Wrist Sprain Treatment: RICE Protocol & Rehabilitation

A wrist sprain is a ligament injury (scapholunate, TFCC, radiocarpal). Grades: I (stretch), II (partial tear), III (complete tear ± instability).

Acute Phase (0–72 hrs): POLICE

• Protection: Removable wrist splint (neutral 0–15° extension) or Buddy strap for Grade I.
• Optimal Loading: Pain-free active ROM (flex/ext, radial/ulnar deviation) within 24–48 hrs; prevents stiffness.
• Ice: 10–15 min q2–3h; barrier cloth.
• Compression: Elastic wrap (distal→proximal); check capillary refill.
• Elevation: Above heart (pillows).

Medication

• NSAIDs: Ibuprofen 400–600 mg q6h ×3–5 days (topical diclofenac alternative).
• Avoid aspirin <18 yr (Reye's risk).

Rehabilitation Progression

Phase	Timeline	Goals	Exercises
Early	Days 3–14	Full pain-free ROM, ↓ edema	Active ROM, tendon glides, isometric wrist flex/ext, grip squeezes (soft ball)
Intermediate	Weeks 2–6	Strength, proprioception	Theraband flex/ext/radial/ulnar deviation, pronation/supination, weight-bearing progress (wall → table → floor)
Advanced	Weeks 6+	Sport/occupation-specific	Plyometrics, impact loading, task simulation

Red Flags for Specialist Referral

• Deformity, gross instability, persistent pain >6 weeks.
• Mechanical symptoms (clicking, clunking) → possible TFCC tear / scapholunate dissociation.
• Neurovascular signs (thenar wasting, paresthesia).

Imaging

• X-ray (AP, lateral, oblique) – rule out fracture (scaphoid, distal radius).
• MRI / MR Arthrogram – gold standard for ligament/TFCC.
• Diagnostic arthroscopy – definitive for partial tears.

Grade I–II typically heal in 2–6 weeks with structured rehab; Grade III may require surgical repair.