Background & Etiology
Ligaments are fibrous bands of connective tissue made of collagen, which join bone to bone. They provide stability and limit excessive motion of the joint. In the wrist there are several ligaments, including the palmar wrist ligaments and the carpal ligaments that can be stretched or torn, causing a sprain.
There are three grades of wrist sprain
Grade 1 – This mildest type of sprain, where the ligament is stretched, but not torn.
Grade 2 – The ligament is partially torn
Grade 3 – The ligament is completely torn. The most serious type of sprain, this condition may require surgery
It is important to have a wrist injury evaluated by a physician to properly diagnose the grade of a wrist sprain. In some cases an X-Ray or CT scan will be used to evaluate the injury.
Wrist sprains are a common injury, often caused by a fall on an outstretched hand (FOOSH.) Typically these falls are the result of athletic or recreational activities, where an individual breaks their fall by bracing the ground with their hands.
- Wrist pain or tenderness
- Swelling or bruising at the wrist
- Pain when moving or using the wrist in daily activities
- A “popping” or “tearing” feeling in the wrist
- Warmth or redness of the skin on the injured wrist
- Decreased ability to move the wrist and use effected hand
If an individual suspects they have a wrist sprain, the initial treatment should consist of avoiding the positions and activities that produce the pain. A course of conservative treatment is usually recommended that includes rest and immobilization, ice, hand therapy and non-steroidal medications to reduce inflammation. If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy. In severe cases surgical intervention may be needed to repair the torn ligament.
Hand Therapists are occupational or physical therapists educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of Wrist Sprain include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage and joint mobilization by a physical therapist to regain mobility and range of motion of the wrist and ligament.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the wrist.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the upper extremity, and improve movement technique and mechanics (for example, throwing or lifting activities) in daily use of the involved upper extremity.
- Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the wrist and ligament
- Home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.
Procedures that your physician may recommend and perform in addition to physical therapy may include:
- REST and ICE
- Splinting or bracing the affected area
- The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
- Steroidal injections to reduce inflammation
- Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
- Surgery to correct ligament damage.
Prognosis
Most people recover full function following a course of conservative care that includes physical therapy, medication and/or injections. It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities. Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of wrist sprain.
