Wrist sprains occur most often in the athletic or occupational setting but can occur from overuse at work, home, or in any activity of daily living. Injury to the scapholunate ligament is the most common injury and most common form of carpal instability; hyperextension of the wrist is a common mechanism for this type of injury.

An acute wrist sprain is an injury to a ligament often due to an acute traumatic event or chronic repetitive movements. Wrist sprains occur when a ligament is pathologically stretched, twisted, lacerated, or torn.

The inciting event typically involves the sudden application of a force, excessive load-bearing, or twisting injury mechanisms. In most cases, this results from a fall on the outstretched hand with varying structures injured depending on the position of the hand and wrist at the time of injury. In severe cases, there can be a large tear in multiple wrist ligament(s), which can cause instability of the wrist and may require surgical interventions.

Anatomy

A wrist sprain occurs when the ligaments in the wrist are stretched or torn. The ligaments are the bands of tissue that connect the bones in the wrist and help to stabilize the joint.

There are several different ligaments in the wrist, including the radial collateral ligament, ulnar collateral ligament, and the intercarpal ligaments. A sprain can occur in any of these ligaments, but the most common type of wrist sprain is a sprained ligament on the thumb side of the wrist.

Symptoms

The symptoms of a wrist sprain can vary depending on the severity of the injury, but common signs include:

• Pain: This is the most common symptom of a wrist sprain. The pain is typically located in the affected area and can be sharp, dull, or aching. Pain may be felt when gripping or moving the wrist.
• Swelling: The wrist may become swollen due to inflammation of the ligaments and the accumulation of fluid in the joint.
• Bruising: Bruising or discoloration of the skin can occur due to bleeding from the damaged blood vessels.
• Stiffness: The wrist may feel stiff and difficult to move due to the injury. This is a common symptom of a more severe sprain.
• Weakness: The affected wrist may feel weak and unstable due to the damage to the ligaments.
• Instability: The joint may feel loose or unstable, and the wrist may move in an abnormal way.
• Deformity: In severe cases, there may be a visible deformity of the joint, such as a bend or twist in the wrist.
• Snapping or popping sensation: Some people may experience a snapping or popping sensation in the joint when they move their wrist.

Causes

There are several common causes of wrist sprains, including:

• Trauma: A fall or impact to the wrist can cause a sprain. For example, landing on an outstretched hand during a fall can cause a sprain.
• Overuse: Repetitive motions, such as those involved in sports like gymnastics or tennis, can cause small tears in the ligaments over time, leading to a sprain.
• Osteoarthritis: This is a degenerative condition that can weaken the ligaments and make them more susceptible to injury.
• Rheumatoid arthritis: this is an autoimmune disorder that causes inflammation in the joints, leading to damage in the ligaments.
• Fractures: A fracture can also cause a sprain by damaging the ligaments.
• Hypermobility: People with hypermobility or ligament laxity are more prone to sprains, as their ligaments are more flexible and can stretch more easily.

Diagnosis

Diagnosis of a wrist sprain typically begins with a physical examination by a healthcare provider. The provider will examine the affected joint for signs of pain, swelling, and tenderness.

They may also move the joint in different directions to assess for range of motion and stability. Imaging tests may also be used to diagnose a wrist sprain. X-rays can help to rule out any fractures and can also show if there is any damage to the bones in the joint. An MRI or CT scan can also be used to confirm a diagnosis and to determine the severity of the injury.

Once a diagnosis of a wrist sprain is made, treatment can begin.

Treatment

Treatment options for a wrist sprain may include:

• Rest: The affected joint should be rested to allow the ligaments to heal.
• Ice: Applying ice to the affected area can help to reduce inflammation and pain.
• Compression: A compression bandage or brace may be used to help reduce swelling and support the joint.
• Elevation: Keeping the affected joint elevated above the level of the heart can help to reduce swelling.
• Over-the-counter pain medication: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help to reduce pain and inflammation.
• Physical therapy: Physical therapy and rehabilitation exercises may be prescribed to restore range of motion and strength in the joint.
• Surgery: In severe cases, surgery may be necessary to repair or reconstruct the damaged ligaments.

Recovery time for a wrist sprain can vary depending on the severity of the injury. Mild sprains may take several weeks to heal, while more severe sprains can take several months to heal. It is important to follow the treatment plan and any physical therapy or exercise recommendations provided by a healthcare provider to help ensure a full recovery.

It’s important to note that even after a wrist sprain has healed, it may be more susceptible to future injuries. Therefore, it is important to take steps to prevent future sprains, such as wearing a brace or splint during activities that put the wrist at risk, and doing exercises to strengthen the wrist.

Exercises

The best exercises for a wrist sprain include:

• Wrist flexion and extension: Gently bend and straighten your wrist to improve range of motion.
• Wrist pronation and supination: Rotate your wrist to improve strength and flexibility.
• Wrist circles: Rotate your wrist in both clockwise and counter clockwise directions to improve flexibility.
• Wrist stretches: Stretch your wrist in different directions to improve flexibility.
• Grip strengthened exercises: Squeeze a ball or use a hand gripper to improve grip strength.

It is important to consult a doctor or physical therapist before starting any exercise program, particularly if you have a severe sprain. They can advise you on the appropriate exercises for your specific injury and guide you through the healing process.

Prevention

• Warm up before any physical activity: Take the time to stretch your wrists and hands before participating in any physical activity that requires repetitive wrist motions, such as playing sports or typing.
• Use proper technique: When participating in sports or other activities that require wrist movements, make sure to use proper technique to avoid putting excessive strain on your wrists.
• Strengthen your wrists: Regularly performing exercises that strengthen the muscles and tendons in your wrists can help prevent injury. Simple exercises such as wrist curls with light weights or resistance bands can be effective.
• Take breaks and alternate activities: If you perform repetitive motions with your wrists for extended periods, take frequent breaks to rest and stretch your wrists. Additionally, alternating activities that use different muscle groups can help prevent overuse injuries.
• Wear appropriate gear: Wearing supportive wrist braces or splints during physical activity can help prevent wrist sprains by providing extra support and stability to the joint.
• Maintain good posture: Poor posture can put extra strain on your wrists, so make sure to maintain good posture while performing any activity that requires wrist movements.