Why does my wrist still hurt when the x-ray was normal?

In short

A normal x-ray rules out the breaks an x-ray can see, and it does not rule out a torn ligament, a cartilage tear, or a scaphoid fracture that does not show at first. Wrist pain that is still there two weeks after a fall should be examined again rather than waited out.

Written for patients by The Hand and Wrist Institute. Prepared for review by John T. Knight, MD. Last updated September 5, 2026How we write and review

Call (817) 382-6789 to have this looked at, or book online with Dr. Knight.

What a normal x-ray actually rules out

Hold your hand out the way it landed when you fell. An x-ray of that wrist is a picture of bone, good at showing a bone that has cracked and moved. Three common injuries from that same fall do not show up well on it. The first is a break in the small boat shaped bone on the thumb side, or what we call the scaphoid, which can be invisible on the first film and only becomes obvious on a repeat film later.¹ The second is a torn strap between two wrist bones, or what we call a ligament injury, which is soft tissue and does not appear on an x-ray at all.² The third is a tear in the cartilage on the little-finger side. All three leave a wrist that hurts on gripping and twisting while the report says the bones look fine.

A normal x-ray and a normal wrist are not the same thing

That is the sentence people mix up, and it is the reason wrist injuries get parked. Here is what to note and bring in, as observations rather than a test that settles anything. Put one finger on the sorest point and note whether it is in the hollow below the thumb, in the middle of the back of the wrist, or over on the little-finger side, because those areas point at different structures. Note whether the pain comes on gripping, pushing off, or twisting a lid, whether it has been settling or holding steady, and the date of the fall. Wrist pain is what Dr. Knight singles out for being misread, and he says so in the words quoted below.

What happens next, in order

1. A repeat exam. Dr. Knight examines the wrist again with the history of the fall in front of him, and where the tenderness sits is much of the answer.
2. Repeat x-rays. A scaphoid fracture that was invisible in the first days often shows on a later film.¹
3. Advanced imaging where the question is still open. An MRI shows soft tissue, and an MRI done with dye injected into the joint first, or what we call an arthrogram, shows the ligaments between the wrist bones.
4. Treatment. For a ligament injury this starts conservatively with a period in a cast or brace, and Dr. Knight sets the length at the visit. Where that fails, he treats these with a small camera inside the joint, or what we call arthroscopic surgery.

The cost of leaving it is practical rather than dramatic. A scaphoid fracture that is never immobilised can heal slowly or fail to unite.¹ A torn wrist ligament left for months is a harder problem than the same tear seen early.

When to call us

• The wrist is still painful two weeks or more after a fall, whatever the first x-ray showed.
• The pain sits in the hollow at the base of the thumb when you press there.
• Gripping, pushing off a chair, or turning a lid brings the pain back every time.
• The wrist clicks, clunks, or gives way when you load it.
• The swelling went down but the pain did not.