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Outlines current management of upper limb conditions in primary care settings

This information is for primary care physicians and a general summary of current practice 

Please consult a physician directly for management of specific injuries  

Wrist Immobilisation 

Immobilisation of the wrist includes:

  • Radiocarpal and Ulnocarpal Joint

  • Midcarpal joint

  • 2nd - 5th Carpometacarpal Joints (CMCJ)

Injuries that require wrist immobilisation

  • Distal Radius fractures

  • Ulna fractures

  • Carpal Fractures (excluding trapezium fractures),

  • Metacarpal base fractures

  • Wrist tendon injuries

  • Wrist ligament injuries

Avoid including joints which do no affect movement at the wrist joints

  • Avoid Including the MCP joints of the finger and thumb

    • ​​​Unnecessarily immobilising the MCPJ may increase stiffness and reduce lymphatic drainage which can increase oedema and pain

    • Bring distal portion of the orthosis to the distal palmar crease of the hand . This will allow full movement of the MCPJs and IPJs


These casts come above the MCPJs, limiting movement and increasing the risk of stiffness and pain

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  • Advise the patient to commence active finger range of movement

    • Movement pushes oedema  through the lymphatic vessels

    • Improving the glide of the flexor and extensor tendons improving movement of the fingers

    • Tendon gliding - series of finger ROM exercises (see right)

  • Avoid bringing too far proximally

    • The cast/splint may put pressure on the volar elbow leading to pressure areas and/or skin abrasions

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