A wrist sprain is a very common injury. It is an injury to the ligaments around the wrist. Wrist sprain healing time will depend on the extent of the damage to the ligaments. Read on to learn more about wrist sprains and how to treat them. Let’s start with anatomy!
The wrist
The wrist is made up of 3 joints. These include the distal radioulnar joint, radiocarpal joint, and the mid carpal joint. The distal radioulnar joint is made up of the ends of the forearm bones, the radius and ulna, at the wrist. This joint is essential for supination and pronation. Pronation is rotating the forearm, so the palm faces downward, and supination is forearm rotation where the palm faces upward.
The radiocarpal joint is made up of the radius and the first row of carpals. Carpals are the small wrist bones in between the forearm bones and the hand bones. The first row of carpals includes the scaphoid, lunate, and triquetrum. The pisiform is also in this row of carpals, but it is not part of the joint. It sits on top of the triquetrum. This joint is the dominant joint for wrist extension. It assists in wrist flexion, radial deviation, and ulnar deviation.
Wrist extension is when the back of the hand moves toward the back of the forearm. Wrist flexion is when the palm of the hand moves toward the forearm. Radial deviation is when the hand moves to the thumb side. Ulnar deviation is when the hand moves towards the little finger side.
The mid carpal joint is the joint made up of the first and second row of carpals. The second row of carpals include the trapezium, trapezoid, capitate, and the hamate. This joint assists in wrist extension and ulnar deviation. It is the dominant joint for wrist flexion and radial deviation.
What is a ligament?
A ligament is a fibrous connective tissue that connects bone to bone. This is particularly true in the joints. Ligaments help to stabilize joints. They prevent the joints from moving too far in certain directions and help keep the bones that make up the joint from dislocating.
What is a wrist sprain?
A sprain is an injury to a ligament. Therefor a wrist sprain is an injury to the ligaments of the wrist. These include the ligaments that stabilize the distal radioulnar joint, the radiocarpal joint, and the midcarpal joint. An injury to a ligament usually indicates that it was stretched beyond its limits and tore. This could be a partial or complete tear of the ligament. The extent of the tear will affect the wrist sprain healing time. There are three grades to indicate the severity of the tear.
- Grade 1
- This is slight stretch to the ligaments but no tear.
- There will be mild pain, swelling, and tenderness.
- Grade 2
- This is a partial tear of a ligament.
- There will be moderate tenderness, swelling, and pain.
- Bruising may be present.
- It will be difficult to use your wrist without pain.
- Could impact the stability of the wrist.
- Grade 3
- This is a complete tear of a ligament
- There will be severe tenderness, swelling, and pain.
- Bruising will be present.
- Decreased ability to move the wrist.
- Decreased stability of the wrist.
What causes a wrist sprain?
Wrist sprains usually are caused by a fall on an outstretched hand. This is called a FOOSH injury. However, it can also be an overuse injury caused by repetitive wrist movements.
What are the symptoms of a wrist sprain?
There are many symptoms associated with a wrist sprain. These include:
- Pain at the wrist
- Especially with movement
- Bruising might be present
- Tenderness to the touch
- A popping sound or tearing sensation inside the wrist
- Increased warmth around the wrist
- Decreased mobility and strength of the wrist
- Feeling of instability in the wrist
Wrist sprain healing time
Recovery time depends on the extent or grade of the injury.
- Grade 1 – Healing time of 1-3 weeks
- Grade 2 – Healing time of 3-6 weeks
- Grade 3 – Healing time can take several months
The risk of re-injury is high especially if you return to your sport or activity before the wrist is fully healed.
Will I need surgery?
Most wrist sprains can be rehabilitated with proper physical therapy. However, if your wrist is not responding to conservative treatment after 6 months, then surgery is an option. Surgery would also be needed if there is significant instability in the wrist.
Who should I see?
- Physical therapy – Physical therapy can help decrease pain and inflammation with techniques including manual therapy and dry needling. PT can evaluate and address abnormal joint mobility, instability, muscle weakness, and muscle tone. Your PT can help you activate other muscles to decrease the load on the wrist. They can assess your posture and form during work or sports to prevent exacerbation of the injury.
- Orthopedic physician – An orthopedist might be necessary if the condition is not responding to physical therapy. Your physician can prescribe medication, give an injection, or order testing/imaging if needed. Surgery is an option if all conservative measures fail or if significant instability is present.
What can I do?
- Relative rest – Resting the area to decrease further pain and damage from occurring is one of the best ways to treat a wrist sprain. Basically, stay away from the activities that are causing pain. This gives the area time to heal. If you keep doing what is causing the injury, it is not going to get better. This might include not participating in your sport or changing how you perform a task or job. If you are not able to participate in your activity or sport, then you can supplement with non-irritating activities such as biking, walking, or jogging while your condition is being treated.
- Ice – Ice can help decrease pain and symptoms at the wrist. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- Wrist brace – A wrist splint is essential to wear after the tear to allow the area to calm down and the tear to heal. It should be worn for 3 to 6 weeks depending on the extent of the injury.
- Wrist flexion and extension stretching – You will need to stretch out the wrist flexors and extensors. This will feel very tight and sore at first. Begin with a gentle stretch. You can stretch more aggressively as the soreness subsides. See the video below.
- Wrist strengthening – It is important to strengthen the wrist after a long period of immobilization. Begin with low to no resistance and slowly increase resistance as it becomes easier. You should have minimal pain when performing the exercise and no pain afterwards. Below is a video showing how to strengthen the wrist using resistance bands.
- Grip strengthening – Strengthening the muscles for gripping is important since a wrist sprain can affect this action. Performing gripping exercises is helpful for recovering hand strength. See the video below.
- Strengthening the muscles around the elbow and shoulder – Strengthening the muscles around the elbow and shoulder are also important in being able to return to your activity. Decrease your resistance or number of repetitions if you are having pain in the wrists. Using loop resistance bands, dumbbells, or resistance bands can increase strength and difficulty. See the videos below.
In review
- The wrist is made up of 3 joints.
- These include the distal radioulnar joint, radiocarpal joint, and the mid carpal joint.
- A ligament is a fibrous connective tissue that connects bone to bone.
- Ligaments help to stabilize joints.
- A wrist sprain is an injury to the ligaments of the wrist.
- This could be a partial or complete tear of the ligament.
- There are three grades to indicate the severity of the tear.
- Wrist sprains usually are caused by a fall on an outstretched hand.
- Symptoms include tenderness, swelling, and pain at the wrist.
- Recovery time depends on the extent or grade of the injury.
- Most wrist sprains can be rehabilitated with proper physical therapy.
- There are things that you can do.
- Rest
- Ice
- After surgery or cast is removed
- Wrist flexion and extension stretching
- Wrist strengthening
- Grip strengthening
- Elbow and shoulder strengthening
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.ncbi.nlm.nih.gov/books/NBK551514/
https://www.physio-pedia.com/Wrist_Sprain