Treatment of Wrist Sprain
The optimal treatment for a wrist sprain includes rest, application of cold therapy for 20-30 minutes several times daily, and possibly a compression wrap for comfort, while avoiding activities that cause pain and seeking medical attention if symptoms persist. 1
Initial Assessment and Diagnosis
- A proper diagnosis is crucial as "wrist sprain" is often an inadequate or precarious diagnosis 2, 3
- Specific injuries should be identified through:
- Locating the precise area of maximum tenderness
- Obtaining appropriate radiographs if indicated by clinical findings
- Following Ottawa Ankle and Foot Rules principles (modified for wrist) to reduce unnecessary imaging
First Aid Treatment
Immediate Management (First 72 hours)
- Rest: Avoid activities that cause pain to prevent further injury 1
- Ice/Cold Therapy: Apply cold (ice and water surrounded by a damp cloth) for 20-30 minutes, 3-4 times daily 1
- Do not place ice directly on skin to prevent cold injury
- Cold therapy has been shown to improve pain scores and reduce edema in soft tissue injuries 1
- Compression: Consider applying a compression wrap for comfort 1
- Ensure it's not too tight to avoid compromising circulation
- Note that evidence shows compression wraps do not significantly reduce swelling or improve recovery time 1
- Elevation: Keep the wrist elevated to help reduce swelling
Functional Support
- Functional support is preferred over immobilization 1
- A brace is recommended over other forms of support 1
- For recurrent sprains, tape or brace may be used based on patient preference 1
Medication
- NSAIDs (non-steroidal anti-inflammatory drugs) may be used to reduce pain and swelling 1
- Studies have shown NSAIDs improve pain control, decrease swelling, and allow for more rapid return to activity compared to placebo 1
Rehabilitation
Exercise Therapy
- Exercise therapy should be started as soon as possible to recover joint functionality 1
- Focus on:
- Proprioception
- Strength
- Coordination
- Function
- For recurrent wrist sprains, exercises should be incorporated into regular activities as much as possible 1
Return to Activities
- Implement a gradual return to activities with:
- Modified grip techniques
- Protective taping or bracing during activities
- Progressive increase in duration and intensity 4
- Supervised exercises are recommended for sport resumption 1
- A return to work schedule should be established to minimize work absenteeism 1
When to Seek Further Medical Attention
- Seek medical attention if:
- Pain persists beyond 2 weeks
- There is significant swelling or bruising
- You're unable to move the wrist normally
- You suspect a fracture (especially in children, where Salter-Harris I fractures are often misdiagnosed as sprains) 5
Long-term Prognosis
Most patients with wrist sprains have excellent outcomes. A study of military cadets showed that after 10 years of follow-up, patients had excellent wrist recovery with average SANE scores of 88 and QuickDASH scores of 7.5, with 96% returning to full duty after a median of 14 days of limited function 6.
What NOT to Do
- Do not immobilize: Immobilization is not recommended for wrist sprains 1
- Do not use RICE protocol: Rest, Ice, Compression, Elevation (RICE) is not advised as a complete treatment modality for sprains 1
- Do not apply heat: Heat is not recommended for acute wrist injuries 1
- Do not ignore persistent symptoms: A diagnosis of "wrist sprain" should not prevent further investigation if symptoms persist 7