Wrist and Hand Post-Fracture Rehab (Advanced)
A 14-week advanced rehabilitation program for post-fracture recovery of the wrist and hand, incorporating tennis ball and dip station exercises to address carpal tunnel, tendons, distal radius, and ulna issues.
Professional rehabilitation program designed for effective recovery and pain management.
Key facts at a glance
- Body part
- upper-limb · wrist-hand
- Injury type
- post-fracture
- Level
- advanced
- Duration
- 14
- Sessions/week
- 3
- Minutes/session
- 60
- Evidence level
- moderate
- ICD-10
- S62
- Cost tier
- moderate
Program Overview This is a 14-week advanced rehabilitation guide for your wrist and hand after a fracture. It is designed for people whose bones are already healing and who have been cleared to move into more active work. Over the weeks, you will steadily rebuild motion, strength, and everyday function with a mix of guided exercises, hands-on therapies, and equipment like a tennis ball and dip station, always at a pace your healing tissues can tolerate.
Who This Program Is For and Its Goal This program suits people recovering from a wrist or hand fracture who are past the early protected stage and ready for advanced loading and strengthening. The goal is to restore full, comfortable movement, rebuild grip and pinch strength, and return you to daily tasks, work, or sport. Your clinician will confirm you are at the right stage before you begin and will adjust the plan to your specific fracture and needs.
Before You Start Please have your therapist or doctor review this plan with you first. They will check your imaging, confirm your fracture is stable, and assess your movement before you start any new exercise. Do not begin if you have limited movement that has not yet been assessed, active inflammation, a known clot risk, or severe osteoporosis, as these need special handling. A proper assessment keeps your recovery safe and on track.
Safety Notes and When to Stop Warm up before every session, and stop any exercise if your pain increases rather than settles. Certain conditions mean this program must be adapted or delayed: limited movement that has not been assessed, active inflammation, clot risk, or severe osteoporosis. Call your clinician promptly if you notice sudden swelling, calf pain, chest pain or shortness of breath, new numbness or tingling, a cold or pale hand, or worsening pain that does not ease with rest.
Weekly Structure You will do three sessions each week, about 60 minutes each, for 14 weeks. Sessions use a tennis ball for grip and hand work and a dip station for graded weight-bearing and upper-body strengthening as you progress. Plan rest days between sessions, and tell your clinician if a session leaves you sore for more than a day, so the plan can be adjusted before your next visit.
How the 14 Weeks Are Organized The plan moves through overlapping phases: early protection, early mobilization, controlled motion, and then progressive strengthening and function. In plain terms, you start gently with protection and light movement, then steadily add range, then controlled loading, then strength and real-life tasks. You only move to the next phase when your clinician confirms you meet the readiness signs for that phase, so everyone progresses at their own safe pace.
What a Typical Session Looks Like Each session follows a warm-up, main work, and cool-down pattern. You will begin with gentle warmth and movement, then do the main exercises and therapies your clinician has selected, such as grip work with the tennis ball or graded dip station work. Cool-down includes gentle stretching and soft-tissue care. Your therapist will tailor the mix and any modalities to your stage and tolerance each visit.
Warm-Up, Main Work, and Cool-Down Start with paraffin wax or contrast baths and gentle hand and wrist movement to warm tissues and ease stiffness. The main work pairs your prescribed exercises with modalities such as therapeutic ultrasound, electrical stimulation for muscle re-education, and tennis-ball grip and hand drills, adding dip station work only when cleared. Cool down with light stretching, edema care, and splinting as advised. Keep every step within a comfortable range.
Tracking Progress Your clinician uses clear readiness signs to decide when you advance between phases, such as stable imaging, improving motion, and controlled pain. They will also track outcome measures like grip and pinch strength, wrist range of motion, and questionnaires such as the MHQ and PRWE. These measurements show how your function is returning and help fine-tune your program. Ask to see your numbers so you can celebrate real gains.
How Progression and Measures Work Together Progression is guided by specific criteria at each phase, not by the calendar alone. Your therapist checks things like fracture stability, pain control, swelling, and whether you have reached the movement and strength targets for your current phase. Outcome measures such as the Jamar dynamometer, goniometer readings, pinch gauge, and questionnaires confirm progress and catch any slowdown early. Together they keep your advancement safe and evidence-informed.
Recovery and Self-Care Recovery happens between sessions too. Follow your clinician's advice on splinting, rest, and activity pacing, and keep doing your home exercises as prescribed. Manage swelling with elevation and the contrast baths if advised. Protect your healing wrist during daily tasks, and avoid pushing through sharp pain. Good sleep, steady hydration, and not overdoing it on good days all support steady healing.
Pain Management Cautions and Red Flags Mild soreness that eases within a day is common as you progress, but stop if pain increases during exercise. Rest the area and contact your clinician if pain worsens, swelling rises, or new numbness appears. Seek urgent care for chest pain, shortness of breath, calf pain or swelling, or a cold, pale, or blue hand. Do not take new medications or change doses without your clinician's guidance.
Recovery phases
Fracture site stability confirmed on radiographs with no displacement,Soft tissue tolerance to immobilized positioning without increased pain,Peripheral circulation intact: radial pulse palpable, capillary refill <2 seconds,Digital sensation preserved: no median nerve or ulnar nerve paresthesia,Edema management achieved: wrist circumference stable or decreasing,Skin integrity maintained over cast/splint interface
→ Advance to: Early Mobilization
Continued fracture stability on follow-up imaging,Active digital flexion/extension without wrist movement,Pain controlled at rest and with protected ADL activities,Soft tissue inflammation decreasing: reduced warmth and tenderness,Scar tissue management initiated if surgical approach used,Median nerve gliding exercises without exacerbating symptoms
→ Advance to: Early Mobilization
Radiographic confirmation of fracture callus formation or healing progression,Wrist flexion/extension range: minimum 15 degrees in each direction achieved,Painless passive ROM: radiocarpal and midcarpal joints mobilizing,Tendon gliding: flexor digitorum superficialis and profundus moving independently,No median nerve irritation with neural gliding exercises,Grip strength measurable: at least 15% of contralateral side
→ Advance to: Controlled Motion
Wrist flexion/extension: 30 degrees flexion, 20 degrees extension achieved,Radial and ulnar deviation: minimum 10 degrees in each direction achieved,Pronation/supination: 45 degrees each direction without distal radioulnar joint pain,Flexor tendon glide: full active digital flexion with wrist in extension,Extensor tendon glide: full active digital extension with wrist flexed,TFCC stability confirmed: no ulnar-sided wrist pain with loaded ulnar deviation
→ Advance to: Motion & Strengthening
Wrist ROM: 45 degrees flexion, 35 degrees extension, 20 degrees radial/ulnar deviation,Pronation/supination: 70 degrees each direction,Grip strength: 30% of contralateral side using Jamar dynamometer,Wrist extensor strength: able to hold 1lb weight with forearm supported,Wrist flexor strength: able to hold 1lb weight with forearm supported,Digital tendon function: full composite fist without tendon adhesion
→ Advance to: Motion & Strengthening
Wrist ROM approaching functional: 50 degrees flexion, 40 degrees extension,Forearm rotation: near full pronation/supination,Grip strength: 45% of contralateral side,Radial nerve innervated muscles: extensor carpi radialis brevis and longus functional,Ulnar nerve innervated muscles: extensor carpi ulnaris functional,Median nerve function: no provocative signs with Phalen's maneuver
→ Advance to: Progressive Strengthening
Wrist ROM: 55 degrees flexion, 45 degrees extension, 25 degrees radial/ulnar deviation,Grip strength: 55% of contralateral side,Wrist extensor endurance: 10 repetitions holding 3lb with forearm pronated,Wrist flexor endurance: 10 repetitions holding 3lb with forearm supinated,Pinch grip: key pinch at 50% of contralateral side,Distal radioulnar joint: pain-free rotation with resistance
→ Advance to: Progressive Strengthening
Full functional wrist ROM achieved: 60 degrees flexion, 50 degrees extension,Grip strength: 65% of contralateral side,Radial styloid loading tolerance: no pain with radial deviation against resistance,Ulnar head loading tolerance: no pain with ulnar deviation and TFCC compression,Carpal stability: no scapholunate or lunotriquetral instability signs,Tendon resilience: pain-free resistive exercises for flexor and extensor groups
→ Advance to: Advanced Strengthening
Grip strength: 75% of contralateral side,Wrist strength testing: break test against resistance grade 4/5,Lunate and scaphoid loading: pain-free with push-up progression,Functional endurance: able to perform 20 repetitive wrist movements with 5lb,Precision grip: able to manipulate small objects without fatigue,Radial and ulnar artery flow: palpable pulses with Allen test normal
→ Advance to: Advanced Strengthening
Grip strength: 80% of contralateral side,Wrist proprioception: joint position sense within 5 degrees of contralateral side,Functional testing: able to lift 10lb from waist to shoulder level,Repetitive task performance: 50 consecutive wrist movements without fatigue,Carrying tolerance: able to carry 10lb for 5 minutes without discomfort,Return to light work activities permitted if job demands met
→ Advance to: Return to Function
Grip strength: 85% of contralateral side,Sport-specific or occupation-specific movement patterns tolerated,No pain with provocative activities: gripping, lifting, pushing, pulling,Wrist kinematic chain: smooth coordinated movement from shoulder to hand,Endurance: able to sustain activity for 30 minutes without symptom exacerbation,Psychological readiness: patient confident in wrist loading
→ Advance to: Return to Function
Grip strength: 90% of contralateral side,Functional capacity: return to full work duties with modifications if needed,Advanced tasks: able to perform power grip and fine motor tasks interchangeably,Carrying capacity: bilateral carrying 20lb, unilateral 10lb,Repetitive stress tolerance: 100+ grip cycles without fatigue,Patient satisfaction: subjective reports of 80%+ return to pre-injury function
→ Advance to: Sport-Specific/High-Demand
Full grip strength: 95% or greater of contralateral side,Sport-specific loading: controlled exposure to impact and loading forces,High-velocity movements: tolerated without compensation or pain,Fatigue management: symptoms do not flare with sustained activity,Joint stability: no laxity with valgus/varus stress testing at wrist,Return to training: cleared for progressive return to practice
→ Advance to: Sport-Specific/High-Demand
Grip strength: 100% of contralateral side or within functional limits,Full ROM: no restrictions in any wrist or forearm motion,Sport/occupation clearance: full return to pre-injury level if criteria met,Education completed: home exercise program independence,Long-term monitoring: follow-up scheduled for 3 and 6 months,Discharge criteria met: patient independent with maintenance program
Return to activity milestones
Pain-free basic activities of daily living
Week 4Patient demonstrates correct scapular setting during arm elevation
Light functional activities and conditioning
Week 6Wrist and finger range of motion full; no tenodesis limitation
Moderate activity and sport-specific conditioning
Week 8Patient demonstrates correct hand therapy exercise technique
Full return to sport, occupation, and recreation
Week 14Elbow flexion and extension range adequate for ADL completion
Precautions
- stop-if-pain-increases
- warm-up-before
Contraindications
- limited-range-before-assessment
- acute-inflammation
- dvt-risk
- severe-osteoporosis
Pain management
- Cryotherapy: ice pack application for 15-20 minutes post-session
- Neural gliding exercises: median nerve and ulnar nerve tensioners
- Soft tissue mobilization: cross-friction massage for tendon healing zones
- Joint mobilization: radiocarpal and midcarpal glides for stiffness
- Positioning and ergonomic education: wrist neutral positioning for ADLs
Equipment & modalities
Frequently asked questions
How much soreness is normal after a session?
Can I skip the dip station work if it feels too hard?
What if I miss sessions or fall behind?
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed October 6, 2026. · Read our editorial policy