Wrist sprain

Introduction

A wrist sprain is an injury to one or more ligaments that stabilize the many small bones of the carpus. It typically occurs during a fall on an outstretched hand, in hyperextension. It is a common reason for consultation, especially among athletes and the elderly. Although most wrist sprains are mild and heal in a few weeks, some serious ligament injuries (such as damage to the scapholunate ligament) can go unnoticed and lead to chronic instability and early osteoarthritis of the wrist.

If you have a painful and swollen wrist after a fall, first contact your primary care physician. If they are unavailable, Docadom offers an emergency consultation with a home doctor: call 021 845 45 45 or use our application available on the App Store and Google Play.

Who is at risk?

Wrist sprains primarily affect athletes (falls from cycling, skiing, rollerblading, skateboarding, gymnastics, judo, basketball) and the elderly for whom a simple fall can reveal an associated wrist fracture. Children and adolescents, whose bone growth is still active, are also affected (injuries are sometimes underestimated). Osteoporotic patients and those who have already had a sprain are at increased risk. Falls from ladders, stools or on slippery ground are classic circumstances.

Symptoms of a wrist sprain

Symptoms occur immediately after the trauma. Their intensity points to the severity of the injury but does not on its own rule out a fracture.

Main symptoms

• Sharp pain in the wrist, sometimes associated with a cracking sound.

• Diffuse or localized edema on the dorsal, palmar, or lateral side.

• Bruising appearing in the following hours.

• Functional impairment: difficulty making a fist, carrying an object, putting pressure on the wrist.

• Limitation of movements of flexion, extension, tilt.

• Sensation of instability or clicking in severe forms.

When to consult in an emergency?

An emergency medical consultation is necessary in the following situations:

• Visible deformity of the wrist ("dinner-fork deformity": Colles' fracture).

• Intense pain preventing any movement.

• Skin break or bleeding.

• Loss of sensitivity or paleness of the fingers (neurovascular distress).

• Sprain in an elderly person, a patient on anticoagulants or osteoporotic.

• Suspected scaphoid fracture: pain in the "anatomical snuffbox" (at the base of the thumb).

What to do before calling Docadom? Immediately apply the RICE protocol (Rest, Ice, Compression, Elevation) and first contact your primary care physician. If they are unreachable or if you need a home doctor outside of opening hours, call Docadom at 021 845 45 45 or request directly from our smartphone application (App Store and Google Play). In case of deformity, skin break, or loss of sensitivity, dial 144 without delay.

Mechanisms and classification

A wrist sprain is most often caused by a fall on the hand, open palm, wrist in hyperextension. The most exposed ligaments are the intercarpal ligaments, especially the scapholunate ligament and the lunotriquetral ligament, as well as the triangular fibrocartilage complex (TFCC) on the ulnar side.

Classification

• Grade I (mild): ligament stretching, no laxity. Recovery in 2 to 3 weeks.

• Grade II (moderate): partial tear, moderate laxity. Recovery in 4 to 6 weeks.

• Grade III (severe): complete tear with instability. Often requires surgery.

Diagnosis of a wrist sprain

The diagnosis is clinical, supplemented by imaging to rule out a fracture.

Diagnostic methods

• Anamnesis: mechanism, position of the hand during the fall, initial intensity.

• Clinical examination: systematic palpation of the wrist, looking for pain in the anatomical snuffbox (scaphoid), evaluation of movements and strength.

• X-rays of the wrist (frontal, lateral, oblique views, and scaphoid views if suspected).

• MRI or arthrogram in case of doubt regarding a ligament or osteochondral injury.

• Ultrasound in certain situations.

Alternative diagnoses

Several injuries can be mistaken for a sprain:

• Scaphoid fracture: should always be suspected (sometimes invisible on early X-rays).

• Fracture of the distal end of the radius (Colles' fracture, Smith's fracture).

• Ulnar fracture, fracture of other carpal bones.

• Lunate dislocation.

• TFCC injury.

• De Quervain's tenosynovitis or tendinitis (delayed after the trauma).

Treatment of a wrist sprain

Treatment combines rest, immobilization, pain relievers, and rehabilitation.

First steps (first 48 hours)

• Ice for 15 to 20 minutes every 2 to 3 hours (protect the skin).

• Rest and discontinuation of pain-causing activities.

• Elevation of the hand above the level of the heart to limit swelling.

• Compression using a soft bandage.

Medical treatment

Paracetamol as first-line treatment. NSAIDs (ibuprofen, diclofenac) can be used for a short duration (3 to 5 days), keeping in mind contraindications. Topical NSAIDs in gel form are a good local alternative.

Immobilisation and rehabilitation

A wrist brace or a removable cast is worn for 2 to 6 weeks depending on the grade. Rehabilitation is essential after the removal of the brace: mobility, muscle strengthening of the flexors and extensors, proprioception. Severe forms (complete tear, scapholunate instability) may justify ligament surgery.

Prevention of recurrences

• Complete rehabilitation to restore mobility and strength.

• Protections suitable for sports (wrist guards for rollerblading, skateboarding, snowboarding).

• Muscle strengthening of the forearm and wrist.

• Systematic warm-up before sports.

• Fall prevention in the elderly: adapted lighting, secured rugs, slip-resistant soles, treatment of osteoporosis.

Possible complications

Chronic carpal instability is the most common complication of neglected severe sprains, particularly scapholunate dissociation, which can progress to wrist osteoarthritis (SLAC wrist). Other complications: joint stiffness, algodystrophy (complex regional pain syndrome), chronic pain, loss of strength, lasting occupational or athletic handicap. An unrecognized scaphoid fracture can progress to nonunion.

When to contact a doctor for a wrist sprain

Every wrist sprain deserves medical attention, especially to rule out an associated fracture:

• As a first resort: contact your primary care physician, who will evaluate the need for an X-ray.

• If your primary care physician is unavailable (evening, weekend, holidays), Docadom offers an emergency consultation with a doctor at home. Call 021 845 45 45 or make your request via our mobile app, available for free on the App Store and Google Play.

• In case of severity signs (deformity, skin break, loss of sensitivity, unbearable pain), immediately dial 144 or go to the emergency room.

Conclusion: rule out fracture, immobilize, rehabilitate

A wrist sprain is a seemingly trivial trauma, but it can hide a scaphoid fracture or an unrecognized serious ligament injury. It is characterized by pain, edema, bruising, and functional impairment, which can lead to complications such as chronic instability, early osteoarthritis, or algodystrophy in the absence of appropriate care. Initial imaging, appropriate immobilization, and rehabilitation are the keys to success.

If in doubt, first seek advice from your primary care physician. If they are not available, Docadom provides an emergency home doctor 7 days a week: call 021 845 45 45 or use our mobile app (App Store, Google Play) to request an emergency consultation.