Wrist pain is extremely common among athletes, healthcare professionals, and anyone who is involved in lifting/carrying of heavy/large objects.  A small pull here and there, happening over time, can easily damage wrist muscles or ligaments.  An injury due to overuse of the wrist can result in chronic wrist pain. On the other hand, a forceful sudden pull is capable of tearing the ligaments or muscles around the wrist immediately causing an acute onset of pain.  I will discuss how to treat and prevent both acute and chronic wrist pain.

Acute Wrist pain:

Acute wrist pain usually happens soon after a person develops an injury. Episodes of acute pain usually last from the time of the incident to around 72 hours.  After that, it is classified as subacute pain. The approach for management of acute pain includes:

1. Management of swelling/edema
2. Pain management
3. Relaxation of the area by providing proper positioning
4. Ruling out fractures as well nerve damage

Management of swelling/edema:

Management of swelling/edema is crucial.  Uncontrolled and unmanaged swelling can cause complications like Median nerve entrapment in the wrist ( a condition known as carpal tunnel syndrome).  Rest, Ice, compression, and Elevation (RICE) are common methods to treat swelling.  When appropriate, compression can be added with ACE wrap with a large amount of swelling. However, frequent skin checks are necessary with ACE wrap.   It is good to consider compression as a short term intervention.

A clinician is able to make a decision about diagnosis with the amount of swelling. A muscle or ligament can be torn minimally (less than 25% of ligament fibers are damaged), partially ( around 50% of fibers are damaged) or full-thickness tear( more than 75% of fibers are damaged). A wrist swelling is also a common symptom of a fracture. When and if needed, a clinician or a physician can ask for more diagnostic tests like X rays, MRI, or nerve conduction tests.

Pain management:

In acute cases, icing, elevation, and compression can manage wrist pain. The use of medications is necessary to reduce pain and inflammation in cases with fractures or partial thicknesses tear. The full-thickness tear does not have any pain associated with it due to nerve fibers being damaged completely – causing no feeling of pain.

Relaxation of the area by providing proper positioning:

The rest to the area is advised to manage swelling and pain. However, a person may not be able to participate in sports for a few weeks. A physician may advise not to move his wrist or fingers too much. A person may have some restrictions like not to lift any heavy objects, or no push/pull. Braces are useful to position the wrist in pain freeway.

Ruling out fractures as well as nerve damage:

If swelling is severe and discoloration is present, a nurse in the ER will ask to get some imaging done. A physician or nurse practitioner can perform (or attempt to perform ROM) prior to consulting imaging.

Initiation of Exercise:

Unlike replacements or post-operative cases, a clinician will not prescribe/ initiate any exercise until the pain is managed. Once pain is within the bearable limit, a therapist will perform ROM as well as stretching exercises. Type and time of exercise will vary depending on the severity of injury/ grade of tear of involved ligaments /muscles.

Wrist Flexion & Extension:

As shown in the figure, a clinician will ask you to move your wrist up and down.

Radial & Ulnar Deviation:

This is done by moving the wrist side to side. The thing we need to remember here is not to move the whole arm. Stabilizing the forearm just below elbow helps to prevent this.

Wrist circumduction:

Perform wrist circumduction by moving the wrist clockwise and anticlockwise as shown in the image below.

Finger flexion/extension:

This is bending the fingers and straightening them. As shown in the picture, it can be a full bending of fingers (at MCP and IP joints) or only being at IP joints but keeping them straight at MCP joints (as shown in center picture).

MCP= MetaCarpal Phalangeal Joint

IP= Interphalangeal joints.

Finger abduction/adduction:

Finger adduction is the act of opening the fingers and abduction is the act of bringing them close together.

Wrist exercise progression for strengthening:

Once pain and inflammation subside, you can start with some resistance exercises to improve muscle strength. You can add some weight with use T- bands, dumbells, or exercise balls. Few figures below talk about some examples that you can use to add resistance to your exercise regime.

Wrist Stretching:

Use of wrist brace:

The use of braces is controversial. The good thing is that braces do not have any side effects (except just regular skin checks). So one can try it and make a decision to use it or not.  It is completely ok to stop using the braces if one does not feel comfortable with it. Braces help to keep the wrist in a certain position and avoid the aggressive use of wrist as well as any sudden movement that the human body tends to perform. Resting or night braces are available to protect the area during sleep.

Chronic Pain:

CDC defines chronic pain as a pain that lasts for more than 3 months even after conservative management. Chronic wrist pain can be due to work-related musculoskeletal disorders, overuse injury to muscles, ligaments, etc.  It can also be a side effect of prolonged use of medications or being in wrong postures for extended periods. As per the CDC, arthritis and wrong ergonomics are some of the main factors leading to chronic wrist pain.

Management of chronic pain includes pain medication, anti-inflammatory medications, use of a brace, and some exercises to maintain wrist ROM. In certain cases, a physician will discuss options of injections to manage chronic pain. Depending on a person’s personality, lifestyle, stress level, as well as activity level, other non-pharmacological measures like relaxation techniques, massage therapy, Yoga, meditation, etc.. can be considered. Check out my previous article regarding pain management without the use of medications to learn more about these widely available options. I discuss chronic wrist pain and how to manage it conservatively in a separate article here.

Hope this article helps to find some solution about wrist sprain and strain. You can download the exercises here.