What’s Better for a Wrist Sprain: Ice or Heat?

Without the correct treatment, a sprained wrist can take much longer to heal. Wrist sprains are divided into three grades, aptly referred to as Grade 1, Grade 2, and Grade 3. Grade 1 sprains are the mildest, while Grade 3 are the most severe.

Understanding the Wrist Makeup

The wrist is one of the most centrally important parts of the body for everyday tasks, and when you injure your wrist, life can very easily come to a standstill. This is in large part because of the makeup of the wrist, which is a complex interlacing of eight small bones (carpals) and four groupings of ligaments, which allow for the complex movements and delicate control that the wrist gives the hand. The most commonly sprained ligaments in the wrists are those that join the carpal bones to the radius and ulna, the long bones of the forearm, and they are called the ulnar/radial collateral ligaments, the palmar/dorsal radiocarpal ligaments, and the palmar ulnocarpal ligament.

Acute Wrist Sprains & Treatment

When any of these ligaments are injured, which is referred to as an Acute Sprain, the first and most important step is to see about treating that injury as soon as possible.
The first step will be to apply ice, or something cold, to the injury immediately, to counteract the swelling and reduce inflammation, which can make treatment more difficult. Ideally, a medical ice bandage is the best to use in these situations, but a bag of ice cubes, or even the iconic bag of frozen peas can work in a pinch.

If you can, find something to wrap around the wrist so that the cold object is held firmly onto it, rather than having to use your free hand to hold it on. It is important to keep the cold bandage pressed firmly against the wrist, but not so tight as to cause pain or cut off the circulation to the hand. If this happens, you will notice darkening and discoloration in the hand and will need to adjust the tightness of the dressing.

At this stage of the injury, any exposure to heat is not recommended, so cold water is important for hand washing, bathing, and showering. Any warmth on a fresh sprain can counteract the work of the cold compress and cause inflammation to recur, along with pain and discomfort. In the case of Grade 1 and 2 sprains (discussed below), the icing need only continue so long as the inflammation persists, but in more serious Grade 3 scenarios, could should be applied to the injured wrist 3 or 4 times a day for 15 to 20 minutes each time, until a marked decrease in inflammation and discomfort is noticed. This may need to be followed by medical intervention, in circumstances outlined below.

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Chronic Wrist Sprains & Treatment

When a wrist sprain is the result of repetitive motion, such as heavy manual labor, or athletics, then this type of sprain is known as a Chronic Sprain, and the method of dealing with this type is different than with a traumatic, or Acute Sprain. In these cases, when the swelling has gone down, and the pain is less, usually in a few days, you may then begin to use warm, moist towels to treat the now reduced inflammation and discomfort. As above, a medical heat bandage is the ideal tool for this kind of treatment, but a washcloth soaked in warm water, or even a moistened paper towel can do the job if that is all you have at hand. Find a time that you can sit still and rest for at least thirty minutes, and wrap the warm object around the wrist, keeping it there for about a half hour. If the compress loses heat, then you may need to replace it, and this is fine, if the total time under heat is at least the thirty minutes recommended.

Grade 1 Wrist Sprains

In a Grade 1 sprain, the ligaments of the wrist are stretched, but no actual tearing occurs, so they remain intact. This is the mildest and most common form of sprain and can result from something as simple as putting pressure on your wrist the wrong way while engaged in an otherwise mundane daily task such as getting up from a chair.

Grade 2 Wrist Sprains

Grade 2 sprains involve some damage to the ligaments and will require more treatment and usually result in some loss of function, at least during the recovery period.

Grade 3 Wrist Sprains

Grade 3 sprains are the most severe and are usually the result of some significant trauma, such as a very hard fall onto the outstretched wrist, or a severe industrial or athletic injury, or really anything that puts the wrist in peril. These Grade 3 sprains need constant monitoring, and are the most likely to require medical intervention. If you suffer one such sprain, and the icing does not seem to have any effect after a day or so, you will need to see a doctor to have diagnostic tests run to determine the extent of the injury.

X-rays will also allow the doctor to ascertain the severity of the injury, because in some cases what might present as a sprain could be a more serious fracture. One common injury that occurs in conjunction with a Grade 3 traumatic sprain is called an avulsion fracture, which is when the ligament is so forcibly torn from the bone that it takes a small chip of bone with it.
Heat can be useful for increasing circulation to an area to facilitate healing, but it should never be used on an acute injury that involves inflammation. Heat should only be used to treat chronic pain from tight muscles or sore joints. Heat can be applied before or after strenuous activity to loosen up tissues or prevent soreness. In cases of traumatic sprain, the most important things you can do are referred to as the RICE protocol. RICE stands for Rest, Ice, Compression, and Elevation, and these are the four steps most important in treating a sprained wrist that occurs due to injury. If these steps don’t serve to alleviate all of the pain and inflammation of the injury you have received, then it may be time to seek professional medical advice, because there could well be a bigger issue at hand.

Recap

1. Sprained wrists need ice placed on the injury as soon as possible. This will immediately begin to bring the swelling down. This can be through a bag of ice or, better, an ice bandage wrapped around the arm from hand to elbow. The ice or ice wrap should feel comfortable on the sprain, and a wrap should never be so tight that blood circulation is cut.

2. Not only is heat treatment unsuitable for a newly sprained wrist, the injured person should also take steps to avoid exposing the injury to any heat such as by taking cooler showers. Heat can cause the sprain to swell up and result in more discomfort, so any exposure should be avoided until the swelling of the sprain has gone down.

3. After a few days have passed since the injury, heat treatment can help reduce the pain of sprained wrist. When the swelling has come down, place a warm, moist towel on the sprain and leave it on the wrist for around 30 minutes.

4. A wrist sprain is caused by a pulled or torn ligament. Sometimes the ligament is completely torn, resulting in a Stage 3 sprain. Ice should be applied as soon as possible after the injury occurs in order to alleviate pain and swelling caused by tissue damage. The first 48 hours after an injury are the most critical in terms of controlling inflammation. Apply ice to the injured joint two to three times a day for 15 to 20 minutes until there is a noticeable decrease in soreness, but do not apply ice directly to the skin to avoid possible tissue damage.

5. Heat can be useful for increasing circulation to an area to facilitate healing, but it should never be used on an acute injury that involves inflammation. Heat should only be used to treat chronic pain from tight muscles or sore joints. Heat can be applied before or after strenuous activity to loosen up tissues or prevent soreness.

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How Dr. Knight Can Help Your Wrist Injury

Dr. Knight has over two decades of experience treating wrist and upper extremity injuries, and sprains number in the tens of thousands treated. With offices in Dallas and Southlake, he is easily accessible to Dallas residents. For those out of town, a virtual consultation can be done. The first thing he will do in the case of a suspected wrist sprain is a physical examination. This includes a history and physical, so once you explain how the sprain happened and its effects, it will become clear to them whether the injury is truly a sprain or not. A subsequent physical examination will tell the doctor which ligament/s are involved in the injury, as well as the extent of the inflammation and pain.

Diagnostic imaging tests, such as an X-ray, will show if there is a fracture, and an MRI can help give an inside view of the damage to the soft tissue. More serious injuries to the wrist may include fractures of the Scaphoid, Lunate, Hamate or Trapezoid bones, which must be treated differently. Also common in injured wrists is the TFCC tear, which can sometimes present with the same symptoms as a sprain. The more serious fracturing of the ulna or radius at the wrist is less likely to be mistaken as a sprain, but a hairline fracture may not show as much pain or displacement, so these injuries are also possible.

Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.