Will I recover active wrist and finger extension with ongoing physiotherapy after a nerve injury, now that only finger flexor function remains?

Recovery Prognosis for Finger Extension After Nerve Injury

Yes, you have excellent potential to regain finger extension function with continued structured physiotherapy, particularly when combining functional electrical stimulation with intensive task-specific wrist and finger extension practice. 1, 2, 3

Why Your Current Progress Is a Positive Sign

• The return of finger flexor function demonstrates that significant nerve recovery has already occurred, which is the most important prognostic indicator for continued upper extremity motor improvement 1
• Your ability to type again (requiring finger flexion) proves that motor reinnervation is actively happening and the rehabilitation pathway is working 1, 2
• Voluntary finger movement of any kind predicts good potential for complete upper extremity motor recovery 1, 2

Critical Treatment Protocol You Must Follow

Primary Intervention: Functional Electrical Stimulation (FES)

• FES applied directly to your wrist and forearm extensor muscles is the most strongly recommended treatment for your specific presentation of preserved flexion with absent extension 2, 3
• The American Heart Association and World Stroke Organization specifically recommend FES for patients with impaired muscle contraction and wrist/finger motor impairment 1, 2, 3
• FES must be combined with active practice—never use it as standalone treatment 1, 2, 3
• FES provides sensory input that facilitates more complete muscle contractions and leads to short-term increases in motor strength when paired with task-specific training 2

Essential Active Rehabilitation: Task-Specific Extension Practice

• Begin with supported finger and wrist extension movements on a table surface, then progress to unsupported movements as control improves 1, 2, 3
• Practice functional activities that progressively challenge finger and wrist extension with graded difficulty, focusing on normal movement patterns 1, 2, 3
• Perform repetitive, goal-oriented activities that require active extension to promote neural reorganization 2
• Gradually increase resistance and complexity as you demonstrate improved control 2

Structured Resistance Training (When Therapy Time Permits)

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

Flexibility 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 Mistakes to Avoid

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

Expected Timeline for Recovery

• Most motor recovery gains occur within the first 6 months, making this your critical window for intensive rehabilitation 1, 2, 3
• Rapid relief of symptoms typically occurs within 3-4 months with appropriate structured rehabilitation 1
• Continue rehabilitation for 9-12 months depending on your functional goals for optimal recovery 1, 2, 3
• Maintenance of gains continues over 12 months with appropriate therapy 1

Why Extension Won't Return Without Proper Treatment

• The absence of motor function in extension represents incomplete recovery that will NOT spontaneously improve without structured resistance training and task-specific practice 1, 2, 3
• Your specific deficit pattern (preserved flexion with absent extension) requires the targeted interventions described above 1, 2

Supporting Evidence from Surgical Literature

While your case appears to be managed conservatively with physiotherapy, research on nerve transfers demonstrates that finger extension can be successfully restored even in severe nerve injuries, with 92.59% achieving satisfactory wrist extension outcomes and 56.52% achieving satisfactory finger extension outcomes 4. This reinforces that extension recovery is achievable with appropriate interventions, whether surgical or through intensive rehabilitation as outlined above.