5 1/2 weeks post-op from having titanium plate screwed into the bone.
Originally, the surgeon told me I would be in a cast for at least 6 weeks.
In each of the three visits I've had with him since the surgery, however, he has told me I am his "star patient", and that I am healing perfectly, far better than most of his patients. Despite my having been told he is the most conservative doctor in his large practice, he surprised me this past Tuesday (5 weeks, 1 day post-op) by telling me he was going to not only take me out of my cast early, but I was healing so well he was going to skip the soft cast and just put me in a brace so I could get a head start on rehab. The brace has just three straps, and looks almost exactly like the wrist braces I wear while rollerblading.
This was very good news. I'm a poker dealer, and do 90% of my work with my right hand. I can't work at all till this thing heals, and it is critical that I do everything I can to minimize any range of motion losses from this injury.
My one issue with my surgeon is, when he sees me, he wants to get in, and get out. He schedules appointments on the :10s, and he doesn't like to spend a lot of time yakkin' and answering questions. When he had them take the cast off, all he told me to do in the 3 weeks till he wanted to see me again was "bend the wrist back" (he demonstrated it with his fingers extended), and "bend the wrist forward" "every couple of hours".
When I got home and started working on those exercises, I was amazed. I could get a little flexion, but almost no extension at all. It's not that it hurt (although it does ... a lot!), it's that the wrist just wouldn't move.
I'd also noticed a huge loss of range of motion in my fingers, and especially my thumb. I did a lot of searching on the internet, and found some resources that convinced me I needed to do more. I've now settled on the following routine:
Wrist Extension (with a fist)
Wrist Flexion (with an open hand)
I've noticed the most improvement in my pronation and supination, then the fingers. There's been a little improvement in the thumb, and in my wrist flexion, but almost none at all in my wrist extension. I can try to extend till I'm shaking, sweating, and nearly ready to vomit from the pain, but it barely moves, and days of doing these exercises have yielded almost no improvement. Even when I try to manually manipulate the wrist extension, all I can get is maybe another 1/4" of extension.
I know use of a dynamic extension and flexion brace is the solution for this. What I don't know is, am I being impatient, or should I be using that dynamic brace now? I am running out of leave time at work, and need to get use of my hand back as soon as possible. I don't want to wait another 2 1/ weeks to see the Dr. if there's more I should be doing now.
Unfortunately, many patients who sustain a significant intraarticular distal radius fracture, never regain "normal" motion (or what it was before the injury). This is mainly due to the extensive scarring of the joint capsule and other soft tissues around the joint.
You are being a little impatient however. While it usually takes about 6 weeks for the bone to unite, it takes much longer for the soft tissues to heal and the scar tissue to mature and soften, sometimes many months. It varies, because each patient heals at their own rate.
And again, some patients regain motion, while others do not.
Your pronosupination has returned fairly quickly, mainly because that motion actually mostly comes from the elbow (head of the radius), with just some rotation at the DRUJ (distal radioulnar joint) of the wrist. And, as you have noted, extension is usually the most difficult to regain. This is not only due to the scarring, but due to the way the bony architecture of the wrist is constructed. The distal radius is normally tilted volarly (palmar) somewhat, so that flexion is easier to do than extension.
Dynamic bracing, itself, probably won't gain you a whole lot of motion, above what you can get with active therapy. Dynamic bracing is mostly used for situations like tendon injuries, where passive motion is desired.
Some patients can get a little more motion with the use of static bracing at the extremes (sometimes called turnbuckle braces) for extended periods (such as when sleeping). This static bracing places a continuous pressure (stretching) on the tissues. But, you have to have a brace made for both extension and flexion. And, they can be very uncomfortable.
But, the tried and true method of regaining motion is continued occupational therapy (hand therapy). Warming of the tissues before doing range of motion (ROM) will help, as warm tissues are more pliable and stretchable than cold ones. So, hot packs, hot bath, paraffin baths are all good for warming the tissues. You might look into getting a paraffin bath (they can be obtained at places like WalMart for not a large amount of money). The wax provides a warming of the tissues and are often used by hand therapists.
Then, the exercises you have mentioned. There is nothing really special about any of the exercises; it is just moving the wrist in all of the directions.
Hopefully, you were moving your fingers while you were in the cast, since surgery. We have our patients moving the fingers in the post-op recovery area and give them the "six pack" of finger motion to do six times a day while in the cast. If you have not been moving the fingers, you are sort of behind the eight ball already. The fingers get stiff and fibrotic very quickly. Though, sometimes that can be overcome with some diligent work.
But, again, it is not uncommon for the wrist joint to really sock in with scar tissue, how much, depends upon the patient's body. Some patients form abundant amounts of scar tissue.
The scar will mature and soften somewhat with time, during which it is important to be moving, so that it will stretch out as much as possible.
All you can do move and do it often. Placing a stretch at the extremes for a count of ten each time (using the other hand as you are doing).
Some patients, who have trouble doing therapy on their own, can benefit from the use of CPM (continuous passive motion). But, the machines for the wrist are not all that common and can usually only be found in large therapy departments. But, if you can do the therapy on your own, these usually don't provide anything above that.
Unfortunately, until we discover something to prevent extensive scarring after intraarticular fractures, decreased range of motion will continue to be a problem.
Keep working. It usually takes many weeks (sometimes months) of therapy before the final outcome is reached. You never know how much motion a patient will obtain, until they have finished therapy. Some patients surprise us, and regain a lot of motion. All you can do is keep working.
You should also start working on activities that you need to do in your occupation. (This is one reason why hand therapy is called occupational therapy.) You will be surprised, that motions you used to do without thinking about, will take some effort to do at first. You will have to relearn to do some of these activities. You may have to devise ways to get around your decreased motion. With elbow and shoulder motion, sometimes patients can make up for any deficits they have in the wrist.
Good luck. Keep working hard with therapy. It is going to take some time and effort, but you should be able to get back to what you need to do. It may not be exactly the way you did it before, but it should work.