In general, only some Grade 2 and all Grade 3 wrist sprains need medical attention. All Grade 1 and most Grade 2 sprains can be managed at home. A Grade 3 wrist sprain can involve an avulsion fracture — the ligament tears away from the bone and takes a small chip of bone with it. The most common ligament sprained in the wrist is the scapho-lunate ligament, which connects the scaphoid bone to the lunate bone.
Grade 3 sprains that involve an avulsion fracture are very painful immediately, and involve both sharp and throbbing type pain. Sprains generate the most pain with movement and are usually much less symptomatic with lack of movement (immobilization). In general, if your wrist is very painful and difficult to move, see your doctor right away and get it assessed.
The more serious the sprain, the more swelling you’ll see localized around the injury, which will make the area look puffy and enlarged. Small hairline (stress) fractures are often more impacted by cold therapy (long term) than more serious fractures, which require medical attention.
Swelling from inflammation doesn’t cause much color change in the skin, aside from some redness from “flushing” due to the heat created. The dark blue color of bruising is caused by blood leaking into the tissues just below the surface of the skin. As the blood degrades and gets flushed out of those tissues, the bruise changes color (lighter blue, then eventually yellowish).
Grade 1 and some Grade 2 sprains heal quickly (one to two weeks), whereas Grade 3 sprains (particularly with avulsion fractures) take the most amount of time to heal (sometimes a few months). Hairline (stress) fractures can also heal pretty quickly (couple of weeks), whereas more serious fractures can take a few months or more, depending if surgery is done.
The most commonly broken long bone within the wrist area is the radius, which is a forearm bone that attaches to the small carpal bones. The most commonly fractured carpal bone is the scaphoid bone, which is unlikely to cause a noticeable wrist deformity. When a bone penetrates the skin and becomes visible, this is known as an open or compound fracture.
Pain from a wrist fracture is often (but not always) preceded by a “cracking” sound or feeling. In contrast, only Grade 3 sprains can produce a sound or similar sensations, and that’s sometimes a “popping” sound as the ligament ruptures. As a general guideline, wrist pain from a fracture will get worse at night, whereas pain from a wrist sprain will plateau and not flare-up in the night if the wrist is immobilized.
If a broken bone in the wrist pokes through the skin, then the risk of infection and significant loss of blood are high. Get medical attention as soon as you can. A severely broken bone in the wrist may completely cut off circulation to the hand. The swelling from the blood causes what is called “compartment syndrome,” which is considered a medical emergency. When this occurs, the hand will feel cold to touch (from lack of blood) and turn pale (a bluish white). A broken bone may also pinch or sever a nearby nerve, which might lead to complete numbness in the region of the hand that the nerve innervates. If there is a lack of circulation to the fingers, severe pain or numbness, go to the emergency room immediately.
An MRI, which uses magnetic waves to provide detailed images of structures within the body, may be needed to detect a fractured bone in the wrist, particularly broken scaphoid bones. Hairline fractures in the wrist are very difficult to see on regular x-rays until all the inflammation fades away. As such, you may have to wait a week or so to confirm the fracture, although by that time, the injury is well on its way to healing. Osteoporosis (brittle bones due to lack of mineralization) is a major risk factor for wrist fractures, although the condition doesn’t really increase the risk of wrist sprains.
