Is there a chance for failed wrist rehabilitation in a patient 2 weeks post-injury with preserved motor function on the ventral (front) side, including fingers, thumb, pinch, and grip, but no motor function on the dorsal (back) side?

Wrist Rehabilitation Prognosis at 2 Weeks Post-Injury

Yes, there is a significant risk of failed rehabilitation if you do not immediately implement intensive task-specific wrist extension practice combined with functional electrical stimulation—the absence of dorsal motor function at 2 weeks will not spontaneously improve without structured intervention. 1, 2

Critical Understanding of Your Deficit Pattern

Your presentation—preserved ventral function (grip, pinch, finger flexion) but absent dorsal motor function (wrist and finger extension)—indicates incomplete nerve recovery that requires immediate, aggressive rehabilitation. 1, 2 This specific pattern will not resolve on its own and represents a critical window for intervention, as most motor recovery gains occur within the first 6 months. 1, 3

Positive Prognostic Indicators

• Preserved finger and thumb function on the ventral side is actually a favorable sign for overall upper extremity recovery potential 1, 2
• The presence of voluntary finger movement indicates significant neural pathways remain intact 2, 3
• Two weeks is still well within the optimal recovery window 1

Required Immediate Interventions

1. Task-Specific Wrist Extension Practice (Primary Treatment)

Begin immediately with supported wrist extension movements on a table surface, then progress to unsupported movements as control improves. 1 The American Heart Association emphasizes that you must:

• Perform repetitive, goal-oriented activities requiring active wrist extension to promote neural reorganization 1
• Practice functional activities with progressively graded difficulty, focusing on normal movement patterns 1
• Gradually increase resistance and complexity as wrist control demonstrates improvement 1

2. Functional Electrical Stimulation (Essential Adjunct)

The American College of Rehabilitation Medicine and World Stroke Organization strongly recommend FES specifically for your presentation. 1, 2 This is not optional:

• Apply FES to wrist and forearm extensor muscles to address the persistent weakness and impaired muscle contraction 1, 2
• FES must be combined with active task-specific training—never use it as standalone treatment 1, 2
• FES provides sensory input that facilitates more complete muscle contractions and leads to short-term increases in motor strength when combined with active practice 1, 3

3. Structured Resistance Training Protocol

Once you demonstrate any active wrist extension (even minimal), implement this protocol: 1, 3

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

4. Flexibility and Range of Motion

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

Critical Management Principles: What You Must AVOID

The American Academy of Physical Medicine and Rehabilitation provides clear contraindications: 1, 2

• DO NOT use splinting or immobilization—this prevents restoration of normal movement and promotes learned non-use 1, 2, 3
• DO NOT rely on passive range of motion alone—active motor practice is essential for recovery 1, 2
• DO NOT position the wrist at end ranges for prolonged periods—this exacerbates symptoms and impedes recovery 1, 2, 3
• DO NOT progress resistance too quickly—start with very low intensity to avoid muscle damage 2, 3

Expected Timeline and Recovery Window

• Continue intensive rehabilitation for 9-12 months depending on functional goals for optimal recovery 1, 2, 3
• The first 6 months represent the critical window where most motor recovery gains occur—this makes immediate intervention essential 1, 2
• Rapid symptom relief typically occurs within 3-4 months with appropriate structured rehabilitation 2

Common Pitfall That Leads to Failed Rehabilitation

The most critical error is assuming that because ventral function is preserved, dorsal function will spontaneously return. 1, 2 The absence of motor function in wrist extension represents incomplete recovery that will not improve without structured resistance training and task-specific practice. 1, 2 Waiting passively or relying only on time will result in permanent functional limitation.

Monitoring for Complications

• Monitor for unremitting pain during follow-up, which would warrant reevaluation 1
• Assess progress in active wrist extension range every 2-4 weeks 3
• If no improvement in dorsal motor function occurs within 4-6 weeks of intensive rehabilitation, consider electrodiagnostic studies to assess nerve recovery 4