After a fall: What to do when you take a tumble and injure your wrist, hand or arm

Have you ever been a victim of a FOOSH?

The guess is you have. Maybe multiple times. If you are older, the possibility of a FOOSH is frighteningly real, and can be debilitating.

Maybe your pet caused it. Or a crumpled rug or a curb you weren’t expecting. Maybe it’s a balance issue that has become clearer post-FOOSH.

FOOSH is a medical acronym – sort of – that loosely stands for “Fall Onto an Outstretched Hand.” It’s fun to say. It can be a nightmare to live with, however, if it happens to you.

According to a national study, nearly nine million Americans were treated in emergency rooms for fall-related injuries in 2023. Additional studies have found 30% of all fall-related injuries in the Unites States involve the upper extremity (from the shoulder to the fingertips) and falls account for nearly three quarters of all upper extremity fractures globally.

When we fall, we typically try to brace ourselves. And that often means throwing our hands and arms out in front of us. It’s a natural reaction, and one that can’t be unlearned because falls happen so quickly.

Unfortunately, that reaction can be costly. The most common injury caused by a fall is a distal radius fracture (broken wrist). There are others that may occur, including: a scaphoid fracture (break near the base of the thumb); a finger fracture; tendon or ligament sprain or strain; elbow or shoulder dislocation and/or rotator cuff (shoulder) tear.

If you fall and injure your upper extremity what’s next? When should you get it evaluated? Who should you see? Will you need surgery? When should you, or do you need to, start rehabilitation? Are there any tips for fall prevention?

We asked a hand therapy expert to lead us through the process, from dealing with an injury after a fall – in this case, a distal radius fracture – through rehabilitation and recovery.

After a fall, when should I get my wrist (or hand/arm) evaluated?

As soon as possible. If you feel pain or see swelling or can’t move your fingers properly, your body is telling you something’s wrong. It’s human nature to let things play out for a little while, but if symptoms aren’t improving in two-to-three days or haven’t completely resolved within a week, absolutely go see someone. Research is clear about this: The sooner you are treated for an injury, the better chance you have of a smoother and quicker recovery.

Where should I go to be evaluated?

Two popular answers are an urgent care facility or an emergency department. Both can administer an X-ray to see if you broke anything. If your state has direct access – initial therapy treatment without a physician’s referral – you can call a physical therapy center for scheduling or walk into one and potentially be evaluated immediately. An occupational or physical therapist can determine what is wrong, begin therapy or, if a break seems likely after an evaluation, send you elsewhere to get an X-ray and/or suggest you see an orthopedist.

If I want to immediately go the therapy route, what type of therapist should I target?

Occupational therapists are typically the ones who deal with hand issues, but physical therapists also are equipped to treat you. Ideally, you’d want a certified hand therapist, which is an occupational or physical therapist who has at least three years of clinical experience, logged at least 4,000 hours of hand therapy treatment, completed advanced training and passed a rigorous certification examination. Because of the stringent requirements and time it takes to become a certified hand therapist, not every center has one. But most will have someone experienced in working with upper extremity issues.

If I suffer a wrist fracture, does that mean I have to have surgery?

Not necessarily. An orthopedist will look at the break area, its severity and other factors to determine whether surgery is the correct course or if a more conservative approach, such as fitting you for a cast, works best in your individual case.

If I get a cast, does that mean hand therapy is put on hold?

No. In fact, beginning therapy for an upper extremity injury while in a cast is encouraged. If your wrist is immobile, that often means your arm, elbow, fingers and shoulder may not be moving much either. They’ll get stiff and start to hurt. Therapy can help address those areas while your wrist fracture is healing.

OK, but once the cast is off, I should be fine, right?

Well, the fracture is healed, but the challenge remains. You’ll likely have range of motion issues and then must rebuild strength. If you come to a center while in a cast, you will probably go through a couple weeks of therapy, maybe once or twice each week, take a break and then resume after the cast is removed. You can expect to be in therapy for a few months.

What if I have surgery, will I need therapy after that?

Yes. Most physicians view therapy after surgery as essential for the reasons stated above.

Once I’ve completed therapy, does that mean my strength and range of motion will be back to 100%?

In therapy, like with many things, you don’t get a full-return guarantee. Therapists will get you over the range-of-motion and pain humps – maybe a 70-80% return – and then you’re expected to keep working on your own. Some patients never regain their previous, full range of motion, especially if they are older, but that doesn’t mean they can’t return to functioning fully in life.

So, why go to therapy if I can’t absolutely get back to 100%?

Because it is all about functionality. About returning to what you enjoy. When you first meet your therapist, you likely will be asked about your goals. Do you want to play pickleball again? Knit? Play the piano? A therapist will cater your treatment toward getting you back to those things.

What will I work on while at therapy?

Through various techniques, therapists will concentrate on reducing swelling and scar tissue as well as improving coordination, dexterity, sensation and mobility. Ultimately, they will focus on strength and fine motor skills. And, of course, education is a big part of rehabilitation.

Why education, considering my fall was a fluke?

That’s one of the things the therapists will explore: the why of the fall. Are you struggling with your balance? Is that an area that needs to be addressed? Did you briefly lose consciousness and then fall? Maybe there is a cognitive or heart issue that needs to be investigated. Is your environment a hazard? Do you have small dogs or throw rugs that can become triggers for a fall? What can be done about making your living area safer? If you and your therapist and medical team can figure out why you fell, it can go a long way in preventing it from happening again.

Is there anything else I can do to prevent falls?

Enhance your conditioning, whether that means losing weight, building strength and stamina or working on improving balance and grip strength. The better shape you are in overall the better chance you have of not stumbling and falling. Your therapist will devise a plan that suits your needs.

But sometimes falls happen, no matter age or condition. Then what?

Then know there are experts in the field – certified hand therapists, occupational therapists and physical therapists – who will work with you to get you back to what is most important to you. You can’t always avoid falls or landing on your hands – FOOSH! – but you can have a plan to seek the best treatment if you take a tumble and end up hurting.

Clinical contribution to this blog provided by Chemaine Crane, national hand/occupational therapy program specialist