Sprained Wrist

• A sprain describes an injured ligament (tissue band that connects bones) where the fibers are stretched or partially or completely torn.
• Wrist sprains affect ligaments that help stabilized the bones that make up the wrist joint.
• The most common mechanism of injury is a fall on an outstretched hand.
• Diagnosis depends upon history and physical exam.
• It may be necessary to perform an X-ray, CT, MRI, or arthrogram to assess severity of injury.
• Treatment ranges from rest and ice to surgery, depending upon severity of injury.
• Physicians may consider physical therapy and rehabilitation for wrist sprain, regardless of severity of injury.
• Doctors measure recovery time from mild sprains in weeks. Recovery from severe injury may take months.

The wrist is a complicated joint that connects the forearm to the hand.

• Two long bones in the forearm, the radius and ulna, form a curved joint surface that forms almost a cup, where carpal bones in the hand fit.
• There are two rows of carpal bones.
  • The scaphoid, lunate, and triquetrum bones form the proximal row (closest to the forearm) and fit into that curved joint surface foot the radius and ulna.
  • The bones that make up the distal carpal row (further from the forearm) are the trapezium, trapezoid, capitate, and hamate.

A ligament is a dense band of tissue that attaches to bones on each side of a joint to help maintain stability as the joint moves.

There are many ligaments in the wrist, including those that span the radiocarpal joint, the main joint of the wrist. Other ligaments stabilize the joints between each of the carpal bones.

Radial wrist sprains (on the thumb side of the wrist) affect the ligaments that connect the scaphoid and lunate bones.

Ulnar wrist sprains (on the little finger side of the wrist) affect the ligaments of triangular fibrocartilagenous complex that connects the ulna to the carpal bones.

A sprain describes injury to a ligament, with it being stretched, partially or completely torn.

• Grade 1 sprain: ligament fibers are stretched
• Grade 2 sprain: ligament fibers are partially torn
• Grade 3 sprain: ligament is completely torn

Most often, a wrist sprain occurs because of an acute injury. Should the wrist bend or twist forcefully (for example, in a fall on an outstretched hand), the ligaments that help support the joint may stretch or tear.

• Since falls are the most common case for wrist injuries, it is the risk for falling that needs to be addressed.
• There are many factors that allow the body to remain upright, and changes in any might cause a fall. From muscle weakness, loss of balance, and poor eyesight to due to aging, to poorly fitting shoes and loose throw rugs, to slipping on the ice, falls are a common injury mechanism that can occur to all regardless of age.
• Wrist injuries also may occur due to sports, due to direct trauma, and sometimes due to overuse injuries like in tennis, racquetball, and golf.

Pain and decreased range of motion are the most common symptom of a wrist sprain. Other signs of symptoms of inflammation may be present as well, including

• tenderness,
• swelling,
• redness, and
• warmth.

Most often, the patient is aware of the injury, and the symptoms occur almost immediately afterward but will likely increase in intensity over time as inflammation increases. Some patients develop pain and stiffness without swelling or bruising.

The patient may notice popping, clicking, or grinding in the wrist area, depending upon what structures might be damaged.

• Initial evaluation and diagnosis of a wrist sprain injury may be done in an urgent care or emergency department or by a primary care provider in an office.
• If the sprain is minor, a primary care provider may continue care and subsequent follow-up. If the injury is more severe, care is often provided by an orthopedic surgeon or sports medicine specialist.
• An orthopedic surgeon or hand surgeon will be involved if surgery is required. Physical therapists are often involved in care and rehabilitation even if no surgery is needed.

The initial evaluation of a wrist sprain begins with the care provider talking to the patients and taking a history to find out how the injury occurred and obtain other relevant medical information.

During physical examination, the provider will palpate, or feel, the wrist joint to find areas of tenderness and swelling.

Other physical findings include evaluating range of motion and power of the wrist and assessing the nerve function in the hand. The nerves that supply the hand have to cross from the forearm into the hand through the wrist joint.

• Physicians often take plain X-rays of the wrist to look for fractures.
• A medical professional may consider a CT scan to look for occult or subtle fractures. It is sometimes difficult to decide clinically between a sprain versus a break.
• MRI is able to look at the other structures in the wrist, including joints, ligaments, tendons, nerves, and blood vessels.
• Arthrograms are special types of imaging, where dye is injected into the joint before images are taken to better assess structures.

Treatment depends upon the severity of the injury and response to treatment. The goal is to return the patient to their previous level of activity before the injury.

• Grain 1 and 2 sprains often respond to symptomatic treatment with RICE (rest, ice compression, and elevation). A removable wrist splint, brace, bandage, or wrap may provide support. Discuss with your health care provider how long you need to follow this protocol.
• Over-the-counter (OTC) pain medications like acetaminophen or NSAIDS (ibuprofen, naproxen) may be helpful. It is important to ask your care provider or pharmacist about the safety of taking OTC medications, depending upon the patient's medical history.
• Grade 3 sprains, complete tears of a ligament, may require surgery to repair the damage.
• Regardless of the severity of injury, physical therapy to regain range of motion and strength may be useful.
• Home exercises may be prescribed to help with stretching, range of motion, and power to aid in recovery.

• Initial home treatment for a wrist sprain is RICE (rest, ice, compression, and elevation).
• It is important to know that many wrist sprains have an associated fracture, and it may be appropriate to seek medical care to make certain a broken bone is not present.

• Recovery from a sprained wrist depends upon the severity of the injury. Mild (grade 1) sprains may resolve in one to two weeks, while more severe injuries may take weeks.
• If surgery is required, the healing time may be eight to 12 weeks, but it might take six months to a year to recover full power and range of motion.

• The goal for wrist sprain treatment and rehab is to return the patient to previous level of function.
• Older patients who have osteoporosis or joint arthritis will be less likely to recover well.

Most wrist sprains occur due to falls. Minimizing the risk of falls will also minimize the risk of wrist sprain.

• This includes wearing appropriate shoes and being careful or wet or icy surfaces.
• Wrist sprains also occur in sport like skateboarding and skiing. Wrist guards or supportive taping may help.