Intermediate Wrist and Hand Post-Surgical Rehabilitation

Pain at rest < 3/10 with splint immobilization of distal radius and carpal tunnel,Incision healing > 90% without signs of infection at median nerve release site,Active digital flexion of flexor digitorum profundus and superficialis intact,No median nerve irritation symptoms (paresthesia in thumb, index, middle finger),Wrist flexion/extension limited to 10-15 degrees within pain tolerance

→ Advance to: Protected Mobility

Wrist range of motion: flexion 20-30°, extension 20-30°, ulnar deviation 10-15°,Forearm rotation: pronation 45-60°, supination 45-60°,Grip strength > 30% of contralateral side using Jamar dynamometer,No tendon gliding dysfunction of flexor tendons within carpal tunnel,Carpal bone stability maintained (no scapholunate interval widening on assessment)

→ Advance to: Strengthening Initiation

Wrist ROM: flexion 40-50°, extension 40-50°, radial deviation 15-20°, ulnar deviation 20-25°,Grip strength 50-60% of contralateral side,Median nerve neural glide testing negative (no reproduction of symptoms in thenar eminence),Distal radius fracture callus formation evident if ORIF performed,Finger flexion tendon glide complete (no triggering at A1 pulley)

→ Advance to: Progressive Strengthening

Wrist ROM: flexion 55-65°, extension 55-65°, full forearm rotation,Grip strength 70-80% of contralateral side,Pinch grip (key pinch, tripod pinch) > 70% of contralateral side,No provocative pain with resisted wrist flexion of flexor carpi radialis/ulnaris,Extensor tendon function intact (full finger extension against resistance)

→ Advance to: Return to Function

Wrist ROM within 10° of contralateral side (flexion, extension, deviation),Grip strength > 85% of contralateral side,Full functional use of hand for ADL activities without compensatory patterns,No residual median nerve symptoms (thenar muscle strength normal, no atrophy),Carpal stability tests negative ( Watson test for scapholunate, midcarpal shift test)

→ Advance to: Discharge