A wrist sprain is the result of excessive stretching or tearing (partial or total) of the ligaments. A fracture, on the other hand, is the breakage of one of the bones in the wrist. Sometimes, it is difficult to distinguish the two injuries, as they cause similar symptoms and are generated by similar accidents, such as a fall on the hyperextended hand or a direct impact on the joint. In addition, a wrist fracture is often accompanied by a sprain of the ligaments. A medical evaluation (often after x-rays) is required to arrive at a definitive differential diagnosis, although it is sometimes possible to distinguish the two types of injury at home before going to the emergency room.
Steps
Part 1 of 2: Diagnosing a Wrist Sprain
Step 1. Move your wrist and assess the situation
The severity of the sprains varies based on the degree of stretch or tear in the ligament. A first degree injury stretches the tissue a little but does not sever it; a moderate (second degree) injury involves tearing the ligament of up to 50% of the fibers and is associated with a partial loss of function. A severe (third degree) sprain involves complete rupture of the ligament; consequently, if you can move your wrist relatively normally (albeit with pain), it is very likely that it is a first or second degree injury. In the worst case, the joint is unstable (excessive range of motion) because the ligament that joins the bones is completely torn.
- Usually, only a few second-degree and all third-degree sprains need to be brought to the doctor's attention; the first ones and most of the second ones can instead be managed at home.
- A sprain of maximum severity can also cause an avulsion fracture - the ligament detaches from the bone, taking a small fragment with it.
- The wrist ligament most prone to injury is the navicular-lunate which joins the navicular to the lunate bone.
Step 2. Identify the type of pain you are experiencing
The wrist is prone to injuries that can vary widely in severity; consequently, the type and intensity of suffering can be very different. A first degree sprain is mildly painful, patients mostly report aching that becomes acute with movement. Second degree injuries are moderately or severely painful, based on the number of torn fibers; in general, they are described as a pulsating suffering and greater than that experienced with first degree distortions, due to the most important inflammatory reaction. Paradoxically, complete (third degree) ligament tears are less painful because they do not excessively irritate the nerve; however, the patient complains of a throbbing sensation due to the inflammation that builds up.
- Injuries that also cause an avulsion fracture are immediately very painful, the patient complains of both stinging and a throbbing sensation.
- Sprains cause more pain with movement, while immobilization reduces symptoms.
- Generally speaking, if you are in a lot of pain and can't move your joint, go to the emergency room right away for an evaluation.
Step 3. Apply ice and observe the reaction
Distortions of any severity level respond well to cold therapy because it can reduce inflammation and numb the surrounding nerve endings. Ice is essential for second and third degree ice, because many inflammatory substances accumulate in the injury site. Applying the ice pack on the injured wrist for 10-15 minutes every 1-2 hours after the accident leads to great results within a day or so and greatly reduces the intensity of suffering, allowing for better mobility. On the contrary, in the event of a fracture, cold therapy is useful for managing pain and inflammation, but the symptoms reappear as soon as the effect wears off. As a general rule, ice packs are more effective on sprains than most fractures.
- The more severe the sprain, the worse the localized swelling, which means the joint is dilated and larger than normal.
- Stress microfractures respond well to cold therapy (in the long run), unlike more severe bone breaks that need medical attention.
Step 4. Check for a hematoma the day after the injury
Inflammation creates swelling, which is not the same as a bruise; the latter is the consequence of localized bleeding in the tissues following damage to the small veins or arteries. In first degree sprains, there is typically no hematoma, unless there has been a violent direct impact that has crushed the subcutaneous blood vessels. Second degree ligament tears cause more pronounced swelling, but not necessarily a bruise, based on the dynamics of the accident; finally, third-degree trauma is accompanied by severe edema and extensive hematoma, because the rupture of the ligament is usually violent enough to tear or damage the surrounding blood vessels.
- The swelling following inflammation does not change the color of the skin much, except a little redness triggered by the localized increase in temperature.
- The dark blue color of a hematoma is due to the blood coming out of the blood vessels and collecting in the tissues just below the surface of the skin; as the blood degrades and is expelled from the tissues, it changes hue to light blue and eventually yellowish.
Step 5. Evaluate the condition of the wrist after a few days
In practice, all first degree sprains and some second degree sprains clearly improve within a few days, especially if you have been following cold therapy. As a result, if your wrist hurts less, there is no noticeable swelling, and you are able to move the joint without too much discomfort, it is likely that no medical intervention is needed. If the sprain is more severe (second degree), but you find that the situation has improved significantly after a few days (although there is still some edema and moderate pain), give the body a few more days to recover. However, if your trauma symptoms have not subsided a little or even worsened, go to the emergency room as soon as possible.
- First and some second degree sprains heal quickly (1-2 weeks), while the most severe ones (especially those involving an avulsion fracture) take longer, usually a few months.
- Stress microfractures resolve in a short time (a couple of weeks), but severe bone breaks take a few months or more, depending on whether surgery is needed or not.
Part 2 of 2: Diagnosing a Wrist Fracture
Step 1. See if the joint is misaligned or twisted
A wrist fracture is caused by accidents and trauma similar to those that result in a sprain. Usually, the stronger and larger a bone is, the less likely it is to break in response to trauma, but ligaments can stretch and tear instead; however, when a fracture occurs, the area may appear crooked or misaligned. The eight carpal bones of the wrist are small and it is therefore difficult (if not impossible) to notice a deformation, especially in the case of stress microfracture; however, the most severe ruptures are fairly simple to spot.
- The long bone that breaks is usually the radius, which joins the forearm to the small carpal bones.
- Among these, the most prone to fractures is the scaphoid, which rarely causes obvious wrist deformities.
- When a bone pierces the skin and becomes visible, it is called an open fracture.
Step 2. Identify the type of pain
Again, the pain caused by a fracture depends on the severity of the fracture, but patients typically complain of very intense twinges with each attempt to move, as well as deep, widespread pain when the wrist is stationary. This symptom tends to get worse when trying to close a fist or grab an object, which rarely happens with sprains. Disorders related to wrist fractures, such as stiffness, poor sensation, and difficulty moving the fingers, involve the hand more than sprains, because broken bone is more likely to damage the nerves. Also, when you try to move the joint, you may feel a screeching or squeak that is absent if the ligament is torn or strained.
- The pain caused by a fracture is often preceded (but not always) by a "snap" or the physical sensation of the break. As for distortions, only those of the third degree emit a similar sensation or noise; typically, patients report a "popping" when the ligament is torn.
- As a general rule, the pain caused by a fracture worsens at night, while that of the sprain, once the joint is immobilized, reaches a level that remains constant without nocturnal flare-ups.
Step 3. See if your symptoms get worse the next day
As already described in the first section of the article, a day or two of rest and cold therapy can have a great effect on mild and moderate sprains, unfortunately the same cannot be said for fractures. With the exception of stress microfractures, most bone breaks take much longer to heal than ligament strains. Consequently, a couple of days of rest and ice packs do not significantly reduce symptoms; often, however, the situation worsens once the body has overcome the initial "shock" of the trauma.
- If the broken bone protrudes from the skin, there is a high risk of infection and bleeding; go to the emergency room immediately.
- A severe fracture could completely cut off blood circulation to the hand. The swelling triggers what is called "compartment syndrome", a medical emergency; in this case, the hand becomes cold to the touch (due to the absence of blood), pale or bluish-white.
- A broken bone can sever or compress a nerve causing complete numbness in the related hand area.
Step 4. Get x-rays
Although all the information described above is sometimes sufficient for an experienced physician to make a diagnosis, only an X-ray, MRI, or computed tomography can provide certain evidence, unless there is an open fracture. X-rays are the most used and cheapest diagnostic tool for seeing the small bones of the wrist. Your doctor may order this test and have the images reported by a radiologist before talking to you. In the plates, only the bones are visible and not the soft tissues, such as ligaments or tendons. Wrist fractures are difficult to see, because the bones are small and crowded in a confined space, sometimes it takes a few days before they are noticeable on X-rays. To visualize the extent of the damage to the ligament, your doctor may require a MRI or computed tomography.
- MRI uses magnetic waves that provide detailed images of the body and may be needed to identify wrist fractures, especially those involving the scaphoid.
- Stress microfractures are very difficult to see on x-rays until the inflammation subsides. For this reason, one has to wait about a week for confirmation even if, in the meantime, the injury is likely to have healed on its own.
- Osteoporosis (bone fragility due to mineral loss) is the greatest risk of wrist fractures, although it does not increase the chances of a sprain.
Advice
- Wrist sprains and fractures are usually the result of a fall, so be very careful when walking on wet or slippery surfaces.
- Skateboarding and snowboarding are activities with a high risk of wrist injury, so you should always wear specific protection.
- Some carpal bones do not receive an abundant blood supply under normal conditions and take several months to heal from a fracture.
