A Physical Therapy Guide to Wrist Fracture
Wrist fractures happen due to a variety of reasons. Even a seemingly simple fall can lead to a wrist crack that does not require surgery. More serious falls will leave you casted for 6-8 weeks to keep your fingers moving. Once your cast comes off, you can gradually return to regular activities.
Other times, wrist fractures can be caused by higher velocity events — like falling from a ladder, or a car accident. Higher velocity falls that lead to wrist fractures are often more complex and require surgical intervention.
Most often, the bone that breaks is the radius bone (the forearm bone on the thumb side that is also part of the wrist complex). The part of the bone that fractures is the distal end located at the wrist — called a distal radius fracture.
Distal radius fractures account for 18-25% of all bone breaks. For unknown reasons, the incidence of these fractures is on the rise, with the highest prevalence being in the pediatric population and the elderly population.1
This guide includes in-depth information about wrist fractures, their treatment, and how seeing physical or occupational therapist can help.
- Understanding Wrist Fractures
- Symptoms of Wrist Fractures
- What are the Most Common Causes of a Wrist Fracture?
- Diagnosing Wrist Fractures
- What to Expect from Hand Therapy for a Wrist Fracture
- What Are Complications That Can Happen?
- Preventing Wrist Fractures
- Is It Time to Seek Treatment?
Our wrists are instinctually used protect our brains from violent impact, which is why our wrists take the brunt of a fall and are one of the most common orthopedic fractures.
Wrist fractures can be a simple in-line (no displacement) fracture with very little intervention required; or they can be complex, shattered, multi-bone fractures requiring surgery, wound care, and therapy from a Certified Hand Therapist. These details of the technical classifications go beyond the scope of this article.
To learn more about the complexities of your wrist, check out CityPT's guide to wrist pain and anatomy.
How a Wrist Fracture Affects Your Daily Life
Without the function of your wrist, you may find yourself in need of assistance with daily activities such as bathing, grooming, cooking, and cleaning. You can develop stiff fingers and a decreased ability to make a tight, strong fist. You may endure pain and swelling.
Luckily, no matter how simple or complex, your healing journey will benefit from seeing a physical or occupational therapist. They can help along the way by validating your experience and being a resource to you for activity modification, pain reduction, and motion restoration.
What are the symptoms of a wrist fracture? Let's review.
- Sharp pain experienced immediately after a fall or adverse event at the location of the wrist
- Swelling or inflammation of the wrist and/or fingers
- Obvious deformity of wrist due to poor alignment
- Bruising in the area
- Severe stiffness or pain at wrist and fingers
- Inability to bear weight or push off your wrist
While many different types of activities leave you vulnerable to wrist fractures, below are the most common risk factors.2
- Participation in sports, like in-line skating or snowboarding
- Osteoporosis or Osteopenia (softening of bones)
- Older than 50 years
- High fall risk
- Female sex
If you think you have a wrist fracture, it is best to seek immediate treatment from a doctor specializing in orthopedic care. Your doctor will likely order imaging to confirm the findings and either recommend casting, splinting, or surgery depending on the severity.
Prolonging treatment can lead to detrimental, permanent damage to your wrist, hand, and function especially if there is nerve damage.
After a fall, there can be a lot of feelings. Recovery and rehabilitation of wrist fractures may sound overwhelming and painful. However, we strive to make it more inviting by providing you with an idea of what you can expect at your evaluation.
Your therapist might ask you questions to get to know you to aid in shaping your recovery. After learning how it happened and details of any surgery, the therapist may ask:
- What helps your pain or swelling?
- What activities or positions make it better or worse?
- Do you have any medical conditions we should know about?
- What are three things you cannot do right now that you wish you could because of your wrist pain?
- What major life changes have you experienced in the last year?
Your therapist will also perform a thorough physical evaluation, which may include:
- Evaluation of soft tissue, joint, or muscle integrity
- Measuring range of motion and strength
- Testing functional abilities
- Noting sensory changes, like numbness or tingling
- Palpating areas of tenderness
- Observing swelling (edema)
Treatment sessions will vary but will include some combination of:
- Custom splint making and adjustments to support healing structures
- Wound care (especially if you have surgery)
- Edema (swelling) control
- Pain reduction techniques like manual therapy (hands on treatment), modalities like deep heat, and meditation
- Being your guide through education and validation of your process
- Gentle, progressive exercises to build motion, function, and strength
While rare, complications can happen during recovery and slow down your recovery time. These complications can look like:
- Pain, swelling, and stiffness beyond the expected intensity or time frame for typical recovery
- Slow bone healing
- Malunion or non-union of the fracture(s)
- Nerve or circulation damage
Often, these complications can be addressed conservatively and with your therapist. Very rarely is additional surgery necessary.
One can reduce the chances of experiencing a wrist fracture with the following suggestions:
- Stay active: Low-impact exercise can be great at improving bone density. Thus, reducing your chance of a wrist fracture.
- Prevent Falls: Exercise activities like tai chi, yoga, and pilates can improve your balance, coordination, and strength thus reducing your fall risk. Other ways to reduce your fall risk include:
- Ensuring your home is well-lit and without obstructions and trip hazards (like rugs)
- Installing grab bars in your bathroom
- Using handrails on stairs/steps
- Keeping your vision and balance in check
- Managing your medications and talking to your doctor about any concerning side effects like dizziness
- Make healthy lifestyle choices: Try to get enough sleep, stay hydrated, and eat nutrient dense foods. Practice healthy stress management. Do your best to stop tobacco use. Your whole body will thank you!
- Wear Protective Equipment: During sports, such as snowboarding or skating, wear wrist braces and other protective equipment to minimize injury while having fun.
- Talk to a Certified Hand Therapist: If you have concerns or want professional advice on splinting, treatments at home, and functional adaptations, make an appointment with a CityPT specialist!
If you suspect a wrist fracture, seek immediate treatment from your doctor. Imaging ordered by your doctor will help determine next steps and get you on the road to recovery faster. Your doctor may then recommend therapy from an occupational or physical therapist who specializes in hand and upper extremity orthopedics, or a Certified Hand Therapist (CHT).
When you're ready, reach out to a CityPT hand therapist to help you on the path to recovery.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012 May;28(2):113-25. doi: 10.1016/j.hcl.2012.02.001. Epub 2012 Apr 14. PMID: 22554654; PMCID: PMC3345129. https://pubmed.ncbi.nlm.nih.gov/22554654/ ↩
Hemenway D, Azrael DR, Rimm EB, Feskanich D, Willett WC. Risk factors for wrist fracture: effect of age, cigarettes, alcohol, body height, relative weight, and handedness on the risk for distal forearm fractures in men. Am J Epidemiol. 1994 Aug 15;140(4):361-7. doi: 10.1093/oxfordjournals.aje.a117258. PMID: 8059771. https://pubmed.ncbi.nlm.nih.gov/8059771/ ↩