A foot catches on a curb, a step is icier than it looked, and your arm shoots out before you have had a single thought. The wrist takes the hit. Doctors even have a shorthand for it, FOOSH: “fall on an outstretched hand.”
After more than 25 years in practice, I can tell you the wrist injuries I worry about most are not always the ones that hurt most on day one.
See a doctor first if any of these are true
Before anything else, rule out a break. The American Academy of Orthopaedic Surgeons (AAOS) says to go to an emergency room right away if:
- Your wrist looks bent, crooked or out of place
- Your fingers feel numb or look pale
- The pain is severe, or it gets worse instead of better
- It hurts badly when someone gently straightens your fingers, or you suddenly have trouble bending your thumb or index finger
You can read the full list on the AAOS page on broken wrists. Even without those signs, AAOS advises getting checked if wrist pain lasts more than a day after an injury.
Why a fall on your hand is so hard on the wrist
When you land on an open palm, the force of the fall travels through a joint made of two forearm bones, eight small carpal bones and a web of ligaments holding them together. Depending on how you land and how strong your bones are, a ligament, a bone, or both absorb that load.
According to AAOS, about 1 in 6 broken bones seen in U.S. emergency rooms is a distal radius fracture, a break at the end of the larger forearm bone, and the most common cause is a fall onto an outstretched arm. In people over 60, many of these breaks come from nothing more than a fall from standing height. AAOS notes that a wrist broken that way can be an early sign of weak bones, which is worth raising with your doctor.
Sprain or break: how do you tell?
A sprain means the ligaments were stretched or torn. The AAOS guide to wrist sprains grades them from mild (stretched, not torn) to severe (completely torn, sometimes pulling a small chip of bone with it). Symptoms include pain, swelling, bruising, tenderness, warmth, and sometimes a popping or tearing feeling at the moment of the fall.
A broken wrist usually causes immediate pain, swelling, bruising and tenderness. Those lists overlap, so you often can’t tell by feel. Cleveland Clinic explains that a provider confirms a sprain with an exam and an X-ray to look for bone damage, and sometimes an MRI or CT scan. Being able to move your wrist does not by itself mean nothing is broken.
The small bone that often gets missed
Pay attention if the pain sits on the thumb side of your wrist, in the little hollow at the base of your thumb. That spot sits over the scaphoid, one of the carpal bones.
The AAOS page on scaphoid fractures describes three things that surprise people:
- The pain may be mild enough to pass for a sprain.
- The break may not show on the first X-ray. Doctors sometimes splint the wrist for 2 to 3 weeks and then take new images, or order an MRI.
- The scaphoid has a poor blood supply, so it has more trouble mending than many other bones. A break that goes unrecognized can mend poorly and may need surgery that earlier care could have avoided.
Ligaments can be missed the same way, because X-rays show bone, not ligaments. A 2022 case report in the Journal of Acute Medicine describes a man whose first wrist X-rays after a fall looked normal. Ten days later, with little improvement, new images showed a widened gap between two carpal bones from a torn ligament. The authors note that injuries of this type are diagnosed late in up to 30% of cases.
Wrist pain after a fall that won’t go away
Cleveland Clinic says it usually takes a few weeks to recover from a sprained wrist, and AAOS says mild sprains often fully recover within several weeks. Cleveland Clinic advises seeing a provider if symptoms are not improving a few days after home care.
If your wrist still hurts past that window, or flares when you push up from a chair or open a jar, get it looked at again rather than waiting it out.
What helps in the first few days
For a wrist that has been checked and is not broken, AAOS and Cleveland Clinic describe the same basics, often called RICE:
- Rest. Avoid the movements that cause pain.
- Ice. A cold pack wrapped in a thin towel, 15 to 20 minutes at a time, never directly on the skin.
- Compression. An elastic wrap that is snug, but not so tight that it hurts or cuts off circulation.
- Elevation. Keep the wrist above the level of your heart when you can.
Your doctor may recommend a splint or brace for a while. AAOS notes that moderate sprains may need a splint, followed by stretching or therapy to get motion back.
Where a chiropractor fits in
Extremity cases are a large part of what we see, and a fall rarely hits just one joint. Once a fracture or serious ligament tear has been ruled out, we look at how the wrist, hand, forearm, elbow and shoulder are moving together, and we put together a plan of hands-on care and home exercises for grip and wrist motion. If anything points to a missed fracture or ligament injury, we refer you for imaging or to a hand specialist first. You can see the joints we work with on our Extremities page.
Not all wrist pain comes from a fall. Numbness and tingling in the fingers can point to carpal tunnel syndrome. Pain on the thumb side that builds with gripping and lifting, with no injury at all, can be De Quervain’s tenosynovitis.
Frequently asked questions
How long should a wrist hurt after a fall?
A mild sprain often feels better within a few weeks. Pain that lasts longer deserves a second look, since some fractures and ligament tears don’t show on early X-rays.
How can I tell if my wrist is broken or just sprained?
Usually not by feel alone. A wrist that looks bent, numb or pale fingers, or severe pain point to a break and need emergency care. Otherwise, an exam and an X-ray are how you find out, sometimes with an MRI.
Can you break your wrist and still move it?
Yes. A scaphoid fracture can cause only mild pain and still let you move the wrist, which is why it is often mistaken for a sprain.
Slovin Chiropractic Center is at 99 Main Street, Norwalk, CT 06851. We accept most major insurance, we speak Spanish, and Saturday visits are available by appointment only.
If your wrist still hurts after a fall, call us at (203) 840-0000 to book a visit.
