What is the treatment for a wrist sprain?

Treatment for Wrist Sprain

The treatment for a wrist sprain should follow the PRICE protocol (Protection, Rest, Ice, Compression, and Elevation) for the first 72 hours, followed by functional rehabilitation with early weight bearing and active exercises to restore movement and strength. 1, 2

Initial Assessment and Management

• Rule out fractures through physical examination, paying attention to signs such as excessive swelling, hematoma, and pain on palpation 2
• Limit activities that cause pain and seek medical attention for painful extremity injuries that limit use 1
• Apply cold therapy (ice and water surrounded by a damp cloth) to reduce pain and swelling, limiting application to 20-30 minutes per session to avoid cold injury 1
• Consider applying a compression wrap for comfort, ensuring it doesn't compromise circulation 1

Functional Treatment Approach

• Implement a functional approach consisting of 3-5 days of rest, ice, compression, and elevation with early weight bearing 1
• Begin active exercises after the initial rest period to promote faster recovery and resumption of daily activities 1, 2
• Use a semirigid brace rather than elastic bandages or tape for better cost-effectiveness and support 1
• Avoid prolonged immobilization as functional treatment leads to faster resumption of work and daily activities 1

Support and Protection

• For protection during recovery, a semirigid brace is the most cost-effective option compared to taping 1
• Functional support devices provide protection against future wrist sprains, particularly important for those with a history of recurrent sprains 2
• Limit the duration of external fixation if used, as prolonged fixation may lead to complications such as finger stiffness 1

Follow-up and Monitoring

• Re-examine the wrist 3-5 days after injury when pain and swelling have improved to better distinguish between partial and complete ligament tears 2
• Monitor for signs of inadequate healing, as improper treatment can lead to chronic problems such as decreased range of motion, pain, and joint instability 1
• Be aware that "wrist sprain" is sometimes used as a catch-all diagnosis when specific injuries are missed; consider advanced imaging if symptoms persist 3, 4

Cautions and Pitfalls

• Beware of misdiagnosis - studies show that many injuries initially diagnosed as wrist sprains are actually fractures, particularly greenstick or torus fractures of the distal radius 5
• Consider MRI if symptoms don't resolve within the first couple of weeks, as MRI can identify pathological findings in approximately 80% of patients with normal X-rays 4
• Recognize that while most patients with wrist sprains have excellent long-term outcomes, some may require limited duty for approximately 2 weeks 6

Prevention of Recurrence

• Both neuromuscular training and bracing have proven beneficial in preventing recurrent sprains 1
• Educate patients on joint protection techniques to avoid adverse mechanical factors 2
• Consider preventive measures for patients with a history of previous wrist injuries, as this is a risk factor for recurrent injury 1