Physical Rehabilitation Medicine/Surgery for wrist fracture


QUESTION: Thank you for your time Brian.  I am a 45 yr old female.  I had a severe displacement of the distal radius, with placement of plate and several screws.  I am a week out from surgery, and had my first follow-up yesterday.  I have a severe osteorosis and take coumadin.  Currently, the arm from the elbow to fingertips is very bruised and very swollen, alot of pain with any rotation of wrist, fingers are better since surgery, thumb movement is still quite painful.  
My questions are:
How long should I expect recovery to take?  I teach preschool.  This is my dominant arm and Im scheduled to start the school year in about 10 days.  
Does being on coumadin or having osteoporosis delay the process?
Would PT be beneficial?  Or am I better on my own?
I was given a slip on splint for occasions.  This is the only thing given.  No directions otherwise.
Thanks for your help.

ANSWER: Chris,

You absolutely need therapy for this one.  Usually I have the best results when a patient is sent day 3-5 out of surgery with open reduction and internal fixation (plate/screws).  That's a little early for most surgeons but the ones I work with trust me and know that I won't screw up their surgery.  The osteoporosis shouldn't matter as long as you don't get in front of a therapist that's going to crank on your arm...then it might.  The coumadin shouldn't matter other than if you start bleeding during therapy it might take a few minutes to clot up but nothing major.  I've seen lots of patients with coumadin with no problems.

Due to the osteoporosis your surgeon may be waiting a little longer than usual due to poor bone structure.  That's understandable.  Ask them when they expect to send you to tx.  Also...try to get a board certified hand therapist to treat you when you attend therapy.  Go to and find one.  It's an additional qualification to treat upper extremity patients that's very important.  Most therapists don't have a clue to do with a hand patient.

Hope this helps!

---------- FOLLOW-UP ----------

QUESTION: Thanks so much Brian.  I have to say I am a little bit bothered by my orthopedic surgeons dismissive advice.  We have wonderful hand therapists locally.  I know two other people that had the same procedures that were sent over.  I have gone myself for another issue.  When I asked the surgeon about PT he said, you won't need it, you'll figure it out on your own.  I can't go without a script from him.  My followup is in one months time.  I'm concerned I will in no way be ready for a class of preschoolers in a week and a half.  Any thoughts.   Thanks for letting me followup.

Get another opinion!!!  It's your right!!!  Go see another orthopedic surgeon...he/she are probably not going to even THINK about doing actual surgery on you but rather do whatever will make you happy.  So if you ask for a script for therapy they will probably write one on the spot and see you back in 4-6 weeks or maybe never. may be able to get a referral from your family MD.  Most of the time insurance will allow that.  Check with your plan.  Easy as that.

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Brian Neville, OTR/L, CWCE


I can answer questions about both conservative and post-operative rehabilitation for UPPER extremity injuries. These include but are not limited to: fractures, tendon repairs, tendon transfers, nerve repairs, lacerations, tenolysis procedures, TFCC injuries, repetitive motion disorders, reconstructive procedures. I have an advanced knowledge of UPPER extremity anatomy and industrial rehabilitation. I have extensive splinting skills for injuries to the upper extremity. Although not a physician or a surgeon I have worked closely with world renowned upper extremity specialists for over 10 years. I can give general information on what some of the most common upper extremity surgeries involve. I can reference those procedures as well. PLEASE DON'T ASK ME QUESTIONS ABOUT ANYTHING OTHER THAN THE NECK, SHOULDER, ARM/HAND. I'M NOT QUALIFIED AND KNOW ABSOLUTELY ZERO ABOUT BACKS/HIPS/KNEES/ANKLES/ETC. THANK YOU!!!


10+ years working closely with orthopedic and hand surgeons and their patients. I have treated patients with small lacerations to major reconstructive procedures. My knowledge base includes both conservative and post-operative rehab protocols and care for upper extremity injuries. I have treated patients all the way from day 1 post-op to return-to-work status.

Kentucky Occupational Therapy Association American Society of Hand Therapy National Nurses in Business Association Roy Matheson and Associates

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Occupational Therapist former Certified Hand Therapist (license currently inactive) Deep Physical Agent Modalities Instructor Certified Work Capacity Evaluator

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