What Is A Sprained Wrist?

Overview

What is a sprained wrist?

A sprained wrist is an injury to the ligament(s) in your wrist.¹ Ligaments are important in supporting your wrist, by connecting the bones in your wrist joint together. A wrist sprain occurs when the ligaments that support the wrist become torn, twisted, stretched beyond their limits or lacerated.¹

How can you sprain your wrist?

You can sustain this injury in many different ways, including abruptly twisting your wrist or falling over and landing on your outstretched arm. The most common cause of sustaining a wrist sprain is falling onto your arm when it is outstretched, and bending the hand backwards.

Grades of wrist sprains

Your sprain will be graded on how severe the injury is to the ligaments in your wrist. The grading system is as follows:

• Grade 1: This is mild, where the ligaments have been overstretched but they are not torn
• Grade 2: This is moderate, where your ligaments have partial tears in them but not completely torn
• Grade 3: This is severe, where the ligaments are completely torn or the ligament has been pulled off the bone it is attached to. Grade 3 sprains require medical and surgical intervention

Symptoms

Pain and tenderness

After sustaining a sprained wrist the muscles and ligaments in the wrist become irritated, which results in a feeling of pain. The trauma to the wrist joint can result in the wrist feeling tender where the sprain was sustained.

Swelling

After sustaining a sprain to your wrist you may experience the following symptoms where the sprain was sustained:

• Redness
• Swelling
• Warmth

Swelling occurs due to the wrist joint becoming inflamed, and there being movement of fluid and white blood cells to the injured wrist.

Bruising

Bruising differentiates between sprains and strains. You get bruising from a sprained wrist but not from a strained wrist. When you sprain your wrist the blood vessels and ligaments in your wrist tear, which causes bruising.

Reduced movement and stiffness

Having swelling in your wrist joint may contribute to stiffness where you have sustained the sprain. Another symptom is decreased motion, especially when you try to move your wrist joint either backwards or in a side-to-side motion.

Diagnosis

Initial diagnosis: physical examination

You will be asked, by a doctor, to describe your symptoms, as well as when and where the injury was sustained. The doctor may ask you for your medical history, including whether or not you have sustained any previous injuries to your wrist. After this consultation, the doctor will conduct a physical examination.

When you are being diagnosed, the doctor will physically examine the wrist, locating where it is painful for you, and checking if there are any limitations on how your wrist moves.

What happens if a diagnosis cannot be reached from a physical examination? 

The doctor will turn to imaging scans.

X-rays can be used to diagnose a wrist sprain. On an X-ray, ligaments and soft tissues will not be visualised. However, a diagnosis can be made depending on how the wrist bones line up. Abnormal alignment may suggest a sprain. X-rays also allow wrist fractures to be ruled out as a diagnosis.

If an accurate diagnosis cannot be reached after conducting an X-ray scan on the wrist, other scans may be used such as magnetic resonance imaging (MRI) or CT scans.

What happens if scans cannot accurately diagnose your wrist injury?

Diagnostic accuracy can be further improved when MRI is used with arthrography, this is because it allows the exact position of the wrist ligaments to be identified.² However, unlike scans, this procedure is invasive, requiring a surgeon to make a small incision on your injured wrist and insert a tube into your wrist joint which is attached to an optic fibre camera. The camera will visualise the injury inside your wrist joint on a monitor.

Treatment

Rest and immobilisation

Treatment for your sprained wrist involves resting the injured wrist for the first 24-72 hours. During the rest period, you should avoid completing any tasks with the sprained wrist.

Ice application

It is important to acknowledge that your sprain will be classified by several different grades, and whilst treating minor sprains with ice application can be beneficial in reducing pain and swelling of the wrist joint, more severe sprains where the ligament completely tears (grade 3 sprains) will not benefit from ice application. In this case, surgery is required.³

If your sprain is minor then you can use an ice pack on the sprained wrist. This should be done for approximately 20 minutes at a time every 2 hours for optimal results. The ice pack can be either crushed ice or a packet of frozen vegetables that have been wrapped in a tea towel, for example. Ice application will help to relieve the pain and swelling of the wrist joint.

Please note that ice should not be directly applied to your skin.

Compression

Compression includes wrapping an elastic compression bandage around your sprained wrist to support the injured joint. Compression of the wrist joint will also help to reduce any swelling that you may be experiencing.

Elevation

During the first 24-72 hours after sustaining the sprain to your wrist, it is important to keep the wrist rested and elevated on pillows, ideally so that the arm is above heart level. This is important to prevent the wrist from swelling further.

Pain management

To help manage your pain you should first try taking painkillers such as paracetamol. Ibuprofen can be used as a gel or mousse to help bring down any swelling where you sustained the sprain. You should discuss with your pharmacist which type of medication is best to relieve pain if paracetamol is not effective.

Physical therapy exercises

Physical therapy can help rehabilitate your sprained wrist.⁴ Many exercises can aid your rehabilitation, including the following:

• Wrist flexion stretch
• Wrist extension
• Grip strengthening
• Wrist circles
• Ulnar deviation circle

It is important to note that these exercises should not increase the amount of pain you are experiencing and that they should be performed gently and slowly. Avoid over-exerting yourself as you may sustain further injury.

Prevention

Proper warm-up before physical activities

Warming up before exercise can help prevent wrist sprains. A warm-up should be done before you start stretching. A warm-up increases your heart rate and therefore increases the amount of blood flowing to your tissues, muscles, ligaments and tendons, preparing them for exercise. A warm-up can include the following:

• Arm swings
• Jogging on the spot for a few minutes
• Lunges
• Squats

Strengthening exercises for wrist muscles

The following exercises can strengthen your wrist muscles to prevent wrist sprains:

• Wrist extension
• Wrist flexion stretch
• Ulnar deviation
• Wrist supination and pronation

Many of these exercises are used to treat wrist sprains too in rehabilitation.

Using protective gear during sports or activities

Protective equipment such as wrist guards have been shown to prevent injuries to the wrist, such as sprains, when participating in activities such as snowboarding.⁵

Complications

Proper diagnosis of injuries sustained to your wrist is necessary as this can avoid long-term problems, including stiffness, arthritis and chronic pain.

What is chronic pain?

Chronic pain is defined as pain that persists for longer than 12 weeks or the normal recovery time after sustaining an injury. Chronic pain can sadly not be cured. However, a healthcare professional can help you find which strategies help manage your pain best for you.

Which long-term joint issues can arise due to a sprained wrist?

Long-term joint issues that can arise after sustaining a sprain include post-traumatic arthritis. Post-traumatic arthritis is a condition that affects your joints, where the trauma from the sprain causes the cartilage, which protects the ends of your bones, to wear away, meaning that the bones rub against each other. This sadly results in irreparable joint damage.

Recovery and rehabilitation

Gradual return to normal activities

The initial pain of a sprained wrist should subside after a few days. However, the damaged ligaments typically take around 6 weeks to recover, although this can vary from individual to individual. After the sprain has healed you can resume your normal activities. However, you should avoid any strenuous exercise for up to 8 weeks after you have sustained the sprain.

Follow-up appointments with healthcare provider

Follow-up appointments after your initial diagnosis may be offered. These appointments will usually be with a physiotherapist who will give you exercises to assist with rehabilitation until your wrist has fully recovered.

When to ring 111 and seek medical assistance?

You should seek medical attention after sustaining a sprain, and ring 111 if you experience any of the following:

• A very painful sprain, where the pain you are feeling is increasing
• Your wrist is very stiff and difficult to move
• If after treating the sprain yourself, using rest, ice compression, or elevation, it is not improving
• Your wrist hurts when you put weight on it
• You are experiencing a very high temperature, and feel shivery, indicating an infection

Summary

• A wrist sprain is when the ligaments in your wrist become damaged
• The most common cause is falling on your outstretched hand
• Sprains are graded depending on the severity of the damage to your ligaments
• Typical treatment for a sprain includes rest, immobilisation, ice, compression and elevating the arm above heart level
• Symptoms include swelling, pain, tenderness, bruising and reduced movement
• Diagnosis is usually achieved after physical examination, an X-ray, CT scan, MRI scan or MRI with arthrography
• Exercises are provided to rehabilitate the wrist by your physiotherapist
• It is important to seek medical advice when the sprain is not improving after home treatment, is getting more painful, hurts to put weight on, or you have a high temperature