Intermediate Wrist and Hand Overuse Rehabilitation

Pain at rest ≤2/10 on VAS scale,Minimal swelling around carpal tunnel and distal forearm,Able to perform active finger flexion/extension without exacerbating symptoms,Wrist splint fitted with wrist in neutral position (0° flexion/extension),Tolerance of median nerve gliding exercises without increased paresthesia,Active wrist ROM: flexion 15°, extension 15° without pain

→ Advance to: Early Mobility Phase

Pain with activity ≤3/10 on VAS scale,Wrist flexion ROM ≥25° with minimal discomfort,Wrist extension ROM ≥25° with minimal discomfort,Flexor tendon gliding exercises tolerated without pain flare,Demonstrated proper median nerve gliding technique,Grip strength ≥50% of contralateral side

→ Advance to: Controlled Motion Phase

Wrist flexion ROM ≥35°,Wrist extension ROM ≥35°,Radial deviation ≥15° and ulnar deviation ≥25°,Pain with resisted wrist flexion ≤3/10,Tolerance of light resistive exercises (1-2 lbs),No provocative symptoms with median nerve compression tests

→ Advance to: Early Strengthening Phase

Full wrist ROM (flexion 70°, extension 70°),Pinch strength ≥60% of contralateral side,Grip strength ≥60% of contralateral side,Wrist flexor and extensor strength 4/5 on manual muscle testing,Tolerance of tendon gliding exercises through full range,Distal radius and ulna pain-free with palpation

→ Advance to: Progressive Strengthening Phase

Grip strength ≥70% of contralateral side,Wrist flexor strength 4+/5,Wrist extensor strength 4+/5,Pinch strength ≥70% of contralateral side,Pain ≤2/10 with functional activities,Able to perform repetitive gripping (10+ repetitions) without flare

→ Advance to: Advanced Strengthening Phase

Grip strength ≥80% of contralateral side,Wrist flexor and extensor strength 5/5,Full pain-free ROM of distal radio-ulnar joint,Tolerates work-specific tasks involving repetitive wrist motion,No nighttime paresthesia in median nerve distribution,Carried object weight ≥5 lbs without symptoms

→ Advance to: Return to Activity Preparation

Grip strength ≥90% of contralateral side,Full pain-free wrist and hand ROM,Able to perform sustained grip (30 seconds),No reproduction of overuse symptoms with loading,Return to modified work duties,Patient education on ergonomics and activity modification complete

→ Advance to: Sport/Work-Specific Training

Full return to work duties without restrictions,Tolerance of sport-specific wrist movements,Plyometric and high-velocity exercises tolerated,No recurrence of symptoms with increased activity,Carried object weight ≥10 lbs without symptoms,Patient demonstrates proper body mechanics and ergonomics

→ Advance to: Return to Full Activity

Grip strength 100% or equal to contralateral side,Complete return to pre-injury activity level,No limitations in carpal tunnel function,No residual pain or paresthesia,Functional tests equal to contralateral side,Patient discharged with home maintenance program