Broken or Sprained Wrist? How to Tell After a Fall

A wet pavement in the first winter rain, a marble staircase at home, a fall from a bike or on the football pitch — and you instinctively put a hand out to save yourself. That is how most wrist injuries happen: a fall onto an outstretched hand. The result can be a simple sprain that settles in a few weeks, or a fracture that needs a splint or a cast. The problem is that the two look very alike in the first few hours. This guide explains the signs that point to a break, why pain at the base of the thumb should never be ignored, and when to go to the ER versus urgent care.

How can you tell if your wrist is broken or sprained?

According to the NHS, you may have broken your wrist if, after an injury, it suddenly became painful, swollen, bruised and difficult to move, and it may also change colour, change shape or feel numb. The NHS adds that it can be hard to tell whether a wrist is broken, dislocated or badly sprained, and that you'll probably need an X-ray. This table sums up the usual differences, but it doesn't replace an examination:

The same logic applies to the rest of the arm and to the ankle; our guide on how to tell if your arm is broken or sprained covers the arm and ankle in detail.

Why pain at the base of the thumb matters

The scaphoid is a small wrist bone on the thumb side, and it usually breaks in a fall onto the palm. According to the American Academy of Orthopaedic Surgeons (AAOS), a scaphoid fracture causes swelling and pain in the small hollow that appears at the base of the thumb when you hold it up in a thumbs-up, and pinching, grasping, pushing or pulling make it worse. AAOS warns that some scaphoid fractures don't hurt much and get mistaken for a sprain, and that wrist pain that doesn't go away within a day of the injury may be a sign of a fracture.

The reason for caution is that parts of the scaphoid have a poor blood supply, so an untreated break can heal slowly or not at all. And because it doesn't always show on the first X-ray, a doctor who suspects one may put the wrist in a splint and repeat the X-ray after about 2 weeks, or refer you for other imaging if needed. Don't treat a normal first X-ray as the end of the story if the pain stays in that same spot.

When should you come in for a wrist injury?

Call 911 for

• Bone showing through the skin, or a wound that is bleeding heavily.
• A hand or fingers that are cold, pale or blue after a severe injury.
• A wrist injury that is part of a bigger accident, such as a fall from height or a car crash.

Go to the ER / come in now

• A wrist that has changed shape or sits at an odd angle.
• Numbness, tingling or pins and needles in the hand or fingers.
• Pain so severe that you can't use the hand at all.
• Large swelling that is getting worse quickly.

Same-day urgent care

• A swollen, painful wrist after a fall that looks normal in shape.
• Pain at the base of the thumb, or pain when gripping or pinching.
• A child or teenager who has hurt their wrist and is avoiding using the hand.
• Someone over 50 who may have broken a wrist in a minor fall.

Home care is usually fine

• Mild pain and swelling around the joint, with full grip and the ability to turn the hand.
• No pain when pressing on the bone or at the base of the thumb, and clear improvement day by day.

What to do while you get to a doctor

• Support the arm in a sling made from a towel or scarf, and don't try to use the wrist.
• Apply a cold pack wrapped in a cloth for up to 20 minutes every 2 to 3 hours.
• Take off rings, watches and bracelets straight away, before the hand swells.
• Stop any bleeding by pressing on it with a clean pad.
• Don't eat or drink if a break looks obvious, in case you need a procedure to set the bone.
• Don't drive yourself; ask someone to take you.

What happens when you arrive

The doctor examines the wrist, gently presses over the bones and checks the feeling and circulation in your fingers, then decides whether you need an X-ray. At Emergency Plus, X-ray is on site and urgent care sees walk-ins around the clock. Depending on what it shows, you may need a splint, a supportive bandage or a referral to an orthopaedic specialist, and if you need a test or treatment that isn't available here, the team will tell you where to go.

How long does a wrist take to recover?

The NHS says recovery from a broken arm or wrist usually takes around 6 to 12 weeks, and longer if the injury was severe. A mild sprain usually feels much better within about 2 weeks. Either way, keep the hand raised above the elbow when you can in the first days, and keep moving your fingers, elbow and shoulder so they don't stiffen.

After a cast or splint comes off, the wrist is usually stiff and weak, and the NHS says a physiotherapist can help. At the Emergency Plus physiotherapy clinic, the physiotherapist works step by step on wrist movement and grip strength, with no referral, 9:00–20:00 daily. For more on rehab after fractures and operations, see physiotherapy after surgery.

Wrist injuries in children and older adults

In children, bones are still growing, and an injury that looks like a sprain may be a small fracture or an injury to the growth plate near the end of the bone. A child who won't use their hand after a fall needs to be checked. In people over 50, a wrist broken in a minor fall can be the first sign of weaker bones; the NHS suggests asking your doctor about a bone health check to help prevent future fractures.

Sources

• NHS — Broken arm or wrist
• AAOS OrthoInfo — Scaphoid fracture of the wrist
• AAOS OrthoInfo — Distal radius fractures (broken wrist)
• NHS — Sprains and strains
• NICE — Fractures (non-complex): assessment and management (NG38)