Wrist sprains/sprains are common injuries, especially among athletes. Sprains occur when the ligaments in the wrist are stretched too far and may tear, either partially or completely. Wrist sprains cause pain, inflammation, and sometimes bruising, depending on the severity of the injury (grade 1, 2 or 3). Sometimes it's hard to tell the difference between a severe wrist sprain and a broken bone. By having the right information, you can tell the difference between the two. However, if you suspect a fracture, for any reason, contact your doctor immediately and seek medical attention.
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Part 1 of 2: Recognizing the Symptoms of a Sprained Wrist
Step 1. Anticipate pain when moving your wrist
Wrist sprains vary in severity, depending on the degree of stretching and/or tearing of the associated ligaments. Mild sprain (Grade 1), involving stretching of the ligaments, but no significant tearing; moderate sprain (Grade 2) involving a significant tear (up to 50% of the ligament fibers); a severe sprain (Grade 3) involves a greater amount of tear or a completely severed ligament. Therefore, in Grade 1 and 2 wrist sprains, movement will be relatively normal, although painful. Grade 3 sprains often cause joint instability (too much mobility) during movement because the associated ligaments no longer attach properly to the wrist (carpal) bones. On the other hand, if the wrist is fractured, movement is usually more restricted and there is often a crunching sensation when the wrist is moved.
- Grade 1 wrist sprains are accompanied by mild pain and are usually described as a sharp pain when the wrist is moved.
- Grade 2 wrist sprains cause moderate to severe pain, depending on the degree of tear; the pain is sharper than a Grade 1 tear and is sometimes accompanied by a throbbing sensation due to inflammation.
- Grade 3 wrist sprains are often less painful (at first) than Grade 2 sprains because the ligament is completely broken and does not irritate the surrounding nerves as much. Even so, Grade 3 sprains will eventually feel intense throbbing due to the accumulated inflammation.
Step 2. Watch for inflammation
Inflammation (swelling) is a common symptom in all types of wrist injury, as is wrist fracture, but inflammation varies greatly depending on the severity of the injury. In general, a Grade 1 sprain causes the least swelling, while a Grade 3 injury causes the worst swelling. Swelling will make the wrist look bigger and swollen than a normal wrist. Inflammation, which is the body's response to injury, especially sprains, tends to be overreacting as the body anticipates the worst-case scenario, such as an open wound that is prone to infection. Therefore, trying to limit the inflammation that usually accompanies a sprained injury with cold therapy, compresses, and/or anti-inflammatory drugs can be very beneficial because it can reduce pain and help maintain wrist range of motion.
- The inflammatory swelling doesn't cause a major change in skin color, just a slight redness due to the "warmth sensation" from all the warm fluid under the skin.
- The accumulated inflammation, usually composed of lymph fluid and various immune system cells, causes a sprained wrist to feel warm to the touch. Most wrist fractures also feel warm due to inflammation, but sometimes the wrist can feel cold because blood circulation is cut off due to blood vessel damage.
Step 3. Check to see if the bruising is getting worse
Although the body's inflammatory reaction causes swelling of the injured area, this is not the case with bruising. Bruises are caused by blood from an injured blood vessel (small artery or vein) seeping into the surrounding tissue. Grade 1 wrist sprains usually don't cause bruising, unless the injury is caused by a hard blow that destroys the subcutaneous blood vessels just under the skin. Grade 2 sprains usually cause more swelling, but again, not necessarily bruising, depending on how the injury occurred. Grade 3 sprains cause severe swelling and are usually accompanied by significant bruising because the trauma causing a complete ligament tear is usually severe enough to tear or damage the surrounding blood vessels.
- The dark color of a bruise is caused by blood seeping into the tissue just below the skin's surface. As the blood breaks up and is removed from the tissue, the bruise will change color over time (dark blue, green, then yellow).
- In contrast to sprains, wrist fractures are almost always accompanied by bruising because greater trauma (force) is required to break the bone.
- Grade 3 wrist sprains can cause an avulsion fracture, a condition when ligament contractions are so strong that they pull on pieces of bone. In this case, there is considerable pain, inflammation and bruising.
Step 4. Apply the ice and see if the condition improves
Wrist sprains of all levels respond well to cold therapy because the cold reduces inflammation and numbs the nerve fibers that produce pain. Cold therapy (with an ice pack or frozen gel) is essential for grade 2 and 3 wrist sprains because of the accumulated inflammation around the injured area. By applying cold therapy to a sprained wrist for 10-15 minutes every one to two hours right after the injury, you will see a positive effect after a day or two as cold therapy reduces pain intensity significantly and makes movement easier. On the other hand, applying cold therapy to a wrist fracture will help reduce pain and also control inflammation, but symptoms often return after the effects of the therapy wear off. Therefore, as a general guide, cold therapy tends to be more effective for sprains than for fractures.
- Hairline (stress) fractures tend to resemble Grade 1 or 2 sprains and do not respond to (long-term) cold therapy as well as more serious fractures.
- When applying cold therapy to an injured wrist, make sure you cover it with a light towel to avoid skin irritation or frostbite.
Part 2 of 2: Seeking a Medical Diagnosis
Step 1. Consult a doctor
While all of the above information can help you understand whether a wrist is indeed sprained and gauge how severe the condition is, doctors are far more competent to make an accurate diagnosis. In fact, a detailed examination leads to a specific diagnosis in about 70% of cases of wrist pain. The doctor will examine your wrist and perform some orthopedic tests, and if the injury seems severe, he or she may order an X-ray of your wrist to rule out a fracture. However, X-rays only show the condition of the bones, not soft tissues such as ligaments, tendons, blood vessels, or nerves. Carpal fractures, especially hairline fractures, may be difficult to see on X-ray because of their small size and closed position. If the X-ray doesn't show a wrist fracture, but the injury is severe and requires surgery, your doctor may order an MRI or CT scan.
- Minor stress fractures of the carpal bones (especially the scaphoid bone) are very difficult to see on a regular X-ray until all inflammation has subsided. Therefore, you may have to wait a week or more for another X-ray. Such an injury may also require additional imaging such as an MRI or the use of a splint/cast, depending on the severity of the symptoms and the mechanism of the injury.
- Osteoporosis (a condition characterized by demineralization and brittle bones) is a significant risk factor for wrist fractures, but the condition does not increase the risk of sprains.
Step 2. Request a referral for an MRI (magnetic resonance imaging)
All Grade 1 wrist sprains and most Grade 2 injuries do not require an MRI or other high-tech diagnostic tests because the injury is short-lived and tends to improve within a few weeks without medical treatment. However, ligament sprains are more serious (particularly conditions including Grade 3) or if the diagnosis remains uncertain, an MRI should be performed. MRI uses magnetic waves to provide detailed images of all structures in the body, including soft tissues. MRI is perfect for giving an idea of which ligament is torn and how badly. This information is very important to the orthopedic surgeon if surgery is to be performed.
- Tendinitis, tendon rupture and wrist bursitis (including carpal tunnel syndrome) produce symptoms similar to wrist sprains, but MRI can differentiate these injuries.
- An MRI is also helpful in assessing the extent of damage to blood vessels and nerves, especially if a wrist injury causes hand symptoms, such as numbness, tingling and/or abnormal discoloration.
- Another condition that can cause wrist pain similar to a minor sprain is osteoarthritis (wear and tear type). However, osteoarthritis pain is chronic, gets worse over time and usually causes a crunching sensation when the wrist is moved.
Step 3. Consider a CT scan
If the wrist injury is severe (and not improving) and the diagnosis cannot be confirmed after X-rays and MRIs, further imaging modalities such as a CT scan are required. A computed tomography (CT) scan combines X-ray images taken from different angles and uses computer processing to create cross-sectional (slice) images of all the hard and soft tissues in the body. The image produced from a CT scan provides more detailed information than a regular X-ray, but has the same level of detail as an MRI image. In general, CT is excellent for evaluating hidden fractures of the wrist, although MRI tends to be better for evaluating more delicate ligament and tendon injuries. However, CT scans are usually less expensive than MRIs, so they can be considered if your health insurance doesn't cover the cost of the diagnosis.
- A CT scan exposes you to ionizing radiation. The amount of radiation is more than a regular x-ray, but not enough to be considered a health hazard.
- The ligament in the wrist most commonly injured is the scapholunate, which connects the scaphoid and lunate bones.
- If all of the diagnostic imaging listed above are negative, but severe wrist pain does not subside, your doctor may refer you to an orthopedic (bone and joint) specialist for further tests and evaluation.
Tips
- Sprained wrists are often the result of a fall. So, be careful when walking on wet or slippery surfaces.
- Skating is a high-risk activity for all wrist injuries. So, don't forget to always wear wrist guards.
- If left untreated, severe wrist sprains can increase your risk of developing osteoarthritis as you get older.
