Occupational Therapy for Distal Radius (Wrist) Fracture

If you’re seeking treatment (especially occupational therapy treatment) for a distal radius—a.k.a. wrist—fracture, we want you to be as informed as possible so we can truly partner to create the best course of treatment for YOU.

In occupational therapy, we tend to work from “menus” of evidence-based assessments and treatments. This gives us the flexibility to meet the specific needs of each patient. Below, you’ll see the assessment and treatment options your therapist may use, along with the evidence that supports them.

Please note that this page is for educational purposes and should not substitute advice from your medical provider. 

At the bottom of this page, you’ll find therapists near you who can support you in your wrist fracture treatment. 

A quick note on why to pursue therapy for wrist fracture 

This post focuses on therapy treatment for wrist fracture. 

Therapy is recommended to optimize your recovery from wrist fracture, reduce your pain, and prevent complications (such as stiffness and loss of range of motion). The American Academy of Orthopaedic Surgeons (AAOS) clinical practice guideline for wrist fracture and the American Society for Surgery of the Hand (ASSH) guideline both emphasize the importance of rehabilitation for this particular condition.

According to a Cochrane Review of rehab for wrist fracture, there is some indication that early rehabilitation can improve hand function in the short term, though more evidence is needed.

Therapist-recommended assessments for wrist fracture

As you can see below, evaluating a wrist fracture case involves much more than assessing the wrist itself. 

In addition to informing treatment at the beginning of your therapy journey, assessments provide a point of comparison to track your progress and response to treatment over time. (Without an accurate and thorough baseline, it can be hard to tell how much the interventions are helping!) As such, your therapist may perform certain assessments at various intervals over the course of therapy.

Core Occupational Therapy Outcome Measures

Here are two metrics that many OTs collect with every patient—regardless of diagnosis. You’ll see that our top assessment focuses on your quality of life. At the end of the day, this is the most important outcome for us. We want our treatments to have a noticeable impact on your day-to-day life. 

• Quality of Life Patient Reported Outcome Measure: The PROMIS Global 10
• Grip Strength (as indicated by healing phase of fracture)

OT Assessments for Wrist Fracture

Patient Rated Outcome Measures

• Patient Rated Wrist Hand Evaluation (PRWHE)
• QuickDASH

Observations

• Edema Measurements and Assessment
  • Wells Screening
  • Volumetry
• Incision/Scar assessment 

Upper Quarter Screen → Dermatomes, Myotomes, and Reflexes as indicated by healing phase of fracture

Neurological Assessment

• Review of any abnormal sensation
  • Semmes Weinstein Monofilament Test to assess light touch⁹

Range of Motion → norms according to the American Academy of Orthopaedic Surgeons 

• Cervical ROM¹⁰
• Shoulder ROM all planes
• Elbow ROM all planes
• Forearm ROM all planes
• Wrist ROM all planes (as indicated by healing phase) 
• Finger ROM all planes
• Kapandji Score¹¹ 
• Thumb Composite Flexion, CMC palmar abduction, and radial abduction

Strength → as indicated by healing timelines 

• Grip Strength bilaterally¹²
• Pinch Strength (including tip-to-tip, palmer, and lateral pinch)
• Manual Muscle Testing (MMT)
  • Shoulder Flex/Abduct/ER/IR/Scapular Retraction
  • Elbow Flex/Extend
  • Forearm Supination/Pronation
  • Wrist Flex/Extend
  • Thenar Eminence Muscles

Comorbidities to be aware of throughout the recovery process

• Chronic Regional Pain Syndrome (CRPS)¹³
• Carpal Tunnel Syndrome 
• CMC Arthritis
• TFCC tear
• Distal ulnar styloid fracture
• Scapholunate ligament disruptions
• Quality of bone impacting fracture stability

Setting goals for wrist fracture therapy

Therapy only works when there is buy-in from the patient. It is important that you work with your therapist to set treatment goals that truly reflect what’s important to you. 

Therapy treatment interventions for wrist fracture

After a thorough evaluation and goal-setting process, it is time to start making progress. Below are treatment interventions that can be implemented as part of a holistic therapy program. 

Edema Management¹⁹

• Manual Edema Mobilization manual techniques, including compression
• Kinesio tape

Aerobic Challenges, Core Exercises, and Posture Exercises^17-18

• Aerobic Challenges
  • NuStep is great for fall risk patients and can be used for just LE or a combo LE and UE
  • When available, Upper Body Ergometer (UBE) can be used for prolonged isometric grip
• Core Exercises
• Posture Exercises
  • Scapular stabilization and postural control (this is particularly important if the patient used a sling during the early phases of recovery)
    • Bruegger’s Exercise

Range of Motion

• Shoulder ROM all planes
• Elbow ROM all planes
• Tendon Glides
• Finger and Thumb Extension
• Thumb Opposition with a focus on “O” shape
• Forearm ROM all planes
• Wrist AROM
• PROM stretches

Manual Therapy

• Instrument Assisted Soft Tissue Mobilization (IASTM) → recommend 4–6 treatment sessions, 3 minutes per area^{24, 25}
  • Multi-Tool from HawkGrips can be used on full body
• Scar Massage and Mobilization
• Myofascial Decompression (cupping) for scar mobility²⁶
• Joint Mobilization as appropriate for phase of healing
  • Carpal Bones, Radial Head, CMC joint

Neuromuscular Re-education → addresses coordination, proprioception, and motor planning at appropriate phase of healing

• Wrist Maze
• Labyrinth apps on your smart phone or tablet
• Stability challenges with oscillations/perturbations
  • Can use a Flexbar
  • Can use a Gyroball

Functional Strengthening → as appropriate for fracture healing phase

• Wrist strengthening progression
• Incorporate functional tasks tied to functional goals of patient

Patient Education on Disease Pathology

• Therapeutic Neuroscience Education is shown to have an NNT (number needed to treat) value of 3, compared to strong opioids at 4.3.²⁰ In addition to pain reduction, it has been shown to improve function and movement as well as decrease healthcare utilization.²¹
• If applicable, provide education about the impact of smoking/tobacco use on healing timelines.

Self-Care Home Management and Activity Modification

• Lifting mechanics
• Ergonomic positioning and setup
• Adaptive tools for joint protection 
• Education for home modality use/precautions

Incorporate Functional Tasks → based on patient goals and affected ADLs

Additional Pain Management tools → modalities (ultrasound, e-stim, paraffin wax, moist heat, TENS)

Home Program → recommend selecting 1–3 priority exercises for the best chance of patient compliance with program

Discharge suggestions

Every individual is unique, and your response to therapy will also be unique. For some, it is not appropriate to continue therapy until the condition completely resolves. For others, pain may resolve before the entire rehabilitation program is established. In the latter case, it is important to remember that pain is a symptom—not a diagnosis—and that strength and endurance deficits must be addressed to prevent recurrence.

Thus, we recommend that you: 

• Follow your therapist’s discharge recommendations to maintain progress made in therapy. 
• Continue to use self-management and empowerment strategies to control any remaining symptoms.
• Remember that normalization of movement and function following a wrist fracture takes time. Follow a home exercise program with a proximal posture component for up to 2 years post-fracture, as wrist fractures continue to evolve throughout that timeframe.  
• Consult your therapist immediately if your condition worsens, or if you continue to have difficulty with your daily activities after 3 months.

Choosing a therapist for wrist fracture therapy

Both occupational therapists and physical therapists can treat wrist fracture. In less severe cases, a generalist therapist from either discipline should be able to help you. 

It is also important to note that both OTs and PTs can pursue advanced certification as a Certified Hand Therapist. To achieve this rigorous specialization of the hand, wrist, elbow, and shoulder, therapists must log 4,000 hours of experience treating the upper extremity and pass a formal examination. They also must complete various recertification requirements every 5 years. 

Below, you can find occupational therapy professionals who have tagged “hand therapy” as a focus area. The ones with a “CHT” in their credentials are Certified Hand Therapists.

Conclusion

Hopefully, this article has helped you understand what therapy for wrist fracture entails, and whether you are a good candidate! 

This article is updated once per month based on new research. If you have any research you would like us to consider for our next update, please drop it in the comments! 

Therapists who would like more fleshed-out information on distal radius wrist fracture treatment can join us as members of the OT Potential Club. 

References

Here’s the science backing the assessments and treatment outlined above.

1. Chung KC. Operative techniques: hand and wrist surgery, 4th ed. Philadelphia, 2021.
2. Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am. 2002.
3. Souer JS, Ring D, Matschke S, et al: Comparison of functional outcome after volar plate fixation with 2.4-mm titanium versus 3.5-mm stainless-steel plate for extra-articular fracture of the distal radius. J Hand Surg Am. 2010.
4. Tavakolian JD, Jupiter JB. Dorsal plating for distal radius fractures. Hand Clin. 2005.
5. Kamath AF, Zurakowski D, Day CS. Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study. J Hand Surg Am. 2006.
6. Wei DH, Raizman NM, Bottino CJ, Jobin CM, Strauch RJ, Rosenwasser MP. Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate. A prospective randomized trial. J Bone Joint Surg Am. 2009.
7. Shafiee E, MacDermid J, Farzad M, Karbalaei M. A systematic review and meta-analysis of Patient-Rated Wrist (and Hand) Evaluation (PRWE/PRWHE) measurement properties, translation, and/ or cross-cultural adaptation. Disability and Rehabilitation. 2022.
8. Polson K, Reid D, McNair PJ, Larmer P. Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire. Man Ther. 2010.
9. Burke, S. L., Higgins, J. P., Mclinton, M. A., Saunders, R. J., & Valdata, L. Hand and upper extremity rehabilitation: A practical guide, 4th Edition. pp. 58-60. Elsevier. 2015.
10. Sukari AAA, Singh S, Bohari MH, Idris Z, Ghani ARI, Abdullah JM. Examining the Range of Motion of the Cervical Spine: Utilising Different Bedside Instruments. Malays J Med Sci. 2021.
11. Kuroiwa T, Nimura A, Suzuki S, Sasaki T, Okawa A, Fujita K. Measurement of thumb pronation and palmar abduction angles with a small motion sensor: a comparison with Kapandji scores. J Hand Surg Eur Vol. 2019.
12. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985.
13. Dutton LK, Rhee PC. Complex Regional Pain Syndrome and Distal Radius Fracture: Etiology, Diagnosis, and Treatment. Hand Clin. 2021.
14. Cooke ME, Gu A, Wessel LE, Koo A, Osei DA, Fufa DT. Incidence of Carpal Tunnel Syndrome after Distal Radius Fracture. J Hand Surg Glob Online. 2022.
15. Dewey WS, Hedman TL, Chapman TT, Wolf SE, Holcomb JB. The reliability and concurrent validity of the figure-of-eight method of measuring hand edema in patients with burns. Journal of burn care & research. 2007.
16. Nadar MS, Taaqi M. Reliability of Occupational Therapy Students Using the Figure-of-eight Technique of Measuring Hand Volume. Hong Kong Journal of Occupational Therapy. 2013.
17. Ashe M, Khan K, Guy P, et al: Wristwatch-distal radial fracture as a marker for osteoporosis investigation, J Hand Ther. 2004.
18. Wigderowitz CA, Rowley DI, Mole PA, et al: Bone mineral density of the radius in patients with Colles’ fractures, J Bone Joint Surg Br. 2000.
19. Miller, L. K., Jerosch-Herold, C., & Shepstone, L. Effectiveness of edema management techniques for Subacute Hand edema: A systematic review. Journal of Hand Therapy. 2017.
20. Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother. 2002.
21. Louw, Adriaan & Zimney, Kory & Puentedura, Emilio & Diener, Ina. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice. 2016.
22. Goodman CC. Screening for Medical Problems in Patients with Upper Extremity Signs and Symptoms. J Hand Ther. 2010.
23. Gates DH, Walters LS, Cowley J, Wilken JM, Resnik L. Range of Motion Requirements for Upper-Limb Activities of Daily Living. Am J Occup Ther. 2016.
24. Gabel, G T; Morrey, B F. Operative treatment of medical epicondylitis. Influence of concomitant ulnar neuropathy at the elbow. The Journal of Bone & Joint Surgery. 1995.
25. Gehlsen GM, Ganion LR, Helfst R. Fibroblast responses to variation in soft tissue mobilization pressure. Med Sci Sports Exerc. 1999.
26. Rozenfeld E, Kalichman L. New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. J Bodyw Mov Ther. 2016.
    

OT Potential does not endorse any treatments, procedures, products, or therapists referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking medical advice should consult their medical provider.