What is a sprained wrist?
Four ligaments support the wrist, connecting your arm and hand bones with bands of fibrous tissue. These ligaments offer stability; when the tissue stretches or tears, the stability of the ligaments and the joints weaken.
In a wrist, the two collateral ligaments—the radial collateral ligament on the thumb side and the ulnar collateral ligament on the outside—support the sides of the wrist, while the lunotriquetral and scapholunate ligaments add additional support.
A sudden fall or trip can cause you to put a hand down to break your fall, causing you to hyperextend the wrist joint and stretch or tear the ligaments within the wrist. Sprains can also happen when extreme twisting motions put too much pressure on a ligament, or a strong hit injures the ligaments.
What are the symptoms of a wrist sprain?
Sprained wrist symptoms will vary based on the extent of the injury. Less severe ligament strains and tears may only cause mild pain and tenderness when moving or twisting the joint. With more intense injuries, you can have pain even when resting that intensifies with movement. Other signs of a sprained wrist include increased tenderness, bruising, and swelling. Wrist sprains can also hamper range of motion and stability.
Athletes may report hearing or feeling a popping sound at the time of the injury. This is consistent with more severe wrist sprains.
Grades of a wrist sprain
Wrist sprains are classified into three grades. Each grade accounts for the severity of stretched and torn ligaments. The intensity of sprained wrist symptoms is often tied to the grade of injury.
A grade 1 wrist sprain is the mildest of the three grades. It occurs when a ligament has been slightly stretched with no tears. A grade 1 sprain often includes only mild pain, swelling, tenderness, and bruising around the wrist. The injured person can still easily use the wrist.
A grade 2 wrist sprain usually results from a partial tear of a ligament in the wrist. Grade 2 wrist sprain symptoms include pain, bruising, tenderness, and swelling. A grade 2 wrist sprain may also make it difficult for an athlete to use their wrist without pain. Pain could occur even without wrist use. Grade 2 sprains can also compromise wrist stability.
A complete tear or rupture of a ligament defines a grade 3 wrist sprain. Along with severe pain, tenderness, bruising, and swelling of the wrist, moving the wrist becomes quite difficult. Grade 3 sprains can hamper the wrist’s range of motion. Wrist stability is often significantly impacted by the lack of ligament strength.
Causes and risk factors of a wrist sprain
A wrist sprain can occur from just about any activity where there's a chance of falling, tripping, or twisting the wrist.
Common causes of a wrist injury during athletic activity include:
- A fall or trip that leads to the athlete putting a hand down to break the fall and having the wrist stretch beyond its normal range of motion at the force of impact
- An athletic movement that places extreme twisting pressure on the wrist
- A strong hit to the wrist that stretches the ligaments
While a wrist sprain can happen to anyone who takes a sudden fall, the most common sports for wrist injuries include basketball, skiing, skating, skateboarding, gymnastics, and baseball. The twisting motions found in tennis and golf can have a small risk of a sprain, and sports such as boxing increase the risk of a wrist injury from a hit.
Once an athlete sprains their wrist, the likelihood of injuring it again increases. If not left to heal properly, the wrist injury can cause damage to the bones and cartilage around the ligament. Returning to activity before the wrist has fully healed risks escalating the injury. Even if the wrist is allowed to recover fully, the risk for re-injury remains high.
Athletes should be in proper physical condition to decrease the risks of injury.
How is a wrist sprain diagnosed?
A doctor can diagnose a wrist sprain using both a physical examination and imaging technology.
A physical examination to diagnose a wrist sprain will often include:
- Questions about the injury and extent of wrist pain
- Observations comparing the injured wrist with the uninjured wrist to determine swelling, range of motion, and bruising
- Inspection of tenderness and the pain associated with it
- Range of motion and stability testing
If the wrist sprain is severe, your doctor may order an X-ray to rule out a bone fracture and confirm whether the wrist is sprained or broken. A magnetic resonance imaging (MRI) scan may be needed to evaluate possible injuries to cartilage and tendons surrounding the wrist.
Get in touch with a Mass General Brigham Sports Medicine specialist to learn more about diagnosing a wrist sprain. Same-day telehealth virtual visits are often available.
How to treat a sprained wrist
Treatment for a sprained wrist includes a mix of rest and restoration of the ligament's range of motion.
Typically, the RICE approach—rest, ice, compression, and elevation—is advised in the first 24 hours following an injury to reduce swelling and protect the ligaments from further damage. Ice, elevation, and compression will help reduce a sprained wrist's swelling, and rest can ensure no further damage happens to the wrist.
Sprained wrist treatment commonly includes range-of-motion exercises, often as soon as 24 hours following the injury. Small stretching exercises are typically performed without weights, allowing the patient to test pain levels as they progress.
In more extreme sprains, immobilization of the wrist joint can help protect the ligaments from further damage as it heals. Patients may require physical therapy for wrist sprains that need more time to recover.
Sprained wrist recovery time
During sprained wrist recovery time, patients will focus on range-of-motion exercises, isometric strengthening, and stretching.
As athletes return to activity, they must carefully monitor pain and limit activities that increase the likelihood of another injury before the wrist is fully healed. Athletes in sports such as skiing and skating, where falls are common, may need to return to physical activity by running or riding a stationary bike before returning to their sport. Bracing or taping the wrist may provide additional support as an athlete returns to more intense activity.
In rare cases of a full tear of ligaments, patients may need surgery to restore the full use of the wrist ligaments.
Commonly, a grade 1 sprain can take one to three weeks for recovery, a grade 2 can take three to six weeks, and a grade 3 recovery can last several months.
Preventing wrist sprains
A strong wrist and proper warm-up can help limit the risk of a wrist sprain. Tips for further wrist sprain prevention include:
- Wear wrist guards and braces when participating in activities with a high likelihood of falling, such as skating and skiing
- Strengthen wrists through exercises
- Don't participate in high-contact activities that increase the risk of falling
- Limit heavy twisting motions on the wrist during athletic activity
FAQs
The length of time a wrist sprain takes to heal is based on the severity of the injury. A grade 1 sprain can take as little as one or two weeks to heal, while a severe sprain can take several months.
Often an athlete will experience a sudden injury where the wrist was stretched beyond a normal range of motion and pain, tenderness, swelling, and bruising will follow.
For the first 24 hours, practice RICE—rest, ice, compression, and elevation—and then slowly work in exercises to improve range of motion and strength.
A wrist sprain can heal on its own; however, taking proper precautions during sprained wrist recovery time and exercising smartly can help the process.
The more extreme the wrist pain, the greater the likelihood of a serious injury. A doctor's exam—both a physical exam and with imaging technology—can help determine the severity of the wrist injury.
Yes, a common symptom of a sprained wrist is tenderness to touch, especially in the soft tissue. Pain when touching the bone could be a sign of a broken bone in the wrist.
Yes, not properly caring for a sprained wrist can lead to further damage to the ligaments, cartilage, and bones in the wrist. The ligaments provide support and stability to the wrist, so not letting a sprained wrist heal can potentially negatively impact both the ligaments and the entire wrist.
