Wrist Sprain

What Is It?

A sprain in the wrist is an injury to its ligaments, the tough bands of fibrous tissue that connect bones to one another inside a joint. Although most people speak of the wrist as a single joint between the forearm and hand, the wrist actually contains many joints that link 15 separate bones. The ligaments that connect these bones can be torn by any extreme twist, bend or impact that suddenly forces the wrist into a position beyond its normal range of motion.

There are three levels of sprain:

• Mild (Grade I) — The wrist's ligaments are stretched or have microscopic tears.
• Moderate (Grade II) — The damage is more severe, and some wrist ligaments may be partially torn.
• Severe sprains (Grade III) — One or more wrist ligaments are entirely torn or torn away from where they normally attach to bones.

Sprains of the wrist are fairly rare in everyday life and in the workplace. Under certain weather conditions, such as during ice storms or after a snowfall, a wrist sprain is commonly caused by a fall in which a person lands on outstretched arm.

For athletes, sprains and other injuries to the wrist or hand account for 3% to 9% of all sports injuries. They are especially common among young males who play football, basketball or baseball. In addition, at least 36 Olympic events have been linked to an unusually high rate of wrist sprains, including roller hockey, baseball, boxing, basketball, volleyball, weightlifting, ice hockey, wrestling and judo.

Among skiers, wrist sprains commonly occur when the skier falls while still gripping a ski pole or still having the pole strapped to the hand. Falls are also a frequent cause of wrist sprains and fractures among snowboarders and inline skaters. In platform divers, wrist sprains can occur when the wrist absorbs an unusually forceful impact as the athlete hits the water. Wrists sprains also occur in racquet sports, wrestling and pole vaulting because the wrist is subjected to extreme twisting movements during these sports.

Symptoms

In a mild wrist sprain, your wrist may be slightly swollen and tender, and you probably will feel some mild pain when you move it.

In more severe sprains, swelling can change the shape of your wrist, and you may have some bruising (a black-and-blue skin discoloration). Also, you'll probably feel significant pain when you try to move your wrist, or when your health care professional moves your wrist while examining it.

Diagnosis

After reviewing your symptoms, your doctor will ask you to describe how you injured your wrist. Include as many details as you can. Did you fall or twist the wrist? What position was your wrist in when you injured it? If you are an athlete, your doctor may want an eyewitness account of your injury from a trainer or coach. Your doctor also will review your medical history, especially any history of previous wrist, hand or forearm injuries.

If the results of your history and physical suggest you have a severe wrist sprain or a fractured bone, your doctor may order wrist X-rays. If these appear normal, but your symptoms are severe and persistent, your doctor may order additional tests such as magnetic resonance imaging (MRI) or a computed tomography (CT) scan. In some people, especially in competitive athletes with moderate or severe wrist injuries, the doctor may do a type of minor operation called arthroscopy to inspect the wrist ligaments directly for signs of damage.

Expected Duration

In milder wrist sprains, symptoms usually improve within two to three days. More severe sprains can take a number of weeks or even months to heal completely.

Prevention

To prevent wrist sprains related to falls, you can stay indoors when it's icy or wet outside. If you must go out, wear shoes with soles that provide traction during slippery conditions and pay careful attention to the surface where you are walking.

To prevent sports-related wrist sprains, wear protective equipment that supports the wrist. In particular, snowboarders and inline skaters should protect their wrists by using wrist guards or snug-fitting plastic wrist splints. Platform divers may wear protective tape, wrist splints or wraps that limit extension of the wrist.

To prevent wrist sprains related to skiing, choose ski poles that have a low-profile grip with finger grooves. Also, grip ski poles without using straps and drop poles during a fall.

Treatment

For milder wrist sprains, initial treatment follows the RICE rule:

• Rest the joint
• Ice the injured area to reduce swelling
• Compress the swelling with an elastic bandage
• Elevate the injured area.

Your doctor also may suggest a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin and others), to relieve pain and ease swelling.

For moderate wrist sprains, especially in professional or competitive athletes, the wrist may be immobilized in a splint or light cast for seven to 10 days. If you have a significant wrist injury, you will need physical therapy as soon as symptoms allow. Athletes usually can return to competition once symptoms subside, although it may be advisable to protect the injured wrist with a support splint. When a severe wrist sprain causes significant instability in the wrist, surgery may be required.

When To Call a Professional

Call your doctor immediately whenever you have symptoms of a severely sprained wrist, especially if your wrist is deformed or severely swollen, or if pain prevents you from moving your wrist normally in any direction. For milder sprains, call your doctor if your wrist symptoms do not improve within two to three days after your injury.

Prognosis

Since most wrist sprains heal with time, the long-term outlook is usually excellent. This is especially true for people who do not routinely play sports that twist or bend the wrist. Among athletes with severe sprains, arthroscopic repair is usually successful.

Additional Info

National Institute of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov/

American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org/

National Athletic Trainers' Association
http://www.nata.org/