Distal radius (wrist) fracture rehabilitation: stages of recovery

The distal radius is the end of the larger forearm bone, where it meets the small bones of the wrist. When it breaks, the bone itself needs weeks to knit, but the tissues around it start to stiffen almost immediately if nothing moves. Rehabilitation is therefore not something that begins only when the cast comes off. It starts on day one with the joints the cast does not cover.

The aim is a hand that can grip, a wrist that bends and turns enough for everyday tasks, and an arm that tolerates load again. Hospitals usually hand out an advice sheet of daily exercises, which the NHS says is meant to speed recovery. If you were not given one, ask the fracture clinic or the physiotherapy department.

Depending on the type of break, treatment may be a splint, a plaster cast, manual realignment under anaesthetic, or surgery to reposition the bones. The NHS notes that casting can be delayed for several days to let swelling go down. If you have a removable splint, NHS inform says you can take it off for washing, but only as your team has advised.

During this stage NHS inform describes keeping the shoulder and elbow moving and exercising the fingers by making a fist, for the first four weeks or so. Raising the hand above heart level when resting is a common instruction from fracture clinics to help swelling, though the pages used here do not set out a schedule, so follow the sheet you are given.

• Move the shoulder through its full range several times a day so it does not stiffen.

• Bend and straighten the elbow fully.

• Open and close the fingers, and touch the thumb to each fingertip, if the cast allows.

• Do not drive or lift heavy items until you have been told it is safe, as the NHS advises.

NHS inform describes the immobilisation coming off at about 4 to 6 weeks, followed by gentle exercises guided by a professional, and then normal activities with gradually increasing weight through the wrist at about 6 to 8 weeks. These are guide figures, and a more complex fracture, or one treated with surgery, can follow a different timetable set by your own team.

Expect the wrist to feel tight and the skin to look dry and unfamiliar when the cast first comes off. Early exercises are usually small and repeated: turning the palm up and down, bending and straightening the wrist, and squeezing a soft object. Load builds as comfort allows, rather than by pushing through sharp pain.

NHS inform describes swelling that spreads down the arm and can persist for months, widespread bruising that changes colour during recovery, and stiffness once the cast is off, all as expected. The pages also say pain at rest can occur and aching beyond the main healing window is not unusual.

What is not expected is worsening pain, a high temperature, a cast that has become loose, tight or broken, numbness in the fingers or arm, blue or white skin, or a bad smell or discharge from under the cast. The NHS says to use NHS 111 for these. Go to A&E for a hand or wrist that looks bent at an odd angle, bone showing through the skin, or severe pain.

NHS inform says you must be able to perform an emergency stop safely once you are out of the splint before driving, and in practice you also need to check your insurer's terms. For work, it says no healthcare professional sign-off is needed, and a phased return can be discussed with your employer according to how much your job loads the wrist.

For sport, NHS inform gives 12 weeks before contact sport. Racquet sports, climbing, gym work with weights through the hands, and cycling all load the wrist differently, and the pages used here give no separate dates for them. Increase gradually and use your fracture clinic or physiotherapist for advice specific to your fracture.

NHS inform advises seeing a healthcare professional if wrist function has not improved within about 6 weeks of following the rehabilitation advice. Persistent severe swelling, colour change, burning pain or hypersensitivity of the hand, new numbness or tingling, or a finger that will not move are reasons to be seen sooner rather than later.

Many areas run NHS musculoskeletal services that accept self-referral for physiotherapy, and the NHS notes hand and wrist physiotherapy may be needed when stiffness persists. A hand therapist is a physiotherapist or occupational therapist with additional training in the hand and wrist.