Acute Wrist & Hand Injuries 

 

What are they?

Sudden onset, often traumatic injuries to the wrist and hand are commonplace. Falls which involve landing with weight through the outstretched hand can result in huge forces through the wrist and hand complex. The most common injuries which result from a fall are either fractures (loss of continuity of the bone), or sprains of the wrist joint capsule or ligaments. Depending on the severity of the injury pain, swelling and bruising will be evident to varying degrees.
 

The most common fractures which occur around the wrist area are Colles’ fractures and scaphoid fractures. Colles’ fractures typically result from a fall on to an outstretched hand and usually affect the elderly more than the young. The fracture occurs at the hand end of the forearm bones (radius and ulna). Scaphoid fractures also occur commonly with falls and affect the young more than the old. The scaphoid bone is one of eight small carpal bones which sit between the ends of the long forearm bones and the bones of the hand (metacarpals). Diagnosis of these fractures is usually confirmed with an x-ray although less obvious scaphoid fractures may require an MRI scan to ensure a correct diagnosis.
 

Ligament sprains present, depending on the severity of the injury, with reduced movement, swelling, pain and a general weakness in the hand. It is very important to ensure that acute wrist injuries are properly assessed by a Physiotherapist or suitable medical professional to ensure a correct diagnosis is arrived at as soon as possible. There are numerous, less common types of ligament sprain around the wrist and hand which may require further investigation and occasional surgery to prevent future disability.
 

Treatment
 

Fracture management involves correcting the position of the bones before immobilizing them in plaster of between 6-8 weeks. Following removal of the cast the wrist and hand will be typically stiff and a little sore. Complex fractures may require some internal fixation surgery to ensure good bony alignment. Physiotherapy rehabilitation will be required to restore full movement, strength and function and will include hands on therapy as well as home exercises.
 

Ligament sprains are usually treated conservatively (non-operatively).

Acute injury early management is focused on the PRICE principles:

• Protection – strapping and/or wrist splint

• Rest – from aggravating activities

• Ice – to reduce swelling and pain

• Compression – to reduce swelling and offer support

• Elevation – to aid swelling reduction

   

Physiotherapy management following the early stages will involve treatment techniques to reduce pain and inflammation, restore joint movement and an individually tailored exercise regime to return full strength, flexibility and function to the joint.