Hand and wrist injuries commonly occur during accidental falls. When you fall forward, your natural response is to put your hands out in front of you to catch yourself.
A DxD reader posted a question regarding a wrist injury she had sustained during a trip to Taiwan. The area around her wrist began to swell up and bruise. An X-Ray showed no fracture which led her doctor to believe it was a ligament or tendon injury.
She felt her wrist wasn't recovering well and wanted to know what she could do about it. Dr Jonathan Lee, an established surgeon in Singapore who specialises in hand surgery, responded to the inquiry. Here's what he had to share.
Don't be fooled, the wrist is a complex body part
Cross section of a wrist
To the naked eye, your wrists seem like a relatively small and simple body part compared to the rest of the body. However, that's far from the truth!
Did you know that your wrist is a complicated joint made up of 2 forearm bones, with 9 small carpal bones to 5 hand bones? It is a complex system of articulating surfaces, supported by a network of restraining ligaments.
It's said to be one of the most complex and beautiful pieces of natural engineering in the human body.  The accurate diagnosis of wrist pain and its appropriate management is can be as challenging as back pain.
You have to start with a detailed physical examination
In order to get to the bottom of the issue, it's crucial that you visit a specialist who has a lot of experience in dealing with wrist injuries.
Dr Jonathan explains that this physical examination can put things into perspectives quickly so your doctor can decide on the course of action required.
How did the injury occur?
The first question your doctor should ask you is: what happened? He/she will need a detailed history of how your injury occurred to understand which area to focus on.
Whether it was a high energy trauma (e.g. a fall from a moving vehicle, mountain bike, or from a flight of stairs) or a low energy trauma (e.g. falling on a slippery bathroom floor).
If you experience significant pain, swelling or bruising, that might suggest that there's a fracture of bone or tears in the supporting soft tissues like ligaments.
Background medical history plays a role in injury severity
The age and gender of the patient must also be considered. Older women are more prone to fractures even with lower energy trauma so there'll be a higher risk of severity.
Also, pre-existing injuries to the same area can also affect diagnosis. 
Wrist injuries can be broadly categorised into 2 types
Hand surgeons generally categorise wrist pain into two common types:
- Radial sided (thumb side)
- Ulnar-sided (little finger side)
They are the structures most often suspected for damage by trauma.
Wrist injuries can be determined by the discomfort of wrist actions
Your doctor can pinpoint the type of injury based on which action causes the most discomfort. 
For example, if you experience pain on the ulnar side of the wrist when you twist a doorknob, turn a steering wheel, or when you're chopping vegetables, it indicates to your doctor to check for triangular fibrocartilage complex (TFCC) tear or radio-ulnar ligament tears.
Splint thumb for De Quervain's tenosynovitis
Whereas, if the pain were on the radial side of the wrist, and made worst by thumb extension and radial deviation activities (e.g. pulling up trousers or reaching behind to a bra strap), then a diagnosis such as De Quervain’s Tendonitis could be considered.
Of course, there are many other variations, permutations and possible diagnoses depending on the pattern of symptoms displayed.
Pain that subsides within 3 days is usually not severe
If the pain and symptoms of the wrist injury persist for less than 3 days, Dr Jonathan doesn't consider it to be an issue.
However, if pain persists for more than 3 weeks, medical attention is definitely required as it's an indication that the wrist isn't healing well.
Diagnostic tests may be required for a conclusive diagnosis
Mini MRI System for Wrist and Knee Imaging
These could be in the form of in-depth imaging (like X-Rays or MRIs) or other diagnostic tests like a keyhole wrist scope (known as Arthroscopy) for better visualisation of internal structures.
Active intervention may also be needed, ranging from physical therapy to protection (bracing or splinting, for example).
Pain that persists over 3 months may require aggressive intervention
By this time, the wrist injury will affect your ability to perform daily tasks or, at the very least, keep you from playing sports.
In some cases, it can lead to significant damage so aggressive diagnostic processes and intervention (including surgery) might be required to resolve the issue.
Early intervention can improve symptoms
By managing the injury before it gets any worse, you'll be able to restore stability, minimise long-term damage and restore functionality to the wrist.
Like most other injuries, timing determines how severe the effects will be or how fast your recovery will be.
Article medically reviewed by Dr Jonathan Lee.