What is the best method for treating a sprained or damaged wrist?

Best Methods for Healing and Restoring a Sprained or Damaged Wrist

For optimal healing and restoration of a sprained or damaged wrist, the initial treatment should include rest, cold application (ice) for 20-30 minutes, and functional support with a brace, followed by early exercise therapy to restore joint functionality. 1

Initial Assessment and Diagnosis

1. Proper Diagnosis is Critical
   • A "wrist sprain" is not a specific enough diagnosis 2, 3
   • Radiographs (X-rays) are always indicated as first-line imaging with a minimum of 3 views: posteroanterior (PA), lateral, and 45° semipronated oblique 1, 4
   • If radiographs are negative or equivocal but symptoms persist, consider:
     • Repeat radiographs in 10-14 days
     • MRI without IV contrast
     • CT without IV contrast 1

Immediate Treatment (First 24-72 hours)

1. Rest and Activity Modification

   • Avoid activities that cause pain 1
   • Limit use of the injured extremity 1

2. Cold Application

   • Apply cold (ice and water in a plastic bag wrapped in a damp cloth) to reduce pain and swelling 1
   • Limit application to 20-30 minutes per session 1
   • Place a barrier between the cold container and skin to prevent cold injury 1
   • Repeat 3-4 times daily 1

3. Functional Support

   • Brace is preferred over immobilization or tape for treatment 1
   • For prevention of recurrent sprains, both tape and brace may be used 1
   • Apply a well-padded splint in slight wrist extension if needed 4
   • Avoid complete immobilization as it is not recommended for wrist sprains 1

4. Pain Management

   • NSAIDs may be used to reduce pain and swelling 1
   • Be aware of potential side effects of NSAIDs 1

Rehabilitation Phase (After Initial Treatment)

1. Exercise Therapy

   • Begin exercise therapy as soon as possible to recover joint functionality 1
   • Focus on:
     • Proprioception
     • Strength
     • Coordination
     • Function 1
   • Supervised exercises are recommended 1

2. Finger Mobility

   • Move fingers regularly through complete range of motion to minimize stiffness 1, 4
   • This is critical to prevent one of the most functionally disabling adverse effects 1

3. Manual Mobilization

   • Consider manual mobilization in combination with other treatment modalities 1
   • Not recommended as a standalone treatment 1

Return to Activities

1. Work Resumption

   • Implement immediate functional treatment and a return to work schedule to minimize work absenteeism 1
   • Most patients require approximately 14 days with limited upper extremity function 5

2. Sport Resumption

   • Supervised exercises focusing on proprioception, strength, coordination, and function 1
   • For recurrent wrist sprains, incorporate exercises into regular training activities 1

Special Considerations

1. Potential Complications

   • Watch for signs of complex regional pain syndrome 4
   • Monitor for persistent pain or dysfunction that may indicate more serious injury 6
   • Most patients (78%) will not have further wrist injury after proper treatment 5

2. When to Seek Additional Medical Attention

   • If pain persists beyond 6 weeks 5
   • If there are signs of vascular compromise (blue or extremely pale extremity) 1
   • If symptoms worsen despite appropriate treatment 1

3. Long-term Prognosis

   • With proper treatment, most patients can expect excellent recovery outcomes 5
   • Average long-term outcomes after 10 years show good functional scores 5

What to Avoid

1. Do Not Use RICE Protocol

   • RICE (Rest, Ice, Compression, Elevation) is not advised as a complete treatment modality for wrist sprains 1

2. Avoid Prolonged Immobilization

   • Immobilization should not be used in the treatment of wrist sprains 1
   • Prolonged immobilization can lead to stiffness and delayed recovery 1

3. Do Not Ignore Persistent Symptoms

   • Wrist sprains that do not improve may indicate more serious injuries requiring advanced imaging 1, 6

By following this evidence-based approach, most wrist sprains will heal effectively with excellent long-term outcomes. The key is to balance appropriate rest with early functional rehabilitation to restore normal wrist function.