By: Makenna Sallade, OTD, OTR/L

One of the biggest misconceptions I run into as a hand therapist is that a wrist fracture is a “wait it out” kind of injury. You get a cast, you rest, and eventually things go back to normal. I want to walk through why that’s not really how it works and what I wish more patients knew from day one.

Therapy for the Casted Wrist

The moment I hear a patient has had a wrist fracture, my priority is getting them in the clinic as soon as possible to start range of motion. Even if patients are still wearing a cast or brace, there are still exercises we can do to address movement of the fingers.

The reason timing matters so much comes down to stiffness. The longer a wrist stays immobile, the harder it becomes to get full motion back due to scar tissue hardening. That stiffness can be very difficult to break through later in recovery, and in my experience, patients who waited the longest to start therapy, work the hardest to gain back the range of motion they lost.

It’s not just the wrist either. Your fingers need to keep moving throughout the healing process. If you’re not actively bending and straightening them, those joints stiffen up right along with the wrist.

I once worked with a patient who was never told when she could take her brace off. She wore it continuously for about two months. Getting her wrist motion back after that took several more months than is typical.

What to Expect Whether or Not You Have Surgery

How does surgery affect the timeline? Although it can shift the timeline a bit, the overall approach is similar in both instances.

If you’ve had a plate and screws surgically placed to stabilize the bone fracture, we can typically start moving the wrist at two weeks. Without surgery, we’re usually looking at four weeks. Either way, the goal is to begin movement as soon as it’s safe.

Bones take about six to eight weeks to heal, which is why we hold off on strengthening until around that six-week mark. We’re not putting resistance through a bone before it’s ready, but we’re also not waiting any longer than necessary to start moving.

What Does Wrist Fracture Therapy Look Like?

Right away, the focus is on the fingers. Full extension, full flexion, making a closed fist. I’m also having patients do things like rotating marbles in the palm, working with buttons and zippers, and practicing typing. These feel simple, but they keep the unaffected joints active while the wrist heals.

At the four-week mark, or two weeks post-surgery, we start moving the wrist. Forward and backward motion, and the palm-up, palm-down rotation we call supination and pronation. That one tends to surprise people.

When you turn your palm upward, the two bones in your forearm actually cross over each other. It’s a specific motion, and after a fracture it’s one of the first places patients struggle. You use it more than you realize, such as when reaching, pouring, driving, and accepting something from someone’s hand. When it’s limited, it shows up constantly in daily life.

By six weeks, we’re into strengthening. That’s where tools like therapy putty come in. Exercises include gripping, pinching, and building up to weight bearing through the wrist. Something as routine as pushing up out of a chair is a real goal in this phase, because it requires solid wrist extension. We work toward it deliberately.

Common Wrist Fractures

Falls are by far the most common cause of wrist fractures. Specifically, falling onto an outstretched hand, most often in the kitchen, the bathroom, or on the stairs, and lately, pickleball. It’s become one of the more frequent causes of a wrist fracture I see, especially given how many active retirement communities we have here in Arizona. People are out having fun, and then a fall happens.

Wrist fractures are incredibly common. What isn’t always common is the follow-through in recovery. That’s the part I want to change.

Early Therapy = More Function

If you’ve had a wrist fracture, don’t wait to be seen. You don’t need to wait until the cast comes off, and you don’t need to wait until something feels significantly wrong. Early movement, done correctly and with guidance, is what gets you back to full function and avoids a stiff wrist and hand.

If you have questions or want to get started, reach out to our hand therapy team at Spooner.