dynamic Splinting with Functional Training
Initiate dynamic splinting that provides wrist and finger extension support through a tenodesis mechanism while avoiding any static immobilization. 1 The American Academy of Physical Medicine and Rehabilitation specifically recommends this approach because:
Static immobilization worsens weakness, causes muscle deconditioning, promotes learned non-use, and can trigger complex regional pain syndrome. 1, 2 Serial casting for similar conditions has been associated with symptom worsening. 2
Dynamic splints allow movement while providing support, preventing the complications of rigid immobilization while maintaining functional capacity. 1
Concurrent Functional Task Training Protocol
Engage in functional tasks that promote normal movement patterns, proper alignment, and even weight-bearing of the affected hand. 1 Specific activities include:
Use the hand to stabilize objects during daily activities (e.g., holding items while the other hand manipulates them). 1, 2
Place the hand on surfaces while standing (kitchen counter, table) rather than letting it hang by the side. 1, 2
Perform bilateral upper extremity tasks that incorporate the affected hand in functional contexts. 1
Grade activities progressively to increase the time the affected hand is used, employing normal movement techniques and avoiding compensatory strategies that reinforce abnormal patterns. 1, 2
Home Exercise Program as Primary Therapy
Implement a directed home exercise program as your primary therapy modality, as evidence demonstrates home programs are equivalent to supervised therapy for uncomplicated cases. 1 This includes:
Active finger motion exercises performed regularly from the initial encounter. 1
Stretching exercises for wrist flexors and extensors. 1
Task-specific practice focused on functional activities, as this approach is strongly recommended for improving upper extremity motor function and activities of daily living. 2
Adjunctive Interventions to Consider
Functional Electrical Stimulation (FES) should be considered if you have demonstrated impaired muscle contraction, specifically for wrist motor impairment, as it provides short-term increases in motor strength and control. 1, 2 Neuromuscular electrical stimulation is suggested as an adjunctive treatment to improve motor outcomes. 2
Mirror therapy may be considered to improve motor outcomes and activities of daily living, particularly if you have very severe paresis. 2
Critical Pitfalls to Avoid
Never use rigid splinting or static immobilization as your primary strategy, as this leads to unnecessary stiffness, muscle deconditioning, and potentially irreversible complications. 1, 2
Do not nurse or protect the affected limb excessively—this promotes learned non-use and worsens long-term outcomes. 2
Avoid over-immobilization of uninvolved fingers, which leads to unnecessary stiffness in joints that should remain fully functional. 3
Do not delay finger exercises waiting for wrist recovery—finger stiffness develops rapidly and is extremely difficult to treat once established. 2
Monitoring and Progression
Reassess function every 2-3 weeks to evaluate splint effectiveness, adjust therapy progression, and monitor for any adverse effects from splinting. 1 Video recording your exercises (with consent from your therapist) can demonstrate changeability in symptoms, highlight successes, and serve as reference points for replicating successful strategies. 1
External wrist stabilization during finger exercises can promote a 20% increase in precision grip force, so consider using your dynamic splint or external support during strengthening activities. 5