General Guideline Principles for Wrist Sprains
for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Wrist Sprains.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Wrist Sprains of Hand, Wrist and Forearm Injuries

Slip, trip, and fall injuries are the most common causes of wrist sprains, which are partially or completely damaged ligaments. When a patient has pain following trauma but no fracture, a wrist sprain is frequently a diagnostic of exclusion. Sprains can also happen in addition to fractures.

Diagnostic Studies of Hand, Wrist and Forearm Injuries

1. Diagnostic Studies of Hand, Wrist and Forearm Injuries X-Rays

   Diagnostic Studies of Hand, Wrist and Forearm Injuries X-Rays are recommended to ascertain the presence of a fracture, especially in individuals who have scaphoid discomfort or scaphoid tubercle tenderness.

    

2. CT Scan

   CT Scan is recommended to establish whether a fracture is present, especially in individuals who have negative x-rays but scaphoid discomfort or scaphoid tubercle tenderness.

    

3. MR Arthrograph

   MR Arthrography is recommended for people whose wrist sprains don’t go well after about 6 weeks of treatment

   Rationale for Recommendations – When diagnosing ligamentous problems including scapholunate, lunotriquetral, and TFCC tears that could be mistaken for mild sprains, MR arthrograms are extremely useful. As a result, MR arthrography is advised after around 6 weeks of clinical therapy if the patient has not improved.

Medications of Wrist Sprains

Ibuprofen, naproxen, or other older generation NSAIDs are recommended as first-line medications for the majority of patients. Although most evidence suggests that acetaminophen (or the analogue paracetamol) is marginally less effective than NSAIDs.

It may be a reasonable alternative for patients who are not candidates for NSAIDs. There is evidence that NSAIDs are as effective as opioids (including tramadol) for pain relief while being less impairing.

1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Wrist Sprain

   Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Wrist Sprain are recommended for acute, subacute, or chronic wrist sprain treatment

   Indications – NSAIDs are recommended for the treatment of acute, subacute, or chronic wrist sprain. Over-the-counter (OTC) medications may be adequate and should be tried first.

   Frequency/Duration: For many patients, using it as needed may be appropriate.

   Indications for Discontinuation: Resolution of symptoms, lack of efficacy, or development of adverse effects, that necessitate discontinuation.

    

2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

   NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended Misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors should be used concurrently in patients at high risk of gastrointestinal bleeding.

   Indications: Cytoprotective medications should be considered for patients with a high-risk factor profile who also have indications for NSAIDs, especially if long-term treatment is planned. Patients at risk include those who have a history of gastrointestinal bleeding, the elderly, diabetics, and cigarette smokers.

   Frequency/Dose/Duration: Misoprostol, sucralfate, and H2 blockers are all recommended. Dose and frequency are determined by the manufacturer. There are no significant differences in efficacy for preventing gastrointestinal bleeding, according to most experts.

   Indications for Discontinuation Intolerance, adverse effects, or discontinuation of an NSAID

    

3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

    

   1. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended Acetaminophen or aspirin as first-line therapy appears to be the least risky in terms of cardiovascular side effects.

       

   2. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended If necessary, non-selective NSAIDs are preferred over COX-2 specific drugs. To reduce the possibility of the NSAID counteracting the beneficial effects of aspirin in patients receiving low-dose aspirin for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or 8 hours before the daily aspirin.

       

4. Acetaminophen for Treatment of Wrist Sprain Pain

   Acetaminophen for Treatment of Wrist Sprain Pain is recommended for the treatment of wrist sprain pain, especially in patients who cannot take NSAIDs.

   Indications: All patients suffering from wrist sprain pain, whether acute, subacute, chronic, or post-operative

   Dose/Frequency: According to the manufacturer’s recommendations; may be used as needed. When taken in excess of four grams per day, there is evidence of hepatic toxicity.

   Indications for Discontinuation: Pain relief, adverse effects, or intolerance

    

5. Opioids of Hand, Wrist and Forearm Injuries

   Opioids of Hand, Wrist and Forearm Injuries is recommended for the treatment of a subset of patients suffering from severe wrist sprains

   Indications − Patients with severe pain from severe wrist sprains who have not received adequate relief from other treatments, including acetaminophen and NSAIDs, or who are contraindicated for NSAIDs, should be considered. Because the duration of treatment for wrist sprains is usually limited, opioids should be used with extreme caution, and only a small number of doses should be prescribed.

Rehabilitation of Wrist Sprains

Rehabilitation (supervised formal therapy) required as a result of a work-related injury should focus on restoring functional ability required to meet the patient’s daily and work activities and return to work, with the goal of restoring the injured worker to pre-injury status to the greatest extent possible.

Active therapy necessitates a patient’s internal effort to complete a specific exercise or task. Passive therapy refers to interventions that do not require the patient to exert any effort, but instead rely on modalities provided by a therapist.

In general, passive interventions are viewed as a way to facilitate progress in an active therapy programme while also achieving objective functional gains. The importance of active interventions should be emphasised over passive interventions.

In order to maintain improvement levels, the patient should be instructed to continue both active and passive therapies at home as an extension of the treatment process.

To facilitate functional gains, assistive devices may be included as an adjunctive measure in the rehabilitation plan.

Therapy – Active of Wrist Sprains

Therapeutic Exercise

Therapeutic Exercise – for treatment of moderate or severe acute or subacute wrist sprains.

Therapeutic Exercise – for treatment of moderate or severe acute or subacute wrist sprains is recommended for the treatment of mild to severe Wrist sprains, either acute or subacute.

Frequency/Dose/Duration – Total visits may be as few as two to three for patients with mild functional deficits or as many as 12 to 15 for patients with more severe deficits who have documented ongoing objective functional improvement.

More than 12 to 15 visits may be indicated if there is documentation of functional improvement toward specific objective functional goals (e.g., increased grip strength, key pinch strength, range of motion, advancing ability to perform work activities) when there are ongoing functional deficits.

A home exercise programme should be developed and performed in conjunction with therapy as part of the rehabilitation plan.

Therapy – Passive of Wrist Sprains

1. Ice – Self-application

   Ice – Self-application is recommended for the treatment of severe wrist sprains

    

2. Heat – Self-application

   Heat – Self-application is recommended for the treatment of a severe wrist sprain

    

3. Mobilization / Immobilization

   Mobilization / Immobilization is recommended Splinting is used to treat moderate to severe acute or subacute wrist sprains.

Surgery of Wrist Sprains

Surgery of Wrist Sprains

Surgery of Wrist Sprains is not recommended in the absence of a repairable defect, for the treatment of acute or subacute wrist sprain

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