Distal Radius Fracture – A Rehabilitation Guide

Wrist Fracture

What is a distal radius fracture?
There are two bones in the forearm, the radius and ulnar. At the wrist joint, the radius is the on the thumb side. The term distal refers to the end of the bone furthest away from the body.

This is the most common type of fracture at the wrist. Most fractures will often be accompanied by sprains to the ligaments around the wrist due to being stretched on impact. Due to this, pain can be common the little finger side of the wrist. On occasion, the ulnar side of the wrist may fracture as well, causing a chip of bone to move away from the ulnar styloid. Your doctor will tell you if this is the case.

A fracture of the wrist is usually treated by immobilising the wrist in a cast for four to six weeks depending on the severity and alignment of the fracture.

If the fracture is not in good alignment, it may require manipulation or surgery to correct it with metalwork fixation.

After any wrist fracture, it is expected that you will have some swelling and stiffness of the wrist, forearm, fingers, and thumb. If you have any excessive swelling that does not improve with elevation and rest, it is advisable to contact your GP or fracture clinic for advice.

Your plaster should not feel too tight and the hand should feel like it belongs to you. The main knuckles of the hand should be free to move. If you have any concerns like this, please contact the fracture clinic.

In rare cases, some patients can experience a tear to the long tendon (extensor pollicis longus), which lifts the end joint of the thumb. This may present with the end of the thumb drooping down, and inability to straighten it. This should be checked for before you are discharged. If you have any concerns about this, please contact fracture clinic or if you have been referred, your physiotherapist.

Complete recovery from a fracture may take up to one year, but you will likely be back to doing lots of normal tasks such as driving by 8-12 weeks following.

Everyone is different in how quickly they may recover, so try not to compare yourself to others you may know who have had the same injury.

Sensation changes are also common. Pins and needles or numbness into the fingers or hand may be felt intermittently in the early days due to the nerves becoming irritated or restricted by swelling, or from being stretched at the time of the injury. This usually resolves on its own.

If persisting, not improving with elevation, movement and is affecting your function, please contact fracture clinic or if you have been referred, your physiotherapist.

Swelling management:

• Elevation of the wrist and hand up onto your chest or by resting your elbow onto a comfortable surface.
• Wearing the splint or some ‘tubigrip’ bandaging for compression.
• Ice application for 10-15 minutes maximum. This should only be completed if you cast has been removed. You can use some frozen peas or a gel pack. Ensure to wrap this in a damp towel to protect your skin. Check your skin regularly over this time to make sure there is no severe blanching of the skin.
• Massage can help with swelling, reducing pain and sensitivity of the skin to light touch. Do this using a non-perfumed moisturiser or oil, starting at your hand and pushing up towards the elbow.

Scar Management
If you have had any surgery to your wrist, it is important that once your wound has healed and the scar has formed that you massage it regularly. This is important for ensuring that your scar doesn’t become overly sensitive to light touch. Exposing it to varied textures, e.g. soft, smooth or rough can help to reduce this and ensure the area adapts to normal stimulus such as clothing over the area.

Scar massage should be completed for up to three minutes, 3 times a day in a circular motion all along the length of the scar, applying a firm but tolerable pressure. Use a moisturiser when doing this if you wish.

Activity advice
You should try to begin to use your affected wrist for light tasks once your cast is removed to assist it in regaining range of movement, strength and dexterity. To start with, you should avoid any heavy lifting or carrying, such as using a kettle or pushing a heavy door.

Examples of manageable light activities to try:

• Using your phone
• Completing personal care e.g. washing, applying make-up, or brushing your hair.
• Dressing e.g. light clothing, zips and easy buttons,
• Writing – signing your name or crossword puzzles
• Washing up light items and wiping tables.

Pain management
It is expected to have some degree of discomfort following this injury and when trying to regain your movement. This does not indicate that you are causing harm or worsening of your injury. Remember that your joint and surrounding soft tissues have been immobilised and have not been used to moving for some weeks. When doing the exercises, you may feel stiffness, stretching or pulling sensations. These are all usual sensations initially and a sign that the tissues are trying to adapt.

These symptoms will ease with time as your wrist and hand adjust to the exercises.

On a pain scale of 0-10 (10 being the worst and 0 being no pain) your pain should not increase beyond a 5/10 when completing the exercises, and any discomfort you feel should settle within 30 minutes.

If you are regularly experiencing pain higher than this, we would recommend discussing your symptoms with your GP or a local pharmacist who may be able to advise if you are taking appropriate pain relief.

Alternatively, if you are struggling with any of the exercises shown, please contact fracture clinic or if you have been referred, your physiotherapist.

What if I have questions/concerns?
This booklet is designed to give you independence with your rehabilitation, but to help you identify when you may need further support.

If this booklet was issued by the physiotherapy department, you may now be on an open appointment via our service called PIFU (patient-initiated follow-up). PIFU allows you to carry out your physiotherapy treatment independently, with support available if required. Please contact the physiotherapy department directly if this is required, within the agreed timeframe. If you have not been referred to/seen by a physiotherapist, please call virtual fracture clinic.

If this booklet was issued by virtual fracture clinic, you should contact them directly with any concerns. They will be able to refer you to physiotherapy if required.

Contact Information:

Physiotherapy departments (Monday to Friday 8:00 – 15:30):
Alexandra Hospital Redditch 01527 512114
Worcestershire Royal Hospital 01905 760294
Kidderminster Hospital 01562 513066

Virtual fracture clinic (Monday to Friday 7:00 – 14:30):
Worcester Royal Hospital (covers all trust locations): 01905 760 259

https://staging.worcsacute.mixd.co.uk/virtual-fracture-clinic

Healing Time Scales – What can I do? When can I progress?

For each time frame shown below, please refer to the corresponding exercises in this booklet.

Whilst in cast: Range of movement (ROM) exercises for the fingers, thumb and elbow and shoulder should be completed whilst in the cast.

Once out of cast (or when you have been advised you can start wrist exercises if managed in a splint only): Begin active range of movement exercises for the wrist and forearm. Finger, thumb, and elbow exercises should be continued. Aim to wean out of the splint if given one by 8 weeks.

6-8 weeks Start to increase the amount you can lift by completing lifting tasks. Lifting activities should not feel strained. You can start to passively stretch into your movements to help regain more range at the joint as tolerated. Strengthening exercises can be started as symptoms allows from approx. 8 weeks.

12 weeks+  Bone strength at the fracture site will now be increasing. Continue to progress loading with lifting tasks as comfortable. You may wish to start some gentle weight bearing exercises.

1 year post  It may take up to one year to feel that your wrist is fully recovered from this injury, but you should be back doing most of your normal tasks by 12 weeks. You are likely to still see small ongoing improvements up to one-year post-injury.

Exercises – For all exercises in this booklet, it important that you are guided by your symptoms and modify the amount/frequency and intensity of the exercise as required.

Exercises within cast
If you have any pain in your shoulder or other joints not assessed, please seek advice before completing these. These are designed to mobilise joints above and below the immobilised fracture site.

Elbow bend and straighten. Standing up or sitting. Hold a supportive surface if required when standing. Relax your arm and straighten your elbow as much as possible. Slowly, bend your elbow bringing your palm towards your shoulder.
Reaching to ceiling Standing up or sitting. Hold a supportive surface if required when standing. With a straight arm, lift your hand up towards the ceiling to flex the shoulder.
Thumb to finger Bring your thumb to meet your index finger as if making the ‘OK’ sign. Then move along to your 3rd, 4th, then 5th fingers. If able, reach for each crease of your 5th finger starting at the top and moving down to where the finger meets the palm.
Finger flexion – small knuckles As best as you can, bend just the end joints of your fingers to the touch the top of the palm and the bottom of the palm to the positions shown below. Please bear in mind that everyone’s range of movement before an injury may differ, if you cannot achieve this on your other hand, aim to reach the same on both. Swelling following your fracture may also limit you at this stage, but trying to do the movements as best as you can will reduce stiffness and improve function when your cast is removed, and as swelling goes down.
Finger flexion – main knuckles Keeping the end two small joints of your fingers straight, bend just the main knuckles of your hand as best as you can. Bring the finger tips towards the thumb.
Thumb flexion and circles 1) Make a ‘thumbs up’ sign. Gently circle the thumb as able. 2) Bend the end joint of your thumb down as able and lift it back up again as shown.

Exercises to do once cast removed or when you have been advised that you can start exercises for the wrist joint.

Wrist flexion and extension Slowly lower your hand down to allow the wrist to bend as far as you can. Lift the hand up to extend the wrist – assist with the other hand to support the weight of your hand if needed.
Forearm pronation and supination Have your forearm resting on a table or the arm of a chair. Palm on its side and your hand over the edge of the surface. Slowly, turn your hand over to face the palm to the floor. Return to the start position and turn your palm upwards to face the ceiling. Tip – Keep your elbow bent and tucked into the side of your body. This is important to prevent compensatory movement from the shoulder or trunk.
Wrist radial and ulnar deviation Have your forearm resting on a table or the arm of a chair. Palm on its side and your hand over the edge of the surface. Tilt the wrist and hand upwards towards the ceiling and then down towards the floor.
Open and close Make a fist, bringing the fingertips into the palm of your hand. Hold for 3-5 seconds Relax, then spread out your fingers as wide as you can.
Prayer stretch Put both palms together with your hands in front of your face. Slowly, lower your hands down towards your chest, lifting the elbows up. Keep the palms together as best as able. Hold the position you can manage until you feel slight discomfort. Do this for 10 seconds at a time if able, then relax.	*Please note that the angle of wrist movement shown above would not be expected to be achieved when starting this exercise. This image is to demonstrate the principle of the exercise. Everyone’s normal range of movement pre-injury varies. Range of movement restored post wrist fracture will vary in everyone and depend on the severity of the injury.

Tip! – Patience with restoring range of movement is important, and it is normal for it to take a few months to see good improvement in some. If you are concerned though, please contact the department for advice.

Exercises from approx. 6-8 weeks onwards (guided by pain)

Table extension In sitting, place your hand flat on the table. Slowly, lift up your elbow so that you feel a bend in the wrist. Hold for 10 seconds.
Flexion with overpressure Have your forearm supported on a table, with your hand and wrist over the edge, palm facing down. Relax the hand down. Using your other hand, apply a downward stretch. Hold for 10 seconds.
Assisted supination and pronation Clasp your hands together, have your elbows bent to 90 degrees and tucked into your side.  Use your other hand to assist the movement of turning your palm upwards and then downwards, as if holding the hand out for coins and then tipping them to the floor.
Assisted radial and ulnar deviation Sit with your forearms supported on a table. Clasp your hands together and tilt the wrist and hands up and down.

Strengthening exercises from approx. 8 weeks onwards (guided by pain)

Towel wringing Roll up a small towel and grip with both hands. Wring out the towel, first moving your hand forward and then backwards like revving a motorbike.
Weighted wrist extension Using an appropriate weight of around 0.5kg (500g – e.g. a tin) or less if this feels too much to start. Have your forearm supported on a table, with your hand and wrist over the edge, palm facing down. Hold the weight and lift it up bending from the wrist as far as you can. Slowly, lower down again.	Tip – the weight used should not feel strained.
Weighted wrist flexion Have your forearm supported on a table, with your hand and wrist over the edge, palm facing up. Hold the weight and lift it up bending from the wrist as far as you can. Slowly, lower down again.
Weighted radial deviation Have your forearm supported on a table, with your hand and wrist over the edge, palm facing sideways. Hold the weight and lift it up bending at the wrist to tilt the thumb up towards the ceiling. Slowly, lower down again.
Weighted ulnar deviation Stand holding the weight with your palm facing your body. Tilt your hand backwards and upwards. Slowly relax.
Weighted pronation and supination Have your forearm supported on a table, with your hand and wrist over the edge, palm facing sideways. Hold the weight at one end and slowly turn it over so your palm faces up. Next turn it down so the palm faces the floor. Tip – To start with, you can make this easier by holding the weight in the centre instead.
Theraband ulnar deviation Using a yellow ‘Theraband’ or a light exercise resistance band. Ask someone to hold the band at the top for you. Or, hold it above your hand to be exercised with your unaffected hand. Hold the other end of the band in your affected hand, with the forearm resting on the table and palm facing sideways. Pull down on the band. Hold briefly and slowly relax, controlling the movement back up.

Week 12+ Exercises

Table top weight bearing Stand in front of a table. Place your palms down onto the table. Gently put some weight through as tolerated. Slowly, shift your weight from one hand to the other. You can control how much pressure you feel you can tolerate and build this up as able. Start with 25%, increase to 50%, 75% and so on. Tip – If you feel unable to put your hand flat on the table, place a small rolled up towel under the heel of your hand to reduce the angle of bend at the wrist. You might be able to reduce this with time.
Wall press-up Stand facing a wall. Place your hands on the wall just below your shoulder height. Slowly, bend your elbows to bring your body closer to the wall. Straighten your elbows and push your body away from the wall again. Repeat as tolerated.
4-point kneeling weight bearing Only complete this exercise if you feel able to get into a kneeling position on the floor and back up again safely. Kneel onto the floor with an exercise mat. Place your hands out in front of you. Wrists under the shoulders or slightly further forward. Knees should be under your hips. Practise leaning weight left to right and forwards back over your hands.	Tip – You may wish to use a towel under the heel of your hand again to increase comfort as shown.
Throwing and catching Using a light ball. Try to throw it up with your affected side and catch it again. You may also wish to try throwing it from one hand to the other, and progress on to gently throwing it forwards under arm and over arm to a partner, or at a wall if the ball is soft and bounces.
Supination and pronation with a stick In sitting or standing, hold the end of a walking stick or umbrella, with its handle pointing up to the ceiling. Slowly, turn the stick over left and right, so your palm turns up and down. Control the movement. As the stick turns further away from your body, you will feel the load increase. Tip – To make this easier, hold the stick further towards the centre. Gradually progress by moving your hand towards the end of the stick.
Radial deviation with a stick In sitting or standing; hold the end of a walking stick or umbrella, with its handle pointing down to the floor in front of you. Your hand should be on its side, thumb on the top. Slowly, tilt the stick up towards the ceiling by bending the wrist upwards. Slowly, lower it back down again. As above, this can be made easier by holding the stick closer to the centre.

Feedback for Inpatient Therapies

Please scan the QR code or follow the link below: 

If you have been seen by a Physiotherapist or Occupational Therapist during your admission, please leave us some feedback by scanning the QR code or following the link and filling in the short survey.

https://apps.worcsacute.nhs.uk/PublicSurvey/AHPFeedback

Ward admitted to:__________________________________

Therapy team who treated you: _______________________

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.  

Version 5.1