The right treatment for a soft tissue injury of the wrist is based upon a good clinical assessment of which tissue is injured, and how badly it is injured.

A lot of wrist sprains heal reasonably quickly with a short period of rest, and there are no lasting side effects. However, a small number of these soft tissue injuries cause significant pain and dysfunction because important structural ligaments have been damaged. The most severe wrist sprains involve damage to the ligaments that hold the 10 bones of the wrist together. These sprains can affect the long-term stability of the entire wrist and lead to ongoing pain and weakness. You might also find your wrist starts to ‘give way’ when you use it to lift something or take your body weight.

Ligament injuries are classified into grades according to severity. Ligament tears can be painful at any grade, especially when they first happen.

Grade 1: The ligaments are stretched, not torn. These usually take 2–3 days to heal.

Grade 2: Moderate sprains with partial tears of the ligament fibres. The ligament is partly intact and can take 2–6 weeks to heal.

Grade 3: The ligament is completely torn. These can take 6 weeks to heal. In some cases, they require surgery.

Wrist sprains happen when the wrist is forced too far in one direction and tissues are stretched or torn. A common cause is a fall onto your outstretched hand, especially from a height or at speed. Young people’s bones are very strong, so they can fall quite heavily and not break a bone. Instead, they might sprain their wrist. The same fall in an older person might result in a fractured wrist.

Soft tissue injuries are very common in ball sports or from falling off a bike. They may also happen when the wrist or hand is over-twisted, like when you use a drill or racquet that forces your forearm into excessive rotation. The force and direction of the injury will affect which soft tissues in the wrist are damaged and how badly.

Another cause of soft tissue injury is called attrition. You can gradually wear down a ligament until it breaks by putting strain through it repeatedly over many years. A good example of this is repeated forceful squeezing of electrical pliers straining the scapholunate ligament in the wrist. You can be doing the exact same thing as always and simply hear a pop, or feel something ‘go’.

It’s important to pay attention if your wrist sprain doesn’t go away completely after a few days. A wrist sprain can be something very simple or a more serious soft tissue injury, requiring the right treatment in order to heal. It’s recommended that you have your wrist injury properly assessed if it’s still sore after a few days. It’s strongly advised that you get a good clinical assessment by your physiotherapist or a hand therapist to get a diagnosis on the injured structure.

Immediately after the injury, the wrist will be painful and swollen. Usually movement will be difficult and it may not be possible to lift anything heavy or lean on it. X-rays will show that no bones are broken, but this does not tell you how serious the sprain is.

As time goes on, you may notice pain when lifting or pushing up from a chair, or you might not be able to complete all your usual activities without pain. In the situation where after a week, your wrist feels better but not 100 per cent, it’s advisable to see your physiotherapist or a hand therapist for a diagnosis. It’s a lot easier to fix the problem in the initial stages compared to six weeks (or months!) later.

Diagnosis

The most helpful thing your physiotherapist can do is make a diagnosis of your wrist sprain and tell you which tissues appear to be injured, and how badly. The right treatment will depend upon this diagnosis.

Treatment

Initial treatment of sprains involves rest, often by placing the wrist in a splint or brace or by taping it. Physiotherapists who specialise in upper limb injuries can make a splint that is best suited for your injury, taking into account the structures that are damaged and need protecting. This may need to be worn full-time initially, followed by a period of part-time use as you get back to your normal pre-injury activities.

Swelling can be reduced by rest, compression, elevation and ice. Your physiotherapist might also perform soft tissue treatments on the surrounding muscles and tendons, which can become tight and painful during the healing phase. To do this, they may use heat, massage or dry needling.

Exercises

Exercises are needed to regain movement, strength and stability (proprioception) of your wrist. The exercises you do will depend on which ligament is damaged, as some muscles help certain ligaments while others put more strain on the ligament. These exercises need to be introduced carefully and gradually by your physiotherapist.

Physiotherapy (or hand therapy) is the right treatment for most moderate to severe soft tissue injuries. If your wrist is unstable due to the complete rupture of one or more ligaments, you may need surgery to repair the injured ligament/s. After surgery, it is very important that your physiotherapist guides you through the rehabilitation phases in conjunction with your surgeon. This will ensure a complete recovery without damaging the repair.

• Elevate the hand to limit swelling
• First aid for any soft tissue injury (including a wrist sprain) is ice, compression and rest
• Use a crepe bandage (available from most pharmacies) or a wrist splint to protect the wrist until it settles down
• Avoid carrying heavy objects or gripping anything too tightly until your symptoms disappear

Wrist sprains can take anywhere from three days to six months to get better. Unfortunately, without correct treatment wrist sprains can also become a chronic injury, causing pain and disability in years to come.

If your wrist is still sore a few days or a week after your injury, it’s a sign you may need a proper diagnosis and professional help from your physiotherapist or hand therapist.

In most cases, once your wrist is immobilised in an appropriate splint, the pain will immediately reduce. This ensures the damaged ligaments are fully supported and accidental movements don’t stretch the healing ligaments. Within the splint or brace, you can usually complete gentle tasks, but must avoid tight gripping as this puts pressure on the ligaments.