Dear Bone Doctor, What is the treatment for a sprained wrist? I fell over the weekend on my right hand and now my wrist is very painful. -- Gladys

Dear Gladys, A sprained wrist is usually the result of a fall onto an outstretched hand or sometimes the result of a direct blow to the wrist. The patient will often have swelling, bruising and pain with movement.

The wrist joint is complex, comprising the distal ends of the radius and ulnar, eight smaller carpal bones and the proximal ends of the fingers.

Around these bones are many ligaments and tendons. The ligaments help to bind all these bones together, and the tendons connect the muscles in the forearm to their individual fingers. This arrangement affords the wrist significant flexibility.

In a fall where the wrist is bent backward, the first thing to get injured are the ligaments and tendons. The degree of injury is based on how much energy is involved in the fall. For example, in a fall from a height there is more energy involved and hence it is more likely that not only would the soft tissues be injured but also the bones might be fractured.

If there are no fractures, a sprained wrist should improve over a few days to two weeks. The mainstay of initial treatment can include rest, icing, a splint, anti-inflammatories if they can be tolerated. If it doesn't then there might be other issues such as a fracture or perhaps a torn ligament.

With persistent wrist sprain, evaluation with radiographs helps to see if there is a fracture. If the X-rays show a fracture then treatment is then geared toward treating that fracture. This treatment can include casting, bracing or surgery.

If the X-rays fail to show a fracture, an MRI scan can help to delineate if there is persistent ligamentous damage or even a fracture that isn't seen on X-rays.

Some ligamentous damage if not severe can be treated once again with bracing or even casting. However, if the damage is severe like a tear in the ligament, then surgical repair might be necessary.

A common injury to the wrist that might present as sprain but is more serious is a fracture of the scaphoid bone, one of the eight bones in the wrist. This injury is usually the result of a fall on an outstretched hand. The pain is usually along the base of the thumb where the scaphoid is located. This fracture can be difficult to diagnose by X-rays and so an MRI is useful.

Treatment is usually by casting but sometimes if the fracture has moved or isn't healing then surgery is necessary.

The opinions expressed are solely those of the writer. Dr. Dwight Tyndall is a practicing Spine Surgeon. He can be reached at dstyndall@yahoo.com (use the subject line "bone doctor column"), spinecarespecialists.com or at Dr. Dwight Tyndall, 730 45th St., Munster, IN 46321. This column is intended for informational purposes only. Readers should seek specific medical advice from their own physician.