Dr. Andrew Tyser lends his expertise on this episode of “The Specialists,” and explains what to look out for when it comes to wrist injuries.">

May 18, 2018 — Even a small slip or fall onto an outstretched hand can injure your wrist, but just how bad is it? Should you ice and elevate the injury? Or go to the doctor for an X-ray? Orthopedic surgeon and hand specialist Dr. Andrew Tyser lends his expertise on this episode of “The Specialists,” and explains what to look out for when it comes to wrist injuries.

Interview

Dr. Miller: Do you have a wrist fracture and what do you do about that if you have one? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. Andrew Tyser and he is an orthopedic surgeon specializing in hand care and hand surgery. Welcome.

Dr. Tyser: Thanks, Tom.

Broken Wrist Vs. Sprained Wrist

Dr. Miller: How would somebody know if they might have a wrist fracture versus a sprain of the wrist? What are the common ways that we get wrist fractures?

Dr. Tyser: That's a great question. I think it's important to know that wrist fractures in general are very common as are wrist sprains. Many times they're caused by similar mechanisms. Lots of times people have a simple fall from ground level, sometimes slipping on the ice, sometimes falling off a bike. And the first question is, this hurts, is it broken or not?

Dr. Miller: How would you know? Is it swollen? Is it red? Is it just not mobile?

Symptoms of Broken & Sprained Wrists

Dr. Tyser: Sometimes it's really obvious. The wrist may look like it's not straight. In that case it's pretty obviously going to be a wrist fracture. However, in many cases the wrist looks pretty normal, maybe a little bit swollen and it's not as clear.

Usually in that case, if the pain subsides over the next few days, it's typically considered a wrist fracture. But if the pain is not getting better and persists and the swelling gets worse, difficult use to the hand, etc., many times an X-ray is warranted to determine if it is a wrist fracture or not.

Dr. Miller: Now there are many bones in the hand and sometimes if you have a fracture it may not be quite obvious and I think that's one of the things you were saying. So maybe for those who wonder if it's fractured they should just have that checked out.

Dr. Tyser: And we see that quite a bit in our clinic as well as in the emergency room or urgent care centers. I think ruling out a fracture is sometimes just as important as diagnosing one. The X-ray is a fairly simple, quick, easy thing to do and will tell us usually one way or the other if you have a fracture or not.

Dr. Miller: And there are certain parts of the wrist that become fractured, the back, the front, one of the particular bones.

Dr. Tyser: I think the most common fracture that we see as hand surgeons and hand specialists, is a fracture of what's called the distal radius. It seems to be a commonly fractured area of all ages. There are a couple of other smaller bones in the wrist that also sometimes get broken, but they're a little bit less common.

Dr. Miller: Is the distal radius closer to the thumb or the little finger? Where is that?

Dr. Tyser: Right where your wrist bends. It's on the thumb side of the wrist and about an inch or so right before your wrist bends. That's the typical area that breaks.

Dr. Miller: And how would you get that fracture? Would you fall on an outstretched hand?

Dr. Tyser: Exactly. Falling on an outstretched hand pretty hard typically. Sometimes people that are skiing or participating in other sports that take a hard fall unexpectedly have that fracture.

How to Treat a Sprained Wrist

Dr. Miller: If you've fallen on your wrist and you think it may just be a strain, is there anything you should be doing between the time you decide that you need to see the doctor? That is, could you ice it? Could you take ibuprofen or aspirin? What would you recommend?

Dr. Tyser: That's a great question and I think I would typically do the normal things that we recommend for many relatively minor injuries to the wrist, that is ice, elevation, resting it, and observing it and keeping a close eye on it. If you are overly concerned, usually your body will tell you if things are getting better or not. If it's not, that may be a good time to get evaluated.

Dr. Miller: And what if you don't go and have this diagnosed as a fracture? What is the long term consequence of that? Obviously for people who have long bone fractures they can't do anything until the fracture is healed. But wrist fractures you might go on for awhile with a swollen wrist and use it, not as much as you're used to. But eventually that could create problems.

Dr. Tyser: I think typically for people that do have a wrist fracture who initially don't realize it, they'll come to realize that within the first few days, within a week I would say. And so the long-term chances of missing it, the long term consequences of missing it aren't too common to see because people do not wait that long to actually go get it evaluated.

Dr. Miller: So you're a hand surgeon, a specialist? How do the patients make their way to you after they're diagnosed with a fracture? Or should they? Or can these fractures be handled by a general practitioner?

Dr. Tyser: That's a great question. I think more and more hand specialists are the ones that are managing fractures about the hand, including the wrist. Many times the sequence of events is patients suspects they have a wrist fracture, they're evaluated in either an emergency room or urgent care center. X-rays are taken and sure enough unfortunately they have a wrist fracture. At that point, they typically have either a reduction of the fracture, meaning putting the bone back in place and setting it and a splint placed. Or if it's not a bad fracture sometimes just a splint placed and are advised to follow up with an orthopedic hand doctor.

Recovery Time for a Broken Wrist

Dr. Miller: How long before a wrist fracture heals typically?

Dr. Tyser: About six weeks. And many of these fractures are able to be treated with conservative measures, such as casting or even splinting. However, there is a fairly significant subset of them do require surgery and in this same sense as far as time goes, it's about a six week recovery also, as far as the bones healing.

Dr. Miller: If you're in an area where a general orthopedic surgeon is available but they don't have a hand surgeon, I don't imagine that some places have access to hand surgeons, is it a good idea to proceed to see a hand surgeon at some point? What is your thought about that?

Dr. Tyser: That's a great question. I think it really depends on the community and also the training of the person taking care of the fracture. Many general orthopedic surgeons are more than qualified to take care of the routine, distal radius and other wrist fractures. However, for more complicated ones, fractures and dislocations at the same time or those involving other small bones of the wrist, many times we see that those are more traditionally taken care of by hand surgeons.

Dr. Miller: So to summarize, it sounds like if you have a fall and your wrist really hurts or is immobile or the pain lasts and the swelling is lasting longer than three days, you probably ought to have that checked out, have an X-ray. And if there is a fracture, you'd advise them to see an orthopedic hand surgeon.

Dr. Tyser: I would and I think that's a good summary of the recommendations.

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