Wrist Fracture

with Rehab

The two wrist bones (radius and ulna) join the bones of the hand at the wrist joint. A wrist fracture involves a partial or complete break (fracture) of one or both of these bones at the wrist joint. Wrist fractures may include the joint between the forearms bones (radius and ulna) or the joint between the forearm bones and the carpal bones of the hand.

CAUSES

Wrist fractures occur when a force is placed on the bone that is greater than it can withstand. Examples include:

  • Direct trauma to the wrist.

  • Indirect stress, such as a twisting injury.

SYMPTOMS

  • Severe pain over the fractures site at the time of injury.

  • Tenderness, swelling, and/or bruising over the fracture site (contusion).

  • Visible deformity if the bone fragments are not properly aligned (the fracture is displaced).

  • Signs of nerve or vascular damage: numbness, coldness, or paralysis in the wrist or hand.

RISK INCREASES WITH:

  • Contact sports (football or rugby).

  • Activities in which falling is common.

  • Age: children younger than 10 years of age, adults older than 60.

  • Bone disease (osteoporosis or bone tumor)

  • Previous wrist injury.

  • Poor strength and flexibility

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted and padded protective equipment.

PROGNOSIS

If treated properly, then wrist fractures usually heal within 6 to 8 weeks for adults and 4 to 6 weeks in children.

RELATED COMPLICATIONS

  • Failure of the fracture to heal (nonunion).

  • Healing of the fracture in a poor position (malunion).

  • Prolonged healing time, if improperly treated or re-injured.

  • Chronic pain or loss of wrist function.

  • Excessive bleeding in the wrist or at the fracture site (uncommon) that results in compartment syndrome. Compartment syndrome is when the nerves and blood vessels are compressed inside the body.

  • Decreased blood supply that results in bone death (rare).

  • Arthritis of the wrist.

  • Bone shortening.

  • Risks of: surgery infection, bleeding, nerve damage, or damage to surrounding tissues.

TREATMENT

Treatment initially involves the use of ice and medication to help reduce pain and inflammation. If the bone fragments are out of alignment, immediate realigning of the bone (reduction) by a person trained in the procedure is required. Fractures that cannot be reduced manually or are open (the bones protrude through the skin) may require surgery to hold the fracture in place with screws, pins, and plates. Once the bones are properly aligned, then the hand, wrist, and possibly elbow must be kept from moving (immobilized) to allow for healing. After immobilization it is important to perform strengthening and stretching exercises to help regain strength and a full range of motion. These exercises may be completed at home or with a therapist.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

COLD THERAPY

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

SEEK MEDICAL CARE IF:

  • Treatment seems to offer no benefit, or the condition worsens.

  • Any medications produce adverse side effects.

  • Any complications from surgery occur:

  • Pain, numbness, or coldness in the extremity operated upon.

  • Discoloration of the nail beds (they become blue or gray) of the extremity operated upon.

  • Signs of infections (fever, pain, inflammation, redness, or persistent bleeding).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Wrist Fracture (Radius and Ulna)

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION – Wrist Flexion, Active-Assisted

  • Extend your right / left elbow with your fingers pointing down.*

  • Gently pull the back of your hand towards you until you feel a gentle stretch on the top of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent rather than extended.

RANGE OF MOTION – Wrist Extension, Active-Assisted

  • Extend your right / left elbow and turn your palm upwards.*

  • Gently pull your palm/fingertips back so your wrist extends and your fingers point more toward the ground.

  • You should feel a gentle stretch on the inside of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent, rather than extended.

RANGE OF MOTION – Supination, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm upward until you feel a gentle stretch on the inside of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

Repeat __________ times. Complete this stretch __________ times per day.

RANGE OF MOTION – Pronation, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm downward until you feel a gentle stretch on the top of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH - Wrist Flexion

  • Place the back of your right / left hand on a tabletop leaving your elbow slightly bent. Your fingers should point away from your body.

  • Gently press the back of your hand down onto the table by straightening your elbow. You should feel a stretch on the top of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Wrist Extension

  • Place your right / left fingertips on a tabletop leaving your elbow slightly bent. Your fingers should point backwards.

  • Gently press your fingers and palm down onto the table by straightening your elbow. You should feel a stretch on the inside of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Wrist Fracture (Radius and Ulna)

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress with the resistance and repetition exercises only as your caregiver advises.

STRENGTH – Wrist Flexors

  • Sit with your right / left forearm palm-up and fully supported. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight or a piece of rubber exercise band/tubing, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Wrist Extensors

  • Sit with your right / left forearm palm-down and fully supported. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight or a piece of rubber exercise band/tubing, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Ulnar Deviators

  • Stand with a ____________________ weight in your right / left hand, or sit holding on to the rubber exercise band/tubing with your opposite arm supported.

  • Move your wrist so that your pinkie travels toward your forearm and your thumb moves away from your forearm.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day

STRENGTH - Radial Deviators

  • Stand with a ____________________ weight in your right / left hand, or sit holding on to the rubber exercise band/tubing with your arm supported.

  • Raise your hand upward in front of you or pull up on the rubber tubing.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Forearm Supinators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm down.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Forearm Pronators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm up.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Grip

  • Grasp a tennis ball, a dense sponge, or a large, rolled sock in your hand.

  • Squeeze as hard as you can without increasing any pain.

  • Hold this position for __________ seconds. Release your grip slowly.

Repeat __________ times. Complete this exercise __________ times per day.