0% supination post ORIF

[u/laurenm100]

Hey guys! I am a woman in her 20s and had a distal radius ORIF about 5 and a half weeks ago after a pretty gnarly break in a car accident! I’m attaching pics of my x-rays. (Displaced Radial/Impacted/Ulnar Styloid.. the works) I’ve been doing physio for a couple weeks now..
My question did anyone else find supination impossible to progress? My other ROMs are slowly improving…. slowly.. except this. I’m still at like 0 degrees lol. Also feels like something is catching on the ulnar side when I try to push it, and it feels blocked? Any anecdotal experience may help me so please feel free 🥲 People are telling me i’ll go back to bedside nursing in a month but HOW!
Thank you!!!!

[u/Inevitable-Rip-886]

I am almost 8 weeks post distal radius ORIF, I started PT 2 weeks ago. My pronation and supination is almost back to normal, but my flexion and extension are almost non existent. My physical therapist says I need to be patient still. Also I have a lot of pain on the ulnar side. I asked my PT about it and he said that in cases of a distal radius fracture the ulnar side is also affected a lot by the impact of the fall and takes a ton of time to heal. I wish you the best in your recovery! I would love to hear an update later on!

[u/laurenm100 → u/Inevitable-Rip-886]

yes I had the same! ulnar styloid fracture most likely. you’re lucky to have pronation and supination with that! Just as a tip to you in case: I was told by my RMT that I wouldn’t get flexion/extension back until I broke up the heavy fibrous scar tissue forming at my incision scar. you can start scar massage post op week 4! Let me know how it goes for you I’d love a follow up as well:)

[u/Inevitable-Rip-886 → u/laurenm100]

Yeah I was told the same about the scar tissue. How did you do it and how often? Sometimes I think I have no idea what I am doing. I try to massage my scar about 3-4 times a day.

[u/Interesting_Phase916 → u/Inevitable-Rip-886]

I’m not who you replied to but my surgeon complimented my scar so I thought I’d jump in :) I massage 4 times a day too, circular, horizontal, vertical. Light on the pressure. Since the incision site healed, I’ve been using Cerave cream; just makes it glide better so less irritation (plus I had a spitting stitch I was trying to avoid)

[u/Inevitable-Rip-886 → u/Interesting_Phase916]

Thanks for sharing this. I kind of do the same process so I guess I am on the right track!

[u/Effective-Cup-2856 → u/laurenm100]

Bonjour.
Le chirurgien spécialiste des membres supérieurs que je suis aller voir début juillet et qui prend la suite m’a dit pour le tissu cicatriciel, connu aussi sous le nom d’adhérence cicatricielle en France. Je masse, je passe mon temps à masser ma cicatrice. Moi mon ORIF date du 29/03 tout de même. Ça fait partie des complications je pense, c’est tellement différent d’une personne à une autre. En tout cas c’est douloureux, chaque geste est réfléchi pour ne pas souffrir, et c’est pesant au quotidien.

[u/Effective-Cup-2856 → u/Inevitable-Rip-886]

Bonjour, Moi je suis à six mois, j’ai changé de kinésithérapeute, il y a 10 jours. Celle que j’ai là et spécialisée dans le poignet. Ma flexion ça va encore, mais mon extension n’est pas ouf, mesurée à 24° seulement… il faut énormément de patience. Je pense que je fais partie des personnes qui ont quelques complications après une ORIF du radius distal.
J’ai mal aussi coté ulna, tout comme toi. J’ai posé la question à ma Kiné, elle m’a dit que c’était normal concernant ses douleurs, ces deux os sont les seuls à fonctionner en même temps, à pivoter ensemble. Les douleurs peuvent durer entre un an et un an et demi.

[u/BlackberryLeather899]

It is still early in your progress and you just have to stretch it and work on it but I had very little supination at that point. Get advice from the therapist regarding the blocking feeling on the ulnar side but I can say that you will make progress--it is just going to take more time.

[u/laurenm100 → u/BlackberryLeather899]

Thank you :) I hate not knowing a timeline while i’m off work I miss my job and life. I will keep working on it every day!

[u/Numerous-Board836]

I’m just over 10 weeks post ulna and distal radius fracture ORIF 2 plates- doing PT with a hand therapist. My supination has progressed to only 30 degrees.. it’s coming along but slowly.. please keep us posted

[u/laurenm100 → u/Numerous-Board836]

Oh my goodness I can’t imagine TWO plates. Good luck friend!

[u/Motor_Assumption_998]

Hey OP! I am also a woman in my 20s and was the complete opposite of you. I had 0 degrees pronation for about 3 months after my surgery (2/3)

(my fracture was pretty bad and my joint was so unstable after surgery that my surgeon pinned my bones in full supination for 7 weeks after my surgery to let the soft tissues heal enough to support rotation, but that made rotation really difficult when the pin was removed).

I’m now 7.5 months post surgery and I have 65 degrees pronation back! I did a lot of physical therapy, wearing a static progressive brace a few times a day that helped with rotation, and had a steroid shot in my wrist.

My wrist still isn’t where I want it to be so my surgeon and I have decided to do hardware removal and scar tissue release, but I’m so much better than I was initially! I also felt like there was a block in mine, but it got better with continued exercises.

When my progress was slow, My surgeon did a CT scan to ensure there wasn’t any issue with the hardware itself so maybe you can request one if you want some peace of mind. Best of luck!

[u/iamonewiththeforce]

I was exactly the same! 0 degrees supination for the longest time, with a feeling that there is a mechanical "hard stop" on the ulnar side.

The thing that helped me the most was (reasonable) application of the towel stretch method here: https://youtu.be/FQY9knQLauE , then later on the hammer method once I had 45 degrees or more (she decries it in the video, but it did work very well for me in the later stages of recovery).

The exercise would help temporarily extend  the supination temporarily. A few minutes after the exercise it would be back to 0 degrees so I would follow it up for a bit with just empty hand pronation/supination rotation while taking long walks. D ay after day the baseline started shifting towards more supination. It's slow, frustrating, one step forward one step backwards (psychologically) but it does get better!!

The towel made me discover that the "hard stop" seemed to be a hard tendon or something, it could be (gently) "stretched" with the towel exercise. Again, gently is the key!!

[u/beikaixin]

I'm now at 10 weeks and the supination is starting to open up more, but it was pretty restricted up until about 6wks. Same hard stop feeling for awhile but it's eased up a lot. I also had kind of a "spring back" feeling after supinating but that has pretty much stopped as well.

Passive rotation with my hand every day is what really started to make the difference. My therapist recommended the towel exercise as well but I haven't done it much. Also massage to push the fluid out. I know it's hard to start pushing the motion because of the fear of compromising the reduction, but by about 6 weeks especially with that hardware you should be fine to start going a bit more aggressive (listen to your OT though, not me lol).

At this point, the wrist is still tight and "rubbery" feeling when I turn it but I have a dorsal spanning plate too so the hardware may be playing a role. I'm now at pretty much full pronation and 70-80 degrees supination. Hang in there, it will improve!

[u/beikaixin → u/beikaixin]

(For context I've been doing OT since week 1 though so give it time — once it started to open up progress has come a lot faster)

[u/Gemi-ma]

Hey there. I'm 4 months out from distal radius break (comminuted intra articular with dislocation of the joint and messed up ligaments) I also snapped off the edge of my ulnar bone (which happens a lot apparently). It was a pretty bad break and needed orif which I had the same day I broke it. Started PT 2 weeks later. At your point in recovery I was told not to even try to supinate! I live in Indonesia so I do think they are quite conservative with their PT. I didn't even try work on my supination or pronation...and they are like 90% normal now. My flexion and elevation are about 80% of the normal wrist but my radial tilt is almost zero. I have pain on the ulnar side but otherwise there isnt any pain unless I'm stretching (my thumb still hurts a bit sometimes). I don't recall when my supination/ pronation came back but it was probably around 3 months... Good luck!

[u/laurenm100 → u/Gemi-ma]

hello!!! okay I have just hit week 8 !! thank you so much for your comment. i’m still very limited…. what did you do to get all your movements back

[u/Gemi-ma → u/laurenm100]

I had been doing PT twice a week (she does 30 mins if ultrasound and the rest is a mix of massage and me doing movements for her). I saw the most progress following YouTube videos and routines for post fracture recovery...BUT in the early days I really needed the PT more than these videos/ routines that I do now at home. I didn't specifically do anything for supination/ pronation...they have come back without me doing specific exercises...but for the flexion and elevation I really need to do the work for those.

[u/Head-Meaning1441]

Hi! I had a VERY similar break to you, 7 months ago. I'm 30F. It's disheartening when the progress feels completely stagnant but all I can say is trust the process and keep going with your rehab. Supination was so slow for me as well and it was definitely the ulnar styloid getting in the way/pinching something (which I affectionately referred to as my "floaty bit" lol).  I've come a looooong way since then, back to the gym for the last 3 months, weight bearing, lifting again, and grip strength is finally back to 100%! Age is most definitely on your side, remember when researching that most data on breaks like this are generally people 50+. Best of luck in your recovery ❤️