Wrist sprains occur when the ligaments in the wrist are stretched too far to tear (partially or completely). In contrast, a wrist fracture occurs when one of the bones in the wrist breaks. It is sometimes difficult to distinguish between a sprain and a wrist fracture because these types of injuries cause similar symptoms and are caused by similar accidents, such as a fall with the hand outstretched or a direct blow to the wrist. In fact, wrist fractures are often accompanied by sprains of the ligaments. To differentiate between these two wrist injuries with certainty, a medical examination (with x-rays) is needed, although sometimes you can tell the difference between a sprain and a wrist fracture at home before going to the clinic or hospital.
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Part 1 of 2: Diagnosing a Wrist Sprain
Step 1. Move your wrist to check it
Wrist sprains vary in severity, depending on the degree of stretching or tearing of the ligaments. Mild wrist sprain (Grade 1), involving stretching of several ligaments, but no significant tearing; a mild sprain (Grade 2) involves a significant tear of the ligament fibers (up to 50%) and may be accompanied by complaints of impaired hand function; a severe (Grade 3) sprain involves a greater degree of tear or ligament rupture. As such, the wrist can be moved relatively normally (though painful) in Grade 1 and 2 sprains. Grade 3 sprains often result in instability of movement (the hand can be moved in many directions) because the ligaments that connect the wrist bones are completely severed.
- In general, only some Grade 2 wrist sprains and all Grade 3 cases require medical treatment. All cases of Grade 1 sprains and most cases of Grade 2 can be treated at home.
- Grade 2 wrist sprains can involve an avulsion fracture, a condition when the ligament breaks from the bone and carries with it a small amount of bone fragments.
- The most common wrist ligament sprain is the scapho-lunate ligament, which connects the scaphoid bone to the lunate bone.
Step 2. Identify the type of pain you are feeling
Again, wrist sprains vary widely in severity. So, the pain caused is also very varied. Grade 1 wrist sprains usually cause mild pain and are often described as stabbing pain when the wrist is moved. Grade 2 sprain is accompanied by moderate or severe pain, depending on the degree of tear; The pain is sharper than a Grade 1 sprain and is sometimes throbbing due to increased inflammation. As paradoxical as it may sound, a Grade 3 sprain is often less painful at first as a Grade 2 sprain because the ligament is completely severed and doesn't irritate the surrounding nerves. However, Grade 3 wrist sprains will eventually feel throbbing as the inflammation builds up.
- Grade 3 sprains involving an avulsion fracture cause immediate pain, either a sharp pain or a throbbing sensation.
- Sprains cause the most pain when the wrist is moved and usually symptoms are relieved by minimizing movement (immobilization).
- In general, if the wrist is very sore and difficult to move, see a doctor immediately for examination.
Step 3. Apply ice and see how it responds
Sprains of any degree respond well to ice therapy or cold therapy because these therapies reduce inflammation and dull the nerve fibers that cause pain. The role of ice is very important to treat Grade 2 and 3 wrist sprains because this condition causes inflammation to accumulate around the injury site. Applying ice to a sprained wrist for 10-15 minutes every 1-2 hours once the injury occurs can make a big difference after a day or so and significantly reduce the intensity of the pain making it easier to move the hand. On the other hand, applying ice to a broken wrist can help control pain and inflammation, but symptoms often return after the effects wear off. In general, cold therapy had a more significant impact on wrist sprains than for fractures.
- The more serious the sprain, the more severe the swelling around the injury site, making the area appear swollen and enlarged.
- Fractures that result from stress resulting in fine cracks often respond very well to cold therapy (in the long term) than more serious fractures that require medical attention.
Step 4. Check the wrist the next day to see if there is any bruising
Inflammation causes swelling, but it is not the same as bruising. Bruises are caused by localized bleeding from an injury to an artery or the small blood vessels that flow into the tissue. Grade 1 wrist sprains usually don't cause bruising, unless the injury results from a hard impact that destroys small subcutaneous blood vessels. Grade 2 sprains cause more swelling, but again, not necessarily bruising, depending on how the injury occurred. Grade 3 sprains cause more swelling and are usually accompanied by significant bruising because the trauma causing the ligament rupture is often severe enough to tear or damage the surrounding blood vessels.
- Swelling due to inflammation does not cause a significant change in skin color, except for a slight redness due to the "warm sensation" from the resulting heat.
- The dark blue color of a bruise is caused by blood seeping into the tissue just below the surface of the skin. Once the blood clot is broken up and removed from the tissue, the bruise will change color (bright blue, then finally yellowish).
Step 5. See how your wrist is doing after a few days
Basically, all Grade 1 wrist sprains, and some Grade 2 cases, feel much better after a few days, especially if you rest your injured hand and apply cold therapy. If your wrist feels much better, there is no visible swelling and you can move it without pain, there may not be a need for medical attention. If you have a more serious wrist sprain (Grade 2), but you feel much better after a few days (even if the swelling hasn't completely gone and the pain is moderate), wait a few more days for the wrist to recover. However, if the injury does not improve significantly or even worsens after a few days, medical treatment may be needed immediately.
- Grade 1 sprains and some Grade 2 cases recover quickly (1-2 weeks), while Grade 3 sprains (especially those with an avulsion fracture) take the longest to heal (sometimes several months).
- Soft/push fractures may also heal fairly quickly (a few weeks), while more serious fractures may take several months or more, depending on whether surgery was performed.
Part 2 of 2: Diagnosing Wrist Fractures
Step 1. Check if the wrist is misaligned or bent
Wrist fractures can be caused by the same types of accidents and trauma as those that cause wrist sprains. In general, the larger and stronger the bone, the less likely it is to fracture as a result of trauma. Instead, the ligament will be stretched and torn. However, if a bone is broken, it often appears misaligned or bent. The eight carpal bones in the wrist are so small that it is difficult (or impossible) to see a misaligned or bent wrist, especially if there is a fine/compressive fracture. More serious fractures will be easier to detect.
- The long bone in the wrist that is most commonly fractured is the radius bone or the forearm bone that attaches to the small carpal bone.
- The carpal bone most commonly fractured is the scaphoid bone, and it is less likely to cause deformity of the wrist.
- When the broken bone penetrates the skin and can be seen clearly, the condition is known as an open or complex fracture.
Step 2. Identify the type of pain
The pain of a wrist fracture also varies, depending on the severity, but is usually described as a sharp pain with movement, and a deep, dull pain when the wrist is at rest. The pain from a wrist fracture tends to get worse when the hand is gripping or squeezing, and this is often not the case with wrist sprains. Wrist fractures usually cause more symptoms in the hand, such as stiffness, numbness or the inability to move the fingers, than wrist sprains, because when the fracture occurs, nerve injury/damage is more likely. Also, you may hear a rattling or rattling sound when you move your broken wrist, which is not the case with wrist sprains.
- The pain of a wrist fracture is often (but not always) preceded by the sound or feeling of something "cracking." In contrast, only Grade 3 sprains can produce a similar sound or sensation, and sometimes a “popping” sound is heard when the ligament is severed.
- As a general rule, pain in the wrist from a fracture will worsen at night, while pain from a sprain will not change or increase at night when the wrist is not moved.
Step 3. Watch if the symptoms get worse the next day
As described above, resting the hand and applying cold therapy for 1-2 days can have a significant impact on mild to moderate wrist sprains, but this is not the case with fractures. Perhaps with the exception of smooth/compressive fractures, most broken bones take much longer to heal than sprained ligaments. Therefore, resting your hand for a few days and applying ice won't have a significant impact on the symptoms caused by the fracture, and in some cases, you may feel worse once your body has overcome the initial "trauma" from the injury.
- If the bone in your broken wrist sticks out through the skin, you are at increased risk of infection and blood loss. Seek medical help as soon as possible.
- Severe wrist fractures can impede blood circulation to the hand. Swelling due to blood causes a condition called “compartment syndrome,” which is considered a medical emergency. If this condition occurs, the hands will feel cold to the touch (due to lack of blood) and turn pale (bluish white).
- A broken bone can also pinch or sever nerves around it. This condition will cause total numbness in the area of the hand where the nerve innervation is found.
Step 4. Have the doctor take an X-ray
While the information above can help you decide whether your wrist has sprained or fractured, in most cases only an X-ray, MRI or CT scan can confirm the actual condition, except for the case of a broken bone sticking through the skin. X-rays are the most economical and common option for viewing the small bones in the wrist. Your doctor may ask you to take a wrist X-ray and read the analysis from a radiologist before consulting with you. X-rays only show images of bones, not soft tissues such as ligaments or tendons. Broken bones may be difficult to see on X-rays because of their small size and narrow scope, and can take several days to be seen on X-rays. To see how severe the ligament damage is, your doctor will order an MRI or CT scan.
- An MRI, which uses magnetic waves to produce detailed images of internal structures of the body, may be needed to detect broken bones in the wrist, especially if the fracture is in the scaphoid bone.
- Fine fractures of the wrist are very difficult to see on a regular X-ray. You have to wait until the inflammation subsides. That way, you may have to wait a week or more for a fracture to occur, even if the injury is already healing.
- Osteoporosis (brittle bones due to lack of mineralization) is a major risk factor for wrist fractures, but it doesn't actually increase the risk of wrist sprains.
Tips
- Wrist sprains or fractures usually result from a fall. So, be careful when walking on wet or slippery surfaces.
- Skating and rollerblading are high-risk activities that can cause wrist sprains and fractures. So, always wear a wrist protector.
- Some of the carpal bones in the wrist don't get a large blood supply under normal conditions so it can take several months to heal if a fracture occurs.
