What is the prognosis for a wrist injury sustained from pushups, which has been at rest for 5 weeks and shows initial improvement but is aggravated by lifting weights?

Wrist Injury from Pushups: Prognosis and Management

Your wrist injury has a favorable prognosis with expected full recovery in 3-6 months, but you must completely avoid aggravating activities (including weight lifting) during this healing period, as continued loading will prevent resolution and may lead to chronic tendinopathy. 1, 2

Understanding Your Injury

This is most likely a repetitive strain injury causing tendinopathy (degenerative tendon changes, not inflammation) of the wrist extensors, commonly affecting the dorsal compartments from the repetitive loading during pushups. 1, 3, 4 The pattern you describe—initial improvement with rest followed by immediate aggravation with loading—is the hallmark of load-related tendinopathy. 1, 3

Expected Recovery Timeline

• 80% of patients achieve full recovery within 3-6 months with appropriate conservative management 1, 2
• Your current 5-week timeline places you in the early-to-mid phase of expected healing
• The fact that symptoms improve with rest is a positive prognostic indicator 1, 5

Critical Management Steps

Immediate Actions (Weeks 1-6)

• Complete avoidance of all weight-bearing activities on the wrist, including pushups, planks, and weight lifting—this is non-negotiable for healing 2, 3
• Apply ice for 15-20 minutes every 2-3 hours to reduce pain and swelling 2
• Wear a wrist splint in neutral position during activities that might stress the wrist 2
• Take NSAIDs as needed for pain control 1, 2

Subacute Phase (Weeks 6-12)

• Begin gentle range of motion exercises when pain allows, but avoid any resistance 2
• Implement eccentric strengthening exercises once pain-free at rest—these specifically promote tendon healing 1, 2
• Continue functional support with bracing during daily activities 2
• Gradually transition from complete rest to controlled movement to prevent stiffness 2

Return to Activity (After 12+ Weeks)

• Do not return to pushups or weight lifting until you have zero pain with resistance testing 2
• Premature return to loading is the most common cause of prolonged symptoms or chronic injury 2

When to Seek Further Evaluation

Imaging Indications

If symptoms persist beyond 6 weeks despite proper rest, obtain imaging to rule out occult fractures or other pathology:

• Start with plain radiographs (3 views: posteroanterior, lateral, and 45° oblique) to exclude fractures or bony abnormalities 1, 2
• If radiographs are negative but symptoms persist, MRI without IV contrast is the next appropriate study to evaluate for occult fractures, stress injuries, or soft tissue pathology 1, 2
• MRI is highly sensitive for detecting radiographically occult fractures and stress injuries common in gymnasts and weight lifters 1

Red Flags Requiring Specialist Referral

• Persistent pain despite 3-6 months of well-managed conservative treatment 1, 2
• Progressive worsening of symptoms despite rest 5
• Development of sensory changes or motor weakness 6

Common Pitfalls to Avoid

• Returning to activities too soon: This is the primary reason for treatment failure and chronic symptoms 2, 3
• Continuing "light" weight lifting: Any loading that reproduces pain will prevent healing 3
• Inadequate rest period: The degenerative tendon tissue requires months, not weeks, to remodel 1
• Skipping imaging if symptoms persist: Up to 30% of wrist fractures can be missed on initial evaluation, and occult fractures are common in weight-bearing activities 1, 6

Technique Modification for Future Prevention

Once fully healed, modify your pushup technique:

• Use pushup bars or parallettes to maintain neutral wrist position 4
• Perform pushups on fists instead of flat palms 4
• Gradually progress loading over weeks to months 2
• Incorporate wrist strengthening exercises into your routine before returning to high-volume pushups 2

Surgical Consideration

Surgery is only indicated after failure of 3-6 months of well-managed conservative treatment and typically involves excision of abnormal tendon tissue and release of scarring. 1, 2 However, functional conservative treatment remains strongly preferred to avoid surgical risks and complications. 2