Grip strength testing to assess progress for a patient following a distal radius fracture.

Physical Therapy for Distal Radius Fractures

A distal radius fracture is a bone fracture that occurs within the last (distal) 3 to 5 cm of the radius. It is considered the second most frequent fracture, only behind hip fractures. Distal radius fractures are the most prevalent upper extremity fracture among adults.  These fractures are most commonly the result of falling on your hand with your arm outstretched. This mechanism of injury is commonly referred to as a “F.O.O.S.H” (Fall Onto OutStretched Hand). Management involves an early protective phase and can be treated operatively or nonoperatively. Recent research has shown that regardless of fracture-treatment type, an accelerated rehabilitation approach may lead to better outcomes. This includes:

• Shorter immobilization time
• Edema control techniques
• Wrist & hand active range of motion 
• Manual therapy to improve joint mobility 

The mobilization phase is initiated when a satisfactory fracture site healing level has been confirmed. The focus of the wrist-mobilization phase is to manage pain and edema while optimizing active and passive range of motion at the wrist. During this phase, physical therapy goals are achieved via both active and passive mobilization methods, which may include joint and soft-tissue mobilization techniques.

The strengthening phase typically starts around 6 to 8 weeks. Strengthening usually encompasses progressive resistance exercises via isotonic, eccentric, power gripping, and perturbation training with increasing loading levels through the wrist and the entire upper extremity. This phase prepares individuals to resume full daily and vocational activities safely.

Older age (>65 years), high baseline levels of disability, and comorbid psychosocial factors (particularly depression) may predict poorer outcomes or longer recovery times related to functional disability in individuals with a distal radius fracture. Treatment is individualized to each patient’s needs and goals and not everyone will require the same number of visits. A physical therapist should be the primary instructor of an home exercise program following operative and/or nonoperative treatment for individuals to improve short- and long-term outcomes for wrist pain, active range of motion, grip strength, and function.