Wrist sprain

Synonym for sprain:

• Strain

What is a wrist sprain?

A wrist sprain is a strain or tear of one or more ligaments—the tissues that connect the bones of the wrist. This injury can cause swelling and bruising, which is discoloration under the skin. Bleeding around the injury may contribute to the bruising.

A wrist sprain is not always equally severe. It can range from a simple ligament strain, with no loss of stability, to a complete tear that causes the joint to become unstable.^{1, 2}

What is a ligament?

A ligament connects bones and helps stabilize a joint—the point where they meet. In the wrist, ligaments hold the small bones in place during hand movements.

What are the causes of a wrist sprain?

A fall onto the hand, a twist, or a blow can injure the ligaments in the wrist. Repetitive movements can also strain them. The medical section on wrist sprains describes both of these situations. Common causes include:

• Falling on your wrist or hand
• Rapid and sudden twisting of the hand or wrist
• Direct blow to the wrist

Here are some classic examples:

• Slipping on ice and falling on your hand
• Falling on your hands while skateboarding or rollerblading
• Use force to open a jar of pickles, then make a sudden flick of the wrist when the lid gives way

Pain that develops gradually does not, on its own, rule out a ligament injury. It may also stem from a tendon—the tissue that transmits force from a muscle to a bone. An evaluation helps distinguish between these causes.

What are the symptoms of a wrist sprain?

Symptoms of a wrist sprain include pain, difficulty moving the hand, and sometimes swelling or bruising. These symptoms may also accompany a fracture, or a broken bone.

The main symptoms are:

• Pain in the wrist or hand
  
  • The pain may be on the inside or outside, on the palm, or very diffuse in the wrist
• Possible swelling in the wrist²
• A bruise may appear on the wrist or hand

What actions can make the pain worse?

• Wrist movements
• Putting weight on the hand (for example, to get out of bed)
• Twisting the wrist (opening a jar, for example)
• Lifting loads (grocery bags, a pot full of water, for example)
• Shaking hands

How to diagnose a wrist sprain?

The diagnosis of a wrist sprain is based on questions about the injury and an examination of the wrist’s range of motion, pain, and stability. The healthcare professional also checks for sensation in the hand and looks for signs of a fracture.

After a wrist or hand injury, the following signs require an evaluation to determine whether an X-ray is necessary:

• Significant swelling of the wrist or hand
• Visible deformity of the wrist or hand: Go to the emergency room
• Pain when the forearm rotates so that the palm faces downward, a movement called pronation

A study of 391 adults evaluated these three signs together. The model identified nearly all fractures, but it also indicated the need for an X-ray in several people who did not have a fracture. Therefore, these signs alone do not confirm a fracture, and their absence is not enough to rule out all injuries.³ After an accident, a numb hand, a deformity, or a deep wound that is bleeding heavily requires urgent medical attention.

In Quebec, a physical therapist who holds the required certification may order an X-ray for an injury to muscles, bones, or joints that occurred less than 72 hours ago. The physical therapist must be the first professional to evaluate you for this injury, prior to a medical consultation. The regulations of the Quebec Professional Order of Physical Therapy govern this authorization. However, urgent symptoms require the medical care described above.

The scaphoid is a small bone in the wrist located on the thumb side. A fracture can reduce blood flow to part of this bone—especially the portion near the forearm—and complicate its healing.⁴ Some scaphoid fractures are not visible on the first X-ray. If the doctor suspects this type of fracture, he or she may immobilize the wrist and schedule a follow-up visit or additional imaging tests.⁵ Have persistent pain after a fall reevaluated, even if the initial X-ray was normal.

When to consult a physiotherapist for a wrist sprain?

You can see a physical therapist for pain, stiffness, or weakness that limits the use of your wrist after a sprain. Any deformity or numbness that develops after the accident requires the emergency care described above first.

You can see a physical therapist directly at a private clinic without a doctor's referral. The physical therapist will determine whether your injury requires a medical evaluation and will take into account any tests and instructions you have already received.

What are the physiotherapy treatments for a wrist sprain?

Physical therapy for a wrist sprain involves the use of appropriate bracing, gradual movements, and exercises to restore strength and function to the hand. The program takes into account the stability of the wrist and medical recommendations.

A mild wrist sprain may start to improve within 24 to 48 hours.¹ This improvement in symptoms does not mean that the ligament has already healed. A more serious injury may require a splint, a brace that limits movement, or sometimes surgery. The healthcare professional will specify how long the protective measures are needed.

Inflammation is part of the body's response to injury and plays a role in the healing process. Protection and the resumption of movement must take into account the affected tissues and the severity of the sprain.

Ice can relieve pain. A review of research reports this effect, but studies comparing ice to other treatments yield mixed results. The effects on swelling and range of motion remain less certain.⁶ If you use ice, wrap it in a cloth to protect the skin, as recommended in the wrist care guidelines.

The physical therapist will work with you to adjust any activities that become difficult during your recovery.

What kinds of challenges might require an adjustment?

• Exercises or activities that are too strenuous for your wrist right now
• Actions That Make the Pain Worse
• Stiffness or difficulty moving the hand
• Concerns or fear about resuming certain activities

Your physical therapist will guide you in choosing movements and exercises. He or she will monitor the progression of your symptoms and adjust the program based on your progress.

Comparing it to a plant illustrates how to care for an injury: pulling on the plant does not replace what it needs. You can make sure it gets enough water, sunlight, and fertilizer. For the wrist, care involves a combination of protection and permitted activities. This analogy does not predict how long it will take to heal.

What does a physical therapist check?

• The ability of the wrist and hand to move
• Sensitivity in the hand and symptoms that may be caused by a nerve
• Movements that hinder you during activities
• Hand strength and wrist stability

How does the brace fit your wrist?

• The physical therapist can gently move the joints of the thumb or wrist with their hands to help relieve stiffness, provided the injury allows it.
• The physical therapist will give you exercises to help you regain strength and control in your thumb and hand.
• The physical therapist works with you to determine the duration and intensity of your daily activities and leisure pursuits.
• The physical therapist will recommend movements that make it easier for you to perform your daily activities.
• A physical therapist may recommend taping—adhesive strips applied to the skin—to support the wrist or thumb and restrict certain movements as needed. When applied to the thumb, taping can also help improve comfort. A study on finger injuries, including some involving the thumb, reported less pain at night with elastic tape. This result applies to all the fingers studied: it does not allow for isolating the effect on the thumb and does not address wrist sprains.

What to do at home for a wrist sprain?

Home care includes protecting the wrist, adjusting your activities, and gradually resuming permitted movements. The PEACE and LOVE principles provide guidelines that can be adapted to your injury. Our article on PEACE and LOVE explains this mnemonic for post-injury care.

PEACE and LOVE tips specific to the wrist

PEACE and LOVE guidelines for the wrist include proper compression, resuming light activities, and engaging in general activities as tolerated. A fracture, severe tear, or surgery may change these guidelines; follow the protective instructions you have been given.

C for compression: support the wrist as needed

An elastic bandage or tape can provide support for your wrist, if it helps you and is in line with the instructions you've been given.

Ask someone to show you how to apply the correct bandage for your injury. One method recommended by St. John Ambulance involves wrapping the bandage in a figure-eight pattern around the hand and wrist, leaving the fingertips exposed. The bandage should provide support without cutting off circulation. Loosen it if your fingers become cold, change color, or feel numb; if these symptoms persist, seek emergency care.

L for Resuming Activities: Use Your Hand Gradually

Resume the permitted wrist movements and light activities without a significant increase in pain. You can do a little dishwashing or handle light objects with your injured hand if your wrist can tolerate it. Reduce the effort if the pain or swelling increases.

Restoring movement and strength is part of wrist rehabilitation. Progress depends on the injury, whether surgery was performed, and the healthcare professional’s instructions.⁷ A study involving 43 adults with pain following an injury compared immediate movement to two weeks of casting. The participants underwent an MRI, which produces detailed images of the wrist. The MRI showed no fractures or injuries to the scapholunate ligament, which connects two small bones in the wrist. The group that kept moving had less difficulty with activities at two and four weeks, and better range of motion at two weeks. At six weeks, the results were similar. These findings support keeping the wrist moving in this specific situation. Do not remove a prescribed splint without following the instructions you have received.

V for Vascularization: Maintain a Tolerable Level of Overall Activity

In this guide, “vascularization” refers to the supply of blood to tissues. The authors of PEACE and LOVE suggest an activity that exercises the heart without causing pain at the site of the injury. This activity allows you to stay active during recovery, although it does not guarantee faster healing of the wrist ligament. Choose an activity that is compatible with the permitted movements:

• Walking
• Riding a stationary bike without putting painful pressure on your wrist
• Run if you don't have pain
• You can swim without pain only if your movements are unrestricted and you don't have a splint that needs to stay dry
• Do another activity that increases your heart rate without making the pain worse

Sources

Links open in a new tab.

1. May Jr DD, Varacallo MA. Wrist Sprain. [Updated August 4, 2023]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. (Back to sections: 1, 2)
2. Morgan WJ, Slowman LS. Acute hand and wrist injuries in athletes: evaluation and management. J Am Acad Orthop Surg. 2001;9(6):389-400. (Back to sections: 1, 2)
3. Eyler Y, Sever M, Turgut A, Ocak NY, Onata A, Gürsoy O. External validation of the “deformity, edema, and pain in pronation” model for predicting wrist fractures. Am J Emerg Med. 2024;78:95-101. (Back to section: 1)
4. Cheema HS, Cheema AN. Radiographic evaluation of vascularity in scaphoid nonunions: A review. World J Orthop. 2020;11(11):475-482. (Back to section: 1)
5. Brooks S, Wluka AE, Stuckey S, Cicuttini F. The management of scaphoid fractures. J Sci Med Sport. 2005;8(2):181-9. (Back to section: 1)
6. Hubbard TJ, Denegar CR. Does Cryotherapy Improve Outcomes in Soft Tissue Injuries? J Athl Train. 2004;39(3):278-279. (Back to section: 1)
7. Levine WR. Rehabilitation techniques for ligament injuries of the wrist. Hand Clin. 1992;8(4):669-81. (Back to section: 1)
8. Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020;54(2):72-73.