A sprain is an injury to a ligament. Ligaments are strong bands of connective tissue that connect one bone to another and hold them together in the joints like wrist, knee, hip and shoulder.
A wrist sprain is a common injury that can occur when the wrist is bent forcefully, such as in a fall onto an outstretched hand. There are many ligaments surrounding in the wrist joint. They can be stretched or torn in a sprain. Sometimes the ligament is not torn but pulls out a small pierce of the bone which it is attached to and this is called an avulsion fracture.
These ligament injuries can be graded.
- Grade 1: Mild sprains. Ligaments are stretched, but not torn.
- Grade 2. Moderate sprains. Ligaments are partially torn.
- Grade 3. Severe sprains. Ligament is completely torn.
Wrist sprains are common when a person falls and the wrist is bent backwards forcefully when the hand hits the ground. The ligaments that are put under tension will be stretched or torn.
What will be the signs and symptoms of wrist sprain?
After injury, the wrist will usually swell and may show bruising. It is usually painful to move. Sometimes the patient may notice a ‘pop’ or tearing sound from the wrist during the fall or knock.
These signs and symptoms are similar to any fractures of the wrist. However, the X-ray of a sprained wrist will not show any fracture unless the fracture is an occult fracture which can commonly occurs in scaphoid fracture.
Making a diagnosis of wrist sprain
Your hand surgeon will ask about the traumatic event that injured the wrist and also any old injuries to your hand or wrist; will also review all the symptoms.
The entire arm and hand will be examined to make sure that there are no other injuries. Tenderness in certain areas may be due to a ligament sprain but also suggest a broken bone.
Your hand surgeon doctor may request for some imaging to determine whether the wrist is sprained or broken. X-rays of the wrist will not show an injury to the ligament, but useful to ensure no broken bone. Some avulsion of the ligament can be seen in the x-ray. If the joint is subluxed, it can also be visualized in the x-ray.
In some cases, a MRI scan or CT scan may also be ordered to look clearly for ligament sprain or a suspected occult fracture.
Initial mild wrist sprains can usually be treated at home by resting the joint for at least 48 hours. Splint can be used to minimize joint motion. Patients can also ice the injury to reduce swelling. Avoid applying ice directly to the skin. Use an ice pack or wrap a towel around the ice or a package of frozen vegetables. Apply ice for about 15 to 20 minutes at a time. Compressing the swelling with an elastic bandage helps but avoid tight bandaging because this will worsen the swelling. Patients need to elevate the injury above the level of the heart to help reduce the swelling. A pain reliever medication may be helpful. If pain and swelling persist for more than 48 hours, a consultation with a hand surgeon is necessary.
Moderate sprains may need to be immobilized with a wrist splint for few weeks. This immobilization may cause some stiffness in your wrist and some stretching exercises are required after the period of splinting to help restore full mobility.
Severe sprains may require surgery to repair the fully torn ligament or to fix the avulsed bone fragment of the ligament. Some ligaments cannot be repaired anymore if the treatment is delayed or the initial injury was too damaging to the ligament. This injury will required a reconstruction of the ligament using donor ligaments or adjacent tissues.
Surgery is followed by a period of rehabilitation and exercises to strengthen the wrist and restore motion. Although the ligament can be expected to heal in 6 to 8 weeks, rehabilitation with full recovery of motion and strength can take several months.