Overview
The most common cause of wrist sprain is falling on an outstretched hand.
Risk factors that increase your chances of spraining your wrist include:
- playing sports
- poor coordination
- poor balance
- inadequate flexibility and strength in muscles and ligaments
- loose joints
- not wearing wrist guards during activities such as in-line skating
Diagnosis
Symptoms of a wrist sprain include:
- pain, tenderness, and swelling around the wrist
- redness, warmth, or bruising around the wrist
- limited ability to move the wrist
The doctor will ask about your symptoms and how you injured your wrist. He will examine your wrist to assess the stability of the joint and the severity of the injury. Tests may include:
- x-rays — to make sure that no bones are broken (Fractures of the small wrist bones can be confused with sprains.)
- magnetic resonance imaging (MRI) scan — to see if a ligament has torn completely (rarely needed)
Wrist sprains are graded according to their severity:
Grade 1
- stretching and microtearing of ligament tissue
Grade 2
- partial tearing of ligament tissue
- mild instability of the joint
Grade 3
- severe or complete tearing of ligament tissue
- significant instability of the joint
Treatment Options
Treatment of a wrist sprain includes:
- rest
Avoid using your injured wrist and hand. - ice
Apply ice or a cold pack to the wrist for 15 to 20 minutes, four times a day for several days. This helps reduce pain and swelling. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin. - compression
Wrap your wrist in an elastic compression bandage (i.e., Ace bandage). This will limit swelling and support your wrist. - elevation
Keep the injured wrist raised above the level of your heart for 48 hours (such as up on a pillow). This will help drain fluid and reduce swelling. - medication
The following drugs can help reduce inflammation and pain:- ibuprofen (Motrin, Advil)
- naproxen (Aleve, Naprosyn)
- acetaminophen (Tylenol)
- aspirin
- brace
You may need to wear a brace to immobilize your wrist. If you play sports, you may need to wear a wrist brace or tape your wrist when you return to play. - cast
If you have a severe sprain, your doctor may recommend a cast for two to three weeks. - rehabilitation exercises
Begin exercises to restore flexibility, range of motion, and strength in your wrist as recommended by your health care professional. - surgery
Surgery is rarely needed to repair a wrist sprain. However, surgery may be needed to repair a ligament that is torn completely, or if there is an associated fracture.
Prevention
Wrist sprains usually occur from accidents that cannot be prevented. However, wearing protective wrist guards when in-line skating will help prevent wrist sprains caused by falling while skating.
How can I prevent a wrist sprain?
Since wrist sprains are nearly always results of falls or other accidents, there is not much that can be done to prevent them. However, wearing protective wrist guards when skateboarding, in-line skating, or snowboarding will help prevent sprains caused by falling.
Keep in mind that the rehabilitation exercises should be continued to ensure protective strength, range of motion, and stability of the injured joint.
Improving sports performance
The key to improving sports performance after recovering from a wrist sprain is a proper a rehabilitation program, and adhering to some of those same principles after the injury is gone.
The single most important aspect of improving performance is stretching before and after you step onto the field, court, ice, or golf course.
Benefits derived from stretching include:
- increased physical efficiency and performance
- decreased risk of injury
- increased blood supply and nutrients to joint structures
- increased coordination
- improved muscular balance and postural awareness
- decreased risk of lower-back pain
- reduced stress
- enhanced enjoyment
Wrist sprain rehabilitation
As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important.
For a mild wrist sprain, or Grade 1, your doctor may recommend an exercise program to strengthen surrounding muscles. The doctor may also prescribe a protective brace or sling for you to wear.
For torn ligaments (Grade 2 or Grade 3 wrist sprain), your doctor may recommend that you wear a cast, and in some very severe cases, surgery may be required.
The most common rehabilitation for a wrist sprain often includes the following:
- Rest
Avoid using your injured wrist and hand. - Ice
Apply ice or a cold pack to the wrist for 15 to 20 minutes, 4 times a day for several days. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin. - Medication
Take ibuprofen to help reduce inflammation and pain. - Compression
Wrap your wrist in an elastic compression bandage (i.e., Ace bandage). This will limit swelling and support your wrist. - Stretching
When the acute pain is gone, start gentle stretching of the wrist and elbow as recommended by your doctor. Stay within pain limits. Hold each stretch for about 10 seconds and repeat 6 times. - Strengthening
Begin strengthening exercises for your wrist extensor muscles as recommended by your doctor. - Brace or sling
You may need to wear a brace to immobilize your wrist. - Cast
If you have a severe sprain, your doctor may recommend a cast or splint for 2 to 3 weeks.
Rehabilitation exercises
The major objectives of rehabilitation from a wrist sprain are to improve the elasticity of the wrist joint and to gradually increase pain-free range of motion. The exercises below stretch the muscles of the forearm and upper arm. These exercises should be performed once or twice daily.
- Wrist flexor stretch
Extend affected arm forward with palm up and elbow straight. Place fingers and palm of opposite hand across palm and fingers of the extended hand and draw back with it until a stretch is felt in the forearm. Hold this position for 3 to 5 seconds then relax for 3 to 5 seconds. Perform this exercise 10 times. - Wrist extensor stretch
Extend affected arm forward with palm down, elbow straight, and fingers slightly curled. Grasp the affected side hand with other hand and draw affected side hand down until stretch is felt in the forearm. Hold this position from 3 to 5 seconds then relax for 3 to 5 seconds. Perform this exercise 10 times. - Pronation/suppination stretch
Extend affected arm forward in a hand-shaking position with palm facing up. Slowly rotate the hand from a palm-up position to a palm-down position. Hold for 3 to 5 seconds and then rotate back. Perform this exercise 10 times. When you work your way up to strength training, you may use a small weight while rotating the hand and wrist. - Tricep stretch
Stand erect with feet at about shoulder width. Raise injured arm at the shoulder with elbow bent and place the forearm behind the head. Grasp the injured elbow with opposite hand and draw it toward the center of the body until stretch is felt. Hold this position for 3 to 5 seconds then relax for 3 to 5 seconds. Perform this exercise 10 times. - Bicep stretch
Stand erect with arms raised to shoulder height and palms up. Press arms backward until stretch is felt. Hold this position for 3 to 5 seconds, then relax for 3 to 5 seconds. Perform this exercise 10 times. The biceps as well as the muscles of the shoulder and upper chest are stretched by this exercise.
Strengthening exercises
The following exercises develop strength of the muscles of the forearm and upper arm. To maintain symmetry of the arms in terms of strength and appearance, perform these strength exercises with the uninjured arm as well as the injured arm.
- Wrist extension
Sit in a chair with forearm resting on the end of a table, palm down. Grasp a light weight dumbbell and raise the weight up as high as possible while maintaining contact with the table top. Hold this position for 3 to 5 seconds. Relax for 3 to 5 seconds. Repeat this exercise 5 to 10 times. Substitute a heavier dumbbell as strength increases. - Arm curls
Either standing or sitting, grasp a 2- to 4-pound dumbbell in one hand. With palm up, flex elbow and draw the dumbbell up to the same side shoulder while maintaining erect posture. Do not bend at the waist or swing the dumbbell. Lower dumbbell slowly and with control to the starting position. Repeat this exercise 10 times. Use a heavier dumbbell as strength increases.
Alternative exercises
During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:
- swimming (if pain allows, and if not wearing a cast)
- jogging
- stationary bicycle
Rehabilitation after surgery
Keep in mind that if your wrist sprain requires surgery, the soft tissue needs time to heal before exercise can begin.
A physical therapy program usually begins with range-of-motion and resistive exercises, then incorporates power, aerobic and muscular endurance, flexibility, and coordination drills.
Finally, patients develop speed and agility through sport-specific exercise routines.
The ultimate goal of reconstructive wrist surgery is to repair torn ligaments, and provide dynamic stability while maintaining full range of motion, so that athletes can return to competitive or recreational sports. Progress is assessed by the patient's perception of how stable the wrist feels and by comparing the strength and stability of the injured and uninjured arms.
How long will the effects of my injury last?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your wrist sprain recovers, not by how many days or weeks it has been since your injury occurred. It also depends on how serious the injury is. Instances where reconstructive surgery is required will obviously create a longer recovery period than patients with a mild sprain.
A good rule is to allow pain to dictate when you're ready to return to activity. You should return in moderation, and back off if you feel any pain.
You may safely return to your sport or activity when you have full strength and range of motion in the injured wrist compared to the uninjured wrist.
When can I return to my sport or activity?
Some may be ready for full participation in two weeks, others not for two months or more. Of course, time for return to activity is much longer if surgery is necessary.
Remember: The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your wrist sprain recovers, not by how many days or weeks it has been since your injury occurred.
