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Condition

Wrist Sprain

A stretch or partial tear of one of the many small ligaments in the wrist, typically from a fall. Most get better on their own, but pain that lingers is worth a second look.

What is a wrist sprain?

A sprain is a stretch or partial tear of a ligament — the strong tissue that connects bone to bone. The wrist is held together by dozens of small ligaments, and after a fall or a twist any one of them can be irritated. A true wrist sprain heals with rest and motion, and most people are back to full activity within a few weeks.

The important thing to understand is that "wrist sprain" is a common first-visit diagnosis, especially in the emergency department, but it is not a one-size-fits-all label. Several more serious injuries can look like a sprain at first — a scaphoid fracture that doesn't show on early x-rays, a scapholunate ligament tear, or a TFCC tear. Part of the reason to have a wrist that is not getting better re-evaluated is to be sure the diagnosis is actually a sprain.

Common symptoms

  • Pain, swelling, and bruising of the wrist after a fall or a twist
  • Stiffness and limited motion
  • Pain with gripping or loading the wrist (pushing up from a chair, opening a jar)
  • A mild, dull ache that improves steadily week by week

Mild swelling and stiffness that steadily improve over 2 to 4 weeks are typical for a true sprain. Worsening pain, pain that is sharp and localized to one specific spot, or pain that has not improved at all by 4 weeks is a signal to be re-checked.

How it is diagnosed

  • Exam. Dr. Barrera will check for tenderness at specific points around the wrist — the anatomic snuffbox (scaphoid), the scapholunate interval, the distal radius and ulna, and the TFCC. Each of these points corresponds to a specific injury that can be missed.
  • X-rays. Routine views, and sometimes dedicated scaphoid views, to rule out a fracture.
  • Stress x-rays or MRI. Ordered selectively when a ligament injury (especially scapholunate or TFCC) is suspected, or when pain has not improved with conservative care.
  • Wrist arthroscopy. Rarely needed in the initial work-up, but considered for persistent mechanical pain or clicking without a clear diagnosis on imaging.

Treatment options

Non-surgical treatment

  • Brace or splint. A removable wrist splint for comfort during painful activities, usually for 1 to 3 weeks. Prolonged bracing is avoided because it causes stiffness.
  • Ice and anti-inflammatories. Ice in the first few days and a short course of ibuprofen or naproxen (if there are no medical reasons to avoid them) help the inflammation settle.
  • Early motion. Starting gentle range-of-motion exercises within the first week is important. The wrist gets stiff quickly if it is kept still for too long.
  • Certified hand therapy. Helpful when pain or stiffness is slow to improve, or when returning to a sport or a job that requires forceful wrist use.

When a sprain is not just a sprain

If pain, swelling, or weakness is not clearly improving after 2 to 4 weeks, the diagnosis should be re-examined. This is usually when a deeper problem is found:

  • An occult scaphoid fracture that was not visible on the first x-ray
  • A scapholunate ligament tear
  • A TFCC tear on the small-finger side of the wrist
  • An extensor or flexor tendon injury

In these cases, treatment shifts to what that specific injury requires.

What to expect at your visit

Dr. Barrera will ask about the injury, examine the wrist carefully, and review x-rays. If the exam is consistent with a true sprain, the plan is usually a short period in a splint and an early return to motion. If any part of the exam suggests a fracture or a ligament tear, further imaging will be ordered so the right injury is being treated.

Dr. Barrera's approach

Most wrist sprains do well with a splint, a short course of anti-inflammatories, and a gradual return to motion. The role of a hand surgeon in sprains is to make sure nothing more serious has been missed. If the wrist is not clearly getting better by 4 weeks, it deserves a second look with focused imaging rather than continued guessing.

When to call the office sooner

Call us if the wrist is obviously deformed, if you cannot move it at all, if you have numbness or persistent tingling in the fingers, if the hand becomes pale or cold, or if pain and swelling are getting worse rather than better.

Related

Scaphoid fracture · Scapholunate ligament injury · TFCC tear · Distal radius fracture

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