Rehabilitation after a broken wrist — once the cast is off

Rehabilitation after a broken wrist, once the cast is off, means gradually restoring movement and strength: reducing swelling by raising the hand and moving the fingers, gentle exercises bending, straightening and rotating the forearm without forcing through pain, and returning to everyday activities. The orthopaedic surgeon’s recommendations come first – they decide when and how much load the hand may take.

Below we explain where the stiffness and swelling come from, which symptoms need a doctor, which 4 exercises are usually safe to start with and how a physiotherapist can help.

Contents

Why is the wrist stiff and swollen after the cast comes off?

During several weeks in a cast the wrist and finger joints hardly move, so the tissues around them stiffen and the forearm muscles weaken. Once the cast is removed, the hand hangs down more often and blood and fluids drain from it less well, which is why swelling appears. Pain on movement, a feeling that the hand is “not your own” and difficulty turning the palm are also typical.

Most often, bending and straightening the wrist and turning the palm upwards – needed e.g. when taking change in a shop – are limited. The bone, although healed, is not immediately ready for full load. We describe the general principles of recovering after injuries on the page rehabilitation after an injury or surgery.

How to reduce swelling in the hand after the cast comes off?

Raise your hand above the level of your heart, for example by resting it on a pillow while sitting and lying down. Several times an hour, make a fist and open your hand and move your fingers. Avoid letting the hand hang down for long periods and keeping it still in a sling, unless the doctor has recommended it. Take off rings and your watch while the swelling persists.

Moving your fingers works like a pump that helps drain fluid from the hand. Swelling often comes back in the evening or after exertion and usually decreases over time. If the hand is clearly warm, red and increasingly swollen, do not wait – that is a reason to contact a doctor.

Which exercises are safe after the cast comes off?

At first, gentle active exercises are usually used: making a fist, bending and straightening the wrist, side-to-side movements and rotating the forearm. Do them slowly, within a range free of sharp pain, several times a day. Do not press the hand with your other hand and do not lift weights until the orthopaedic surgeon or physiotherapist allows it.

1. Fist and open hand. Position: sitting, forearm on a table. Movement: clench your hand into a fist, then spread your fingers wide. Dose: 10 repetitions, 3–4 times a day.
2. Bending and straightening the wrist. Position: forearm on a table, hand over the edge. Movement: slowly lift the hand up, then lower it down. Dose: 10 repetitions, 3 times a day.
3. Rotating the forearm. Position: sitting, elbow bent and pressed against your side. Movement: turn your palm up, then down. Dose: 10 repetitions, 3 times a day.
4. Side-to-side movements. Position: hand flat on a table. Movement: slide the hand towards the thumb and the little finger without lifting it off the table. Dose: 10 repetitions, 2–3 times a day.

Only do these exercises once the orthopaedic surgeon has allowed wrist movement. We describe the general rules of safe exercise in our post exercising at home – 7 rules. If the pain gets worse or spreads, stop the exercise and consult a physiotherapist.

How does a physiotherapist help after a broken wrist?

The physiotherapist measures the range of movement and grip strength, assesses the swelling and the scar, and then chooses exercises suited to the stage of healing and the orthopaedic surgeon’s recommendations. They may use manual therapy, techniques to reduce swelling and, after surgery, scar therapy. They also teach you how to gradually return to work, driving or housework. A consultation costs 180 PLN.

Physiotherapy consultationassessment of hand mobility and strength after the cast comes off, home exercise plan180 PLN

Prices valid from 08.2026. The physiotherapist decides on the number of visits individually after the consultation.

Summary

After the cast comes off, the wrist is usually stiff, weak and swollen. Raising the hand, moving the fingers often and 4 gentle exercises done without forcing through pain help, always within the orthopaedic surgeon’s recommendations. Increasing pain, skin changes or numb fingers need a doctor, and persistent stiffness needs a consultation with a physiotherapist.

Frequently asked questions

Is pain during exercise after the cast comes off normal?

A slight pulling sensation, discomfort and tiredness in the hand during exercise are common after immobilisation. Sharp pain, pain that lasts long after exercising, increasing swelling or a change in skin colour should be a cause for concern. In that case reduce the range of movement and contact a physiotherapist or doctor. Do not force the hand, hoping for a faster result.

When can I lift things after a broken wrist?

When you may put load on the hand is decided by the orthopaedic surgeon, based on the bone healing visible on the X-ray and the type of fracture. You usually start with light everyday objects, and heavier shopping, leaning on your hand or gardening are introduced gradually. A physiotherapist helps you plan this return safely.

Is it worth having a bone density test after a broken wrist?

Often, yes. A wrist fracture after an ordinary fall from standing height, especially in a person over 50, can be the first sign of osteoporosis. Ask your GP or orthopaedic surgeon whether a bone density (DXA) scan is advisable. Diagnosing osteoporosis makes it possible to prevent further fractures early, for example of the hip.

Is rehabilitation different after a fracture treated with a plate?

The principles are similar, but after fixation with a plate the doctor often allows earlier wrist movement, and work on the surgical scar is added. When to start exercising and how much load to put on the hand is set by the surgeon in their recommendations. The physiotherapist adapts the exercises to them and can provide scar therapy once the wound has healed.

Sources

• American Academy of Orthopaedic Surgeons (AAOS), Management of Distal Radius Fractures: Evidence-Based Clinical Practice Guideline, 2020.
• Handoll H.H.G., Elliott J., Rehabilitation for distal radial fractures in adults, Cochrane Database of Systematic Reviews, 2015.
• Nellans K.W., Kowalski E., Chung K.C., The epidemiology of distal radius fractures, Hand Clinics, 2012.
• Harden R.N. et al., Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 5th Edition, Pain Medicine, 2022.