How does injury occur?
The most common mechanism is a fall on an outstretched arm, when the entire body weight falls on the extended hand. The ligaments are stretched beyond the limits of their elasticity, and some of the fibers are torn. The second mechanism is a sharp twist when holding a heavy object or when the stop is broken. The third is chronic overload in athletes and people whose work involves repetitive wrist movements. The degree of damage varies: from micro-tears of individual fibers to complete rupture of the ligament with instability of the wrist bones.
- Falling on an outstretched arm
- Sharp hyperextension of the hand
- Twisting while holding a load
- Sports injuries with emphasis on the palms
- Chronic overload
- Degrees: from micro-fractures to complete rupture
Symptoms and differences from a fracture
A sprain is manifested by pain with movement, swelling along the dorsum or palm of the wrist, sometimes bruising and a feeling of weakness in the hand. However, the same signs occur with a fracture. Point pain over the bone, pain with axial load on the finger, deformation, and inability to lean on the hand should alert you. A special situation is pain in the anatomical snuffbox, a small depression at the base of the big toe: it is typical of a scaphoid fracture, which may not be visible on an early image and requires re-examination.
- Pain with movement and exertion
- Swelling around the joint
- Bruising
- Limitation of movements
- Point pain over the bone - suspected fracture
- Anatomical Snuff Box Pain - Scaphoid Check
First aid
In the first 48 hours, a simple algorithm works: rest, cold, soft fixation and elevated position of the hand. Cold is applied through the cloth for 15–20 minutes several times a day - this reduces swelling and pain. The hand is fixed with an elastic bandage or orthosis without tightening: if the fingers become numb or blue, the bandage needs to be loosened. The hand is kept raised. You should not knead or rub the injured wrist, apply warming ointments and go to the bathhouse in the first days - this increases swelling and hemorrhage.
- Rest for the hand, no stress
- Cold through fabric 15–20 minutes
- Elastic fixation or orthosis
- Elevated hand position
- Pain medication if necessary
- Refusal to knead and warm up in the first days
Survey
The traumatologist evaluates the range of motion, points of pain, joint stability and the condition of the vessels and nerves of the hand. An X-ray of the wrist joint is almost always performed to rule out fracture and dislocation. If pain in the scaphoid area persists, and the first image did not show a fracture, a repeat examination is prescribed after 10–14 days or immediately a CT or MRI. Ultrasound helps evaluate ligaments and tendons, and MRI provides the most complete picture if ligament rupture or damage to the cartilaginous complex is suspected.
- Stability inspection
- X-ray of the wrist joint
- Repeated X-ray if a scaphoid fracture is suspected
- Ultrasound of ligaments and tendons
- MRI for persistent pain and instability
- Assessment of sensitivity and blood supply to the hand
Treatment and recovery
Mild sprains are treated with rest, a brace for a period determined by the doctor, and pain relief. It is important not to turn the fixation into a multi-week immobilization: as soon as the pain decreases, gentle movements begin so that stiffness does not develop. Then add exercises to restore range of motion and grip strength. If the ligaments are severely torn and unstable, more rigid fixation or surgery may be required. Return to sports and heavy work is acceptable when strength and range of motion are restored and there is no pain with activity.
- Orthosis for the period prescribed by the doctor
- Early soft development of movements
- Grip Strength and Stability Exercises
- Physiotherapy according to indications
- Surgical treatment for complete ligament rupture
- Return to exercise after regaining strength