Advanced Wrist and Hand Post-Fracture Rehabilitation

Wrist immobilized in neutral to 15° extension with digital and elbow motion permitted,Active finger flexion/extension to prevent flexor tendon adhesion within carpal tunnel,Shoulder and elbow active ROM to maintain proximal limb function,Ice therapy 15-20 minutes 3-4x daily for swelling reduction around distal radius and ulna,Digital sensation intact verifying median nerve function within carpal tunnel,Strict wrist immobilization allowing only forearm rotation for TFCC protection

→ Advance to: Early Mobility Phase

Wrist AROM flexion 20°, extension 20°, radial deviation 10°, ulnar deviation 10°,Forearm pronation 45°, supination 45° achieved without pain,Scar mobilization along volar wrist crease for flexor tendon gliding,Digital ROM full within splint constraints, flexor digitorum superficialis/profundus moving freely,Minimal swelling at distal radius dorsum, no median nerve compression signs,Painless passive wrist motion within tolerance, protecting healing carpal bones and TFCC

→ Advance to: Intermediate Strengthening Phase

Wrist AROM flexion 40°, extension 40°, radial deviation 15°, ulnar deviation 20°,Forearm pronation 70°, supination 70° with near-normal rotation,Tenodesis effect achieved - passive wrist extension produces digital flexion and vice versa,Grip strength measured ≥30% of contralateral side using Jamar dynamometer,Median nerve neurodynamic testing negative for carpal tunnel syndrome signs,Wrist flexor and extensor tendon gliding exercises without resistance, targeting flexor carpi radialis, flexor carpi ulnaris, extensor carpi radialis longus/brevis

→ Advance to: Strengthening Phase

Wrist AROM full or near-full: flexion 60-70°, extension 60-70°, radial deviation 20°, ulnar deviation 30°,Forearm rotation full: pronation 80°, supination 80°,Grip strength ≥50% of contralateral side with progressive resistance,Wrist flexor strengthening: flexor carpi radialis and flexor carpi ulnaris against resistance,Wrist extensor strengthening: extensor carpi radialis longus/brevis and extensor carpi ulnaris against resistance,Light functional activities initiated - lifting <2 lbs, basic ADL with modified technique

→ Advance to: Advanced Strengthening Phase

Grip strength ≥70% of contralateral side, endurance approaching baseline,Wrist isokinetic testing at 90°/sec showing >70% bilateral symmetry,Heavy resistance training for forearm flexors and extensors (5-10 lbs),Repetitive task training simulating work-related activities involving carpal manipulation,No pain with sustained gripping or repetitive wrist motion,Proprioceptive training for radiocarpal and midcarpal joints with joint position sense

→ Advance to: Return to Function Phase

Grip strength ≥85-90% of contralateral side, full endurance restored,Wrist ROM within 10° of contralateral side in all planes,Full return to occupational and sports activities without restrictions,Median nerve conduction studies normal if previously abnormal (carpal tunnel resolution),TFCC stability confirmed via supination grip test negative,Patient demonstrates proper body mechanics and injury prevention education for wrist-hand

→ Advance to: Discharge