Acute Wrist Pain (Sudden Onset)

Sudden onset injuries or acute injuries include wrist fractures, sprains, strains, and contusions. Here we explain the treatment and rehabilitation of acute wrist injuries. If a broken bone (fracture) is suspected, then always seek medical advice immediately.

On this page:

  • Wrist sprains & strains
  • Distal radius fracture (Colles fracture)
  • Scaphoid fracture
  • Sprained wrist
  • Hook of hamate fracture
  • TFCC tear
  • Dislocated wrist

Wrist sprains & strains

Wrist sprains and strainsA wrist strain is an injury to the tendons which connect muscle to bone and enable movement in the wrist. A sprained wrist is an injury to any of the ligaments which connect bone to bone in the wrist, of which there are many. It is a common wrist injury usually caused by a significant impact like a fall. There are different grades of a sprain, depending on their severity, but they can all cause significant pain.

Symptoms of a wrist sprain vary depending on the extent of the injury and the location of the sprain. Sudden pain in the wrist will be felt at the time of injury and in more severe sprains a tearing or popping feeling may be felt. Pain will be felt when moving the wrist and a tender spot may be felt where the ligament is damaged. Mild swelling could be visible and bruising might develop in more severe injuries.

Read more on wrist sprains & strains.

Wrist fractures

Have I broken my wrist? There are many different types of wrist fracture. Symptoms will be sudden onset pain, swelling, restricted movement. If you are in any doubt about whether you have a fractured wrist then seek medical advice immediately.

Distal radius fracture (Colles fracture)

Broken WristA Colles fracture is a particular type of broken wrist which involves a break of the radius or forearm bone on the thumb side of the wrist. Deformity, severe pain and swelling would indicate this type of fracture, which is most often caused by a fall. Medical help is needed immediately to repair this wrist injury.

Symptoms include instant pain in the wrist with rapid swelling. The wrist may look deformed. This is known as a dinner fork deformity. The patient will have considerable pain when trying to move the wrist. In very severe wrist fractures one end of the bone may pierce the skin which is known as an open fracture.

Read more on wrist fractures.

Scaphoid fracture

Scaphoid FractureThe scaphoid is one of the small group of bones in the wrist called the carpal bones. It is the most common carpal bone to fracture among athletes and is often caused by falling onto an outstretched hand. Wrist pain and trouble gripping things are symptoms of this type of fracture, and medical advice should be sought for treatment.

Symptoms of a scaphoid fracture include pain in the wrist at the time of injury and rapid swelling at the back of the wrist. Pain may settle down soon after the fall but the patient will have difficulty gripping things. There will be tenderness when pressing in on the wrist compared with the noninjured wrist.

Read more on wrist fractures.

Hook of hamate fracture

Hook of Hamate FractureThe wrist contains a number of small bones called carpals. The hamate is a carpal bone on the outside (little finger side) of the wrist. It has a hook-shaped part which protrudes outwards and can under certain circumstances be fractured. With this injury, wrist pain occurs on the side of the little finger and the strength of grip can be reduced.

Read more on wrist fractures.

TFCC tear

A TFCC tear is an injury to the triangular fibrocartilage complex, found in the wrist, between the end of the ulna bone and the carpals. A tear can be caused by a specific incident or come on gradually, resulting in wrist pain and restricted wrist and hand function. This wrist injury can often be treated with a splint, although if it is too severe, surgery may be needed.

Read more on TFCC tears.

Distal radioulnar joint instability

The distal radioulnar joint is the joint at the wrist, between the radius and the ulna, the two forearm bones. This injury is usually a subluxation, or a partial dislocation, although fractures of either bone can be involved. It is often caused by a direct impact like a fall, and medical help is needed immediately to check and treat the wrist injury.

Distal radial epiphysis injury

A distal radial epiphysis injury is an injury to the growth plate at the wrist end of the radius bone in the forearm. It mostly affects young athletes and is most often caused by overuse. Resting and changing training accordingly can help, although activities that exacerbate wrist pain should be stopped.

It more commonly affects young athletes between the ages of 6 and 10 years old, particularly gymnasts, and can come on through overuse, although fractures following a fall onto an outstretched arm can also occur. The epiphysis is the name given to the rounded end of a long bone also sometimes known as the growth plate and is the part of the bone which is growing.

Symptoms

Symptoms include pain in the wrist, especially when the wrist is bent backward with the palm facing down (known as dorsiflexion). They are likely to have limited ability to dorsiflex the wrist which can affect gymnasts from performing certain movements. There may be tenderness and swelling around the end of the bone.

There will be no sign however of ganglion cysts, wrist tendonitis, or other joint dysfunction which may also present with similar symptoms. An X-ray can help with the diagnosis and the bone on the affected side may look more hazy and different to the other unaffected wrist. In particular, a widening of the growth plate may be seen. If there is a narrowing of the growth plate then a Salter-Harris type stress fracture should be considered.

Treatment of a distal radial epiphysis Injury

Treatment involves rest and managing the condition by changing the training program to reduce the load on the bones of young athletes and gymnasts. If the pain is present, then activities that cause pain should not be done at all.

Strengthening the forearm muscles with specific wrist and hand exercises should be done. This will reduce the load and balance of weight bearing on the wrist which is often overextended to compensate for a lack of strength and is thought to be a significant cause of a distal radial epiphysis injury.

In some cases, a splint or plaster cast is applied to ensure adequate rest and recovery of the bones takes place although this is usually only necessary in severe cases. A distal radial epiphysis injury can take months to recover from and should not be rushed.

Dislocated wrist

A dislocated wrist is a dislocation of any of the eight small bones called carpal bones which make up the wrist. A wrist dislocation will occur as a result of a traumatic event or a fall onto the wrist. There is usually an obvious deformity along with acute wrist pain when dislocation occurs. Medical help is needed immediately, particularly as the ligaments and nerves can be seriously damaged.

Symptoms usually include severe pain with an obvious deformity in the wrist. Tingling may develop in the thumb, index, and middle fingers which suggests associated median nerve damage. Medical attention should be sought immediately if a dislocation is suspected.

The eight carpal bones in the wrist are the hamate, capitate, pisiform, trapezoid, trapezium, scaphoid, lunate, and triquetrum. There are a number of ways in which the carpal bones dislocate and the lunate bone is usually involved in most of them. A dislocation of the carpal bones will involve severe ligament damage and if left untreated can result in permanent disability. Two significant dislocations are anterior (front) dislocation of the lunate and perilunar dislocation of the lunate.

Treatment for a dislocated wrist:  Carpal dislocations usually require surgical treatment by a specialist wrist and hand surgeon. He or she will put the bones back in place and repair any ligament and soft tissue damage. The wrist is then immobilized in a cast for 8 weeks to allow time for the injury to heal.

Once out of the plaster cast a full rehabilitation program with wrist strengthening exercises should be done to restore the hand and wrist to full normal functioning and help prevent any future injury.

This article has been written with reference to the bibliography.