WRIST SPRAIN

Presentation By :- Shivam Gavasane

CONTENTS
INTRODUCTION SIGNS & SYMPTOMS

ANATOMY EVALUATION

ETIOLOGY TREATMENT
CLASSIFICATION REHABILITATION
PROTOCOL
INTRODUCTION
A wrist sprain is an injury to the ligaments of the wrist region,
including the ligaments connecting the carpal bones and the
ligaments connecting the proximal row of carpal bones with the
radius and the ulna.

An acute wrist sprain is an injury to a ligament often due to an

acute traumatic event or chronic repetitive movements.

Wrist sprains occur when a ligament is pathologically stretched,

twisted, lacerated, or torn.
ANATOMY The hand and wrist have a total of 27 bones.
The carpal bones are bound in two groups of
four bones :-
1. The pisiform, triquetrum, lunate and scaphoid
on the upper end of the wrist.
2. The hamate, capitate, trapezoid and trapezium
on the lower side of the hand.
Other bones of the hand are:
3. The metacarpals – the five bones that comprise
the middle part of the hand
4. The phalanges (singular phalanx) – The 14 narrow
bones.Collateral ligaments,Volar carpal ligaments
The Ligaments include :- Ulnocarpal and
radiocarpal ligaments,Dorsal radiocarpal
ligaments.
ETIOLOGY
 CLASSIFICATION
There are three grades :-
1. A mild overstretching of the ligaments, without joint
instability.
2. A partial rupture of the ligaments, with no or mild joint
instability.
3. A complete rupture of a ligament with severe joint instability.
SIGNS & SYMPTOMS
DIAGNOSTIC EVALUATION

Plain radiographs can be obtained to ensure

there is no fracture or dislocation of the
carpal bones.
CT scan or MRI may be obtained, with a
preference for MRI over CT if a sprain is
suspected.
SPECIAL TEST Watson (Scaphoid Shift) Test

The patient sits with elbow resting on the table and the
examiner faces the patient.
Examiner holds the patient's wrist with one hand so that
the thumb applies pressure over the distal pole of
scaphoid.
The other hand grasp the patient metacarpal to control
the wrist.
Move the wrist firstly in ulnar deviation and slight
extension and then in radial deviation and slight flexion.
This creates subluxation stress if the scaphoid is
unstable.
If the scaphoid (and lunate) are unstable, the dorsal pole
of the scaphoid subluxes or 'shifts' over the dorsal rim of
the radius and the patient complains of pain indicating
the positive test.
TRIANGULAR FIBROCARTILAGE COMPLEX LOAD TEST

The examiner holds the patient's

forearm with one hand and the
patient's hand with the other hand.
The examiner the axially loads and
ulnarly deviates the wrist while moving
it dorsally and palmarly or by rotating
the forearm.
A positive test is indicated by pain,
clicking, crepitus in the area of the
TFCC.
DIFFERENTIAL DIAGNOSIS
During the evaluation of wrist pain following an acute
injury, fractures and dislocations should have an
evaluation, and plain radiographs are in order if a fracture
is suspected with additional imaging as needed.
If imaging studies fail to show bony pathology, one should
also evaluate for tendon injuries, evidence of infection.
TREATMENT
1. CONSERVATIVE MANAGEMENT
For mild cases of acute wrist sprain :- Protection, Rest, Ice,
Compression & Elevation with emphasis on mobilization will work,
and most patients will feel better in 24 to 48 hours

Moderate to severe injuries may require the use of a semi-rigid brace,

soft lace-up brace, or a volar/dorsal forearm splint to allow protection
and healing of the injury.
SURGICAL MANAGEMENT
In some cases a surgery may be needed to repair a
ligament that was completely torn (grade 3 injury).

Closed reduction and pining :- In the arthroscopic

procedure, a doctor stabilizes the injured ligament by re-
aligning the carpal bones , a process is known as reduction

LIGAMENT RECONSTRUCTION :- Wrist sprain may be

reconstructed using tendon grafts. Tendon strips are either
attached or drilled through the carpal bones to achieve carpal
stability.
 Physiotherapy Rehabilitation Protocol
Phase 1: Acute Phase (0-3 Days) Phase 2: Subacute Phase (3-7 Days)
Treatment:
Treatment:
1. Protection & Rest :-
Immobilize the wrist with a splint or brace. 1. Range of Motion Exercises :-
Avoid activities that strain the wrist. Wrist flexion/extension: Gentle active or passive motion within pain-
free limits.
2.Ice Therapy :- Wrist radial/ulnar deviation: Slowly moving the wrist side to side.
Apply ice for 15-20 minutes every 2-3 hours to reduce swelling. Pronation/supination: Turning the forearm so the palm faces up and
down.
3. Compression & Elevation :-
Use compression bandages to limit swelling. 2. Soft Tissue Mobilization :-
Elevate the wrist above heart level when possible. Gentle massage to reduce scar tissue formation and enhance
circulation.
4. Pain Management:
Pain modalities like TENS (Transcutaneous Electrical Nerve 3. Proprioception Training :-
Stimulation) or ultrasound can be used. Start with simple exercises like placing the hand on a soft surface and
performing gentle wrist movements.
5. Early Mobilization (if tolerated):
Begin gentle finger, elbow, and shoulder movements to prevent 4. Isometric Strengthening :-
stiffness. Isometric exercises for the wrist flexors, extensors, and grip muscles.
Gentle wrist range of motion (ROM) exercises if pain allows.
 Phase 3: Strengthening and Phase 4: Advanced Strengthening
Functional Training (1-3 and Return to Activity (3-6 Weeks
Weeks Post-Injury) Post-Injury)
Treatment: Treatment:

1. Progressive Strengthening: 1. Dynamic Strengthening:

Resistance Band Exercises :- Continue resistance band or dumbbell exercises with increased
Wrist flexion and extension using light resistance bands. resistance.
Radial and ulnar deviation exercises. Wrist curls, reverse wrist curls, and pronation/supination
strengthening.
Grip Strengthening :-
Use hand grippers or squeeze a soft ball. 2. Functional and Sport-Specific Drills:
Focus on wrist extensors and forearm muscles. Begin functional training that mimics daily or sport-specific tasks
(e.g., gripping objects, dribbling a ball).
2. Proprioception and Balance :- Plyometric exercises like light ball toss or catching exercises to
Foam Pad: Perform wrist stabilization exercises to enhance increase wrist reactivity.
proprioception.
Functional activities like catching a light ball or performing 3. Plyometric Drills:
fine motor tasks. Introduce higher-intensity plyometric exercises that demand
wrist control and stability.
3. Joint Mobilization :-
Gentle joint mobilization techniques for the wrist and carpals 4. Return-to-Activity Plan:
to maintain mobility. Gradual reintroduction to activities with proper wrist support
(splints or taping if needed).
4. Stretching :- Ensure full range of motion and strength before allowing full
Gentle stretches for wrist flexors and extensors. return to sport.
Thank You