A sprain is an injury to a ligament. Ligaments are the connective tissues that connect bones to bones; they could be thought of as tape that holds the bones together at a joint.The most common ligament to be injured in the wrist is the scapho-lunate ligament.Wrist instability commonly occurs in a spectrum of severity in hyperextension injuries.
Sprains can be considered :
Grade I: Mild injury – wrist ligaments are stretched, no rupture.
Grade II: Moderate injury – wrist ligaments partially ruptured.
Grade III: Severe wrist sprain – wrist ligaments are completely ruptured and the wrist may be unstable.
Causes & Symptoms :
Sprains are common when a person falls. The wrist is usually bent backward when the hand hits the ground. After an injury, the wrist will usually swell and may show bruising. It is usually painful to move.
Signs & Symptoms :
- Pain with movement of the wrist
- Swelling at or around the wrist joint or into the hand
- Bruising of the skin at the wrist or into the hand
- Tenderness over the wrist
- Burning/tingling/pins and needles at the wrist or into the hand
- Reduced function particularly with weight-bearing and gripping activities.
The first step to managing any injury to rule out any red flags. Red flags are signs and symptoms that indicate a potentially more serious or sinister condition. A physiotherapist will thoroughly assess you to rule out red flags.
In the early stages, it is best to avoid the activities that aggravate the pain. However, it is important to keep the wrist moving fully to prevent stiffness. Simple, graded exercises are to be performed to help gain the full function of your wrist and hand. Wrist and Elbow Strengthening and Stretching Exercises are to be performed.
In a second phase, gradual retraining exercises, including active mobilizations, to increase flexibility and range of motion, and exercises for the strengthening of the injured wrist is to be started. Start these exercises early in the rehabilitation, to prevent stiffness and weakness from developing and to ensure the wrist is functioning correctly. You can start exercising as soon as pain allows. It is very important that the patient is guided during the exercises. Active mobilizations are preferred above the passive ones, but in some cases, we can do passive mobilizations to treat hypomobility, by adding traction.
First perform radiocarpal and midcarpal traction, to see whether this movement provokes pain. This handling can be used to treat hypermobility in different directions. To stimulate flexion, the dorsal sliding technique is applied. During this technique, the convex carpal bones will move in dorsal direction over the concave surface of the distal radius. To stimulate the extension volar sliding technique is given. This will cause the sliding of the convex carpal bones in the volar direction over the concave surface of the radius. The ulnar sliding technique will stimulate radial deviation. The radial sliding technique will stimulate ulnar deviation. After these passive mobilizations change to the active mobilizations. We can combine mobilizations with some stretching exercises for the extensors and flexors. Before starting to stretch, perform an isometric contraction and hold this for 5 seconds.
After mobilizations start exercises to improve muscle strength. These exercises will be very similar to the mobilizations, except for the fact that you should use some tools. By tools we mean weights, Theraband, pull machine and many others. The goal of these tools is to put resistance on the movement. You should start with a low resistance/weight and many repetitions to train the muscle endurance first, then gradually increase resistance/weight but decrease repetitions to train muscle strength, do this depending on the possibilities of the patient.
It is important to do some proprioceptive exercises, especially for practicing sports, like gymnastics, where the athletes frequently us the hands as weight carriers. These exercises are often performed in a push-up position. You will gradually change the surface under the hands starting with flat ground, followed by, normal pillow, Airex pad, Sissel pillow and wobble board.