Early management of hand/wrist sprains and strains

Minor injuries to the Hand and Wrist, such as a mild sprain or strain should settle with time and can be managed at home.

A sprain or strain to the Hand and Wrist may result in the following:

• Pain
• Swelling
• Bruising
• Stiffness and loss of function

The pain can be particularly strong in the first three weeks as this is the inflammatory phase of your body healing itself. Typically, these injuries last 4 to 6 weeks depending on the severity.

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Up to date guidelines can be found on the NHS website:

Paracetamol

Go to an urgent treatment centre or A&E if you:

• have severe pain
• feel faint
• are dizzy or sick from the pain
• heard a snap, grinding or popping noise at the time of the injury
• are not able to move your wrist or hold things
• have a wrist that’s changed shape or colour, such as blue or white

These could be signs of something more serious.

You can also call 111 for advice or go 111.nhs.uk.

Speak to a GP or physiotherapist if:

• the pain is severe or stopping you doing normal activities
• the pain is getting worse and/or keeps coming back
• the pain has not improved in any capacity after treating it at home for 2 weeks
• you have ongoing symptoms of giving way or locking
• click here to self-refer to a physiotherapist.

How to manage a sprain or a strain

Day 1 – Early Management

Protect: Rest or restrict movement for 1 to 3 days after injury to minimise bleeding and prevent further injury.

Elevate: Elevate the injured limb above heart level to reduce swelling.

Avoid anti-inflammatories: Avoid non-steroidal anti-inflammatory drugs (NSAIDs), like Ibuprofen and Naproxen, as the inflammatory process is necessary for tissue repair. Icing a new injury can hinder the natural healing process so avoid this if you can. You can use pain medication like paracetamol. Take this regularly to control the pain and always follow the instructions on the packet.

Compression: Use an elastic bandage or wrap to help reduce swelling.

Education: Best practice advice now focuses on an active recovery, encouraging movement, and there is a recommendation to avoid passive treatments where you remain still and treatment is done to you. An active approach has been shown to improve recovery in the short and long term.

 After the first few days, follow the L.O.V.E guide below

Load: Gradually reintroduce movement and normal activities. Optimal loading without increasing pain promotes tissue repair, builds tissue tolerance, and improves strength.

Optimism: Maintain a positive outlook. Psychological factors like depression,  fear and worry regarding damage to tissues or getting moving again can hinder recovery.

Vascularisation: Engage in pain-free cardiovascular activity to increase blood flow to the injured area and promote healing.

Exercise: Restore strength, mobility, balance and coordination by incorporating specific exercises into the rehabilitation plan as soon as you feel able.

WEEK 1 – Early Mobilisation and Recovery

After 72 hours is important to start using your wrist and hand normally again. Start to do normally everyday activities. You should also try doing these exercises 3 – 4 times a day. Repeat each one 10 times. 

Hand and wrist exercises

Bend your elbow and tuck it into your side. Turn your palm as far as possible upwards, without moving your elbow, now turn the hand back over again as far as possible.

Hold your hand with the palm of your hand facing upwards. Touch your thumb to the base of your little finger. Now stretch the thumb out the opposite way.

As you start to do these exercises you may feel there is some discomfort, however, this is normal and you should continue. If you have discomfort and pain for more than 2 hours after these exercises, then you shoulder reduce the number and gradually build up again.  

Recovery time and returning to activity 

It usually takes 6 weeks to heal from this type of injury; however everyone recovers from injuries at different rates. You may be back to normal in 2 weeks however in some cases it can take up to 3 months. 

Returning to work – Gradually build up your strength and function, practice similar tasks at home that you would do at work. Start doing this little and often ensuring there is no pain or swelling. 

Returning to hobbies/sport – it is advised not to return to these activities until you have full strength and range of movement without pain or swelling. If you play sport that involves different actions of the wrist and hand, practice the specific activities such as throwing a ball and build this up before returning.