Fractures in the wrist are usually caused from a fall on an outstretched hand. The bigger the force when you fall (eg, from a height or with speed), the worse the fracture. A fractured wrist will be treated with either a cast or an operation. The right treatment for you will depend mostly on the severity and the position of the break. Most people think that a fractured wrist will be fine after the cast comes off and they are surprised if the wrist is still stiff, sore or swollen. It’s actually quite normal to need physiotherapy to get the wrist moving normally again after a cast or operation.

Reduced movement in your wrist after the cast is removed can be due to the fracture position. If the fracture went through the wrist joint, or involved the joint between the two forearm bones, there is likely to be some restriction to your movement in the early phases of rehabilitation.

Pain and swelling after the cast is removed may be because soft tissues (such as ligaments) were injured at the same time as the wrist fracture.

Ongoing symptoms can be related to the final fracture position and a host of other reasons. It’s not always possible to get the wrist to heal back into a perfect position, for example.

Whatever the reason for ongoing symptoms, your physiotherapist will have a lot of treatment options to help you.

It’s usually very painful and clear when an adult has fractured their wrist. That being said, occasionally small cracks may be missed and if you have ongoing pain after a fall, you are advised to get an X-ray.

However, children often have small fractures that are missed or put down to a sprain. It’s always advisable to see your GP or physiotherapist about a child’s painful wrist after a fall or a heavy blow (eg, from a hockey stick).

Signs of a fractured wrist include reduced movement, pain and swelling. Diagnosis is made after reviewing X-rays.

Physiotherapists and hand therapists are often involved in fitting fractured wrists with protective splints to immobilise them (keep them still) as they heal, especially in children and for simple, undisplaced fractures. Undisplaced fractures are where the bone only breaks in one spot and the two pieces of the bone remain aligned.

Physiotherapy is often required in the rehabilitation stage once the fracture is healed and will include:

• Exercise: You will be given a graduated exercise program to regain the movement, strength and stability (proprioception) of the wrist. 
• Mobilisation and soft tissue techniques: Hands-on techniques such as joint mobilisation and massage will help you to regain movement in the joint, and will also reduce any discomfort in the wrist and arm.
• Swelling management: You may require some form of compression if you have ongoing swelling. This may be a compression sleeve or a glove in addition to elevation.
• Return-to-work and sport: The timing of your return to work and sport will depend upon your injury, your recovery and the demands placed on your wrist from particular activities.
• Brace: A brace may help you return safely to sport or work earlier.

Physiotherapy that’s started early after a wrist fracture has been shown to improve outcomes associated with pain, strength and movement. It has also been shown to lead to an earlier return to function.

Keeping your arm elevated in the early days after a fracture helps to reduce swelling. It is also important to make sure your shoulder, elbow and fingers don’t get stiff, so move them gently and carefully a few times a day.

If your wrist remains very painful or is getting more painful, get back in touch with the person or place that put your cast on. If you are unable to make a full fist, you should also check in with them. Sometimes the first plaster can be too long or too tight and cause finger stiffness.

You will be given a home exercise program to complete by your physiotherapist or GP. It’s very important to follow their recommendations to ensure you get the best possible outcome. Most people underestimate the impact of a wrist fracture, so it’s best to listen to the advice you’re given.

As a general rule it takes 12 weeks for your fracture to heal, but it’s fairly common for people to still experience some stiffness or mild discomfort for 12 months (or even longer) after they’ve fractured their wrist.