Treatment of Left Wrist Pain with Limited Extension

Initial Assessment and Diagnosis

The American College of Radiology recommends obtaining plain radiographs as the first-line imaging study to evaluate for bone, joint, and alignment abnormalities in patients with chronic wrist pain 2
Assessment of specific wrist extension capability, including measurement of active wrist extension degrees and finger extension degrees, guides treatment eligibility 3, 1, 4
Evaluation of grip strength is also necessary, as it may remain preserved despite limited extension 1

The American College of Rehabilitation Medicine suggests implementing task-specific practice focusing on wrist extension movements as the primary rehabilitation strategy 1
A structured exercise program of flexibility and resistance training should be combined with task-specific practice, with flexibility training performed 2-3 times per week 1
Static stretches should be held for 10-30 seconds with 3-4 repetitions for each stretch 1
Resistance training should begin with low-intensity exercises at 40% of 1-RM with 10-15 repetitions and progress to moderate intensity (41-60% of 1-RM) with 8-10 repetitions as tolerated 1

The American Academy of Physical Medicine and Rehabilitation advises against using splinting, as it may prevent restoration of normal movement and function 1, 4
Prolonged positioning of the wrist at end ranges should also be avoided, as it exacerbates symptoms 1, 4
Rehabilitation should continue for 9-12 months, depending on return-to-work goals, for optimal functional recovery 1

The American College of Radiology recommends MRI without contrast as the next appropriate study for soft tissue evaluation when radiographs are normal or nonspecific 2
MRI provides superior sensitivity for ligamentous injuries, occult fractures, and avascular necrosis compared to radiographs 2
Functional Electrical Stimulation (FES) may be considered for patients with demonstrated impaired muscle contraction, specifically for wrist motor impairment, as it leads to short-term increases in motor strength and motor control 3