Sprains are injuries to the ligaments surrounding a joint. In the wrist, a tough band of ligaments connects fifteen separate bones. Any movement that twists, bends, or impacts the wrist, forcing it beyond its normal range of motion, can damage these ligaments. Wrist sprains are most commonly caused by falls and landing on an outstretched hand. They are often mild, but can be more severe.
Strained and sprained wrists have some overlapping characteristics, but they are two distinct injuries. Sprains are ligament injuries and are most common in the wrists, ankles, and knees. Strains, on the other hand, are overstretched or torn muscles. Pulled muscles are most common in the knees, back, feet, and legs.
It is possible to mistake a sprained wrist for a break. Both usually present with pain and swelling, but in different ways. In a sprain, pain and swelling encompass the entire wrist, while in most breaks, these symptoms are only seen on the bone. Breaks have other tell-tale signs, including visible deformities or a crunching sensation. Numbness and tingling can occur with both breaks and more serious sprains.
Sprains are graded depending on severity. Grade 1 sprains are mild and caused by stretched ligaments. In grade 2 sprains, the ligaments are partially torn, and the wrist may lose some function. Grade 3 is the most severe. In this type of sprain, the ligament is completely torn or detached. If the ligament tears away and takes a bone chip with it, it is an avulsion fracture.
Symptoms of a wrist sprain include pain, swelling, and bruising. Even grades 1 and 2 sprains can cause loss of stability or strength. Stiffness may set in after a few days when the injury begins to heal. Severe sprains involve significant pain, along with looseness. Depending on the injury, the person may experience a complete loss of function.
Most wrist sprains are treatable at home and will start to heal in a few days. However, some sprains cause significant injuries and may be accompanied by a fracture. Someone with an injured wrist who cannot move the joint, has pain directly over the bone, or has numbness in the wrist or hand should see a doctor right away.
When evaluating a wrist sprain, the doctor will ask how the injury was sustained. They also need to know about previous injuries to the joint and current symptoms, specifically any numbness or tingling. The doctor will carefully examine the wrist, assessing the range of motion, and looking at the precise location of the pain. They will likely examine the hand and arm to make sure there are no additional injuries.
To confirm a diagnosis of a sprained wrist, the doctor may order an x-ray. This test does not visualize the ligaments, but it will tell if the wrist bones are out of alignment and identify any broken bones. If the sprain is severe and more information is needed, the doctor may order an MRI or CT scan. An arthrogram involves dye injected into the wrist, which makes the joint and the ligaments show up clearly on the scan.
One reason that it is important to get some wrist sprains looked at by a doctor is the risk of an unrecognized break or occult fracture. If this type of break goes untreated for too long, it will not heal properly and may end up requiring a previously unnecessary surgery. If a wrist injury does not improve quickly, a doctor should evaluate it.
R.I.C.E. is an acronym to remember for the care of a sprained wrist at home. R.I.C.E. stands for rest, ice, compression, and elevation. Rest by avoiding activities that could stress or cause pain to the wrist. Place an ice pack on the wrist for 15 to 20 minutes every two to three hours for the first few days. Compress the area with a wrap to keep the swelling down; start wrapping at the end farthest from your heart and make sure the wrap does not get too tight during the day. Finally, elevate the wrist about the level of the heart to reduce swelling. Over-the-counter NSAIDs can treat pain. After about two days, gently begin to use the wrist again.
Moderate to severe wrist sprains require more intense treatment. Splinting may be required for a week or more, and stretching exercises can help regain former mobility. If the ligament is fully torn, the injured person will need surgery to reattach it, either directly to the bone or using a graft. After surgery, strengthening exercise help restore range of motion. The ligament usually heals in less than 12 weeks, but it can take up to a full year to recover completely.
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