Usually, a wrist sprain can be diagnosed without imaging or arthroscopy, and can be managed conservatively. If a diagnosis is unclear, imaging can be completed to show there is no fracture or dislocation of the carpal bones. The gold standard is an MRI or arthroscopy, though an ultrasound can be an acceptable alternative to an MRI. A wrist sprain can then be graded into the following categories:

– Grade 1: ligament stretched with no tear and minimal bleeding.

– Grade 2: partial tear

– Grade 3: complete tear

A TFCC injury can be further classified into the following categories:

– Class 1: Traumatic injury

A: central perforation of the triangular fibrocartilage disc proper

B: avulsion of the ulnar attachment

C: distal avulsion

D: avulsion of radial attachment

– Class 2: Degenerative changes

A: TFCC wear with thinning/fraying without perforation

B: TFCC 2A findings with lunate, triquetral and/or ulnar chondromalacia

C: TFCC perforation with or without 2B findings

D: lunotriquetral ligament perforation with or without features of 2A, 2B and/or 2C

E: any or all of the above with ulnocarpal arthritis

A scapholunate ligament injury can be diagnosed conservatively using the caphoid shift test. The scaphoid shift test provokes a sublaxation of the scaphoid over the dorsal rim of the radius. The practitioner will place their thumb over the palmar prominence of the scaphoid and wrap their fingers around the distal radius, placing constant thumb pressure and moving the ulnar-deviated and slightly extended wrist toward the radial side and into flexion. The test is positive if the scaphoid is subluxed and the patient reports pain. Alternatively, imaging can be performed and then a classification can be made:

– Grade 1: Moderate radiocarpal involvement of scapholunate ligament, without mid-carpal instability.

– Grade 2: More severe involvement, with ligament fragility or radiocarpal perforation, and palpator passing between the scaphoid and lunate bones mid-carpally.

– Grade 3: Perforation of the scapholunate ligament at radiocarpal joint allowing passage of palpator, and greater instability between the scaphoid and lunate bones at mid-carpal, joint classically allowing passage of palpator and increased interval between the bones on rotary maneuver

– Grade 4: Total ligament tear, allowing passage of arthroscope between the two bones in whichever joint

A person with a wrist sprain will generally report pain, swelling, bruising and difficulty moving the wrist. Someone who has injured the TFCC will present with ulnar-sided wrist pain and a positive ulnar fovea sign. The ulnar fovea is between the ulnar styloid and flexor carpi ulnaris tendon. The ulnar fovea sign is positive when there is pain on palpation. Generally, an injury to the TFCC occurs with a fall producing a sudden and high axial load on the ulnar aspect of the wrist. As the TFCC plays an important role in wrist stability, an injury to this complex can cause discomfort and limit wrist activity.

Someone who has injured the scapholunate ligament has usually had a fall onto their hand landing on a dorsally extended and ulnar deviated hand. Pain is reported to be dorsal-radial and there is an inability to weight-bear in wrist extension. With palpation, there is tenderness over the ligament.

For those with a mild wrist sprain, someone may recover within 48 hours with rest and ice, mobilising the wrist as much as possible. An MRI with no negative findings can have a quick recovery with immediate mobilisation, when compared to someone who immobilises with a cast. Moderate to severe sprains may require bracing to assist healing.

Physiotherapy treatment may include both passive and active interventions to improve pain, range of motion, and strength of the wrist and hand. Passive interventions such as ice to reduce pain and swelling, and manual therapy including soft tissue mobilisation and joint mobilisation to reduce swelling and improve mobility.

Active interventions, or exercise, is important to increase function and return the injured person to their normal activities. Range of motion exercises can improve mobility and reduce prognosis depending on the severity of the wrist sprain. Strength exercises should be employed and may begin as isometric exercises, progressing to heavy loading of the hand. A focus on multi-directional loading, and grip strength is important to return to full function. Following this, sport-specific or functional movements can be applied to gradually return to normal sports and occupational activities.

If there is no improvement with conservative treatment, then further imaging and consultation for surgical intervention may be necessary.