The Twist Behind Wrist Sprains
By Orthopaedic and Neurology Clinic
A wrist sprain is an injury to the capsule and ligaments surrounding the wrist joint. A sprain is typically caused by a traumatic injury to the wrist, such as a fall on an outstretched hand, but can also be caused by repetitive use of the wrist such as seen in athletes who play racket sports or people who place a lot of stress through the wrist joint (boxers, gymnasts, weightlifters).
Wrist sprains is often characterized by pain, tenderness, swelling, and stiffness of the wrist joint. The pain occurs in the location of the injury and is often felt in multiple locations around the joint. It typically hurts when you try to move the wrist, grasp objects (especially heavy objects), or with twisting motions.
You should see our specialist if your pain started after a fall or other traumatic event, if the joint is hot or swollen, if you have trouble moving the wrist, or if your pain persists after stopping the aggravating activities.
What are some classifications of Wrist Sprains?
Grade one or mild
A mild sprain is one in which the ligament is stretched, but not torn. A person may experience tenderness over the injured ligament, mild swelling, and some discomfort when the hand is moved through flexion and extension or moved side to side.
Dependent on the individual’s pain tolerance, a person with a first-degree ligament sprain may be able to continue to compete if protective taping is applied to the wrist for support.
A second-degree sprain
Is considerably worse than a first-degree sprain. The primary difference is that a second-degree sprain includes a partial tear of the injured ligament(s) along with notable instability when the ligament is tested. A partial tear may result in increased laxity of the joint possibly making the joint unstable.
The signs and symptoms of a second degree sprained wrist include moderate swelling throughout the joint, significant discomfort upon any movement of the wrist, increased pain upon palpation, and instability when the ligament is tested. The functional ability of the wrist/hand may be significantly compromised in a second-degree sprain.
The person may complain of pain, “clicking”, and a feeling that something is giving away with a partial ligament tear. This type of injury may result in dynamic instability (instability of the bones when the wrist/hand is in motion).
Third-degree or grade three
The most severe type of sprain is a third-degree sprain because it is the result of a complete rupture of one or more ligaments. It would take a significant force to completely rupture one or more ligaments in the wrist, but it can occur with a fall from a height greater than the person (upended basketball player after jumping into the air or a “flyer” falling on an outstretched arm after being tossed into the air).
The person may present with significant pain and possible deformity of the wrist. Completely ruptured ligaments can result in dislocations of one or more of the carpal bones. The function of the hand/wrist would be compromised as well resulting in the individual’s inability to use the hand (inability to grip).
Individuals suspected of either a second or third-degree wrist sprains should have their wrist/hand immobilized and be transported to a local emergency room for further medical evaluation.
“A sprained wrist is a fairly common injury seen in adult and children because it usually is a result of a fall on an outstretched hand. This can occur in any number of sports or daily activities in which gravity is a factor.”
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What types of diagnosis?
Discuss your medical history and general health, our doctor will ask about any previous injuries to your hand or wrist. He will want to know how and when your current injury occurred and will ask you to describe your symptoms, including whether you have any numbness in your hand or pain in any other locations.
Our doctor will then carefully exam your wrist to see where it hurts and to check how it moves. Tenderness in certain areas may also be consistent with a broken bone. He will then examine your entire hand and arm to make sure you have no other injuries.
Our Specialist may order imaging tests to help confirm the diagnosis.
X-rays. Although an x-ray will not show the ligaments themselves, it can suggest a ligament injury if the wrist bones do not line up correctly. An x-ray can also help our doctor rule out a broken bone in your wrist.
Other tests. If more information is needed, a magnetic resonance imaging (MRI) scan, computerized tomography (CT) scan, or arthrogram may also be ordered. In an arthrogram, a special dye is injected into the wrist joint. This makes the joint and ligaments show up more clearly on an imaging study.
Possible treatment methods?
Our therapist can implement specific treatments and exercises for wrist sprains, injuries and ligament problems. If you need surgery, our physical therapist can also help with rehabilitation after the operation. You may also benefit from having an ergonomic evaluation that addresses workplace factors that may prevent further injuries.
Moderate wrist sprains may need to be immobilized with a wrist splint for one week or more. Because immobilization may cause some stiffness in your wrist, our doctor may recommend some stretching exercises to help you regain full mobility.
Severe sprains may require surgery to repair the fully torn ligament. Surgery involves reconnecting the ligament to the bone or using a tendon graft to reconstruct the injured ligament. Our Surgeon will talk with you about which option is best in your situation.
Surgery is followed by a period of rehabilitation that includes exercises to strengthen your wrist and restore range of motion. Although the ligament usually heals in 8 to 12 weeks, it can take from 6 to 12 months for a full recovery. The length of the recovery process and your outcomes will depend on the severity of the sprain.