A wrist sprain is a fairly common injury, especially among athletes, and occurs when the ligaments of the joint are subjected to excessive traction that can tear them partially or completely. This trauma causes pain, inflammation and sometimes even a hematoma, depending on the severity (which is classified as grade 1, 2 or 3). Sometimes, it can be difficult to tell a bad sprain from a bone fracture, so being well informed can help to recognize the two types of injury. However, if for some reason you suspect it is a fracture, go to the emergency room for proper care.
Steps
Part 1 of 2: Recognizing the Symptoms of a Wrist Sprain
Step 1. Expect to feel pain when you move it
A wrist sprain can be more or less severe depending on the degree of strain and / or tear that has affected the ligaments. A mild (Grade 1) sprain involves stretching the ligament that does not involve a significant tear; when it is moderate (grade 2) some fibers of the ligaments are torn (up to 50%); when it is severe (Grade 3) it means that the ligament has been severely torn or completely ruptured. Consequently, with a grade 1 and 2 sprain, movements are relatively normal, albeit painful; a grade 3 sprain, on the other hand, leads to joint instability (excessive mobility) during movement, because the involved ligament is not properly connected to the wrist bone (carpal). On the other hand, when there is a fracture, the movement is usually much smaller and a screeching or friction sensation is felt during the movement.
- Grade 1 sprains cause mild pain, which is typically described as aching that worsens with movement.
- A grade 2 sprain causes moderate to severe pain, depending on the type of tear; it is more acute than that associated with grade 1 injury and is sometimes pulsating due to inflammation.
- A grade 3 sprain in the beginning often causes less pain than second-degree injuries because the ligament is completely severed and doesn't irritate the surrounding nerves much. However, pulsating suffering occurs with this injury due to the accumulating inflammatory substances.
Step 2. Check for inflammation (swelling)
It is a typical symptom of wrist sprain, as well as fracture, but it can vary greatly depending on the severity of the injury. Generally, first degree trauma involves less swelling, which is much more severe in grade 3 sprains; the swelling makes the joint larger and swollen than its uninjured counterpart. The inflammatory response of the organism, especially in the case of sprains, generally tends to be exaggerated, because it anticipates a much worse situation: an open wound more susceptible to infection. You should therefore try to limit sprain-induced inflammation through cold therapy, cold packs, and / or anti-inflammatory drugs to reduce pain and maintain wrist range of motion.
- The swelling due to inflammation does not cause an excessive change in skin color, if not a little redness due to all the hot fluids that "flow" under the skin.
- Due to the accumulation of inflammatory substances, which consist of lymphatic fluid and a variety of specialized cells of the immune system, the sprained wrist is warmer to the touch. Most fractures also create a sensation of heat due to inflammation, but sometimes the wrist and hand can be cold because blood circulation is reduced due to damage to the blood vessels.
Step 3. Check for a bruise
Although the body's inflammatory reaction causes swelling at the injury site, it is not the same as bruising. This is caused by blood seeping from injured blood vessels (small arteries or veins) to surrounding tissues. Grade 1 sprains do not typically cause a bruise, unless the injury was caused by a strong impact that ruptured the small blood vessels directly under the skin. Grade 2 sprain causes more swelling but, as mentioned, does not necessarily involve a large bruise - this basically depends on how the injury occurred. When it is grade 3, the sprain causes a lot of swelling and usually even a noticeable bruise, because the trauma that results from a completely torn ligament is usually severe enough to tear or damage surrounding blood vessels.
- The dark color of the bruise is due to blood seeping into the tissues just below the skin surface. When the blood degrades and is expelled from the tissues, the bruising changes color over time (it becomes dark blue, green and then yellow).
- Unlike what happens with sprains, in the event of a fracture there is almost always a bruise on the wrist, because a greater force has intervened that has broken the bone.
- Grade 3 sprains can lead to an avulsion fracture, when the ligament tears a small piece of bone; in this case, immediate intense pain is felt, inflammation develops and ecchymosis appears.
Step 4. Apply ice and see if the situation improves
Wrist sprains of any degree respond well to ice therapy, because the low temperature reduces inflammation and numbs the surrounding nerve fibers, which are responsible for the painful sensation. Cold therapy (ice pack or frozen gel) is particularly important when the injury is Grade 2 and 3, as this triggers the accumulation of more inflammatory substances around the site of the sprain. Applying ice to the wrist for 10-15 minutes every hour or two immediately after the accident greatly improves the situation within a day or two, significantly reducing the intensity of pain and making movement easier. In the event of a fracture, ice still helps control the pain and inflammation, but symptoms return once the numbness has subsided. Therefore, as a general rule, remember that cold therapy tends to benefit sprains more than most fractures.
- Stress microfractures manifest with symptoms similar to those of Grade 1 or 2 sprains and respond better to cold therapy (in the long run) than more severe fractures.
- When applying ice to your injured wrist, be sure to wrap it in a thin cloth to avoid irritating the skin and the risk of chilblains.
Part 2 of 2: Getting a Medical Diagnosis
Step 1. Contact your family doctor
While the information listed so far can help you figure out if the wrist is actually sprained and also determine the severity of the injury, your doctor is much better qualified to make an accurate diagnosis. Indeed, a detailed report on the dynamics of the accident makes it possible to develop a specific diagnosis in about 70% of cases. The doctor will want to examine the wrist and perform some orthopedic tests; if the injury appears severe, he will prescribe an x-ray to rule out a possible fracture; however, X-rays show only bones and not soft tissues, such as ligaments, tendons, blood vessels, or nerves. If there is a carpal bone fracture, especially a microfracture, it can be difficult to see on X-rays, due to its small size and limited wrist space. If the x-ray shows no fracture, but the injury is severe and surgery is required, your doctor will order a computed tomography or MRI scan.
- It is very difficult to see stress microfractures or the carpal bone (especially the scaphoid bone) through X-rays until the inflammation has completely resolved; you should therefore wait about a week and repeat the x-ray. This type of injury may require additional imaging tests, such as MRI, or the use of a brace / splint, based on the severity of symptoms and the dynamics of the trauma.
- Osteoporosis (a disease characterized by fragile, mineral-poor bones) is a major risk factor for wrist fractures, although it does not increase the chances of suffering from a sprain.
Step 2. Get a prescription for an MRI
This type of examination or other high-tech diagnostic tests are not necessary for all first degree sprains and for most second degree sprains, as these are short-lived traumas, which tend to heal spontaneously over a period of time. a few weeks without medical treatment. However, if you have severe ligament injuries (such as in Grade 3 sprains) or when the diagnosis is unclear, it is worth having an MRI scan. The procedure involves the use of magnetic waves that provide detailed images of the internal structures of the body, including soft tissues. MRI is a great tool to see which ligaments are severely torn and to assess the extent of the damage; this is valuable information for the orthopedic surgeon, should an operation be required.
- Tendonitis, tendon ruptures, and wrist bursitis (including carpal tunnel syndrome) have symptoms similar to those of a sprain; however, the magnetic resonance is able to distinguish the various problems.
- An MRI is useful for quantifying vascular and nerve damage, especially if the injury causes hand symptoms, such as numbness, tingling, and / or loss of normal coloration.
- Osteoarthritis is another cause of wrist pain that can be confused with a sprain. However, this disease presents with a chronic suffering that slowly worsens with the passage of time and which is accompanied by a sensation of "friction" during movements.
Step 3. Consider a computed tomography
If the injury is quite severe, shows no signs of improvement, and the diagnosis is still not well defined after x-rays and MRIs, further tests, such as computed tomography, may be needed. This technique involves the use of a computer to combine the radiographic images detected at different angles and thus create transversal images (of the "slices") of all the internal structures of the body, both soft and hard. These images provide more detailed information than x-rays, but very similar to those of MRI. Computed tomography is generally excellent for detecting hidden wrist fractures, although MRI is more suitable for evaluating damage to tendons and ligaments. Tomography scans are less expensive than MRI scans, which is why doctors often prefer to prescribe them first and only in case of doubt they submit the patient to MRI.
- Computed tomography exposes the body to ionizing radiation, usually in greater quantities than an x-ray, but not to the point of being considered dangerous.
- The ligament of the wrist most frequently subjected to sprains is the intercarpal interosseous scaphoid-lunate ligament which joins the scaphoid to the lunate bone.
- If all of the tests described above fail but severe pain persists, your doctor may refer you to an orthopedist (the skeletal system specialist) for further evaluation.
Advice
- Wrist sprains are often the result of falls, so be careful when walking on wet or slippery surfaces.
- Skateboarding is a high-risk activity for wrist injuries, so always wear protective gear.
- If neglected, a severe wrist sprain can increase the chances of suffering from osteoarthritis in old age.
