Wrist Fracture Recovery Program

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Where are you right now?

A wrist fracture is four different problems depending on when you are reading this. Pick the one that matches.

Just fallen?

Fell on an outstretched hand (FOOSH)? What to do first

A fall onto an outstretched hand, often called a FOOSH injury, is how most wrists break. The first step is a doctor and an X-ray, not therapy. Hand therapy starts once the doctor has decided on a cast, a splint or surgery, and we work to that plan.

• Go to the emergency department now if the wrist looks bent or out of shape, bone has come through the skin, or the hand is cold, pale or numb.
• See a doctor the same day if the end of the forearm is swollen and tender to press, or the hollow at the base of the thumb hurts, even if you can still move the wrist. A scaphoid fracture can hide on the first X-ray.
• See a doctor soon if it is still sore or your grip is still weak after a few days.

A FOOSH can also injure the elbow, the shoulder or the wrist ligaments. If the X-ray was clear and it still hurts, see fracture or sprain below, or TFCC injuries.

How the program runs

4-Stage Structured Recovery

Clinicians know the stages. Patients rarely do, and that gap is where people stop too early. You move up a stage when you meet the criteria for it, not when a number of weeks has passed. That is what Criteria Before Clearance means, and it is why the last appointment is a graduation rather than a discharge.

Most people reach us needing Stages 1 and 2 together, when the cast comes off. Nothing is put down when the next stage starts. The swelling and finger work keeps running underneath the strength work, which is why your therapist still checks your fist at week ten. Coming in earlier is better, because Stage 1 is where finger and shoulder stiffness is prevented rather than treated.

The shape of it

What happens, week by week

The program runs 12 weeks, in four stages, which is the shape the published distal radius protocols use. The weeks below are the standard structure for a straightforward fracture. Your surgeon’s protocol takes precedence over anything on this page, every time.

• Weeks 0 to 2Stage 1 · Calm & ProtectSwelling control and elevation, and the fracture or the repair protected. The joints outside the cast or splint move from the first days or they stiffen: full fist to full stretch, thumb to each fingertip, elbow bend and straighten, arm overhead. Stiff fingers take longer to fix than a stiff wrist.
• Weeks 2 to 6Stage 2 · Move & MobilizeWrist movement and forearm rotation, within what your surgeon allows. After a plate this often starts from week 1 or 2, with a removable splint between exercises. In a cast the wrist waits, and Stage 2 begins when the cast comes off, usually around week 4 to 6.
• Weeks 6 to 8Stage 3 · Rebuild & StrengthenOnce your surgeon allows load. Grip work, wrist curls, weight through the hand, and real tasks: a kettle, a jar, a bag of groceries. Strength measured against the other side rather than estimated.
• Weeks 8 to 12Stage 4 · Return & PerformTested against what you actually need: the tools, the keyboard, the push-up, the racquet, the distance you used to run. You graduate when you meet the Stage 4 criteria for those things, not when week 12 arrives.

Twelve weeks is the program. It is not the whole recovery. Full strength commonly takes 6 to 12 months, and some loss of forearm rotation can remain after a complex fracture. Scaphoid fractures, fractures into the joint, older adults and thinner bone all take longer, and your therapist tells you at the assessment if yours is one of them.

The first two weeks out of the cast

Is this normal?

The first look at your wrist after a cast can be a shock. Most of what you are seeing is expected. Some of it is not, and the difference matters.

We would rather send you back to your surgeon early than be the reason you went late.

Logistics

When can I…

Your surgeon decides, based on healing and what your job demands. These are the typical points, not permissions.

The program

What it costs and what is in it

Does everyone need supervised hand therapy?

No, and it depends mostly on your age.

If you are under 60, the fracture was straightforward and there are no complications, the published evidence does not show that supervised therapy produces a better result than a home program you have been properly taught. What it does show is that a therapist should be the one teaching it.

Over 60 is a different picture. Two trials comparing supervised physiotherapy with a home program in people over 60 found a large advantage for supervised therapy at six weeks, still there at one year, of around 18 points on a 100-point wrist score. By two years the gap had closed.

We tell you which of those you are at the first appointment, including when the answer is that you do not need us for long.

Who you will see

Managed by our hand therapy team

Hand and wrist cases are managed by the hand therapy team. All five of our hand therapists treat wrist fractures, so you can start at the clinic nearest you. You are matched to the therapist whose declared clinical interest fits what happened to you, rather than to whoever is free that week, and you stay with the same one through the twelve weeks.

Mavis Tham

Principal Hand Occupational Therapist. Wrist fractures, TFCC and wrist ligament injuries, custom splinting. Around 250 wrist fractures since 2018.

Tanjong Pagar

Shamaine Soh

Principal Hand Occupational Therapist. Stiffness and scar tightness after hand or wrist surgery.

Orchard, Sundays

Yuna Zhuang

Principal Hand Occupational Therapist. Carpal and cubital tunnel, sports wrist and finger injuries, tennis elbow.

Orchard, Serangoon, Tampines

Nurul Nadzirah

Principal Hand Occupational Therapist. Finger and wrist fractures, De Quervain’s, wrist ligament injuries.

Orchard

Jasmine Ang

Principal Hand Occupational Therapist. TFCC and wrist ligament injuries, trigger finger, thumb and wrist pain after pregnancy.

Jurong East, from 25 October

Whichever clinic you attend, your plan, your measurements and your surgeon’s protocol move with you. Changing clinic does not mean starting the history again.

Wrist fracture: the clinical detail

A wrist fracture is a break in one of the bones at your wrist. The most common type is a distal radius fracture, a break at the end of the larger forearm bone, after a fall on an outstretched hand. A doctor confirms the fracture on an X-ray, sets the bone if it has shifted, and holds it in a cast or fixes it with surgery.

The doctor fixes the bone. Hand therapy gets the hand working again.

The bones, and the types

Two forearm bones reach the wrist: the radius on the thumb side and the ulna on the little-finger side. Beyond them sit eight small carpal bones in two rows. A fracture can involve any of these. A fracture and a break are the same thing.

Distal radius fracture. The bone that breaks most often. Doctors describe it by where the broken end has moved. A Colles fracture tilts toward the back of the hand and can give the wrist a curved dinner-fork shape. A Smith fracture tilts toward the palm, often after a fall onto a bent wrist. A fracture into the joint runs into the joint surface, and surgeons aim for a smooth joint surface to lower the risk of arthritis later.

Ulnar styloid fracture. The bony tip of the ulna often breaks at the same time. In most cases it needs no separate treatment.

Scaphoid fracture. A small boat-shaped carpal bone at the base of the thumb, under the hollow that appears when you lift the thumb. It can hide on the first X-ray. Its blood supply enters from the far end, so the near end can be slow to heal or fail to join. Treated with a cast, or fixed with a screw.

Hairline fracture. A crack that has not shifted out of line, which doctors call undisplaced. It still needs an X-ray and a plan, because a crack in the scaphoid heals on a different timeline from a crack in the shaft of the radius.

Buckle fractures in children. Children’s bones bend more than adult bone, and one side crumples without breaking through. Most heal in a removable splint or soft cast over about 3 weeks. Falls from the bars, the beam or a trampoline are a common cause, covered in the gymnastics and trampoline injuries guide.

Signs of a broken wrist

Pain after a fall on the hand, worse when you move the wrist, grip or turn a door handle. Swelling that builds over the first hours, with bruising spreading into the hand and forearm. A wrist that looks bent or bumpy if the fracture has shifted. Tenderness when pressing on the end of the radius, or into the hollow at the base of the thumb. A grip that feels unsafe holding a cup. Numbness or tingling in the thumb, index and middle fingers, which is common after this fracture and worth a doctor’s review soon if it is steady or settling. If that numbness is getting worse hour by hour, with rising pain, go to A&E now and do not drive yourself.

Many people with an undisplaced or scaphoid fracture can still move the wrist and fingers. Movement does not rule out a fracture.

Fracture or sprain?

You cannot tell with certainty without an X-ray. A distal radius fracture hurts at the end of the forearm above the wrist crease, with fast swelling and a bone that is tender to press. A scaphoid fracture hurts in the hollow at the base of the thumb and the wrist may still move. A wrist sprain hurts in the soft tissue around the wrist and eases over days, though a severe one still needs an X-ray. Pain on the little-finger side that lingers can be an ulnar styloid fracture or a TFCC injury.

How doctors diagnose it

A doctor at A&E, a GP clinic or an orthopedic clinic diagnoses a wrist fracture with an examination and an X-ray. Hand therapists do not order X-rays or read them to diagnose a fracture. If you come to us first after a fall and a fracture seems likely, we refer you to a doctor before we start treatment.

Standard X-rays include a front and a side view, with scaphoid views added if the base of the thumb hurts. A scaphoid fracture can hide on the first X-ray, so if the hollow is tender the doctor may splint you and repeat the X-ray after 10 to 14 days, or order an MRI, which shows a hidden fracture sooner. A CT scan helps a surgeon plan a complex break into the joint.

Cast or surgery

An orthopedic or hand surgeon decides, based on the X-ray, your age, which hand you use most, and what you need the wrist for.

Cast, often 4 to 6 weeks. For stable breaks that have not shifted. Closed reduction and cast: the doctor pulls the bone back into line under anesthetic, for displaced breaks that stay in line once set. Plate and screws: a volar locking plate on the palm side, for unstable or displaced breaks and breaks into the joint, and earlier movement is often possible. Pins or an external frame: for selected fractures. Scaphoid screw: for displaced scaphoid fractures, or to shorten time in a cast.

In the cast. The cast protects the bone. The joints outside it need movement from the first days or they stiffen. Full fist then full stretch, ten times every hour while awake. Thumb to each fingertip. Elbow bend and straighten. Arm overhead several times a day. Keep the hand above heart level for the first few days and keep the cast dry.

A custom thermoplastic wrist splint, shaped in the appointment

After the cast. Expect stiffness, swelling, dry skin, a weak grip and a wrist that feels fragile. Your surgeon may want a removable splint for a few more weeks, and a hand therapist can make a custom thermoplastic splint when your surgeon agrees.

After a plate. Many surgeons allow wrist movement earlier, sometimes within the first 1 to 2 weeks, with a removable splint between exercises. Some people later feel the plate irritating a tendon, and a surgeon may remove it. See post-surgery rehabilitation for what to expect more generally.

Exercises

Start wrist exercises when your doctor or surgeon clears you to move the wrist. Selection, timing and dosage below are pending clinician sign-off.

In the cast. Finger fists, ten times every hour while awake. Thumb touches to each fingertip, ten rounds several times a day. Elbow and shoulder, ten repeats three times a day.

Stage 2, movement. Wrist bends with the forearm on a table and the hand over the edge, ten repeats three to four times a day. Forearm turns with the elbow at your side, palm up and palm down, holding a light hammer or wooden spoon once it eases. Table slides on a towel, forward and back then side to side. Tendon glides through straight hand, hook fist, full fist and flat fist.

Stage 3, strength, once your surgeon allows load. Grip with therapy putty, two to three sets of ten. Wrist curls palm up and palm down, lowering over three seconds, three sets of twelve. Weight through the hand on a table with the wrist bent back, adding load over the weeks. Task practice: groceries, jars, a kettle.

Expect a stretching discomfort. Stop or scale back if pain turns sharp, goes above four out of ten, or is still higher the next morning. One thing to avoid: forceful stretching by another person, or hanging weights to force the wrist. That flares pain and swelling and sets you back.

Complications worth catching early

Most wrist fractures heal without trouble. These are less common, and early action changes what happens next.

Acute carpal tunnel syndrome. Swelling presses on the median nerve, causing numbness in the thumb, index and middle fingers. Numbness that is getting worse hour by hour, with rising pain, means A&E now, and do not drive yourself, because building pressure on the nerve needs releasing urgently. Numbness that is steady or settling is common after this fracture and needs a doctor soon rather than tonight. More on carpal tunnel syndrome.

Complex regional pain syndrome. Pain out of proportion to the injury, swelling, changes in skin color, temperature or sweating, and stiff shiny fingers. Early treatment by your doctor and hand therapist matters.

Tendon rupture. A sudden loss of the ability to lift the thumb, weeks after the fracture or surgery. See your surgeon soon.

A tight cast. Pale, blue or cold fingers, severe pain, or fingers you cannot move. Go back to A&E.

Stiffness that stalls. Slow progress turning the palm up or down needs a program review and sometimes a splint to regain range.

A bone that heals out of line. Ongoing pain, a visible bump or poor movement. A surgeon decides whether more treatment helps.

A wrist fracture after 50

A wrist fracture from a fall at standing height, after age 50, can be the first sign of osteoporosis. It often comes years before a hip or spine fracture, which makes it a chance to act. Ask your GP about a bone density scan and a fall-risk check. Balance and strength work, non-slip bathroom mats, grab bars and a review of medicines that cause dizziness all lower the risk of another fall.

What slows recovery

Letting the fingers stiffen in the cast, because stiff fingers take longer to fix than a stiff wrist. Keeping the arm in a sling all day, which stiffens the shoulder and elbow. Forcing the wrist. Skipping swelling care. Exercising through numbness or rising pain. Missing the bone health check after a fall-related fracture past 50.

Questions we get asked

Where we are

Clinics across Singapore