Immobilization Phase (Initial Phase – often 6-12+ weeks):

• Goal: Protect the fracture for healing.
• Physio Role: Education on cast care, swelling management (elevation, ice to non-casted areas), maintaining mobility of non-immobilized joints (fingers, elbow, shoulder).

Post-Immobilization/Post-Surgical Phase:

• Pain & Swelling Management: Modalities (ice), gentle massage.
• Restore Range of Motion (ROM):
  • Gentle Passive & Active-Assisted ROM: Wrist flexion/extension, radial/ulnar deviation, forearm pronation/supination, and thumb movements (flexion, extension, abduction, opposition).
  • Progressive Stretching: Gradually increasing intensity as tolerated.

Strengthening:

• Isometric Exercises: Initial gentle muscle contractions without movement.
• Gradual Resistance: Progressing with light resistance bands, therapy putty, light weights. Focus on:
• Wrist Extensors/Flexors: For overall wrist stability.
• Forearm Pronators/Supinators: Important for hand function.
• Thumb Intrinsic & Extrinsic Muscles: Crucial for pinch and grip strength.
• Grip Strength: Squeezing soft balls, putty.

Proprioception & Neuromuscular Control:

• Balance & Stability Exercises: Activities to improve wrist and hand awareness in space (e.g., tracing patterns with the hand, using unstable surfaces like foam pads or dynamic cushions).
• Fine Motor Control: Practicing tasks requiring dexterity (e.g., picking up small objects, buttoning).

Functional Rehabilitation:

• Task-Specific Training: Gradually reintroducing daily activities, work tasks, and sport-specific movements (e.g., throwing, gripping tools) with proper technique.
• Joint Protection: Education on proper lifting, gripping, and carrying techniques to minimize stress on the healing scaphoid.

Scar Management (Post-Surgery): Massage, silicone sheeting to prevent adhesions and improve scar mobility.