Wrist Sprain (Sprained Wrist)

What happens in a wrist sprain

The wrist joins the two forearm bones (radius and ulna) to 8 small carpal bones, held together by many ligaments. When the hand is forced backward, sideways or twisted, ligaments can stretch or tear. The most commonly injured is the scapholunate ligament, between the scaphoid and lunate bones.

Grades of wrist sprain

Symptoms

• pain, especially with movement or gripping
• swelling and bruising
• tenderness over the injured ligament
• a feeling of popping or tearing at the time of injury
• warmth
• weakness and reduced range of motion
• clicking or clunking with movement in significant tears

Sprain vs fracture

It is often impossible to tell a sprain from a fracture without an X-ray.

A scaphoid fracture may not show on the first X-ray. If you have tenderness at the base of the thumb, a doctor will often splint the wrist and repeat imaging, or arrange an MRI. Missed scaphoid fractures can fail to heal and lead to arthritis. See also wrist fracture.

Diagnosis

• examination for swelling, tenderness, movement, strength and stability
• X-rays to rule out fractures and look for widened gaps between bones
• MRI or MR arthrogram for suspected ligament tears, hidden fractures or TFCC tears
• arthroscopy (camera in the joint) in some cases

Treatment

Home care (RICE)

1. Rest the wrist for at least 48 hours, avoiding activities that cause pain.
2. Ice for 15 to 20 minutes every 2 to 3 hours for the first 2 days, wrapped in a cloth.
3. Compression with an elastic bandage, not too tight.
4. Elevation above the heart.
5. Pain relief: ibuprofen, naproxen or acetaminophen (paracetamol), following the label dose.

Splinting

A removable wrist splint for a few days (grade 1) to several weeks (grade 2). Severe sprains may need a cast.

Rehabilitation

Gentle range-of-motion exercises start once pain allows, followed by grip and wrist strengthening, often with a hand therapist. Return to sport when strength and movement are nearly normal, sometimes with taping or a brace.

Surgery

For complete tears causing instability, especially scapholunate injuries, surgery to repair or reconstruct the ligament is best done early, within weeks.

Complications

• chronic wrist pain and instability
• wrist arthritis (for example, scapholunate advanced collapse) after untreated complete tears
• stiffness
• missed fractures

Prevention

• wrist guards for skating, snowboarding and skateboarding
• strengthening and flexibility exercises
• learning to fall safely in sports
• fall prevention at home for older adults

Frequently asked questions

How do I know if I sprained or broke my wrist?

You often cannot tell without an X-ray. Deformity, pinpoint bone tenderness, tenderness at the base of the thumb, severe swelling or inability to use the wrist suggest a fracture. See a doctor if pain is significant or does not improve in a few days.

How long does a sprained wrist take to heal?

Mild sprains usually heal in 1 to 2 weeks, moderate sprains in 4 to 6 weeks, and severe tears can take several months, especially if surgery is needed.

Should I wear a brace for a sprained wrist?

A wrist splint or brace helps rest the ligaments in the first days to weeks and reduces pain. Avoid wearing it longer than advised, because prolonged immobilization causes stiffness. Gentle exercises help recovery.

When should I see a doctor for a wrist sprain?

See a doctor if you have severe pain or swelling, tenderness at the base of the thumb, numbness or tingling, deformity, clicking or weakness, or if symptoms are not improving after a week or two.