This document discusses the management of various wrist injuries including fractures, tendon injuries, nerve injuries, and joint injuries. For fractures, rehabilitation focuses on gradual mobilization and strengthening after immobilization. For tendon injuries like de Quervain's tenosynovitis, treatment involves splinting, stretching and strengthening exercises. Nerve injuries like carpal tunnel syndrome are initially treated with splinting and exercises before possible surgery. Rehabilitation for joint injuries like triangular fibrocartilage complex tears focuses on immobilization, bracing, strengthening and range of motion exercises. Modalities, nerve gliding exercises and sensory re-education are also used in managing various wrist conditions.

1. WRIST INJURIES
MANAGEMENT
-Dr. Krupal Modi (MPT)
22/9/2018

2. Fracture of the scaphoid
• Post-immobilization rehabilitation
• Complication: stiff wrist joint and muscles wasting.
• Mobilization and strengthening of the wrist and other stiff
structures should begin immediately after cast removal.
• Paraffin wax bath

3. splints
• Compression tubing worn
under the protective splint
reduces edema and
improves comfort.
• Different sports have
different rules about what
constitutes an ‘allowable’
protective cast.

4. De Q’s tenosynovitis
• Pre-operative:
• Splinting , electrical modalities, stretching, strenthening.
• Postoperative Management
• The hand is maintained in a soft bulky dressing for the first 2
to 3 days.
• A forearm-based thumb spica splint is then applied during the
first 2 weeks to control postoperative pain and swelling.
• Gentle active ROM and tendon gliding should be initiated in
the first few days postoperatively.

6. • Grip and pinch strengthening exercises may begin at
approximately 3 weeks and can be progressed gradually.
• By six weeks the patient usually is able to resume full
activities.
• Modalities
Modalities such as ultrasound, superficial heat, or
cryotherapy have been used in the postoperative treatment
of de Quervain’s release.

7. • Strengthening Exercises:
• Strengthening exercises can be initiated when painful
symptoms have subsided.
• Graded symptom-free exercises have bee shown to
increase metabolism, speed repair and prepare the
patient to meet the physical demands of daily
activities.
• Resistive exercises may be done in the isometric,
isotonic, or isokinetic modes depending on patient’s
tolerance.
• Putty, free weights, and theraband are practical for
home use.

9. Triangular fibrocartilage
complex tear
• Conservative Treatment: (RICE)
• The rehabilitation program has to consist of rest, activity
modification to remove the inciting force of injury, ice
application and splint immobilization for 3 to 6 weeks.
• After the immobilization, the patient should receive physical
therapy
• Treatment may include protective bracing,
• strengthening when able(more likely to give eccentric grip
strengthening exercises,),
• heat and/or electrotherapy modalities for pain.

10. • For restricted ROM - Passive mobilization of wrist joint.
• - To promote the wrist flexion we used the dorsal sliding
technique.
- To promote the wrist extension we used the volar sliding
technique.
- To promote the radial deviation we used the ulnar sliding
technique.
- To promote the ulnar deviation we used the radial sliding
technique

11. Carpal tunnel syndrome
• Most individuals with mild-to-moderate carpal tunnel
syndrome respond to conservative management, usually
consisting of splinting the wrist at nighttime for a
minimum of 3 weeks.
• Splinting
• Wrist splints are recommended for use either at night, or
both day and night.
• These help to keep wrist straight and reduce pressure on the
compressed nerve.

12. Tendon gliding exercises

13. Mediannerve
mobilization
(Nerveglidings)
NEURODYNEMICS(Butler or
Shacklock)

14. Ulnar nerve compression
• Pain reduction : TENS , activity modification
• Splinting
• Ulnar nerve mobilization
• Strengthening exercises (Grip)
• Sensory Re-education

16. NEURODYNEMICS
Ulnar nerve gliding

17. Sensory Re-education