Return to Work Clearance for Grade I–II Wrist Sprain
Your patient with a grade I–II wrist sprain who has achieved full pain-free range of motion, normal grip strength, and no functional limitations is cleared to return to all work duties without restrictions immediately.
Clinical Rationale
The evidence strongly supports early return to full activity once functional recovery is complete, regardless of arbitrary time-based restrictions:
Functional recovery supersedes time-based protocols. When patients demonstrate pain-free range of motion and normal strength, they have met the physiological criteria for unrestricted activity 1.
Long-term outcome data confirms safety of early return. A 10-year follow-up study of wrist sprains showed that 96% of patients returned to full military duty (including physically demanding tasks) after a median of only 14 days of limited upper extremity function, with excellent long-term outcomes (mean SANE score 88, QuickDASH 7.5) 1.
Most wrist sprains resolve within 6 weeks with excellent recovery. The American Society for Surgery of the Hand advises that symptoms typically resolve in 6 weeks with excellent recovery, and your patient has already achieved this endpoint 1.
Work Clearance Letter Template
To Whom It May Concern:
[Patient Name] has been under my care for a grade I–II wrist sprain. The patient has now achieved:
- Full pain-free range of motion
- Normal grip strength bilaterally
- No functional limitations with work-simulated activities
The patient is medically cleared to return to full work duties without restrictions as of [date].
No accommodations, modified duty, or lifting restrictions are required. The patient may resume all job tasks immediately.
Key Clinical Considerations
Why immediate clearance is appropriate:
Grade I–II sprains represent minor ligamentous injuries without significant structural damage requiring prolonged healing 2.
Functional capacity is the best predictor of safe return to work, not arbitrary time intervals 1.
Delayed return without medical justification increases risk of deconditioning and psychological barriers to work resumption 3.
Common Pitfalls to Avoid
Do not impose arbitrary time restrictions (e.g., "wait 6 weeks") when functional recovery is already complete. This delays return to productivity without medical benefit 1.
Do not confuse "wrist sprain" with more serious injuries. True grade I–II sprains with complete functional recovery do not require MRI or prolonged restrictions 1, 2.
Do not recommend modified duty or lifting restrictions when grip strength is normal and pain-free function is demonstrated. This creates unnecessary workplace accommodations 1.
Red Flags That Would Change This Recommendation
If any of the following were present, further evaluation would be needed before clearance:
- Persistent point tenderness over specific carpal bones (suggests occult fracture or ligamentous instability) 2
- Pain with provocative maneuvers despite "normal" range of motion 4
- Subjective instability or clicking with movement 4
- Inability to perform work-simulated tasks without pain 5
Since your patient has none of these findings and demonstrates complete functional recovery, immediate return to full duties is both safe and appropriate 1.