What is Wrist Sprain?
A wrist sprain is a usual injury, especially in jobs and sports. This injury typically occurs in the ligaments of the wrist. Ligaments are the flexible bands of tissue that connect bones to each other. In the wrist, there are 20 of these ligaments connecting the eight small bones in the wrist to each other, as well as to the forearm and the hand.
You can sprain your wrist through a sudden injury or from doing the same movements over and over again. Certain ligaments are more likely to get injured, mainly based on their location and how they function during movement. For example, two parts of the wrist that are more likely to get injured are the triangular fibrocartilage complex (a part of the wrist that acts like a cushion) and the scapholunate ligament complex (a group of ligaments connecting two specific wrist bones).
Most of the time, wrist sprains can be diagnosed by a doctor without needing advanced images like an MRI or a wrist scope (a procedure to look inside the wrist). These injuries can often be treated without surgery. But, in some cases, advanced tests and/or surgery may be necessary.
What Causes Wrist Sprain?
Wrist sprains happen when a ligament, which is a tough band of tissue connecting bones, is excessively stretched, twisted, scratched, or torn. Most often, this happens due to a sudden force, carrying too much weight, or a twisting injury. A common cause is falling on an outstretched hand, with the exact injuries depending on the hand and wrist’s position at the time of the fall.
In serious cases, there can be a large tear in one or several wrist ligaments, which could make the wrist unstable and might need surgery to fix.
Risk Factors and Frequency for Wrist Sprain
Wrist sprains are frequently seen in both sports and work settings, but they can also happen from overuse at home or during everyday activities. The most common type of wrist injury and instability is damage to a ligament known as the scapholunate. This usually happens when the wrist is forcefully extended. Another area that can be wounded is the triangular fibrocartilage complex or TFCC, usually due to heavy pressure or pull applied to the front part of the forearm and wrist, or from repetitive motions that involve moving the wrist up-down, rotating it, or moving it side-to-side.
Signs and Symptoms of Wrist Sprain
Acute wrist sprain symptoms include pain, swelling, bruising, and difficulty moving the wrist, usually after an injury like falling on an outstretched hand.
Injuries to the TFCC, a part of the wrist, usually cause pain on the pinky side of the wrist. A common sign of this injury, the fovea sign, is pain when pressing on a specific point of the wrist, between the bone on the pinky side and a tendon in the wrist. This sign is relatively reliable for diagnosing TFCC injuries. The pain can worsen with specific wrist movements or activities that put more pressure on the TFCC. Injuries to the TFCC can result in wrist instability, causing issues in everyday activities and severe consequences in some cases.
The Scapholunate ligament injury often happens after a fall onto a dorsally extended and ulnar deviated hand. Symptoms usually include pain in the top and thumb side of the wrist, accompanied by an inability to put weight on the extended wrist, such as in a push-up position. Physical examination may indicate tenderness over the scapholunate ligament area, which is at the top of the wrist, just below the start of the forearm. A certain test (scaphoid shift test) can help diagnose this injury. Imaging tests are also useful to confirm the diagnosis.
Testing for Wrist Sprain
If you think you’ve sprained your wrist, a doctor can usually make that determination through a physical exam. In some cases, however, imaging tests might be helpful.
X-ray images can be taken to rule out any fractures or dislocations of the small bones in your wrist, known as carpal bones. If the initial X-rays do not show anything, but your doctor is still suspicious, they might take X-rays of your other wrist for comparison or take X-ray images while you make a fist or move your wrist to the side. These movements can help diagnose injuries or instability in the ligaments of the wrist. Your doctor will also check for any unusual spacing between the bones which could indicate damaged or ruptured ligaments.
Other imaging tools like ultrasounds, CT scans or MRIs can be used if the diagnosis is still unclear. Ultrasounds, for example, have a high accuracy rate and can be a good alternative to an MRI if the technician is well-trained. If a sprain is suspected, an MRI is preferred over a CT scan. In fact, an MR arthrogram, which involves injecting a contrast dye directly into the joint before the scan, can provide even better images. However, the definitive way of diagnosing as well as treating a wrist sprain is by visualizing the injury through a procedure known as arthroscopy.
Once the sprain is visualized, it can be graded. A grade 1 sprain involves stretching of the ligament without a tear and minimal bleeding. A partial tear is a grade 2 and a complete tear is a grade 3.
For specific types of wrist sprains, such as those involving the triangular fibrocartilage complex (TFCC) or the scapholunate complex, there are detailed classification systems based on the type and severity of the injury. These classifications can help your doctor understand the exact nature of your injury and plan the best treatment.
Once a diagnosis is made, your doctor will consider several factors, like any bone deformity, cartilage defect, or other specific injuries, to predict how your injury will progress and to decide on the best treatment approach.
Treatment Options for Wrist Sprain
If your doctor finds out that you’ve injured a ligament in your wrist, but everything else is fine, you’re most likely going to receive a non-invasive treatment, which means no surgery. This kind of treatment is called conservative care.
If your wrist sprain is mild, the best thing to do is to rest, elevate your wrist, and apply ice. Moving your wrist is also important. Most people feel better within one or two days. Sometimes, people with a suspected sprain who had negative MRI results (meaning the MRI scan didn’t show any injury) are recommended to start moving their wrist immediately. Doing this has been shown to speed up the recovery process and improve the wrist’s range of movement compared to wearing a cast.
For moderate to more severe injuries, you might be asked to use a semi-rigid brace, soft lace-up brace, or a forearm splint, which covers the front and back of your forearm. These will help protect your wrist and allow the injury to heal. How long you’ll have to use these and whether you’ll need to use them at all depend on several factors. These factors include your needs (for example, if you’re a professional athlete), how well you can use your wrist, how bad the pain is, how long you’ve had the pain, and whether the pain is affecting your daily life.
If your wrist doesn’t improve with these non-invasive treatments, or if you have a confirmed ligament tear or rupture, you might need further imaging tests. These tests can help determine if you will need surgery. Some situations may suggest that surgery is necessary. In such cases, surgical fixation (securing the bones in place to allow healing) and cleaning out the injured area, via either a keyhole (arthroscopic) or open surgery, are common treatments. If possible, the keyhole approach is usually preferred because it’s less invasive. This means it causes less damage to the soft tissues and allows for better wrist movement compared to open surgery.
What else can Wrist Sprain be?
If you hurt your wrist and it’s causing you pain, your doctor might suspect a bone problem like a fracture or dislocation. The usual way to check for this is by taking simple X-ray pictures. If the X-rays don’t show any problems with the bones, you may need additional tests.
There could be other things causing your pain, such as:
- Injury to a tendon, which connects muscle to bone
- A hidden ganglion, which is a small cyst in the wrist
- An infection or new growth (neoplasia)
- Issues with blood vessels or nerves
Your doctor will do the necessary tests to figure out what’s causing your pain.
What to expect with Wrist Sprain
Most injuries start to get better within 24 to 48 hours when treated conservatively. More serious injuries might need a brace or splint for a short time, around 6 to 8 weeks, before they are looked at for possible surgery. If surgery is needed, getting back to regular activities can take a few weeks, like 6 weeks on average for a type of surgery called “arthroscopic debridement”. In contrast, surgeries that involve fixation procedures could need a recovery period of three months or more.
The kind of surgery, demands of your job, or the necessities of a specific sport can also affect how long it takes to recover and what to expect during recovery. After surgery, the doctor usually recommends physical or occupational therapy to help you get back on track.
Possible Complications When Diagnosed with Wrist Sprain
In the more serious cases that require surgery, there can be a risk of complications. These can include stiffness with decreased ability to move, infection, scarring, and injuries to tendons or nerves. Generally, patients who’ve had a sprain might be more prone to getting injured again. As a result, they should think about changing their activities, using protective gear, and considering physical therapy to help their recovery proceed more smoothly.
Possible Complications and Suggestions:
- Stiffness with decreased range of movement
- Infection
- Scarring
- Injuries to tendons or nerves
- Increased risk of re-injury
- Activity modifications
- Usage of protective equipment
- Consideration of physical therapy for improved recovery
Preventing Wrist Sprain
It’s important to teach patients about moving their injured wrist early on, and also avoiding actions that make their pain worse. Patients should be provided with helpful information on how they can exercise at home, alongside their physical therapy. This will aid in their healing and help speed up their recovery process.
