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Wrist Sprain
October 2000

Q. A week ago, I was running and I had to stop short on a wet surface which caused me to slip and fall onto my left wrist. The initial pain seemed like a normal jam but I had it X-rayed anyway and the results were negative, and I was told it was just a sprain. The next day the pain was much worse and supination was (and still is) painful. Being involved in sports my whole life, I don't mind the pain too much. What bothers me most is that when I attempt to supinate, my wrist/lower arm creates an audible click seemingly in the region below my thumb, where the hand and the arm meet. Is the pain linked to this click? If so, is it part of the sprain? Will it disappear as the pain disappears? Could it be something more serious?

A. About a quarter of the bones in your entire body are in your hand and wrist. This means that this area is incredibly complex and difficult to see well with regular x-rays. The fact that you have fallen, have extreme pain, clicking, and yet normal x-rays does not mean that this is necessarily just a sprain (though it is the most common diagnosis). If you are continuing to have problems, I suggest that you go back to the doctor at least ten days after the initial x-rays. Oftentimes, after that period of time x-rays that were initially negative have turned positive and can show an abnormality that wasn't apparent earlier. This is important to do because if there is a fracture there, and the fracture goes untreated, it can cause life-long problems.

One particular area of concern is called a navicular fracture, a fracture of one of the bones of the wrist. It is traditionally very hard to diagnose. You can learn more about wrist fractures in general, and navicular fractures in particular, at the following two Web addresses: <http://www.ucbones.com/navicular_or_scaphoid_fracture.htm>
<http://www.ncemi.org/cse/cse0923.htm>

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