Intermediate Wrist and Hand Post-Surgical Rehabilitation

Surgical incision healing progression with no signs of infection or wound dehiscence,Pain controlled at ≤3/10 on VAS at rest and during passive wrist flexion,Passive wrist ROM: 20° flexion, 20° extension without pain,Active digit flexion to full composite fist achieved,Edema reduction with girth measurement decreased by ≥10% from initial,Median nerve gliding tolerance without radiating symptoms

→ Advance to: Phase 2

Continued wound closure with sutures intact or staples stable,Passive wrist ROM: 30° flexion, 30° extension within tolerance,Active forearm pronation 70°, supination 70°,Sensibility testing: normal two-point discrimination <6mm at median nerve distribution,No tendon rupture signs during passive digit extension,Isometric wrist flexor and extensor contractions at submaximal resistance (10% max) tolerated

→ Advance to: Phase 2

Passive wrist ROM: 45° flexion, 45° extension achieved,Active wrist extension against gravity for 10 repetitions without fatigue,Full composite fist and individual digit flexion-exursion achieved,Tendon gliding exercises: straight fist, hook fist, full fist sequences pain-free,Grip strength ≥30% of contralateral side measured by dynamometer,Wrist flexor and extensor isometric hold for 5 seconds at 25% maximal effort

→ Advance to: Phase 3

Passive wrist ROM: 60° flexion, 60° extension with minimal stiffness,Wrist flexion and extension against resistance: 25% body weight tolerated,Functional grip for activities of daily living (ADL) for 10+ minutes,No median or ulnar nerve provocation with dural mobilization techniques,Pronation and supination full range against resistance grade 3/5,Carpal tunnel symptoms: no nocturnal paresthesia or positive Tinel's sign reproduction

→ Advance to: Phase 3

Grip strength ≥50% of contralateral side,Wrist extensor strength: MMT 4/5 (resistance against gravity + some resistance),Wrist flexor strength: MMT 4/5,Radial and ulnar deviation through full range against resistance,Extensor carpi radialis brevis and longus endurance: 15 repetitions at 50% resistance,Flexor carpi radialis and ulnaris endurance: 15 repetitions at 50% resistance

→ Advance to: Phase 4

Grip strength ≥70% of contralateral side,Wrist flexor and extensor strength: MMT 4+/5,Fine motor coordination assessed: Purdue Pegboard test within 85% of normative,Repetitive wrist flexion-extension: 50 repetitions at moderate resistance without fatigue,Distal radius fracture healing confirmed via radiograph if applicable,Tolerance to functional activities requiring repetitive wrist motion for 30+ minutes

→ Advance to: Phase 4

Full pain-free wrist ROM: 70° flexion, 70° extension, 20° radial, 35° ulnar deviation,Grip strength ≥85% of contralateral side,Wrist flexor and extensor strength: MMT 5/5,Return to work or sport-specific activities without restrictions,No symptom reproduction with provocative tests (Tinel's, Phalen's, carpal compression),Patient-reported outcome measures: DASH score <15 or improvement ≥20 points from baseline

→ Advance to: Discharge to maintenance program