Physical Therapist's Guide to Wrist Fracture
De Quervain's (dih-kwer-VAINS) tendinitis is a condition that causes pain and tenderness at the thumb side of the wrist, at the base of the thumb and forearm. Pain is worsened with grasping or extending the thumb (pulling it back like "thumbing a ride"). People of all ages can develop this condition, which usually happens when the tendons are strained by prolonged or repetitive use of the hand, rapid or forceful hand use, or use of the hand or arm in an awkward position. Tendons at the wrist become irritated and thickened, resulting in pain when moving the thumb and grasping objects. Common forms of treatment for De Quervain’s include splinting and range-of-motion exercises. Injection for cortisone by a doctor is common treatment. Persistent cases may require surgery.
What is Wrist Fracture?
A fracture is a crack or a break in a bone. Wrist fractures due to falls happen most often when people stretch the arm straight out to catch themselves as they fall. The wrist is made up of 8 small bones called carpal bones, and 2 bones in the forearm called the radius and the ulna. A wrist fracture is diagnosed when any of those bones breaks or cracks. The most frequently fractured bone is the radius, the bone in the forearm that is closest to the thumb.
There are 3 types of bone fractures:
- Type 1 – a "nondisplaced" fracture, where the bone is broken but is still in a normal position.
- Type 2 – a fracture where a fragment of bone is shifted from its normal position.
- Type 3 – the most serious type of fracture, with multiple breaks of the bone or bones.
Type 1 and 2 fractures usually are treated without surgery. Type 3 fractures, however, usually require surgery.
How Does it Feel?
A fractured wrist is usually painful and movement is affected. If you have sustained a wrist fracture, you may experience:
- Pain in the area of the fracture, which could be anywhere in the wrist, depending on which bone was affected. The pain can radiate from the wrist into the fingers, and even into the forearm.
- Swelling in the wrist and possibly in the hand, usually on the top surface of the wrist and hand.
- Tenderness to touch in the wrist.
- Difficulty and pain when moving the wrist or fingers
How Is It Diagnosed?
An x-ray is the best way to diagnose a wrist fracture. If you have sustained a fall and are experiencing any of the symptoms mentioned above, you need to visit an emergency room, an urgent-care center, or your physician to get a complete diagnostic x-ray.
If a physical therapist suspects that you have a wrist fracture, the therapist may arrange for an x-ray and refer you to an appropriate physician. Your physical therapist can check for damage to other joints and muscles, and make sure that the nerves and blood vessels in your wrist, forearm, and hand have not been affected by the broken bone. In most cases, people with fractures visit a physician with a specialty in managing bones and joints (an orthopedist). Depending on the type of fracture, the physician might prescribe a cast or a sling to immobilize the area for a period of time until the fracture is healed. The amount of healing time varies, depending on the individual and the type of fracture, and can be anywhere from 4 to 10 weeks. If the fracture is severe, surgery will be required. The recovery time may be longer following surgery, depending on the severity of the injury.
How Can a Physical Therapist Help?
Your physical therapist will work with you following a wrist fracture to help you regain normal wrist motion, strength, and function, and will provide education and training to help you prevent future fractures.
While Your Wrist Is In a Cast or a Sling
While your bone heals, your arm will be in a cast or a sling to keep it still and promote healing. During that time, it is important to ensure that the arm does not get too stiff, weak, or swollen. Depending on the amount of activity that is allowed for your type of fracture, your physical therapist will prescribe gentle exercises to keep your shoulder, elbow, and fingers moving while you are in the cast or sling.
Most people with wrist fractures will slowly return to exercising the other arm and the legs, so that the rest of the body doesn't get out of shape while the fracture is healing. Your physical therapist can help you adapt your exercise program, so that you can maintain your overall strength and fitness without interfering with the healing of your wrist.
When the Cast or Sling Is Removed
After your cast or sling is removed, your wrist will most likely be stiff, and your arm will feel weak. Your physical therapist will examine your wrist, and select treatments to improve its function and restore strength to your arm.
Your rehabilitation will include treatments to:
Reduce Pain. Your physical therapist might use either warm or cold therapeutic treatments, or electrical stimulation, to help control pain or swelling in your wrist, hand, or arm.
Relieve Stiffness. Your physical therapist may use skilled hands-on techniques (manual therapy) to enable your joints and muscles to move more freely with less pain.
Increase Your Strength and Ability to Move. Physical therapists prescribe several types of exercises during recovery from a wrist fracture. Early on, your physical therapist can help you begin to gently move your elbow, using "passive range-of-motion" exercises. As your arm gets stronger, you can exercise it yourself without weights ("active range-of-motion" exercises). Once the bone is well-healed, you can begin to perform resistance exercises, using weights or elastic bands. In addition to prescribing range-of-motion and strengthening exercises, your physical therapist can help you retrain your muscles to react quickly when you need to protect yourself from a fall.
Get Back to Your Daily Activities. Your physical therapist will help you remain independent by teaching you how to perform your daily activities (eg, dressing, working on a computer, and cooking), even while wearing a cast or a sling. Once you can move your arm freely without pain, your physical therapist may begin adding activities that you were doing before your injury, such as using your arm for dressing, grooming, and housekeeping. Your physical therapist will design your individualized program based on an examination of your wrist, goals, level of physical activity, and general health.
Prepare for More Demanding Activities. Depending on the requirements of your job or the type of sports you play, you might need additional physical therapy tailored to meet specific demands. Your physical therapist will develop a specialized program to address your unique needs and goals.
Prevent Long-Term Disability. Everything your physical therapist prescribes for you will help prevent long-term disability by:
- Returning the arm to a strong level of fitness.
- Restoring full movement and strength in a safe manner, while healing occurs.
- Assessing the fracture to make sure that you can return safely to previous home and work activities.
- Guiding you to a safe return to sports and other physical activities. A return too early after a fracture may increase the risk of another fracture.
- Recommending protective equipment, such as wrist guards, for use during sports.
Can this Injury or Condition be Prevented?
In addition to helping individuals prevent long-term disability following a wrist fracture, physical therapists can help different at-risk populations prevent fractures.
- For the aging population, avoiding falls and other trauma is the best way to prevent fractures. Physical therapists are experts at determining your risk of falling, and can teach you how to perform balance exercises and take precautions to avoid falls. They also can perform work and home safety evaluations to make sure that your daily environment is safe.
- For postmenopausal women with osteoporosis leading to a higher risk of wrist fracture, a physical therapist can teach weight-bearing exercises to help build stronger bones. Your physical therapist also may refer you to a nutritionist for vitamin D supplements or other dietary changes to help make your bones stronger. Education in proper posture and body mechanics and joint protection techniques can be helpful in preventing strain on the wrist and arms.
- For children, wearing proper protective gear, such as wrist guards, can reduce the risk of a wrist fracture when playing certain sports. Making sure that playground equipment your child uses is safe and built on a soft surface can also reduce the risk of wrist fractures due to falls.
Real Life Experiences
Ellen is a 52-year-old teacher who also coaches junior varsity girls basketball. She keeps to a strict schedule. This morning, following a cold rainstorm last night, Ellen took a quick step outside her front door, and slipped on a patch of black ice. She extended her left arm to break her fall, but hit hard on the heel of her hand. She felt a sharp pain in her wrist.
Her neighbor witnessed her fall and rushed over to help. Ellen was able to stand and walk, but her left wrist was throbbing with pain, and she realized that she couldn't move it. Her neighbor kindly drove her to the emergency room.
Upon review of Ellen's x-ray, the emergency room doctor diagnosed a type 2 wrist fracture, where the radius bone was fractured and shifted from its normal position. The doctor assured her that surgery was not needed, and placed her arm in a cast, telling her it would need to stay on for 6 weeks. He referred Ellen to physical therapy, explaining that, by following the guidance of her physical therapist, she could speed her recovery in the safest way possible.
Ellen's physical therapist took her health history, and asked her to describe how she had sustained the fracture. Luckily, Ellen was holding her briefcase in her right hand when she fell, and fractured her left wrist. She was relieved to know that she could still use her dominant right hand to perform her daily tasks.
Ellen's physical therapist evaluated her left wrist after the cast was removed, noting that it was stiff and weak. She taught Ellen some gentle range-of-motion exercises for the wrist and hand. She also showed her how to apply heat at home to help ease any stiffness and pain.
When Ellen had restored normal motion in her wrist, her physical therapist instructed her in the use of light weights and resistance bands to begin strengthening exercises. She designed an individualized home-exercise program for Ellen, to continue strengthening at home.
A month into treatment, Ellen's physical therapist introduced some easy basketball drills, including passing and shooting. Ellen also worked on the stationary bike in the clinic to maintain her cardiovascular fitness, and continued to perform her leg-strengthening routine, so that when her wrist healed, she would be ready to resume basketball coaching.
Five weeks after the cast was removed, Ellen felt her wrist was back to its normal strength, and more. She performed all of her daily activities, in the classroom and the gym, with her usual verve. Last evening, Ellen coached her junior varsity basketball team to its first win of the season!
This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:
- A physical therapist who is experienced in treating people with orthopedic problems. Some physical therapists have a practice with a orthopedic focus, and some even specialize in upper-body injuries.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopaedics physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with fractures.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
Revised by Julie Mulcahy, PT, MPT. Authored by E. Anne Reicherter, PT, DPT, PhD, OCS, CHES. Reviewed by the MoveForwardPT.com editorial board.
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