Winter is a wonderful time for outdoor fun; but it can also be a time for falls and wrist injuries. A fall on an outstretched hand can occur while walking on ice and snow to even the most cautious person. There are a variety of wrist injuries that can occur from a spontaneous fall on an outstretched hand. These injuries are sometimes termed FOOSH (fall on an outstretched hand) injuries.
One of the most common and well known FOOSH injuries is the distal radius fracture. A fractured distal radius may cause pain, swelling, bruising and tenderness, and, in some cases, the wrist may look abnormal or even out of place. Other symptoms can include numbness and tingling in the fingers, or the inability to bend or straighten the fingers. As a Certified Hand Therapist at Advanced Physical Therapy & Sports Medicine, I probably see one distal radius fracture per week during the winter months, and sometimes more than that.
If a FOOSH injury occurs, a doctor may need to evaluate the wrist, and if they suspect that the radius is fractured, an X-ray of the forearm, wrist, and hand will be taken. If the doctor determines there is a fracture of the distal radius, a decision will be made regarding how to treat the break. Some fractures will require simple immobilization in a cast; others may require surgery to realign the bone.
The hand therapists at Advanced Physical Therapy & Sports Medicine work closely with the doctor to discuss when a patient is ready to begin moving the wrist after immobilization or surgery, and progressing functional use at home, work or school. We also educate and instruct the patient on how to reduce swelling and pain while the fracture heals. For protection, we might also make an orthosis or protective splint to help support the wrist while it continues to heal. When it is safe, exercises that will help move and strengthen the fingers, wrist and forearm will be started.
A single blind randomized clinical trial completed in 2016 found that a supervised PT program is effective in the short and medium term, showing a clinically and statistically significant increase in function. This treatment also reduces pain and improves wrist ROM compared with a HEP in patients older than 60 years with distal radius fracture. For the patient, this would mean a faster return to every-day activities including work, home activities, and life! Sounds like a win to me!
The hand therapists at Advanced Physical Therapy are located at the Appleton, Green Bay and Marinette clinics. Please contact them with any questions or to schedule an appointment.
H. Gutiérrez-Espinoza et al. Supervised physical therapy vs home exercise program for patients with distal radius fracture: A single-blind randomized clinical study. Journal of Hand Therapy 30 (2017) 242e252.
