Wrist Sprain

Upper Limb

Overview

Wrist sprains involve acute ligamentous injury to the wrist complex, commonly affecting the scapholunate, lunotriquetral, or radiocarpal ligaments. These injuries typically result from forced hyperextension, hyperflexion, or radial/ulnar deviation mechanisms. Severity ranges from Grade I (mild ligamentous stretching) to Grade III (complete ligamentous rupture).

Pathophysiology

Ligamentous structures around the wrist are stretched or torn when the joint is forced beyond its normal range of motion. This causes disruption of collagen fiber alignment, inflammatory cascade activation, and microvascular bleeding within the ligamentous tissue. The injury compromises proprioceptive feedback and joint stability, leading to inflammation, swelling, and pain. Grade I involves microscopic tearing without functional instability; Grade II involves partial tearing with some functional compromise; Grade III represents complete rupture with significant instability and potential for chronic pain or instability if not properly managed.

Typical Presentation

Site

Dorsal or volar wrist, often localized to the radiocarpal joint, scapholunate joint, or lunotriquetral articulation; may involve multiple ligamentous structures

Quality

Sharp, aching, or throbbing pain; may be accompanied by clicking or clunking sensations indicating ligamentous laxity

Intensity

Grade I: mild to moderate (3-5/10); Grade II: moderate to severe (5-7/10); Grade III: severe with functional limitation (7-10/10)

Aggravating

Gripping activities, forced wrist extension or flexion, radial/ulnar deviation movements, weight-bearing through the hand, twisting motions, sports involving ball handling

Relieving

Rest and immobilization, ice application, elevation, non-steroidal anti-inflammatory medications, gentle passive motion within pain-free range

Associated

Swelling (may be diffuse or localized), bruising, reduced grip strength, warmth over injury site, reduced wrist range of motion, difficulty with fine motor tasks, apprehension with certain movements, possible feeling of instability or 'clunking'

Orthopaedic Tests

Test descriptions are written with AI assistance from standard clinical texts. Where a test lists Sources, its description has been checked against them; those sources are independent and do not endorse OsteoKit. Accuracy figures and grades (A–D) appear only when checked against the published study; tests without one are marked “No accuracy study”.

Further reading: full test procedures are described in standard clinical examination texts, e.g. Magee & Manske, Orthopedic Physical Assessment (7th ed.), and Cook & Hegedus, Orthopedic Physical Examination Tests: An Evidence-Based Approach (2nd ed.).

Grade D
A+ABCDLimited value: little effect on the diagnosis on its own
limited standalone value (graded conservatively from a reported range).

Scaphoid Shift Test (Watson's Test)

Procedure

Patient seated, forearm pronated. Grip the wrist from the radial side and press your thumb firmly on the scaphoid tubercle on the palmar side. Move the wrist from ulnar deviation with slight extension into radial deviation with slight flexion, keeping the thumb pressure on, then release the pressure. Test both wrists.

Positive Finding

A painful clunk as the scaphoid is pushed dorsally over the rim of the radius and then reduces when the pressure is released, or reproduction of the patient's dorsal wrist pain.

Sensitivity / Specificity

50–61%/62% (suspected SL injury subgroup)

Reference: Schmauss D, Pöhlmann S, Weinzierl A, Schmauss V, Moog P, Germann G, et al. Relevance of the Scaphoid Shift Test for the Investigation of Scapholunate Ligament Injuries. J Clin Med. 2022;11(21).

Interpretation

Suggests scapholunate ligament injury or instability. Pain without a clunk is common and less telling. A painless clunk can occur in lax but uninjured wrists, which is why both sides are tested. Suspected scapholunate injury after trauma needs imaging and a hand surgery opinion. The reference previously shown for this test could not be matched to any published paper and has been withdrawn. From 447 patients checked against arthroscopy for scapholunate ligament injury: sensitivity 50% overall and 61% in patients referred with suspected scapholunate injury, where specificity was 62%. A negative test does not exclude injury.

Sources

No accuracy study

Scaphoid Compression Test (Axial Loading)

Procedure

With the wrist in neutral, hold the patient's thumb and push it gently along its long axis towards the wrist.

Positive Finding

Pain at the radial side of the wrist, in the snuffbox region.

Interpretation

On a 'sprained' wrist, the purpose of this test is to screen for a missed scaphoid fracture. Radial-sided pain with axial loading after a fall means treat as a possible scaphoid fracture and arrange imaging. The reference previously shown for this test could not be matched to any published paper and has been withdrawn. The figure previously stored here was identical to the one on the scaphoid fracture page and had no source. This test screens for scaphoid fracture; no study reports its accuracy for wrist sprain, so no figure is shown.

Sources

No accuracy study

Wrist Flexion-Extension Range of Motion Assessment

Procedure

With the forearm supported and the fingers relaxed, measure active and then passive wrist flexion and extension with a goniometer. Compare with the other wrist.

Positive Finding

Less range than the other side, or pain at end of range.

Interpretation

Records how much the injury limits movement and gives a baseline for rehabilitation. It does not identify which structure is injured. A painful, clearly limited wrist after a fall needs a fracture excluded first.

Sources

No accuracy study

Radial and Ulnar Deviation Range of Motion

Procedure

With the forearm pronated and supported, measure active radial and ulnar deviation with a goniometer and compare with the other wrist.

Positive Finding

Less range than the other side, or pain on the movement.

Interpretation

Pain on ulnar deviation points towards ulnar-sided structures (TFCC, ulnocarpal region); pain on radial deviation points towards radial-sided structures (radial styloid, scaphoid). Use it to decide which specific tests to add.

Sources

No accuracy study

Wrist Ligament Stress Test (Radial and Ulnar Collateral Ligament)

Procedure

Stabilise the forearm, hold the hand and gently apply radial and then ulnar deviation stress with the wrist in neutral. Compare with the other wrist.

Positive Finding

Pain on the stressed side of the wrist, or more give than on the other wrist.

Interpretation

Pain suggests a sprain of the wrist capsule, but isolated collateral ligament injuries of the wrist are uncommon. Localised pain or instability should prompt the specific tests (scaphoid, scapholunate, TFCC) and imaging if a fracture is possible.

Further reading

Performance measure

Grip Strength Testing (Dynamometry)

Procedure

Patient seated, elbow at 90° by the side, forearm in neutral. Measure grip with a hand dynamometer, three trials per hand, and record the mean.

Positive Finding

Weaker grip on the injured side, or pain during gripping.

Interpretation

Pain-limited grip is common after any wrist injury. Useful as a baseline and for tracking rehabilitation; it does not identify the injured structure.

Sources

⚠ Red Flags

  • •Severe swelling with signs of compartment syndrome (pain disproportionate to injury, pain with passive finger extension, paresthesias)
  • •Signs of neurovascular compromise (absent distal pulses, severe pallor, cold hand, progressive paresthesias)
  • •Open wound or penetrating injury suggesting possible foreign body
  • •Severe deformity suggesting possible associated fracture (particularly scaphoid fracture)
  • •Loss of conscious control or severe neurological symptoms
  • •Signs of infection (spreading erythema, warmth, systemic fever)
  • •Wrist instability with clinical evidence of midcarpal instability (positive scapholunate dissociation test)

⚡ Yellow Flags

  • •Litigation or compensation claim related to injury
  • •Significant fear-avoidance behavior disproportionate to clinical findings
  • •High pain catastrophization scores
  • •Previous chronic pain history or central sensitization features
  • •Psychological distress or mood disorder affecting rehabilitation adherence
  • •Poor social support for recovery
  • •Occupational demands incompatible with recovery timeline

Osteopathic Techniques

Once a fracture and a complete ligament tear have been ruled out, wrist sprains are treated conservatively: rest, elevation and ice with an emphasis on early movement, and a brace or splint for moderate to severe sprains. In MRI-negative wrist sprains, early movement gave better motion and function at 2–4 weeks than a cast. No trials of osteopathic techniques were found.

Safety: Scaphoid fractures are often missed on the first X-ray. With snuffbox or radial wrist pain after a fall, the wrist is splinted and X-rayed again in 7–14 days, with MRI or CT if the suspicion persists.

Region

Wrist ligaments and radiocarpal region

Technique

Soft tissue, wrist and handNo trials found

Rationale

Soft tissue to the wrist and hand: flexor retinaculum, palmar fascia, thenar and intrinsic muscles.

How it's done, cautions & evidence

How it's done

Hands-on kneading, stroking and sustained pressure to the soft tissues of the wrist and hand: the flexor retinaculum and thenar muscles over the carpal tunnel, the first dorsal compartment, the wrist ligaments, the palmar fascia, the hand intrinsics and the finger flexor sheath at the A1 pulley. In carpal tunnel trials, soft tissue mobilisation was often combined with neural mobilisation.

Cautions

In Guyon canal syndrome, avoid prolonged pressure over the hypothenar eminence. After a fall on the hand, rule out a fracture first: scaphoid fractures are often missed on the first X-ray.

Evidence in Wrist Sprain

Searched 26 Oct 2026: no trials of soft tissue technique in wrist sprain.

Region

Radiocarpal, midcarpal and intercarpal joints

Technique

Articulation, wrist and hand
Grade D
Low evidence: expert consensus or could not be verified against literature
No trials of wrist mobilisation in wrist sprain. Early active movement beat a cast in one trial.

Rationale

Gentle glides of the wrist, carpal and hand joints to restore movement.

How it's done, cautions & evidence

How it's done

Passive, rhythmic, low-velocity glides of the radiocarpal, midcarpal and intercarpal joints, the distal radioulnar joint, the thumb carpometacarpal (CMC) joint and the finger joints, within or up to the end of the available range. In thumb-base osteoarthritis trials this was Maitland-style passive accessory gliding of the CMC joint.

Cautions

After a fall on the hand, rule out a fracture first: scaphoid fractures are often missed on the first X-ray, so snuffbox pain needs a splint and repeat imaging. Do not move a joint that is splinted for a tendon injury: the DIP in mallet finger, the PIP in a central slip (boutonnière) injury.

Evidence in Wrist Sprain

Searched 26 Oct 2026: no trials of passive wrist mobilisation in wrist sprain. Indirect: Clementson 2016: in wrist sprains without fracture or SL ligament injury on MRI, immediate mobilisation gave better motion and DASH scores than a cast at 2–4 weeks, with no difference at 6 weeks.

Region

Wrist flexors and extensors

Technique

Muscle energy, elbow and forearmNo trials found

Rationale

Muscle energy technique to ease tight forearm muscles that act on the wrist (wrist extensors or flexors, pronators or supinators).

How it's done, cautions & evidence

How it's done

The wrist or forearm is taken to the barrier of the tight muscle group (wrist extensors or flexors, pronators or supinators). The patient pushes gently back, at about 10–20% effort, against resistance for 5–10 seconds, relaxes for 3–5 seconds, and the new barrier is taken up.

Cautions

Not used with an acute fracture, a joint infection or a bone malignancy; take care with severe osteoporosis or after surgery that limits muscle contraction. Use the least force needed: too much can tear a muscle or pull off a tendon, especially in older patients.

Evidence in Wrist Sprain

Searched 26 Oct 2026: no trials of forearm muscle energy technique in wrist sprain.

Rehabilitation Exercises

Wrist Flexion-Extension Pendulum Swings

Range of MotionBeginner

Wrist Radial-Ulnar Deviation in Neutral Position

Range of MotionBeginner

Wrist Extensor Stretch (Flexed Wrist with Finger Pressure)

StretchingBeginner

Wrist Flexor Stretch (Extended Wrist with Dorsal Finger Pressure)

StretchingBeginner

Isometric Wrist Flexion Resistance (No Movement)

StrengtheningIntermediate

Isometric Wrist Extension Resistance (No Movement)

StrengtheningIntermediate

Resistance Band Wrist Flexion with Progressive Resistance

StrengtheningIntermediate

Resistance Band Wrist Extension with Progressive Resistance

StrengtheningIntermediate

Proprioceptive Training: Wrist Stabilization on Balance Disc

BalanceAdvanced

Forearm and Wrist Posture Correction During Computer Use

PosturalBeginner

Grip Strengthening with Therapy Ball (Progressive Squeezing)

StrengtheningIntermediate

Active Pronation-Supination in Neutral Wrist Position

Range of MotionIntermediate

Referral Criteria

  • •Any sign of red flag symptoms (neurovascular compromise, compartment syndrome, infection, significant instability)
  • •Persistent pain and dysfunction beyond 6-8 weeks despite conservative management
  • •Clinical evidence of scapholunate dissociation or other midcarpal instability requiring specialized imaging and intervention
  • •Suspected scaphoid fracture (pain in anatomical snuffbox, positive scaphoid compression test) requiring orthopedic evaluation
  • •Grade III ligamentous tear with significant functional impairment potentially requiring surgical reconstruction
  • •Development of chronic pain features or central sensitization requiring pain medicine or psychology referral
  • •Failure to progress with conservative management or repeated re-injury suggesting need for specialist hand therapy
  • •Occupational demands requiring functional restoration beyond scope of primary practitioner
  • •Associated injury to multiple ligaments or suspected perilunate injury requiring specialist hand surgery assessment