Wrist

*If you are experiencing persistent pain, diminished function, loss of strength, range of motion, and/or sensation, BCPT recommends that you contact your physician, as a serious underlying physical condition may be present.

Colles' Fractures

The most common fracture at the wrist is actually a fracture of the distal end of the forearm bone called the radius. The fracture usually occurs by falling on an outstretched hand. Management of Colles' fracture ranges from closed reduction with casting, to open reduction with internal fixation (ORIF), depending on the severity of injury. Healing rates of upper extremity fractures generally take 8-10 weeks. This time may be longer if nearby joints have been injured. The necessary immobilization required for healing leads to joint stiffness, tendon tightness, and edema. Therefore, after the immobilization device has been removed, it is important to initiate active and passive range of motion exercises of all the surrounding joints. Full functional recovery can take from 4 months to a year.

Scaphoid Fracture

Fractures to this wrist bone, located at the base of the thumb, constitute approximately 60% of all wrist fractures. These fractures are most frequently caused by a fall on an outstretched hand and less commonly by a direct blow to the hand. Fractures of the scaphoid occur at three distinct locations. Rate of healing, and extent of complications, depend on the location of the fracture, and its associated blood supply. Whereas the midportion and the bone is well vascularized, the proximal portion has a relatively poor blood supply. This poor vascularization can lengthen healing time and lead to avascular necrosis (bone death due to a loss of blood flow) or fracture non union, if not appropriately treated and imobilized. Once the cast is removed, focus must shift to increasing motion of the wrist and thumb with gradual progression into strengthening and functional training exercise.

Gamekeeper's Thumb

Stresses to the inner aspect of the thumb can result in rupture of the ligament of the inside of the thumb. This injury is frequently sustained when skiing, as forces are placed on the thumb through the ski pole. Injury to this ligament results in lateral instability of the thumb. These injuries can be managed with casting or splinting, however, if significant displacement of the bony attachment (avulsion) of the ligament is present, surgery may be required. In either case, the spica cast or splint is usually removed at 6 weeks, when active and gentle passive motion exercises are initiated.

References: Norkin, CC and Levangie, PK: Joint Structure and Function, A Comprehensive Analysis Magee, DJ: Orthopedic Physical Assessment Richardson, JK and Iglarsh ZA: Clinical Orthopaedic Physical Therapy