A wrist sprain is when the ligaments in the wrist stretch too much and tear (partially or completely). On the other hand, a wrist fracture occurs when bones in the wrist break. Sometimes it is difficult to distinguish between the two injuries because they have similar symptoms and are caused by similar accidents, such as a fall on the outstretched hand or a blow on the wrist. In fact, a broken wrist often results in torn ligaments. A medical examination (X-ray) is required to definitively differentiate the two injuries. However, it is sometimes possible to distinguish a fracture from a sprain at home before going to the doctor or hospital.
Part 1 of 2: Diagnosing a wrist sprain
Step 1. Move your wrist and assess it
A sprain can have different degrees of severity depending on how severely the ligament (s) have been pulled or torn. In a mild sprain (grade 1), ligaments were pulled without significant tears. With a moderate sprain (grade 2), significant tears (up to 50% of the fibers) and impaired function of the wrist occur. In the case of a severe sprain (grade 3), even more pronounced tears in the fibers or even the complete rupture of the ligament occur. Therefore, with Grade 1 and 2 sprains, you can still move your wrist relatively normally (albeit with pain). In grade 3, the wrist becomes unstable (too much mobility) because the ligaments that connect the wrist bones are completely torn.
- In general, only a few 2nd degree sprains and all 3rd degree sprains require medical treatment. All 1st degree and most 2nd degree sprains can be treated at home.
- A 3rd degree sprain can lead to an avulsion fracture, which means that the ligament pulls a small piece of bone with it when it ruptures.
- The most commonly pulled ligament in the wrist is the scapholunate ligament, which connects the navicular bone to the lunar bone.
Step 2. Identify the nature of your pain
As I said, sprains differ in their severity, which is why the type and strength of the pain can vary greatly. With 1st degree sprains only mild pain occurs, which often resembles sore muscles, but can be stabbing when moving. For 2nd degree sprains, the pain is moderate to severe, depending on the severity of the crack. The pain is more sharp than Grade 1 and sometimes throbbing due to increased inflammation. Paradoxically, 3rd degree sprains are often less painful to begin with than 2nd degree sprains because the ligament is completely torn and therefore the surrounding nerves are not as irritated. With 3rd degree sprains, however, throbbing pain soon occurs due to the increasing inflammation.
- Third-degree sprains that result in an avulsion fracture are very painful immediately, with both stabbing and throbbing pain.
- In the case of sprains, most pain occurs during movements, which often decrease significantly when there is no movement (immobilization).
- In general, if your wrist is very painful and difficult to move, you should have it examined by a doctor immediately.
Step 3. Put ice on and see how your wrist reacts to it
Ice or cold work very well on sprains of all degrees, because cold soothes the inflammation and numbs the surrounding fibers that are causing the pain. Ice is particularly important for Grade 2 and 3 sprains because they cause more inflammation in the injured area. Immediately after the injury, apply ice to the sprained wrist for 10-15 minutes every hour or two. That has a huge impact on how the injury looks after a day or so. The pain is also significantly reduced, which makes movements easier. In contrast, if the wrist is broken, cold may reduce pain and inflammation, but symptoms return when the cooling subsides. Therefore, it is generally accepted that cold therapy is more effective for sprains than for fractures.
- The stronger the sprain, the greater the swelling around the injury. This means that the wrist looks swollen and enlarged.
- Small hair breaks or stress breaks react more strongly to cold therapy (in the long term) than serious breaks that require medical care.
Step 4. Check your wrist for bruises
Inflammation leads to swelling. But that's not the same as hematoma. Instead, hematomas are bleeding from injured blood vessels into the surrounding tissue. First-degree sprains tend not to have bruises unless the injury was caused by a hard blow that crushed the small, subcutaneous blood vessels. With 2nd degree sprains there is more swelling, but - as I said - not necessarily severe bruises. However, it depends on how the injury came about. With 3rd degree sprains, there is severe swelling and often severe bruises. The cause is usually severe trauma due to the torn or torn ligament or damage to the surrounding blood vessels.
- In the case of swelling due to inflammation, there are hardly any changes in the color of the skin, but mostly only redness due to the heat that occurs.
- The dark blue discoloration in hematomas is caused by blood flowing into the tissue just under the skin. As the blood breaks down and breaks down from this tissue, the color of the hematoma also changes (to a lighter blue, then to yellowish).
Step 5. See how your wrist feels after a few days
Almost all 1st and some 2nd degree sprains improve significantly after a few days. This is especially true if you immobilize your wrist and cool it down. This means that if there is no visible swelling and you can move your wrist without causing severe pain, you probably won't need to see a doctor. If the sprain is worse (Grade 2), but still feels much better after a few days (even if there is some swelling and the pain is still moderate), then give your wrist some time to heal. However, if the injury has not gotten significantly better or even worse, then you should see a doctor as soon as possible.
- 1st and some 2nd degree sprains heal quickly (in a week or two). Such 3rd degree (especially with an avulsion fracture) take a long time to heal (sometimes a few months).
- Hair or stress fractures also heal relatively quickly (in a few weeks). Serious fractures take a few months or more, depending on whether surgery was needed or not.
Part 2 of 2: Diagnosing a fracture in the wrist
Step 1. Look for misalignment or misalignment
A wrist fracture can be caused by an accident or trauma similar to a sprain. In general, the bigger and stronger the bones, the less likely they are to break. Instead, the ligaments are stretched and pulled. If bones break, however, they often cause malpositions or misalignments. The eight carpal bones are small, which is why misalignments are often barely or not at all noticeable. This is especially true for hair fractures. However, larger breaks are much easier to recognize.
- Most often, a fracture in the wrist occurs at the radius. This is the forearm bone that is connected to the small carpal bones.
- In the carpal bones, a fracture occurs most often in the navicular bone, with a noticeable change in the wrist rarely seen.
- When a bone passes through the skin and becomes visible, it is called an open or complicated fracture.
Step 2. Identify the type of pain
How severe the pain is depends on the severity of the fracture. Most often they are described as stabbing when moving and strong without moving. The pain usually gets worse when the hand is gripped or squeezed. This is rarely the case with wrist sprains. A wrist fracture tends to cause more symptoms, such as stiffness, numbness, or an inability to move your fingers. And nerve damage is more common than with sprains. In addition, there may be a grinding or cracking noise when moving a broken wrist. This does not happen with sprains.
- Wrist fracture pain is often (but not always) preceded by a clicking sound or feeling. In contrast, just a 3rd degree sprain often produces a similar sensation, i.e., a pop when the ligament breaks.
- In general, the pain of a fracture gets worse at night, while that of a sprain often stays the same and does not increase when the wrist is immobilized.
Step 3. Assess whether the symptoms are worse the following day
As stated above, a day or two of immobilization and cold therapy can work wonders for a mild to moderate sprain. The same does not apply to fractures. Except for a hair fracture, most bones take significantly longer to heal than strained ligaments. Therefore, with most fractures, it is of little use to immobilize and cool the wrist for a few days. In some cases, once your body gets over the initial shock of the injury, you feel worse.
- If a bone on the wrist sticks through the skin, there is a high risk of infection and blood loss. If this happens, see a doctor as soon as possible.
- A severe fracture in the wrist can immediately cut off blood circulation to the hand. The swelling due to the bleeding is also called “compartment syndrome” and it is considered a medical emergency. In this case, the hand will feel cold (due to the lack of blood) and it will turn pale (bluish white).
- A broken bone can also pinch or damage a surrounding nerve. This can lead to complete numbness in the area of the hand that supplies the nerve.
Step 4. Get an X-ray
The above information can help you decide whether you have compressed or broken your wrist. But only an X-ray, MRI or CT examination can in most cases really distinguish between the two, unless it is an open fracture. An X-ray is usually the most common and cheapest way to see the small bones in the wrist. Your doctor will likely send you to a radiologist for an x-ray and discuss the findings with you in front of you. The x-ray only shows bones and no soft tissue such as ligaments or tendons. Fractures in the hand are often difficult to see on X-rays because the bones there are very small and in a confined space. This is why they can often only be seen on X-rays after a few days. To see damage to ligaments, your doctor will refer you for an MRI or CT scan.
- An MRI, in which magnetic waves produce detailed images of structures in the body, may be necessary to detect fractures in the wrist. This is especially true for fractures in the navicular bone.
- Hair fractures in the wrist are very difficult to see on normal x-rays before the inflammation has completely subsided. Therefore, it can take weeks to confirm a fracture. After this time, the injury is likely to have largely healed.
- Osteoporosis (brittle bones due to mineral deficiency) increases the risk of fractures in the wrist, but not significantly that of sprains.
- A fall is often the cause of a wrist sprain or fracture. Therefore, walk carefully on wet or slippery surfaces.
- There is a high risk of breaking or spraining your wrist while skateboarding or snowboarding. This is why you should always wear wrist guards.
- Some wrist bones do not normally have blood supply, which can take several months to heal after a fracture.