Types of wrist sprain and their recovery

A sprain is a ligament injury produced by a traumatic elongation or distension of its fibers. Remember that a ligament is a structure of conjunctive tissue that joins the different bones that make up a joint and gives it stability. In function of the intensity of the injury mechanism we can find one more or less serious injury.

The most common sprains affect the joints of ankle, knee, elbow, wrist and thumb.

Wrist structure

The wrist or carpus is the most complex joint in the body. We find two rows of small bones (four bones in each) that are interconnected to each other and in turn connect with the bones of the hand (metacarpals) and with the forearm bones (radius and ulna):

• The first row The carpus is made up of the bones: scaphoid, lunate, pyramidal and pisiform.
• The second row It is made up of the bones: trapezoid, trapezoid, large and hooked.

The position of the wrist bones is due to their anatomical shape and their ligamentous support. They describe extrinsic ligaments that join the bones of the forearm with the wrist; and the intrinsic ligaments that relate the bones of the two rows of the wrist to each other.

As a curiosity, the ligament that is most frequently injured in the wrist is the one that joins the scaphoid with the lunate, which is called the ligament. scapholunate.

How does a wrist sprain occur?

The most frequent injuries are hyperflexion and hyperextension. It would be the typical example of the one in which we extend our hand to cushion the blow and bruise directly on the palm producing a forced hyperextension of the wrist. It will immediately cause us a mechanical pain, which becomes more acute with movement, and most likely a inflammation of the soft parts and a generalized pain. The carpal navicular is the most frequently injured bone in the wrist and, it may require surgical treatment in some cases.

As in the rest of the joints, we will talk about three degrees of sprains depending on the integrity of the ligament:

• Grade I sprain: It is mild due to ligamentous strain but not rupture.
• Grade II sprain: is moderate. There is a partial injury to the ligament.
• Grade III sprain: it's bad. For ligamentous rupture.

What should I do in the event of a possible sprain?

If we have injured our wrist or have suffered a trauma and we suspect that we could have a sprain, the first thing we should do is go to the doctor, specifically to. During the examination we will observe the external inflammatory signs and palpate the bony prominences. We will check joint stability and perform one that will rule out a bone injury. We must be aware that the ligamentous injury should be clinically suspected but we cannot verify it on the x-ray since the ligament is a non-visible structure in this complementary test.

Recovery after sprain

If a major ligament injury is suspected the joint will be immobilized and other complementary tests will be requested, such as nuclear magnetic resonance or ultrasound to study the ligamentous paths. These tests are done on a scheduled basis, not in the ER.

• In case of grade I sprain of wrist we will advise Rest, local ice application, and a wrist strap or a simple elastic bandage together with an anti-inflammatory treatment on demand.
• If he sprain is grade II may be required rigid immobilization semicompressive bandage type forearm or a plaster splint forearm.
• If it is from grade III a imaging study to assess whether surgery is required (which can be arthroscopic (without the need to make a surgical incision in the skin). Of course, we will immobilize up to get the definitive diagnosis.

In summary: we will always apply local cold (not directly on the skin), if possible we will put a bandage that maintains the immobilized joint and a sling (to avoid inflammation of the fingers). We will go to a medical visit to be assessed.

Let us bear in mind that untreated acute ligament injuries may duly lead to chronic injuries and even to bone wear by friction. Despite proper treatment, a wrist sprain may require a rehabilitative treatment after acute phase immobilization and to ensure recovery of joint mobility.

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What you should know:

• Most often, a wrist sprain is caused by sudden hyperflexion or hyperextension. The typical fall in which we reach out to cushion the blow.
• Faced with trauma in this area, we must go to a medical visit, specifically to Traumatology emergencies.
• Despite proper treatment, a wrist sprain may require a rehabilitative treatment after acute phase immobilization and to ensure recovery of joint mobility.

Specialist in Family Medicine and Sports Medicine