Content

• To step
• Part 1 of 2: Recognizing the symptoms of a sprained wrist
• Part 2 of 2: Getting a medical diagnosis
• Tips

Wrist sprains are relatively common injuries, especially among athletes. A sprain occurs when the ligaments in the wrist are stretched too far and tear in whole or in part. A sprained wrist causes pain, inflammation, and sometimes bruising, depending on the severity of the injury (first degree, second degree, or third degree). Sometimes it can be difficult to tell the difference between an annoying sprained wrist and a bone fracture, so knowing more about them can help you differentiate them. However, if you suspect a fracture for any reason, make an appointment with your doctor for medical treatment.

To step

Part 1 of 2: Recognizing the symptoms of a sprained wrist

1. Expect some pain during movement. Wrist sprains can vary widely in the severity of the injury, depending on the degree of stretching and / or tearing in the affected ligament. A slight wrist sprain (first degree) involves slightly stretching the ligament, but without obvious tears; an average sprain (second degree) involves significant tears (up to 50% of the fibers); a severe sprain (third degree) involves larger tears or a complete rupture of the ligament. The degree of movement with a mild or moderate sprain of the wrist will thus be relatively normal, albeit painful. A severe sprain often leads to joint instability (too much mobility) during movement, because the involved ligament no longer connects properly to the bones of the wrist (carpal bone). In contrast, the degree of movement is much more limited with fractures of the wrist and there is often a scraping sensation during movement.
   • First degree sprains are somewhat painful and the pain is usually described as one that can be sharp with movement.
   • Second degree wrist sprains generate moderate to severe pain, depending on the extent to which the ligaments have been torn; the pain is more acute than that of a first degree sprain, and sometimes throbbing because of inflammation.
   • Third degree wrist sprains are often less painful (initially) than those from a second degree sprain, because the ligament is completely ruptured and cannot greatly irritate surrounding nerves - although such a sprain can eventually throb significantly due to foci of inflammation.
2. Watch for inflammation. Inflammation (swelling) is a common symptom of all wrist sprains, as well as all fractures of the wrist, but it differs significantly according to the severity of the injury. In general, first degree sprains cause the least swelling, while third degree sprains cause the most swelling. Swelling will make your sprained wrist look thicker and swollen in relation to your uninjured wrist. The body's inflammatory response to damage, especially with sprains, tends to be an overreaction, as it anticipates the worst care scenario - an open wound prone to infection. So limiting the inflammation caused by a sprain with cold therapy, compresses, and / or anti-inflammatory agents is beneficial as it reduces pain and helps maintain the range of motion in your wrist.
   • Swelling of the inflammation does not cause much of a color change in the skin, other than some redness from the "flushing" due to all the warm moisture under the skin.
   • As a result of the build-up of the inflammation, which consists of lymph fluid and a variety of specialized immune system cells, a sprained wrist will feel warm. Most wrist fractures also feel warm due to the inflammation, but sometimes the wrist and hand can feel cold due to blocked blood flow from damage to the blood vessels.
3. Check to see if bruises develop. While the body's inflammatory response causes swelling at the site of injury, it is not the same as bruising. Bruises are caused by blood seeping from damaged blood vessels (small arteries or veins) into surrounding tissues. Minor wrist sprains usually don't cause bruising unless the damage was caused by a hard blow that damaged the tiny blood vessels under the skin directly under the skin. In an average sprain, there is more swelling, but again not necessarily accompanied by a lot of bruising - it depends on how the damage occurred. Severe sprains are associated with a lot of swelling and usually significant bruising, because trauma that causes completely ruptured ligaments is usually severe enough to damage or rupture surrounding blood vessels.
   • The dark color of bruises is caused by blood seeping into the tissues just below the surface of the skin. As the blood breaks down and is flushed out of the tissues, the bruise also changes color (from dark blue to green and yellow).
   • Unlike sprains, wrist fractures will almost always involve contusions because they require trauma (force) to break a bone.
   • A third degree sprain of the wrist can lead to an avulsion fracture, in which the ligament has pulled away a small piece of bone. In this case, there is a lot of immediate pain, inflammation and bruising.
4. Apply ice and watch for any improvement. Wrist sprains of all levels respond well to cold therapy because it reduces inflammation and numbs surrounding nerve fibers that cause pain. Cold therapy (ice or frozen gel packs) is especially important for first- and second-degree wrist sprains, because those sprains are associated with a build-up of inflammation around the site of the injury. Applying ice to a sprained wrist for 10-15 minutes every one to two hours immediately after an injury provides a noticeable positive effect after a day or two, by significantly reducing the intensity of the pain and making it easier movements. In contrast, cooling a broken wrist is also helpful for pain relief and inflammation, but symptoms often return after their effect wears off. So, as a general guideline, cold therapy is usually more helpful for sprains than for most fractures.
   • Small hairline (stress) fractures often resemble minor or moderate sprains and respond better to cold therapy (long-term) than more severe fractures.
   • If cold therapy is applied to your affected wrist, wrap it in a thin towel first to avoid skin irritation or frostbite.

Part 2 of 2: Getting a medical diagnosis

1. Consult your doctor. While the above information can help you determine if your wrist has been sprained and roughly estimate to what extent, a doctor is much more qualified to make an accurate diagnosis. The fact is that a detailed history of the injury in about 70% of wrist pain cases leads to a specific diagnosis. Your doctor will examine your wrist and perform some orthopedic tests, and if the damage appears to be severe, he or she will likely order an X-ray to rule out a fracture. However, X-rays only show bone tissue, not soft tissue, such as ligaments, tendons, blood vessels and nerves. Broken bones in the hand, especially hairline fractures, can be difficult to see on an X-ray due to their small size and confined space. If the X-rays do not suggest a wrist fracture, but the injury is serious and requires surgery, the doctor may request an MRI scan or CT scan.
   • Small stress fractures of the carpal bones (called the scaphoid bone) are very difficult to see on regular X-rays until all inflammation has disappeared. So you may have to wait a week or so before getting another X-ray. Such injuries may also require additional photos such as an MRI or a splint / cast, depending on the severity of the symptoms and the injury.
   • Osteoporosis (a condition characterized by demineralization and brittle bones) is a major risk factor for wrist fractures, although it will not increase the risk of wrist sprains.
2. Ask for a referral for an MRI. For all first- and most second-degree sprains, there is no need for an MRI or any other high-tech diagnostic test, as these injuries are short-lived and will usually heal within a few weeks without medical treatment. For more serious ligament sprains (especially third degree) or if the diagnosis is unclear, an MRI will be warranted. An MRI uses magnetic waves to create detailed images of all structures in the body, including soft tissues. MRI is great for visualizing which ligament has been torn and to what extent. This is very useful information for an orthopedic surgeon if surgery is found to be necessary.
   • Ruptured tendons, tendonitis and bursitis of the wrist (including carpal tunnel syndrome) resemble wrist sprains in terms of symptoms, but an MRI can distinguish between the different injuries.
   • An MRI is also helpful in assessing the severity of blood vessel and nerve damage, especially if the wrist injury is causing symptoms in your hand, such as numbness, tingling, and / or discoloration.
   • Another cause of wrist complaints that resemble a minor wrist sprain is osteoarthritis - the wear-and-tear type. Osteoarthritis pain, however, is chronic, gets worse over time and usually gives a grinding sensation when moving the wrist.
3. Consider a CT scan. If your wrist injury is quite serious (and does not appear to be improving), but the diagnosis after X-rays and an MRI remains unclear, it is possible to have other pictures taken, such as a CT scan. CT (computed tomography) scans combine X-rays taken from different angles and use software to create sections (segments) of all the hard and soft tissues in your body. CT photos provide more detailed information than regular X-rays, more similar to that of MRIs. In general, a CT scan is excellent for detecting hidden fractures of the wrist, although an MRI is often more suitable for detecting more subtle ligament and tendon injuries. CT scans are usually less expensive than MRIs, so this is a factor if your health insurance does not cover the cost of the diagnosis.
   • CT scans expose you to ionizing radiation. The amount of radiation is more than ordinary X-rays, but not enough to be considered harmful.
   • The ligament most often sprained in the wrist is the scaphoid lunate, which connects the scaphoid bone to the lunate bone.
   • If all of the above diagnostic pictures are negative (cannot indicate a cause), but your wrist symptoms persist, your doctor will likely refer you to an orthopedic (bones and joints) specialist for further testing and examination.

Tips

• A sprained wrist is often the result of a fall, so be careful when walking on wet or slippery surfaces.
• Skateboarding is a high-risk activity across all wrist injuries, so always wear wrist straps.
• If left untreated, a severe wrist sprain will increase the risk of developing osteoarthritis with age.
• Try an ice treatment and take care not to put pressure on it. If no improvement occurs, see a doctor.