How to Tell the Difference Between a Sprained Wrist and a Fractured Wrist

A wrist sprain occurs when the ligaments in the wrist are overstretched or torn (partially or completely). On the other hand, a wrist fracture involves one of the wrist bones breaking. It can sometimes be difficult to differentiate between a sprained wrist and a fractured wrist because both injuries share similar symptoms and are caused by similar types of trauma—such as bracing your hand during a fall or a direct impact to the wrist. In fact, wrist fractures often also include a sprained wrist. To accurately determine which injury has occurred, a medical diagnosis (such as an X-ray) is required, although in some cases, you may be able to distinguish between the two at home before seeking medical attention.

Test the wrist's mobility and assess. A wrist sprain can occur at different levels, depending on how much the ligaments are stretched or torn. In mild cases (grade 1), the ligaments are stretched but not significantly torn. In moderate cases (grade 2), there is more substantial ligament damage (up to 50% of the fibers torn), and some functionality may be lost. Severe sprains (grade 3) involve more severe tearing or complete rupture of the ligaments. In grades 1 and 2 sprains, you may still be able to move your wrist somewhat normally (despite the pain). However, a grade 3 sprain typically leads to instability in movement (excessive range of motion) due to the complete rupture of the ligaments that attach to the wrist bones.

• In general, only some grade 2 sprains and all grade 3 sprains require medical care. Most grade 1 and many grade 2 sprains can be treated at home.
• A grade 3 sprain may include a bone fracture when the ligament tears away from the bone and takes a small piece of bone with it.
• The scapho-lunate ligament, which connects the scaphoid and lunate bones, is the most commonly overstretched ligament in wrist sprains.

Identify the Type of Pain. Wrist sprains vary greatly in both intensity and type of pain. A grade 1 sprain typically causes mild pain, often described as aching, with sharp pain during movement. A grade 2 sprain results in moderate to severe pain depending on the extent of ligament tearing; the pain is more intense than grade 1, with sharp sensations from increased swelling. Interestingly, a grade 3 sprain usually causes less pain initially compared to a grade 2 because the ligament is completely torn, reducing nerve stimulation around the injury. However, as swelling increases, the pain intensifies.

• Grade 3 sprains with bone fractures cause immediate, intense, sharp pain.
• Wrist sprain pain is most noticeable during movement; symptoms often improve with immobilization.
• Generally, you should seek immediate medical attention if your wrist pain is severe and you have trouble moving it.

Apply Ice and Monitor the Response. All levels of wrist sprains respond well to ice or cold compress therapy due to its ability to reduce swelling and numb the surrounding pain-causing nerves. Ice therapy is particularly important for grade 2 and 3 wrist sprains because of the increased swelling around the injury. Applying ice to the sprained wrist about 1 to 2 hours after the injury, for 10-15 minutes each time, is highly effective after the first day and significantly reduces pain, making movement easier. On the other hand, ice for a wrist fracture also helps with pain and swelling but the effects often wear off after a while. In general, ice therapy is more effective for wrist sprains than for most fractures.

• The more severe the sprain, the greater the swelling and the larger the area of pain.
• Bone fractures usually respond better to long-term cold therapy than to severe fractures that require medical care.

Check for Bruising the Following Day. Note that swelling is different from bruising. Bruising occurs when blood from small arteries or veins leaks into the tissues. A grade 1 sprain typically doesn't cause bruising unless a strong impact ruptures blood vessels under the skin. A grade 2 sprain usually causes swelling but may not show significant bruising—it depends on how the injury occurred. A grade 3 sprain results in significant swelling and often bruising, as the ligament tear is typically severe enough to rupture or damage nearby blood vessels.

• Swelling doesn't usually change the skin color except for redness from the heat generated.
• Bruising causes the skin to turn dark blue as blood seeps into the tissue just beneath the skin surface. As the blood breaks down and is reabsorbed, the bruise changes color (light blue and eventually yellow).

Monitor the Progress Over a Few Days. In general, grade 1 and some grade 2 sprains significantly improve after a few days, especially when immobilized and treated with ice. Therefore, if your wrist feels better, the swelling is less noticeable, and you can move it without pain, there's no need for medical intervention. If a more severe sprain (grade 2) feels much better after a few days (despite lingering swelling and pain), you may need to wait a bit longer for full recovery. However, if the injury shows little improvement or worsens after a few days, medical examination is essential.

• Grade 1 sprains and some grade 2 sprains heal relatively quickly (1 to 2 weeks), while grade 3 sprains (especially those with bone fractures) take the longest to recover (sometimes several months).
• Hairline fractures may heal fairly quickly (a few weeks), while severe bone fractures may take several months or more, depending on whether surgery is required.

Observe for signs of misalignment or distortion. Injuries such as sprained wrists can also lead to fractures. Generally, larger and stronger bones are less prone to fractures due to injury, with ligament strains or tears being more common. However, when fractures do occur, they are often accompanied by visible signs of misalignment or distortion. The eight small bones of the wrist can make it harder to spot misalignment or distortion, especially in cases of hairline fractures, though more severe fractures are easier to detect.

• The most commonly fractured bone in the wrist is the radius, which connects the forearm to the smaller wrist bones.
• The most frequently fractured wrist bone is the scaphoid, though this injury is less likely to cause noticeable deformity.
• A fracture where the bone pierces through the skin is known as an open fracture.

Identify the type of pain. The severity and type of pain from a wrist fracture depends on the injury's extent, but it is typically described as sharp when moving the wrist and aching when at rest. The pain from a wrist fracture tends to increase when grasping or squeezing the hand, which usually doesn't happen with sprains. Compared to sprains, wrist fractures typically cause more symptoms in the hand, such as stiffness, numbness, or an inability to move the fingers, as they have a higher chance of nerve damage. Additionally, a cracking sound when moving the fractured wrist is common, which doesn't happen with sprains.

• Wrist fracture pain usually (but not always) follows a cracking sound. In contrast, only third-degree sprains create a similar sound or sensation, sometimes even with a 'pop' when the ligament tears.
• Generally, the pain from a wrist fracture worsens at night, while sprain pain stabilizes and doesn’t intensify when the wrist is immobilized.

Monitor whether symptoms worsen the following day. As mentioned earlier, mild to moderate sprains can improve within a day or two with rest and ice, but fractures do not heal this quickly. Apart from hairline fractures, most broken bones take significantly longer to recover than sprains. Thus, applying ice and resting for a few days may not help alleviate symptoms in most fractures. In some cases, you may feel the condition worsening after the initial shock of the injury has passed.

• If the fractured wrist bone protrudes through the skin, the risk of infection and significant blood loss is high. Seek medical attention as soon as possible.
• A wrist fracture can completely cut off blood flow to the hand, leading to a condition known as 'compartment syndrome,' which is a medical emergency. In this case, the hand will feel cold (due to lack of blood) and appear pale (white or blue).
• A fracture can also compress or sever nearby nerves, causing complete numbness in the affected hand area.

Get an X-ray as recommended by your doctor. The information above may help you determine if your wrist injury is a sprain or a fracture, but only diagnostic imaging methods like X-rays, MRIs, or CT scans can provide a clear diagnosis in most cases—unless the bone has pierced the skin. X-rays are the most common and cost-effective way to examine the small wrist bones. Your doctor may refer you for an X-ray, and a radiology specialist will interpret the results before advising you. X-rays only show bone images and do not display soft tissues like ligaments or tendons. Fractures in small bones are often hard to detect on X-rays due to limited space, and it may take a few days for the fracture to be visible. To assess ligament damage, your doctor may suggest an MRI or CT scan.

• An MRI, which uses magnetic waves to provide detailed images of bone structures, may be necessary to identify wrist fractures, particularly scaphoid fractures.
• Hairline fractures in the wrist are often difficult to see on a regular X-ray until the swelling subsides. Therefore, it may take a week before the fracture is identified, even though the injury may be healing by then.
• Osteoporosis (bone fragility due to mineral deficiency) is a major risk factor for wrist fractures but does not significantly increase the risk of wrist sprains.

• Wrist sprains and fractures are often caused by falls, so be cautious when walking on wet or slippery surfaces.
• Activities like skateboarding and skiing carry a high risk of wrist sprains and fractures, so it's important to always wear wrist protection.
• Some wrist bones receive limited blood supply under normal conditions, meaning recovery from a fracture may take several months.

• If left untreated, a fractured wrist can increase the likelihood of developing osteoarthritis.