A wrist sprain is an injury to the ligaments of the wrist area, including the ligaments that connect the carpal bones and the ligaments that connect the proximal carpal bones to the radius and ulna. By damage we mean sprain, as well as partial or complete rupture of the ligaments.
Thus, there are three degrees of ligament damage:
- A mild sprain that is not accompanied by joint instability.
- Partial rupture of the ligaments, which may be accompanied by instability of the joint.
- Complete ligament rupture with severe joint instability.
Clinically Relevant Anatomy
There are two types of wrist sprains: radial and ulnar wrist sprains.
- The most common is a radial carpal sprain, which involves damage to the ligaments connecting the lunate to the scaphoid, specifically the scapholunate ligament and the volar radiocarpal ligament.
- In the case of an ulnar wrist sprain, it may be a rupture of the triangular fibrocartilaginous complex or lunate triquetrum complex ligaments.
How to treat a sprained hand
To relieve pain and inflammation, ointments based on NSAIDs ( Bystrumgel, Indovazin, Dolgit ) are most often used. In severe cases, decongestants, angioprotective, absorbable, warming or cooling agents may be additionally prescribed. They promote the resorption of hematomas, improve microcirculation in tissues, strengthen vascular walls and help relieve swelling faster.
Physiotherapy procedures that are included in the treatment of hand sprains:
- paraffin therapy;
- medicinal electrophoresis;
- magnetic therapy;
- wave therapy;
- mud therapy.
During the recovery period, the patient requires physical therapy. Special exercises help restore normal range of motion and completely restore the functions of the affected limb.
The most important step in treating a sprained arm is complete immobilization. Experts advise applying an elastic bandage for 7-14 days after the injury. It is better to take it off at night.
Differential diagnosis
When a patient experiences functional impairment and pain after a wrist injury, we want to know whether there is a fracture or not. To make a diagnosis, in most cases it is necessary to do an x-ray examination. At the moment, a group of scientists is trying to develop the “Amsterdam Wrist Rules”, as we already know the “Ottawa Ankle Rules”. The purpose of their study is to establish guidelines to follow when deciding whether you need to have your wrist x-rayed or not.
Friends, on July 17 in Moscow, as part of the #RehabTeam project, Anna Ovsyannikova’s seminar “Rehabilitation of the hand after a fracture of the distal radius (fracture of the “radius in a typical place”)” will take place.” Find out more... In addition, on July 18, she will conduct a seminar “Rehabilitation of the hand after fractures of the metacarpal bones (Boxer fracture).” Find out more...
Dislocations of the hand
Dislocation of the wrist joint occurs mainly during falls with emphasis on the hand or during a direct blow with a fist or a heavy object. Injury also occurs when the hand is strongly arched. After the injury, the patient complains of sharp pain in the wrist joint. Visually, you can determine pronounced swelling of the tissues and sharp pain during palpation. Motor activity in the joint is sharply limited. If the median nerve is compressed during an injury, there will be a loss of sensitivity in the innervated area.
Inspection
- We will begin the examination by collecting anamnesis. During this we want to know more about the origin of the injury and can already assess whether there are (according to the patient) any functional impairment. Have the patient describe the symptoms (the most common complaint is pain). It is also important to ask about expectations from therapy. You can gather information about previous injuries and any possible factors that may interfere with the healing process.
- After taking a history, you should examine the injured wrist, comparing it with the other wrist. A sore wrist may be swollen, red, warm, and painful to the touch.
- After completing the examination, you can palpate the wrist with all its structures. Most structures can be felt very well, but swelling and tenderness may interfere with this.
- After palpation, you should evaluate each joint for pain, abnormal movement, or crepitus.
- Physiological wrist movements can be examined using simple palmar flexion, dorsiflexion, radial and ulnar deviation tests.
- You should also test functional movement by allowing the patient to do things such as grasping, pinching, holding, and manipulating objects.
- When there is severe swelling, you can expect that even the simplest movements will be very painful for the patient.
- To test muscle strength, you can evaluate resistance movements. This is possible at the moment of flexion, extension, radial and ulnar abduction. Be careful as this can be very painful or even impossible for patients with severe wrist injuries where passive mobilizations are already painful and not fully feasible.
- Your test results, and therefore your functional impairment, will depend on the severity of your injury.
You can also do some more specific provocative tests to look for wrist injuries.
- Watson's scaphoid shift test.
- Lunate-triquetral ballot test.
- Extension of fingers against resistance.
- Mid-palm test.
- Distal radioulnar joint test.
- Stress test of the triangular fibrocartilaginous complex.
- Stress test of the triangular fibrocartilaginous complex with compression.
- Grip and rotation test.
These tests will give you more information about which ligaments are damaged and whether there is instability in the wrist.
What happens if you don't get treatment?
If left untreated, sprains are complicated by acute and then chronic tendinitis. The pathology is characterized by the development of an inflammatory process with progressive dysfunction of the hand. Subsequently, the inflamed ligaments become ossified, that is, calcium salts are deposited in them. At this stage, a person is bothered by chronic pain and severe stiffness of the arm. It becomes impossible to cure the pathology conservatively.
In case of grade III sprains, the lack of medical care is fraught with irreversible loss of limb function. The victim loses the ability to perform certain movements with his fingers and hand. An operation performed untimely may not help correct the defect.
Physical therapy
Phase 1
First you have to follow the RICE algorithm:
- Rest: Stop using the injured wrist for 48 hours or until pain and swelling subsides.
- Ice: Apply an ice pack wrapped in a towel to the injured wrist (for about 15 minutes, several times a day for several days). Do not use ice for more than 20 minutes at a time!!! —— It is believed that cryotherapy allows you to narrow the superficial vessels, thereby reducing local blood flow and swelling. There is some debate about the effectiveness of cryotherapy, but most studies support the fact that cryotherapy has an analgesic effect. There are also indications that cryotherapy affects inflammation, but more research is needed to confirm these findings.
- Compression: Apply an elastic compression bandage to your wrist. This should help drain fluid from damaged tissue. Start applying the bandage at the base of the fingers and stop just below the elbow, i.e. we move towards the heart. The wrap should be tight, but be careful not to restrict blood flow.
- Elevated position: Try to keep your wrist higher than your heart (as often as possible for two days). This will help fluid drain and reduce swelling around the wrist. The use of non-steroidal anti-inflammatory drugs (NSAIDs) is also recommended.
In cases of severe injury, wrist immobilization may be recommended. In some cases, surgery may be required to repair a completely torn ligament.
What to do if you have a sprained arm
First of all, the patient needs to stop doing work. The affected limb should be immobilized, that is, immobilized. To do this, it is better to secure the hand with a tight bandage made of an elastic bandage. To relieve pain, apply a cold compress or ice to the hand.
Fixing bandage for immobilization.
You can treat a mild hand sprain at home. In more severe cases, you should definitely see a doctor. He will examine you and prescribe the necessary treatment. If you are diagnosed with a fracture, serious tear, or avulsion, be prepared for a cast or even surgery.
Never apply ice directly to the skin. This puts you at risk of frostbite. It is better to put it in a plastic bag and wrap it with a dry, clean cloth.
First aid for bruises and other injuries to the hand
Immediately after the injury, the patient must make sure that he received a minor bruise and that no bone remains are visible at the site of the injury. The wound is washed with warm water and soap, gently dried and treated with antiseptic. Then you need to apply dry ice for 5-10 minutes. After this time, the hand must be examined again, finger activity and range of motion checked.
In case of damage to the hand with a violation of the integrity of the skin, it is necessary to apply a bandage of a sterile bandage. When applied correctly, the bandage completely covers the damaged tissue, does not hinder movement and does not cause any pain. Make sure that the bandage does not squeeze the skin. If the tissues begin to turn blue and sensitivity decreases, this indicates that the bandage urgently needs to be loosened or replaced.
Dry ice must be applied every hour for 5-10 minutes. Usually this is enough to reduce pain and prevent the appearance of a hematoma. Intermittent cold therapy is an effective treatment for minor bruises and injuries. More serious injuries require specialist consultation and a comprehensive examination.
The main tasks of first aid for hand injuries:
- immobilization of the limb to prevent the development of complications;
- stopping bleeding from a wound;
- antiseptic treatment for prophylactic purposes;
- reduction of swelling, pain, signs of an inflammatory reaction.
Patients are not always able to provide first aid for hand injuries, especially if the wound is bleeding and there is severe pain. If you cannot adequately assess the complexity of the situation and your condition, it is recommended to immediately contact medical professionals. They will carry out antiseptic treatment themselves, relieve pain and, if necessary, use immobilization.
Cause of radial head subluxation in children
The reason that causes subluxation of the head of the radial bone is usually a movement in which the child’s arm, which is in an extended position, is subjected to a sharp stretch by the hand or the lower end of the forearm along the longitudinal axis of the limb, often upward, sometimes forward. From the anamnesis it is possible to establish that the child stumbled or slipped, and the adult who was leading him, most often holding his left hand, pulled it to keep the child from falling. Sometimes in a small child this stretching of the arm occurs during play, when he is taken by both hands and rotated around himself, or when putting on and taking off a narrow sleeve. In some cases, adults indicate that the hand crunched.