Sports

Management of a sprained wrist

Spraining a wrist is a relatively common condition characterised by damage or tearing of the connective tissue of the wrist.

This is condition that mostly affects sportspeople who participate in an activity that involve catching with the hands. The wrist comprises the joining of eight small bones in the hand and the two bones of the forearm. Between the wrist bones lie many small joints, each of which comprises strong connective tissue wrapping around the bony ends and cartilage which lies between the joint surfaces, cushioning the impact of one bone on another during activity.

During certain movements of the wrist, stretching or compression forces are placed on the joints of the wrist. If these forces are excessive due to too much repetition or high force, injury to the joints may occur. This may involve damage to the cartilage or tearing to the connective tissue surrounding the joint. When this occurs, the condition is known as a sprained wrist.

A sprained wrist most commonly occurs due to a specific incident such as a fall onto an outstretched hand. This may occur with any fall, but is particularly common in sports such as cycling, skateboarding or snowboarding (particularly in icy conditions) where a fall onto a hard surface is unforgiving. A wrist sprain may also occur during weight lifting or boxing particularly in those with poor lifting or punching technique. Occasionally, a sprained wrist may occur due to repetitive strain associated with overuse. This may be the case in patients who perform heavy manual work involving the wrist such as the repetitive use of a hammer or screw driver.

Those with a sprained wrist often experience a sudden onset of wrist pain during the causative activity. However, patients may also experience pain and stiffness after the provocative activity, particularly the next morning. Symptoms may be felt on the front, back or sides of the wrist. Occasionally pain may be referred into the forearm or hand on the affected side. Symptoms are generally exacerbated with heavy activities that involve use of the hand and wrist such as opening jars or doors, picking up heavy objects, general gripping activity or placing weight through the affected hand (e.g. doing push-ups). It is also common for patients to experience pain on firmly touching the affected region, and, in some cases, a feeling of weakness in the wrist and hand may also be present.

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a sprained wrist. Investigations such as an X-ray, MRI or CT scan may be required to assist diagnosis and rule out other injuries (particularly fractures).

In cases of a minor to moderate wrist sprain, return to sport or normal activity can usually occur in two – six weeks with appropriate management and treatment. Patients with a more severe injury will usually require a longer period of rehabilitation to gain optimum function.

Physiotherapy for a sprained wrist can hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise: electrotherapy (e.g. ultrasound), anti-inflammatory advice ,joint mobilisation ,dry needling,wrist taping,wrist bracing,ice or heat treatment, exercises to improve flexibility and strength, activity modification advice and finally a gradual return to activity programme.

The writer is a physiotherapist at Kenyan Premier League side Mathare United

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