Grade 1 wrist sprains are mildly painful and the pain is usually described as a soreness that can be sharp with movement. Grade 2 wrist sprains generate moderate-to-severe pain, depending on the degree of tearing; the pain is sharper than a Grade 1 tear and sometimes also throbbing because of inflammation. Grade 3 wrist sprains are often less painful (initially) than Grade 2 varieties because the ligament is completely severed and not irritating surrounding nerves as much — although Grade 3 injuries eventually throb significantly due to accumulating inflammation.
Swelling from inflammation doesn’t cause much color change to skin, aside from some redness from “flushing” due to all the warm fluid underneath the skin. Due to the accumulation of inflammation, which consists of lymph fluid and a variety of specialized immune system cells, a sprained wrist will feel warm to the touch. Most wrist fractures also feel warm due to inflammation, but sometimes the wrist and hand can feel cold because the circulation gets cut off due to blood vessel damage.
The dark color of bruising is caused by blood seeping into the tissues just below the skin’s surface. As the blood degrades and gets flushed out of the tissue, the bruise changes color with time (dark blue, green, then yellow). In contrast to sprains, wrist fractures almost always exhibit bruising because it takes more trauma (force) to break a bone. A Grade 3 wrist sprain can lead to an avulsion fracture, where the ligament tears away a small chip of bone. [5] X Research source In this case, there’s lots of immediate pain, inflammation and bruising.
Small hairline (stress) fractures tend to mimic Grade 1 or 2 sprains and do respond to cold therapy (long term) better than more serious fractures. When applying cold therapy to your inured wrist, make sure to wrap it in a thin towel so as to avoid skin irritation or frost bite.
Small stress fractures of carpal bones (particularly the scaphoid bone) are very difficult to see on regular x-rays until all the inflammation fades away. Thus, you may have to wait a week or so to get another x-ray. These types of injuries may also require additional imaging such as MRI or splinting/casting depending on severity of symptoms and mechanism of injury. Osteoporosis (a condition characterized by demineralization and brittle bones) is a significant risk factor for wrist fractures, although it doesn’t increase the risk of wrist sprains.
Tendinitis, ruptured tendons and bursitis of the wrist (including carpal tunnel syndrome) mimic wrist sprains, but an MRI can distinguish between the different injuries. An MRI is also helpful to see the extent of blood vessel and nerve damage, particularly if your wrist injury is causing symptoms in your hand, such as numbness, tingling and/or loss of normal color. Another cause of wrist pain that can mimic a low-grade sprain is osteoarthritis — the wear and tear type. However, osteoarthritis pain is chronic, gets slowly worse over time and typically involves a grinding feeling with wrist movement.
CT scans expose you to ionizing radiation. The amount of radiation is more than plain x-rays, but not enough to be considered harmful. The most common ligament sprained in the wrist is the scapho-lunate ligament, which connects the scaphoid bone to the lunate bone. [12] X Research source If all the above mentioned diagnostic imaging results are negative, but your severe wrist pain persists, then your doctor will likely refer you to an orthopedic (bone and joint) specialist for more testing and evaluation.
