From Medscape Medical News

Revised Definition Recommended for Wrist Sprain

Larry Hand

Authors and Disclosures

August 30, 2012 — Wrist sprain turned out to be an inaccurate diagnosis in 80% of patients with negative X-rays during a 1-year study at a Norwegian outpatient clinic, prompting researchers to call for a revised definition of wrist sprain, according to a study published in the October 2012 issue of Injury. The researchers also write that magnetic resonance imaging (MRI) should be used to make accurate diagnoses for wrist injuries.

Torbjørn H. Bergh, assistant professor in the Department of Surgical Sciences, University of Bergen, Norway, and colleagues conducted a prospective study involving 155 patients presenting to the Bergen Accident and Emergency Department with acute wrist trauma that required X-rays between November 5, 2009, and November 4, 2010. All 155 patients had normal X-rays. Subsequent MRIs were administered within a median of 1 day (range, 0 - 31 days).

The patients ranged in age from 18 to 49 years (median, 28 years); 85 were men and 70 were women. The right wrists were injured in 85 patients and the left wrist in 70 patients. Falls caused most of the wrist injuries and, again, all of the X-rays were normal. Ordinarily, such injuries are diagnosed as wrist sprain, the researchers write.

Of the 155 MRIs, 125 (4/5) showed pathological findings despite negative X-rays. Per the International Wrist Investigator Workshop sprain is defined as a partial ligament tear or injury. Thirty MRIs were normal.

The researchers found that 44 patients (28%) had a total of 54 fractures and 33 (22%) had a total of 56 bone bruises. Other injuries included 15 ligament injuries, 13 partial tendon ruptures, 8 muscle contusions, 23 uniloculated ganglions of the wrist, and 69 cases of synovitis. The researchers found that only 13% of the patients had ligament tears, or wrist sprain as currently defined.

"Consequently, the clinical and radiological investigations fail to adequately diagnose the complete pathology in wrist sprains," the researchers write. "Alternatively, the diagnosis and definition of a sprained wrist are incomplete and inaccurate according to the present definition and ought to be changed."

They continue, "We also find, like others, MRI to be a good diagnostic tool to identify injuries associated with wrist sprain. Proper MRI modalities enable simultaneous diagnosis of the soft tissue-, ligament- and bone injuries."

Limitations of the study include the possible loss of patients that could have been included, as well as the "various degrees of clinical and radiological experience" of the doctors on call who conducted the examinations, the researchers write.

Nevertheless, they recommend that the current International Wrist Investigator Workshop definition of wrist sprain be revised to "occult partial or complete soft tissue (ligament, tendon, muscle) or bony injury in relation to a trauma with negative X-ray."

They also conclude, "Based on this study, we recommend early MRI of acute wrist sprains with pain or functional symptoms that does not settle within 2 weeks. This will provide a more specific diagnosis, which hopefully will lead to more appropriate treatment."

The authors disclosed support from research grants from the University of Bergen and the Norwegian Research Council.

Injury. 2012;43:1732-1742. Abstract