What should I do for a suspected sprain of my left wrist and hand after falling off a bicycle and landing on my left hand, with bruising on the top of my thumb and pain from my thumb to my wrist?

Immediate Management of Acute Wrist and Hand Injury

You need to get X-rays immediately—specifically a 4-view series including posteroanterior (PA), lateral, oblique, and scaphoid views—because your injury pattern (fall onto outstretched hand with bruising over the thumb and pain extending to the wrist) has a high risk of occult fractures, particularly scaphoid fractures, which can lead to devastating complications like avascular necrosis if missed. 1, 2

Why Imaging Cannot Wait

• Bruising over the thumb with pain extending to the wrist indicates significant soft tissue injury and raises concern for underlying fractures that may not be immediately apparent clinically. 1, 2
• The American College of Radiology establishes that radiographs are the mandatory first imaging study for all acute hand and wrist trauma, and relying on clinical examination alone or waiting to see if symptoms improve is inadequate. 3
• Missed scaphoid fractures specifically lead to nonunion, avascular necrosis, and post-traumatic arthritis—all of which cause permanent disability and require complex surgical reconstruction. 1

Specific Imaging Protocol Required

• Request a minimum 4-view series: PA view, lateral view, 45° semipronated oblique view, and dedicated scaphoid view—the 4th view (scaphoid) increases diagnostic yield for both distal radius and scaphoid injuries. 1, 2
• Standard 2-view or even 3-view series miss significant pathology in wrist injuries, making them inadequate for your injury pattern. 1, 2

Immediate Self-Care While Arranging Imaging

• Apply ice immediately and continuously for the first 48-72 hours to control acute inflammation, which if left unchecked will significantly hamper your rehabilitation. 4
• Rest the injured hand completely—avoid any weight-bearing activities or gripping until imaging is obtained to prevent displacement of any occult fracture. 1
• Use compression (elastic bandage) and elevation above heart level to minimize swelling. 4
• Take acetaminophen or NSAIDs (ibuprofen/naproxen) for pain control and to reduce inflammation. 4, 5

What Happens After Initial X-rays

If X-rays Show a Fracture:

• You will need orthopedic or hand surgery evaluation within 24-48 hours, as intra-articular involvement, displacement >3mm, or carpal malalignment requires operative fixation. 2
• Begin active finger motion exercises immediately (even if casted) to prevent finger stiffness, which is the most functionally disabling complication and extremely difficult to treat later. 2

If X-rays Are Normal But Pain Persists or Worsens:

• The American College of Radiology recommends either: (1) immobilization in a short arm cast with repeat X-rays in 10-14 days, OR (2) immediate MRI without IV contrast to detect occult fractures, bone contusions, or ligament injuries. 3, 1
• MRI has 94.2% sensitivity and 97.7% specificity for occult scaphoid fractures and can also detect scapholunate ligament tears, lunotriquetral ligament tears, and bone contusions that explain your symptoms. 1
• Worsening pain despite negative initial X-rays is a red flag demanding advanced imaging—ligamentous injuries can present with normal radiographs but cause progressive pain and chronic wrist instability if not diagnosed early. 1

Critical Red Flags Requiring Urgent Evaluation

• Increasing pain over the first 2 weeks despite rest and ice 1
• Inability to bear weight through the hand or grip objects 6
• Numbness or tingling in the fingers (suggests nerve injury) 3
• Visible deformity or abnormal wrist position 2

Common Pitfalls to Avoid

• Do not wait to "see if it gets better"—occult fractures and ligament injuries worsen with delayed diagnosis and lead to permanent complications. 1, 2
• Do not skip imaging because you can "move everything"—range of motion does not exclude fracture, and scaphoid fractures in particular may have minimal initial symptoms. 1
• Do not accept 2-view X-rays only—insist on the full 4-view series as standard 2-view imaging misses significant wrist pathology. 1, 2
• Do not delay finger motion exercises once treatment begins—finger stiffness is the most disabling long-term complication. 2