What is a wrist sprain?
A wrist sprain is an umbrella term used to describe an injury to the soft tissues of the wrist. Soft tissues include muscles, the joint capsule, ligaments and tendons. ‘Wrist sprain’ doesn’t specify which exact tissue is injured, or how badly it is injured.
A lot of wrist sprains heal reasonably quickly and there are no lasting side effects. However, the most severe wrist sprains involve damage to the ligaments that hold the 10 bones of the wrist together. These sprains can affect the long-term stability of the entire wrist and lead to ongoing pain and weakness.
Ligament injuries are classified into grades according to severity. Ligament tears can be painful at any grade, especially when they first happen.
Grade 1: The ligaments are stretched, not torn. These usually take 2–3 days to heal.
Grade 2: Moderate sprains with partial tears of the ligament fibres. The ligament is partly intact and can take 2–6 weeks to heal.
Grade 3: The ligament is completely torn. These can take 6 weeks to heal. In some cases, they require surgery.
Signs and symptoms of a wrist sprain
Immediately after the injury, the wrist will be painful and potentially show signs of swelling. Usually movement will be difficult and it may not be possible to lift anything heavy or lean on it. You may also notice pain when pushing up from a chair.
What causes a wrist sprain?
Wrist sprains are usually a result of some form of trauma. It can happen when the wrist is forced too far in one direction and tissues are stretched or torn. A common cause is a fall onto your outstretched hand, especially from a height or at speed. These injuries are also very common in ball sports or from falling off a bike. They may also happen when the wrist or hand is over-twisted, like when you use a drill or racquet that forces your forearm into excessive rotation. The force and direction of the injury will affect which soft tissues in the wrist are damaged and how badly.
Another cause of soft tissue injury is called attrition. You can gradually wear down a ligament until it breaks by putting strain through it repeatedly over many years. A good example of this is repeated forceful squeezing of electrical pliers straining the scapholunate ligament in the wrist. You can be doing the exact same thing as always and simply hear a pop, or feel something ‘go’.
Treatment of a wrist sprain
Diagnosis. The most helpful thing your physiotherapist can do is make a diagnosis of your wrist sprain and tell you which tissues appear to be injured, and how badly. The right treatment will depend upon this diagnosis.
Treatment. Initial treatment is dependant on the severity of the sprain. It may be required to place the wrist in a splint or brace or for less serious injuries taping it.
Swelling can be reduced by compression and ice over the first few days.. Your physiotherapist might also perform soft tissue treatments on the surrounding muscles and tendons, which can become tight and painful during the healing phase. To do this, they may use heat, massage or dry needling.
Exercises are needed to regain movement, strength and stability (proprioception) of your wrist. The exercises you do will depend on which ligament is damaged, as some muscles help certain ligaments while others put more strain on the ligament. These exercises need to be introduced carefully and gradually by your physiotherapist.