Sports Medicine

Wrist Sprains

Anatomy

The wrist is a complex joint containing 8 small bones (carpals), the lower end of the forearm bones (distal radius and ulna), and many strong bands of connective tissue (ligaments) that connect one bone to another and support the joints of the body.

Description

A sprain occurs when a ligament is forced to stretch beyond its normal range, or when the elastic fibers of the ligament are torn. Wrist sprains are common injuries that can occur with use. They are often caused by a fall, such as onto an outstretched hand, or when the joint is bent forcefully or suddenly twisted.

Wrist sprains are graded according to the degree of injury to the ligaments, and they can range from mild to severe.

• Grade 1, mild sprain—Ligaments are stretched but not torn.
• Grade 2, moderate sprain—Partial tearing of the ligament; may involve some loss of function.
• Grade 3, severe sprain—Complete tearing of the ligament; these are significant injuries requiring medical or surgical care. In some cases, as the ligament tears away from the bone, it takes a small chip of bone with it—this is called an avulsion fracture.

Symptoms

The symptoms of a wrist sprain may vary in intensity and location. Commonly experienced symptoms include one or more of the following:

• Swelling in the wrist
• Pain at the time of injury
• Persistent pain when moving or using the wrist
• Bruising or discoloration of skin around the wrist
• Tenderness at the injury site
• A sensation of popping or tearing inside the wrist
• Skin around the wrist feels warm or feverish

Diagnosis

It is important to note that in some instances, even with a severe sprain or fracture, there may be little swelling and you may be able to move the wrist without much discomfort. In all but very mild cases, it is necessary to have the injury evaluated by your physician.

Prompt medical diagnosis and treatment are essential to avoid long-lasting stiffness and pain. For example, an unrecognized (occult) fracture may be mistakenly considered a mild or moderately sprained wrist. If the broken bone is left undiagnosed and untreated, it may require surgery that could have been avoided with early, appropriate treatment. In some instances, however, surgical repair of a torn ligament is required in order to help prevent future problems.

Nonsurgical Treatment

Mild wrist sprains can usually be treated at home. Your physician may recommend the following:

• RICE (Rest, Ice, Compression, Elevation)—After 48-72 hours, ice and heat can be alternated.
• Nonsteroidal anti-inflammatory medication (NSAIDs)—Drugs such as aspirin or ibuprofen may help reduce swelling and relieve pain. Most people are familiar with nonprescription NSAIDs such as aspirin and ibuprofen, however, whether using over-the-counter or prescription strength, they must be used carefully. Using these medications for more than one month should be reviewed with your primary care physician. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk to your doctor.

Surgery

Severe sprains may require surgery to repair the fully torn ligament and reconnect it to the bone. Your orthopaedic surgeon will discuss the surgical options that best meet the needs of your injury.

With any surgery there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.