I fell on my hand last week, how do I know if it is broken versus sprained?

You probably cannot tell from the outside, and that is why a fall on an outstretched hand with persistent wrist pain deserves an X-ray. A scaphoid fracture in particular can look and feel like a bad sprain, and Rhemrev and colleagues' 2011 review in the International Journal of Emergency Medicine is clear that the clinical tests are sensitive but not specific. If there is tenderness in the anatomical snuffbox, pain with axial loading of the thumb, or pain that is not steadily improving after a week, I would want imaging before settling on a sprain diagnosis.

Does a wrist sprain always need a brace?

A short course of bracing, usually one to three weeks, helps an acute ligament-dominant injury settle. The point is to protect the ligament while pain and swelling come down, not to immobilise you for months. For ulnar-sided TFCC patterns and low-grade scapholunate irritations, I tend to use a brace for pain control and protect it during sport, then transition into progressive loading quickly. Immobilisation beyond what the ligament needs tends to stiffen the wrist and slow the return to sport.

Why does my wrist click or clunk even after the pain has settled?

Clicking on its own, without pain and without feeling unstable, is usually not a problem. A click that comes with a clear painful moment during a specific movement, particularly radial-ulnar deviation or forearm rotation under load, is more interesting. In those cases I am thinking about the scapholunate interval or the TFCC and I will often push for imaging or an orthopaedic opinion rather than keep loading blind.

Can I still lift or do push-ups with a wrist sprain?

Not while it is hot. Weight-bearing through the wrist in extension is the one loading pattern most sprains really dislike early on. I will take you through pain-free loading alternatives first, things like dumbbell work with a neutral grip, push-up variations on fists or on handles, and then rebuild full weight-bearing through the palm once the tissue can tolerate it. Forcing through the sharp pain buys nothing and tends to drag the recovery out.

What is the dart throwing motion and why does everyone keep mentioning it?

It is the path your wrist takes when you throw a dart, from radial extension to ulnar flexion. Through that arc the scapholunate interosseous ligament is under far less strain than it is during pure flexion or pure extension. Early in rehab, especially after a scapholunate-type injury, it is a useful way to keep the wrist moving without stressing the ligament, and there is a growing body of work supporting its use in scapholunate and TFCC rehab.

How long should a wrist sprain take to heal?

A mild ligament strain usually quietens down over two to four weeks, with return to full loading by six to eight. A clear partial tear of the scapholunate or a TFCC lesion runs longer, often two to three months of graded rehab, and a small subset end up at imaging or a hand surgeon if symptoms plateau. If you are at the eight-week mark and your wrist is still catching, still sore with grip, or still refusing to take weight through the palm, it is time to reassess rather than push.

When should I see a surgeon?

Any deformity, inability to use the hand, or severe pain after a fall should be seen that day. Beyond that, I refer when clinical signs point to a significant scapholunate or TFCC tear with distal radioulnar joint instability, when pain has not shifted after a proper six to eight week course of rehab, or when imaging findings do not match what the clinical exam shows. Most wrist sprains do not need a surgeon, but a small number clearly do.

Wrist Sprains & Strains Treatment in Burlington | Kareem Hassanein Physiotherapy

Wrist Sprains & Strains

Ligament and soft tissue injuries

Treating wrist sprains & strains at my Burlington clinic. Convenient for Waterdown and Flamborough residents.

Important: When to seek immediate medical attention

Sudden onset of severe deformity or inability to move wrist

May indicate fracture or complete ligament rupture - requires immediate medical evaluation

Signs of infection including fever, red streaking, or severe swelling

Possible septic arthritis - urgent medical assessment needed

Progressive neurological symptoms or numbness

May indicate nerve compression - requires prompt medical evaluation

No improvement after 6-8 weeks of appropriate conservative treatment

Consider imaging and surgical consultation

Pathophysiology and contributing factors.

Inside Overview

The Science of Wrist Sprains & Strains

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Wrist sprains involve damage to the ligaments that connect the bones of your wrist, most commonly affecting the scapholunate ligament complex or the triangular fibrocartilage complex (TFCC). These structures are crucial for maintaining proper carpal bone alignment and allowing coordinated wrist movement. The scapholunate interosseous ligament is particularly vulnerable to injury during falls on an outstretched hand or rotational movements under load. When this ligament is damaged, it can lead to abnormal movement patterns between the scaphoid and lunate bones, potentially causing long-term instability if not properly managed. TFCC injuries affect the complex of ligaments and cartilage on the pinky side of your wrist. This structure acts as a shock absorber and stabilizer for the distal radioulnar joint, allowing smooth rotation of your forearm while maintaining wrist stability. The healing potential of wrist ligaments varies significantly depending on their blood supply. Some areas have excellent healing capacity, while others, particularly the central portions of certain ligaments, have limited blood flow and may heal slowly or incompletely without proper treatment.

Wrist Sprains & Strains

The Science of Wrist Sprains & Strains

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