Distal Radius Fractures and Finger Exercises during Immobilization. Why are they important?

The distal radius fracture is positioned as the most common MSK injury with the highest incidence worldwide in the adult population. According to a recent systematic review, the incidence of radial fractures reaches 212 cases per 100,000 individuals per year. This shocking statistic highlights the relevance of effectively addressing this condition.

The consequences of these fractures go beyond numbers, directly affecting patients’ quality of life. Symptomatology such as hand pain, loss of mobility and strength, impose important restrictions on the daily activities and social participation of those who suffer from them.

However, its impact is not only limited to peripheral aspects, but also extends to the Sensorimotor System itself. This reveals especially significant consequences in the body segment with the highest corticospinal representation: the hand.

This scenario of involvement of peripheral and central structures gives rise to maladaptation processes that impede the patient’s correct recovery. These injuries require a process of “relearning” and an effective reintegration of the segment in the body scheme.

👉Deepen into the evidence-based approach for the treatment of Distal Radius Fractures in our blog Distal Radius Fracture | Rehabilitation Evidence-Based

Radius Fractures and Central Nervous System. What is known so far?

Previous research has confirmed that hand and wrist injuries, surgical interventions and even immobilization have a direct impact on brain circuits. This compromise of the central systems leads to a decrease in muscle strength and activation, as well as a deterioration of sensorimotor control of the hand.

A 2020 study (Newbold et al) revealed that, after hand immobilization and within hours, the brain subcircuit corresponding to the hand disconnect from the rest of the CNS. This finding highlight the urgency of actively addressing the sensorimotor implications of injuries, surgeries and immobilizations.

The first opportunity to start rehabilitation arises at this critical moment, immobilization, since this is when these alterations of the sensorimotor system begin to appear.

The sooner we cut this central “reorganization”, the better results we will obtain.

In one study, Clark et al 2014, observed that exercise in non-injured tissue maintained upper limb strength levels, while non-exercisers experienced a decrease in upper limb. These results emphasize the importance of targeted exercise during the rehabilitation process, which provides valuable information to guideline and design effective programs and improve patient recovery.

Sensorimotor Rehabilitation of the Hand and Wrist after Distal Radius Fractures

Re-education of the sensorimotor system is based on active and proprioceptive work of the hand musculature. Key aspects such as fine motor skills, kinesthesia and neuromuscular control should be addressed.

Several studies support the efficacy of specific strategies, such as performing touches and movements on a touchscreen Tablet , to generate positive impacts on motor cortex reorganization. These innovative interventions offer a promising approach to rehabilitation, leveraging technology to improve the connection between the nervous system and hand function.

This technology-centered approach not only represents an opportunity to optimize rehabilitation, but also highlights the importance of continuous adaptation of clinical practices.

👉 What should I evaluate in my patients with Distal Radius fractures? We tell you about it in the blog 7 Tips to evaluate in a Distal Radius Fractures

Finger exercise during immobilization of a wrist fracture?

A pilot study published in 2013 demonstrated the clinical effectiveness and safety of finger-specific exercise programs in patients in the immobilization period following a distal radius fracture.

The benefits of this specialized approach are remarkable, as it has demonstrated significant improvements in key clinical variables such as hand strength and grip, as well as overall function and dexterity. A highlight is that this early rehabilitation approach did not increase the risk of developing bone deformities, underscoring that the exercise program is not only beneficial but also safe.

ReHand exercises during immobilization of wrist fractures

Thanks to the ReHand telerehabilitation system with artificial intelligence, patients can receive a tailored exercise programme from the first day after the onset of immobilization focused on fingers and thumb mobility. This early intervention combats edema, promotes motor relearning, exercises the hand musculature and slows the loss of muscle mass.

ReHand combines the latest evidence in sensorimotor system approach with artificial intelligence to facilitate therapeutic exercise prescription and optimize health outcomes for your patients. ReHand has proven to be effective in the rehabilitation of bone and soft tissue injuries of the wrist hand and finger segment, accelerating clinical recovery and reducing the number of referrals and face-to-face physiotherapy sessions, in one of the most important telerehabilitation clinical trials in Europe.

ReHand is not just an tabllet app with exercises. ReHand is a tool for us healthcare professionals, consisting of three systems:

🔸 Prescription system (Dashboard): enable us to prescribe a therapeutic exercise program to our patient according to his/her pathology.
🔸Treatment system (App ReHand): deliver access to a tailored exercise programme in a tablet app to our patients.
🔸 Monitoring system (Reports): facilitate to receive weekly information about the patient’s adherence to treatment and evolution.

Pathologies such as thumb osteoarthritis, Carpal Tunnel Syndrome, Wrist and Hand Fractures, Scaphoid Fractures, Sudeck or Complex Regional Pain Syndrome, Carpal Instabilities, and many others, can be recovered thanks to this tool.

Learn how to prescribe Hand and Wrist Exercises with Technology!⭕

References

– Valdes K, Naughton N, Algar L. Sensorimotor interventions and assessments for the hand and wrist: A scoping review. J Hand Ther. 2014;27(4):272–86.
– Hagert E. Proprioception of the Wrist Joint: A Review of Current Concepts and Possible Implications on the Rehabilitation of the Wrist. J Hand Ther. 2010 Jan;23(1):2–17.
– Clark BC, Mahato NK, Nakazawa M, Law TD, Thomas JS. The power of the mind: the cortex as a critical determinant of muscle strength/weakness. J Neurophysiol. 2014;112(12):3219–26.
– Karagiannopoulos C, Sitler M, Michlovitz S, Tucker C, Tierney R. A descriptive study on wrist and hand sensori-motor impairment and function following distal radius fracture intervention. J Hand Ther. 2013;26(3):204–15.
– Newbold DJ, Laumann TO, Hoyt CR, Hampton JM, Montez DF, Raut R V., et al. Plasticity and Spontaneous Activity Pulses in Disused Human Brain Circuits. Neuron. 2020 Aug 5;107(3):580-589.e6.

Pablo Rodríguez Sánchez-Laulhé

Physiotherapist, PhD Candidate and Health Researcher | Hand Therapy and Digital Health