Wrist sprains are commonly diagnosed by primary care physicians, hand or orthopedic surgeons, and sports medicine physicians.
When a wrist sprain suspected, a doctor will take a medical history and conduct a physical examination that includes tests to evaluate the wrist’s stability. Medical imaging and other advanced tests may be ordered if necessary.
Physical Examination and Medical History
The first step in diagnosing a wrist sprain requires a doctor visit, which includes:
- A physical examination, in which the doctor typically checks for:
- Tenderness and/or swelling on palpating (gently applying pressure) the wrist joint
- Flexibility and range of motion of the injured wrist compared to the uninjured one
- Deficits in strength, sensation, or reflexes in the wrist and/or fingers
- Review of medical history, which includes the doctor asking about:
- Onset of pain and other symptoms
- Type and nature of pain
- Trauma or injury to the wrist area
If a wrist sprain is suspected, the doctor may perform specialized wrist instability tests.
Wrist Instability Tests
The doctor will check for ligament injuries and stability of the carpal bones using certain physical tests. These tests can also help assess the injured wrist’s strength and flexibility.
- A scaphoid shift test involves the doctor grasping and firmly pushing the scaphoid bone to check the stability of the bone.
- A ballottement test checks for the stability of the lunotriquetral ligament. The doctor uses a technique to stabilize the lunate bone and checks for pain, grinding sounds, and/or excessive mobility of the lunotriquetral joint.
- Grip strength of the wrist is measured by a device called Jamar dynamometer. The patient holds and squeezes the device and the strength is assessed.
Wrist instability tests are usually performed at the doctor’s office and may be a part of the physical examination.
Medical Imaging Tests for Wrist Sprain
Imaging diagnostic tests are performed to confirm a suspected wrist sprain. A few examples include:
- X-ray. Standard x-rays do not show ligaments, however, in chronic wrist sprains, the presence of gaps, overlapping, and/or rotation of the carpal bones may be seen—indicating ligament injury.
- Ultrasound. Ultrasound of the wrist is useful in analyzing ligament inflammation and tears as well as associated joint, artery, vein, and nerve injuries. Swelling and fluid accumulation may also be analyzed in ultrasounds.
- Magnetic resonance imaging (MRI). MRI of the wrist is useful in detecting ligament injury and injuries related to other soft tissues, nerves, cartilage, and joints.
While physical examination and imaging tests can be sufficient in diagnosing some wrist sprains, more invasive diagnostic methods may be necessary in other cases, particularly if symptoms do not improve over time.
Invasive Diagnostic Tests for Wrist Sprain
Invasive diagnostic procedures are any diagnostic procedures that break the skin, including injections. Less frequently, these may be used if diagnosis cannot be confirmed with examination or other advance imaging including x-ray or MRI. Invasive diagnostic procedures for wrist sprains include:
- Magnetic resonance arthrography (MRA). A wrist MRA is a two-step procedure used to diagnose wrist ligament injuries. First, a contrast dye is injected into the location to be examined, then an MRI is performed. This technique allows for a detailed evaluation of the intrinsic ligaments and surrounding soft tissues.
- Multiple detector computed tomography (MDCT) arthrography. Like MRA, MDCT arthrography is a two-step procedure that uses contrast dye. In MDCT arthrography, a rotating x-ray tube is used to take images in a sequence. Intrinsic wrist ligaments can be viewed in high detail in this procedure.
- Wrist arthroscopy. Wrist arthroscopy is a surgical procedure that involves insertion of an arthroscope (a small device with a lens and light) into the wrist joint. The arthroscope is connected to a video screen and monitor, which enables the doctor to view the inner structures, such as ligaments and cartilage of the wrist. A surgeon will typically perform necessary repairs during the same procedure.
Diagnostic tests also help determine the grade and severity of ligament injury. Ligaments may appear elongated, torn, or torn with a bone attached to it.