Sports Medicine
Sports Injury Prevention & Rehabilitation

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Sprained Wrist

(Also known as Wrist Sprain)
What is a sprained wrist?
A sprained wrist is a relatively common condition characterized by damage or tearing of the connective tissue (such as ligaments, cartilage and joint capsule) of the wrist.
The wrist comprises the joining of eight small bones in the hand and the two bones of the forearm (radius and ulna). Between the wrist bones lie many small joints, each of which comprises of strong connective tissue wrapping around the bony ends and cartilage which lies between the joint surfaces, cushioning the impact of one bone on another during activity.
During certain movements of the wrist, stretching or compression forces are placed on the joints of the wrist. If these forces are excessive due to too much repetition or high force, injury to the joints may occur. This may involve damage to the cartilage or tearing to the connective tissue surrounding the joint. When this occurs, the condition is known as a sprained wrist.

Causes of a sprained wrist
A sprained wrist most commonly occurs due to a specific incident such as a fall onto an outstretched hand. This may occur with any fall, but is particularly common in sports such as cycling, skateboarding or snowboarding (particularly in icy conditions) where a fall onto a hard surface is unforgiving. A sprained wrist may also occur during weight lifting or boxing particularly in those with poor lifting or punching technique. Occasionally, a sprained wrist may occur due to repetitive strain associated with overuse. This may be the case in patients who perform heavy manual work involving the wrist such as the repetitive use of a hammer or screw driver etc.

Signs and symptoms of a sprained wrist
Patients with a sprained wrist often experience a sudden onset of wrist pain during the causative activity. However, patients may also experience pain and stiffness after the provocative activity, particularly the next morning. Symptoms may be felt on the front, back or sides of the wrist. Occasionally pain may be referred into the forearm or hand on the affected side. Symptoms are generally exacerbated with heavy activities that involve use of the hand and wrist such as opening jars or doors, picking up heavy objects, general gripping activity or placing weight through the affected hand. It is also common for patients to experience pain on firmly touching the affected region, and, in some cases, a feeling of weakness in the wrist and hand may also be present.

Diagnosis of a sprained wrist
A thorough subjective and objective examination from a physician is usually sufficient to diagnose a sprained wrist. Investigations such as an X-ray, MRI or CT scan may be required to assist diagnosis and rule out other injuries (particularly fractures).

Treatment for a sprained wrist

Most patients with a sprained wrist heal quickly and have a full recovery with appropriate physical therapy. One of the key components of treatment is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free (a wrist brace or protective taping may be required). Activities which place large amounts of stress on the wrist should also be minimized, particularly heavy lifting, gripping, weight bearing, pushing or pulling activities.
Rest from aggravating activities ensures the body can begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Treatment of a wrist sprain in the first 48 – 72 hours is vital to reduce bleeding, swelling and inflammation. This should involve following RICE which comprises of rest from aggravating activities, regular icing, the use of a compression bandage and elevation of the affected limb. Anti-inflammatory medication may also be useful in this initial phase of injury and can hasten the healing process by reducing the pain and swelling associated with inflammation.
It is important for patients with this condition to perform movement and strength exercises early in the rehabilitation process to prevent stiffness and weakness from developing and to ensure the wrist is functioning correctly. These exercises should be implemented as soon as pain allows and should be guided by the treating physical therapist. A gradual return to activity should occur once the patient is pain-free, provided symptoms do not increase.

Prognosis of a sprained wrist

In cases of a minor to moderate wrist sprain, return to sport or normal activity can usually occur in 2 – 6 weeks with appropriate management and treatment. Patients with a more severe injury will usually require a longer period of rehabilitation to gain optimum function.

Physical therapy for a sprained wrist
Physical therapy for a sprained wrist can hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • anti-inflammatory advice
  • joint mobilization
  • wrist taping
  • wrist bracing
  • ice or heat treatment
  • exercises to improve flexibility and strength
  • education
  • activity modification advice
  • a gradual return to activity program

Other intervention for a sprained wrist
Despite appropriate physical therapy management, a small percentage of patients with a sprained wrist do not improve adequately. When this occurs the treating physical therapist or doctor can advise on the best course of management. This may involve further investigations such as an X-ray, CT scan or MRI, or a review with a specialist who can advise on any procedures that may be appropriate to improve the condition.