WRIST SPRAIN AND STRAIN

CONDITION

A wrist sprain happens when ligaments (strong bands of tissue that attach bones to bones) around the wrist are partially or completely torn (Figure 1 below). A wrist strain happens when tendons (strong bands of tissue that attach muscles to bones) crossing the wrist or muscles attached to those tendons are partially or completely torn.

Figure 1

The wrist is made up of the ends of the two forearm bones (radius and ulna) and many smaller bones (carpals) that fit together and are attached by small ligaments.
Sprains that happen to the ligaments between the forearm bones and the smaller wrist bones are usually mild, but sprains that happen to the small ligaments between the smaller wrist bones can be very serious.
Some serious wrist sprains require surgery, but mild to moderate sprains will usually get better with rest and rehabilitation.
Many tendons cross or are attached to the wrist bones. Movement of the wrist and hand in all directions is made possible by contraction of muscles that attach to the tendons.
Most strains affect the point where muscles and tendons come together.
Rarely, tendons can be completely torn through or away from their attachments.
Most strains get better with rest, but a few such injuries require casting or surgery.
Partial sprains or strains are often referred to as “stretched” tissue but anytime tissue is stretched it is actually torn, although tears can be very small

Causes

Sprains and strains usually result from a fall on an outstretched hand. It is a natural response to stick your arm and hand out in front of you to catch yourself when you fall. As you fall onto your hand, your wrist usually bends backward.
Falls in certain sports commonly cause wrist injury. These include snowboarding, skateboarding, inline skating, rollerblading, gymnastics and skiing.

Symptoms and Signs

There will be pain over affected structures immediately after the injury. Pain can be sharp, aching or burning. It may range anywhere from mild to severe.
Your wrist will swell shortly after the injury. There may be redness and warmth where your wrist is swollen.
You may have problems bending your wrist (extending it back, flexing it forward or twisting your palm up or down).
You may develop bruising over injured tissues.
You may notice popping that can be caused by injured wrist bones, torn ligaments, certain tendon injuries or torn cartilage (smooth tissue between bones in joints).
You may develop numbness, tingling or loss of sensation in part of your hand and fingers.
With more severe injuries that cause dislocation (a condition in which the bones are no longer properly aligned), your injured wrist may look deformed when compared to your other wrist.

Signs and symptoms vary in location and severity, depending on which ligaments or tendons are injured.

WHEN TO CALL YOUR DOCTOR

Call 911 if:

You have a wrist deformity and numbness or loss of sensation in your hand and fingersand/or your hand is pale or grey.

Seek immediate care if:

You have a wrist deformity and severe pain but no numbness or loss of sensation in your hand and fingers and no change in hand or finger color.
You feel bones or other tissues clicking, crunching or shifting when you try to move your hand and wrist after an injury.

Call your doctor right away (night or day) if:

You have moderate to severe pain and swelling in your wrist after a fall or other injury.
You have a lot of bruising in your wrist and hand after a fall or injury.
You have problems bending or twisting your hand or wrist after a fall or injury.
You have hand or finger numbness or tingling or loss of sensation that lasts more than two hours but no wrist deformity.
You have pain and swelling over your wrist between the base of your thumb and the end of your forearm. There is a very serious injury that can happen to the bones and ligament in this area that requires prompt attention.

Call your doctor during regular office hours if:

Any of the following symptoms does not get better within two weeks:

mild wrist pain and swelling after a fall or injury
minor bruising around your wrist after a fall or injury
mild discomfort when you bend or twist your wrist and hand.

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SELF-CARE AT HOME

For injuries that require you to seek immediate care or call your doctor right away:

You may place your wrist in a neutral-position wrist splint to keep it in place until your see your doctor. However, don’t delay your doctor visit to get a splint if you have the concerning signs or symptoms listed above.
- Splints can prevent significant wrist motion that causes pain or further injury.
- The fit of most commercial splints can be adjusted for comfort. Splints are often available in drug stores or general merchandise stores.
Place an ice pack or cold pack over your injured wrist for 20 minutes every hour.
- Place a thin washcloth between the cold pack and your skin to minimize the risk of frostbite.
- You may hold the cold pack in place with an elastic wrap.
You may take an anti-inflammatory medication such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®) for pain and inflammation. (See the labels for dose and risks.)
If you have swelling or throbbing in your wrist, elevate it above the level of your heart by placing your elbow, with a pillow underneath it, on a table or the armrest of your chair or couch when you or sitting. Do this anytime you can for as long as you can.

For mild injuries:

When doing things that cause pain, back off to the point where you don’t feel discomfort.
Change the way you lift things to minimize your symptoms:
- Until your wrist is better, avoid bending and twisting motions that increase your symptoms.
- When using your wrist, keep it in a neutral position (hold it straight and don’t bend it either toward your thumb or toward your pinky finger).
Use your other hand and wrist as much as possible to rest your injured wrist.
To decrease pain and swelling, place an ice pack or cold pack over affected tendons for 20 minutes three to six times daily.
- Place a thin washcloth between the cold pack and your skin to minimize the risk of frostbite.
- You may hold the cold pack in place with an elastic wrap.
- If you are busy, you may choose to ice during meals so as to save time and avoid interrupting other activities.
You may take an anti-inflammatory medication such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®) for pain and inflammation. (See the labels for dose and risks.)
- You may try these medications for two weeks, provided there is no medical reason you cannot take them.
- If you develop stomach upset or other side effects (listed on the label), stop the medicine and call your doctor.
If you have swelling or throbbing in your wrist, elevate it above the level of your heart by placing your elbow, with a pillow underneath it, on a table or the armrest of your chair or couch when you or sitting. Do this anytime you can for as long as you can.
If you have to keep doing activities at work that make your symptoms worse, use a neutral-position wrist splint (Figure 2 below), available at most drug stores. However, wearing a splint for more than a week or two can cause wrist stiffness and sometimes make your injury worse.

Figure 2

You may try gentle wrist stretches once or twice daily, repeating each stretch two to three times, and holding stretches for 20 to 30 seconds. Two common stretches are pictured in Figure 3 below.
Figure 3
- Stretch just until you feel a slight pulling or discomfort in your affected tendons.
- Make your stretches smooth and don’t bounce or force stretches. Stretches that are best for your affected tendons are usually performed by bending the joint and hand that the tendon crosses away from or to the opposite side of the affected tendons.
You may try gentle strengthening exercises using a small weight (such as a soup can) or something to provide resistance (like a bungee cord). Two common wrist strengthening exercises are pictured in Figure 4 below.
Figure 4
- Let your pain be your guide: if it hurts, don’t do it.
- Start by doing 10 to 15 repetitions of each exercise.
- Move slowly in both directions.
- Take a brief rest between exercises and repeat each exercise two to three times.
- The number of repetitions and weight can be gradually increased as your symptoms allow.

PREVENTION

Wear wrist protectors or splints in sports that have a high rate of wrist injuries with falls, such as inline skating, rollerblading, skateboarding and snowboarding.

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FOR MORE INFORMATION

REFERENCES

Honing E: Wrist injuries: Part 2: Spotting and treating troublemakers. The Physician and Spotsmedicine 26(10) 63-70, 1996.
Parmelee-Peters K: The wrist: common injuries and management. Primary Care.32(1) 35-70, 2005.
Watson J, Weikert D, van Zeland N: Hand and wrist injuries. In Madden C, Putukian M, McCarty E, Young C: Netter's Sports Medicine, Saunders Elsevier, Philadelphia, p.368-378, 2010.

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Authored by Christopher Madden, M.D.

Favorably reviewed by The American Medical Society for Sports Medicine

http://amssm.org

Disclaimer: This content is reviewed periodically and is subject to change as new healthcare information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.