What should I do if I experience sudden hand and wrist pain when lifting an object?

Immediate Management of Sudden Hand and Wrist Pain When Lifting

Start with rest, ice, compression, and elevation (RICE) immediately, then obtain standard 4-view radiographs (PA, lateral, oblique, and scaphoid views) within 24-48 hours to rule out fracture, even if pain seems minor—missed fractures can lead to permanent disability including nonunion, avascular necrosis, and post-traumatic arthritis. 1

Initial Self-Care (First 24-48 Hours)

• Apply ice for 15-20 minutes every 2-3 hours to reduce pain and swelling 2, 3
• Compress the area with an elastic bandage to minimize swelling 2
• Elevate the hand above heart level whenever possible 2
• Avoid lifting or weight-bearing activities with the affected hand until imaging is obtained to prevent displacement of any occult fracture 1

Mandatory Imaging Evaluation

Obtain radiographs as your first imaging study—this is non-negotiable. 4

• Request a minimum 4-view series: posteroanterior (PA), lateral, 45° semipronated oblique, and scaphoid view 1
• Two views are inadequate and miss critical fractures, particularly scaphoid injuries which are notorious for causing long-term complications 1
• Radiographs identify fractures, arthritis, bone tumors, and alignment abnormalities before considering soft tissue pathology 1

If Radiographs Are Normal But Pain Persists or Worsens

This is a red flag scenario requiring advanced imaging. 1

Two Management Options:

Option 1 (Conservative):

• Place the hand/wrist in a short arm cast or splint 1
• Repeat radiographs in 10-14 days 1
• Continue avoiding weight-bearing activities 1

Option 2 (Preferred for persistent/worsening pain):

• Obtain MRI without IV contrast immediately (sensitivity 94.2%, specificity 97.7% for occult fractures) 1
• MRI detects occult scaphoid fractures, bone contusions, ligamentous injuries (scapholunate/lunotriquetral tears), tendon injuries, and early avascular necrosis 1
• Ultrasound is an equivalent alternative for evaluating tendon injury, tenosynovitis, or tendon pathology 4, 5

Critical Injuries That Must Not Be Missed

Scaphoid fractures are the most dangerous missed injury:

• Can appear normal on initial radiographs 1
• Lead to nonunion, avascular necrosis, and post-traumatic arthritis if untreated 1
• Require early diagnosis and immobilization 1

Ligamentous injuries (scapholunate or lunotriquetral ligament tears):

• Present with normal initial radiographs but progressive pain and instability 1
• Require early diagnosis to prevent chronic wrist instability and arthritis 1

Tendon injuries (closed tendon ruptures or tenosynovitis):

• Common in lifting injuries and can cause permanent disability if diagnosed late 6
• MRI or ultrasound can identify tendinopathy, tendon tears, intersection syndrome, and stenosing tenosynovitis 4, 5

When to Seek Immediate Medical Attention

• Visible deformity of the hand or wrist 4
• Inability to move fingers or wrist 6
• Numbness or tingling suggesting nerve injury 7
• Pain that worsens over 2 weeks despite rest and initial negative radiographs 1

Symptomatic Treatment While Awaiting Evaluation

• Topical NSAIDs are first-line pharmacological treatment due to superior safety profile 5
• Oral NSAIDs for limited duration if topical agents provide insufficient relief 5
• Splinting/orthoses for symptom relief, particularly for thumb base involvement 5
• Avoid oral analgesics alone without imaging—pain relief can mask serious injury 1

Referral Indications

Refer to hand surgery or orthopedics if:

• MRI reveals scaphoid fracture 1
• Ligamentous injury requiring repair 1
• Suspected focal dystonia or progressive weakness 7
• Severe structural abnormalities 7

Common Pitfalls to Avoid

• Never rely on "it doesn't hurt that much" to skip imaging—occult fractures are common with minimal initial pain 1
• Never assume normal 2-view radiographs rule out fracture—4 views are essential 1
• Never delay advanced imaging if pain worsens after 2 weeks—this indicates missed pathology 1
• Never continue lifting activities before imaging—you risk converting a stable fracture into a displaced one 1