Pain guide · Wrist and hand pain
A sprain is a stretched or torn ligament, and wrists and thumbs are among the commonest places for one. It usually follows a fall onto an outstretched hand or a twist. It can be hard to tell a broken wrist from a dislocation or a bad sprain, and you'll probably need an X-ray.
Check the warning signs first. Then the plan on this page takes you from the first days through moving, stretching, weight through the hands and strengthening, following an NHS wrist rehabilitation programme. After a fracture, follow your team's timings.
Exercise is for pain that has been checked or is clearly mild and settling.
Both cause pain, swelling and bruising. The NHS says it can be hard to tell a broken wrist from a dislocation or a bad sprain, so you'll probably need an X-ray. A changed shape, a snap at the time of the injury, numbness, or a pale or cold hand need A&E.
The scaphoid is a small wrist bone at the base of the thumb, felt in the hollow (the snuffbox) between the thumb tendons when you give a thumbs-up. It usually breaks in a fall onto an outstretched hand, and accounts for about 70% of broken wrist bones. In one adult population, about 29 in 100,000 people broke it each year, mostly young men, most often in a simple fall from standing.
Parts of the scaphoid have a poor blood supply, so a fracture heals slowly and can fail to heal. A first X-ray can look normal, and no examination finding can confirm a fracture, although no tenderness in the snuffbox makes one much less likely. NICE suggests considering MRI as the first scan after a thorough examination; in one trial, an MRI straight away was more accurate, found other fractures more often (22.4% against 7.7%) and cost less by 6 months.
In one Scottish health board, only 0.35% of 1,739 people with a suspected scaphoid fracture needed an operation.
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The commonest wrist fracture is at the end of the radius (a distal radius fracture), usually treated in a splint or cast for about 4 weeks. The NHS says recovery usually takes 6 to 12 weeks, and people over 50 should ask about a fracture liaison service for their bone health. A scaphoid fracture is treated with a cast or surgery depending on where and how badly it is broken; the cast or splint can be needed for up to 6 months, and stiffness afterwards is common.
The NHS advice for the first 2 to 3 days: protect it, rest it, use ice for up to 20 minutes every 2 to 3 hours, a compression bandage in the day, and raise it. Avoid heat, alcohol and massage at first. Once you can move without pain stopping you, keep moving so it doesn't stiffen.
Most sprains feel better within 2 weeks; severe ones can take months. Avoid strenuous exercise for up to 8 weeks.
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An NHS trust programme stages it: active wrist bending, turning and finger work as soon as the cast comes off; passive stretches from about 2 weeks; weight through the hands from 6 weeks after the injury or surgery; then strengthening with weights every other day. It suggests working to about 5 out of 10 discomfort that settles within 30 minutes, and says regular exercise improves the outcome. Another trust's leaflet adds passive stretches such as palms together, lowered in front of the chest, and a hand flat on a table with the body moved over it.
No trials of exercise for a simple wrist sprain were found. The plan below adapts the NHS fracture programme to sprains (editorial): for a mild sprain, move through the stages as comfort allows.
Some discomfort during these exercises is fine and doesn't mean you are doing damage. Keep it to about 5 out of 10 or less. It should settle within half an hour or so, and your hand should be no worse the next morning. If it is, do fewer, smaller or lighter next time, not nothing. An NHS wrist rehabilitation booklet uses the same limit: an unpleasant stretch of about 5 out of 10 that settles within 30 minutes.
Tingling and numbness are different: stop and get advice if an exercise brings them on and they don't fade quickly, or if your grip or thumb gets weaker.
Don't rest the hand completely for long, either: for repetitive strain, the NHS says resting for more than a few days makes the area weaker and less flexible. If a joint becomes hot, red and swollen, stop and get it checked.
Start at the first stage. Each move opens a full guide with a 3D demo.
Days 0 to 3: PRICE, as above. Then, from about day 3 for a sprain or as soon as the cast comes off, move the wrist, fingers and thumb. Also practise the dart thrower's movement (holding a pen, tip the wrist back towards the thumb, then forward towards the little finger, 5 times), and use the hand for light tasks such as washing up, dressing and typing. Doses follow an NHS wrist programme.
3D demoWrist & forearm flowBeginner · No equipment5 to 10 reps, 10 to 15 s holds at each end · Bend and lift the wrist; turn the palm up and down
Harder: Wrist flexor stretch
3D demoTendon glides (hand tendon gliding exercises)Beginner · No equipment4 to 6 of each position, 5 s holds · Up to 4 times a day, as in an NHS leaflet
Harder: Ball squeeze
Thumb lifts and O-sign (thumb base exercises)Beginner · No equipmentA few rounds of the O-sign · Thumb to each fingertip, then slide it down the little finger
Harder: Band finger extension
Move on when: The wrist moves through most of its range and light daily tasks are comfortable.
From about 2 weeks on. Add the prayer stretch (palms together in front of your chest, lower the hands until you feel a stretch, hold 30 s) and assisted forearm turns (the other hand helps the palm turn up, then down, 30 s each way, twice), as in the NHS programme.
3D demoWrist flexor stretchBeginner · A wall2 holds of 30 s · Hand on a wall or a table
Easier: Wrist circles · Harder: Quadruped wrist rocks
3D demoWrist & forearm flowBeginner · No equipment5 to 10 reps · Keep the active movements going
Harder: Wrist flexor stretch
Move on when: The stretches pass the pain rule and the range keeps improving.
From 6 weeks after a fracture, with your team's OK; earlier for a sprain once the stretch stage is comfortable (editorial). Lean through a table or wall with a quarter of your weight, then half, three-quarters and all of it, as in the NHS programme.
3D demoWall push-upBeginner · A wall5 holds of 5 to 10 s · Leaning more weight through the hands each time
Harder: Push-up
3D demoIncline push-upBeginner · A bench or box5 holds of 5 to 10 s · The top position, hands on a table
Harder: Push-up
3D demoQuadruped wrist rocksBeginner · No equipment10 slow rocks in each of 4 hand positions · Lean in only as far as is comfortable at first
Easier: Wrist flexor stretch · Harder: Bar hang
Move on when: You can take your full weight through the hands on all fours without pain lasting beyond half an hour.
Every other day, with a weight you can lift 10 times before the wrist tires. Add the thumb-up wrist lift (forearm resting, thumb on top, tip the hand up towards the thumb with a light weight, 10 reps with 5 s holds) from the NHS programme. Push-ups and carries are editorial.
3D demoWrist curlsBeginner · A dumbbellUp to 3 sets of 10, 5 s holds · The NHS programme's dose
Easier: Wrist-extensor eccentrics · Harder: Seated One-Arm Dumbbell Palms-Down Wrist Curl
3D demoReverse wrist curlBeginner · A dumbbell + A bench or boxUp to 3 sets of 10, 5 s holds
Easier: Wrist-extensor eccentrics · Harder: Seated One-Arm Dumbbell Palms-Down Wrist Curl
3D demoDumbbell forearm rotationBeginner · A dumbbell + A bench or box5 reps, building up
Easier: Wrist-extensor eccentrics · Harder: Dumbbell reverse curl
3D demoPush-upIntermediate · No equipment2 to 3 sets of 8 to 12 · Once knee push-ups are easy
Easier: Wall push-up · Harder: Close-grip push-up (close triceps position)
3D demoFarmer's carryBeginner · A dumbbell + A kettlebell3 walks of 20 to 30 m
Harder: Suitcase carry
Move on when: Grip and push-ups feel normal; the push-up guide covers getting back to yoga, gym work and handstands.
Heat, hot baths, alcohol and massage for the first 2 to 3 days. Body weight through the hand (push-ups, planks, yoga on the hands) before a fracture has healed and you've been cleared: the NHS programme starts it at 6 weeks. Falls risks such as skating and trampolines after a scaphoid fracture until you're cleared. Removing a cast or splint early, or driving or lifting heavy things before you're told it's safe.
Don't ignore pain in the snuffbox after a fall because the wrist moves fine.
You often can't tell without an X-ray, the NHS says. Go to A&E if the wrist has changed shape, you heard a snap, or the hand is numb, pale or cold. Get same-day help if it is very painful, very swollen or you can't use it, or if it is tender at the base of the thumb after a fall.
Yes. A first X-ray can look normal, so you may be put in a splint and checked again, or have an MRI: NICE suggests considering MRI as the first scan after a thorough examination. In one trial, an MRI straight away was more accurate and cost less by 6 months.
Most sprains feel better within 2 weeks; severe ones can take months, and the NHS advises avoiding strenuous exercise for up to 8 weeks. A broken wrist usually takes 6 to 12 weeks to recover.
A support in the first days is part of the NHS's PRICE advice; then wean off it as you start moving the wrist. After a fracture, wear the cast or splint for as long as your team says.
After a fracture, an NHS programme starts weight through the hands about 6 weeks after the injury or surgery, with your team's OK; then follow the push-up guide's stages. After a mild sprain, build back through the stages here as comfort allows.
Yes, if it is tender at the base of the thumb on the back of the wrist: a broken scaphoid can be missed, and a missed one heals slowly. Reassuringly, only 0.35% of people with a suspected scaphoid fracture in one Scottish study needed surgery.
Ice in the first 2 to 3 days, wrapped in a towel, for up to 20 minutes every 2 to 3 hours. Avoid heat, hot baths, alcohol and massage for those first days.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
