What is the management for a wrist contusion?

Management of Wrist Contusion

The initial management of a wrist contusion should include rest, ice application, compression, and elevation (RICE protocol) to reduce pain and swelling, followed by radiographic evaluation to rule out fractures. 1

Initial Assessment and Imaging

• Radiographs of the wrist are usually appropriate as the initial imaging for any acute blunt trauma to the wrist, including contusions 1
• A standard three-view radiographic examination should include:
  • Posteroanterior (PA) view
  • Lateral view
  • 45° semipronated oblique view 1
• If initial radiographs are negative but symptoms persist, follow-up imaging may be needed:
  • Repeat radiographs in 10-14 days
  • MRI without IV contrast
  • CT without IV contrast 1

Acute Management

Immediate Care (First 24-48 hours)

• Apply ice for 15-20 minutes every 2-3 hours to reduce swelling and pain 1
• Compress the area with an elastic bandage to minimize swelling 1
• Elevate the wrist above heart level to reduce edema 1
• Immobilize with a wrist splint in neutral position to provide pain relief and prevent further injury 1
• Administer appropriate analgesics for pain control 1

Monitoring for Complications

• Assess neurovascular status regularly to detect potential acute carpal tunnel syndrome, which can develop following wrist contusion 2, 3
• Watch for signs of:
  • Progressive sensory loss in median nerve distribution
  • Severe wrist pain
  • Elevated interstitial pressure in the carpal tunnel (>40 mm Hg if measured) 2
• If acute carpal tunnel syndrome is suspected, urgent carpal tunnel release is indicated within 40 hours of symptom onset for best outcomes 2

Subacute Management (After 48-72 hours)

• Gradually transition from complete rest to controlled movement to prevent stiffness 1
• Continue with intermittent ice application as needed for pain and swelling 1
• Begin gentle range of motion exercises when pain allows 1
• Avoid activities that exacerbate symptoms 1

Rehabilitation Phase

• Progressive range of motion exercises to prevent contracture formation 1, 4
• Gradual strengthening exercises once pain-free range of motion is achieved 1
• Monitor for development of post-traumatic contracture, which may require more aggressive intervention if it persists 4
• For persistent contracture, arthroscopic mobilization may be considered as it has shown effectiveness in improving range of motion 4

Special Considerations

• High-energy wrist injuries may involve complex fractures or dislocations that are not immediately apparent on initial assessment 5
• In cases with persistent symptoms despite conservative management, consider:
  • MRI to evaluate for occult fractures or soft tissue injuries 1
  • Ultrasound to assess for tendon pathology 1
• Be vigilant for nerve injuries, which may present with motor and sensory deficits, severe pain, or cold intolerance 6

Return to Activities

• Gradual return to daily activities as symptoms improve 1
• Return to sports or heavy manual labor should be delayed until:
  • Full, pain-free range of motion is achieved
  • Normal grip strength is restored
  • No pain with resistance 1

Common Pitfalls to Avoid

• Failure to obtain appropriate imaging to rule out fractures 1
• Prolonged immobilization leading to stiffness and contracture 1, 4
• Missing signs of acute carpal tunnel syndrome, which requires urgent intervention 2
• Returning to activities too soon, which may lead to prolonged symptoms or reinjury 1