Wrist Fracture Exercises: Rehabilitation After Distal Radius Fracture

A distal radius fracture (broken wrist) is one of the most common fractures, often occurring from a fall onto an outstretched hand. Whether treated with a cast or surgery, rehabilitation exercises are essential for restoring wrist mobility, strength, and function. Starting exercises at the right time can mean the difference between full recovery and lasting stiffness.

Understanding Wrist Fractures

Types of Distal Radius Fractures

• Colles Fracture: Most common, wrist bends backward
• Smith Fracture: Wrist bends forward (reverse Colles)
• Barton Fracture: Involves the wrist joint surface
• Intra-articular: Extends into the wrist joint

Treatment Options

• Casting: For stable, non-displaced fractures (4-6 weeks)
• Surgery (ORIF): For displaced, unstable, or joint-involved fractures

Healing Timeline

• Bone healing: 6-8 weeks typically
• Full recovery: 3-6 months
• Final improvement: Up to 1 year

During Immobilization (Week 0-6)

Even while in a cast or splint, exercises prevent stiffness elsewhere:

Finger Exercises

Keep fingers mobile:

Finger Tendon Glides:

1. Start with fingers straight
2. Make a hook fist (bend at middle joints)
3. Make a full fist
4. Make a tabletop (bend at knuckles only)
5. Return to straight

Finger Spreads:

1. Spread fingers wide apart
2. Bring together
3. Repeat

Perform: 10-15 cycles, every 1-2 hours

Thumb Exercises

1. Touch thumb to each fingertip
2. Move thumb away from palm, then back
3. Circle thumb gently

Perform: 10-15 reps, 3-4 times daily

Shoulder and Elbow

Prevent stiffness from guarding:

Elbow Flexion/Extension:

1. Bend and straighten elbow fully
2. Move through complete range

Shoulder Circles:

1. Roll shoulders forward and backward
2. Raise arms to side and front (within comfort)

Pendulums (if shoulder stiffens):

1. Lean forward, let arm hang
2. Swing gently

Perform: 15-20 reps each, 2-3 times daily

Edema Control

Reduce swelling:

1. Elevate hand above heart level frequently
2. Pump fingers (make fist, release)
3. Gentle massage toward body (if not over fracture)

Phase 1: Early Mobility (Week 6-8)

When Cast Comes Off

Begin after immobilization ends and cleared by physician.

Goals

• Restore wrist range of motion
• Continue finger mobility
• Reduce stiffness
• Manage swelling

Wrist Flexion/Extension

1. Rest forearm on table, wrist over edge
2. Bend wrist down (flexion)
3. Bend wrist up (extension)
4. Move to end of comfortable range

Perform: 15-20 reps, 5-6 times daily

Wrist Radial/Ulnar Deviation

1. Rest forearm on table, palm down
2. Move wrist toward thumb side (radial)
3. Move wrist toward pinky side (ulnar)
4. Keep forearm still

Perform: 15-20 reps, 5-6 times daily

Forearm Rotation

1. Elbow at side, bent 90 degrees
2. Rotate palm up (supination)
3. Rotate palm down (pronation)
4. Move through full available range

Perform: 15-20 reps, 5-6 times daily

Table Slides

1. Place palm flat on table
2. Slide hand forward, letting wrist bend
3. Slide back toward you
4. Use table for support

Perform: 15-20 reps, 3-4 times daily

Passive Stretching (Gentle)

Wrist Flexion Stretch:

1. Hold affected hand with other hand
2. Gently bend wrist down
3. Hold 15-30 seconds

Wrist Extension Stretch:

1. Hold fingers
2. Gently bend wrist up
3. Hold 15-30 seconds

Perform: 3-5 reps each direction, 3 times daily

Grip Work (Light)

1. Squeeze soft ball or putty
2. Very light pressure initially
3. Progress as tolerated

Perform: 15-20 squeezes, 2-3 sets

Phase 2: Progressive Strengthening (Week 8-12)

Goals

• Increase wrist strength
• Progress grip strength
• Return to daily activities
• Improve functional use

Wrist Curls

Flexion:

1. Forearm on table, palm up, wrist over edge
2. Hold light weight (1-2 lbs or soup can)
3. Curl wrist up
4. Lower slowly

Extension:

1. Same position, palm down
2. Extend wrist up
3. Lower slowly

Perform: 15-20 reps each, 3 sets

Pronation/Supination with Weight

1. Hold hammer or weight
2. Rotate forearm fully
3. Control the movement

Perform: 15-20 reps, 3 sets

Resistance Band Exercises

Band Wrist Flexion:

1. Anchor band under foot
2. Hold with palm up
3. Curl wrist against resistance

Band Wrist Extension:

1. Same setup, palm down
2. Extend wrist against resistance

Perform: 15-20 reps each, 3 sets

Grip Strengthening

Hand Gripper:

1. Start with light resistance
2. Squeeze fully
3. Release slowly

Putty Work:

1. Pinch, squeeze, and twist therapy putty
2. Work all fingers

Perform: 15-20 reps, 3 sets

Finger Resistance

1. Place rubber band around fingers
2. Spread fingers apart against resistance
3. Return slowly

Perform: 15-20 reps, 3 sets

Phase 3: Functional Recovery (Week 12+)

Goals

• Full strength restoration
• Return to all activities
• Sport/work-specific training
• Address any remaining deficits

Weight-Bearing Progression

Wall Push-Ups:

1. Hands on wall
2. Push-up motion
3. Progress to incline, then floor

Quadruped:

1. On hands and knees
2. Rock forward and back
3. Weight through wrists

Perform: 10-15 reps, 3 sets

Loaded Exercises

Farmer's Carries:

1. Hold weights at sides
2. Walk 30-50 feet
3. Progress weight as tolerated

Dumbbell Exercises:

1. Bicep curls
2. Overhead press
3. Rows

Perform: 10-15 reps, 3 sets

Sport-Specific

Golf/Racket Sports:

1. Start with light swings
2. Progress intensity
3. Focus on wrist position

Weightlifting:

1. Gradual return to pressing
2. Wrist wraps may help initially
3. Progress load slowly

Work Simulation

Practice job-specific tasks:

• Typing
• Tool use
• Lifting
• Writing

Expected Range of Motion

Normal Wrist ROM

• Flexion: 75-80 degrees
• Extension: 70-75 degrees
• Radial deviation: 20 degrees
• Ulnar deviation: 35 degrees
• Pronation: 80 degrees
• Supination: 80 degrees

After Fracture

• May achieve 80-90% of normal
• Functional range is most important
• Some stiffness may persist

Complications and Concerns

Stiffness

Most common issue:

• Early motion is key
• Consistent stretching
• May need hand therapy
• Most improve over 6-12 months

Complex Regional Pain Syndrome (CRPS)

Watch for:

• Disproportionate pain
• Color or temperature changes
• Excessive swelling
• Shiny skin

Seek immediate evaluation if suspected.

Malunion

If bone heals in poor position:

• May cause wrist deformity
• Limited motion
• May need additional treatment

Arthritis

Long-term consideration:

• More common with joint involvement
• May develop years later
• Staying active helps

Scar Management (Post-Surgery)

If surgical:

Scar Massage:

1. Once incision healed (2+ weeks)
2. Use lotion or vitamin E
3. Massage in circular motions
4. Massage across and along scar

Desensitization:

1. Rub different textures on scar
2. Start soft, progress to rough
3. Reduces sensitivity

Perform: 5-10 minutes, 2-3 times daily

Sample Weekly Schedule (Phase 2)

Daily (Multiple Times)

• Wrist ROM exercises: 15-20 reps each direction
• Finger exercises: 10 reps each
• Forearm rotation: 15-20 reps

Monday/Wednesday/Friday

• Wrist curls (flexion/extension): 3x15
• Pronation/supination with weight: 3x15
• Grip strengthening: 3x15
• Stretching: 3 reps each stretch

Tuesday/Thursday

• Resistance band exercises: 3x15
• Putty work: 5 minutes
• Finger resistance: 3x15

Tips for Faster Recovery

1. Start early - Begin finger exercises while still casted
2. Frequent short sessions - Multiple times daily beats one long session
3. Heat before exercise - Warm shower or heat pack loosens tissues
4. Ice after exercise - Reduces any exercise-related swelling
5. Be patient - Full recovery takes 3-6 months

When to Seek Help

Contact your provider if:

• Increasing pain despite therapy
• No progress after 2-3 weeks of exercise
• Significant swelling or discoloration
• Fever or signs of infection (if surgical)
• Numbness or tingling that worsens

Key Takeaways

Wrist fracture rehabilitation requires consistency:

1. Move fingers early - Even while casted
2. Start wrist motion when cleared - Stiffness sets in quickly
3. Progress gradually - ROM before strength
4. Multiple sessions daily - Frequency matters
5. Full recovery takes months - Be patient with the process

Most people regain good wrist function after fracture, but outcomes improve significantly with dedicated rehabilitation. The effort you put into exercises directly impacts your final result.