Management of Wrist Contusion

Initial Assessment and Imaging

The American College of Radiology recommends radiographs of the wrist as the initial imaging for any acute blunt trauma to the wrist, including contusions, to rule out fractures 1, 2, 3
A standard three-view radiographic examination should include posteroanterior (PA) view, lateral view, and 45° semipronated oblique view 2, 4
If initial radiographs are negative but symptoms persist, follow-up imaging may be needed, including repeat radiographs in 10-14 days, MRI without IV contrast, or CT without IV contrast 1, 3, 5

The American Academy of Orthopaedic Surgeons recommends applying ice for 15-20 minutes every 2-3 hours to reduce swelling and pain, compressing the area with an elastic bandage, elevating the wrist above heart level, and immobilizing with a wrist splint in neutral position 6, 7
Administer appropriate analgesics for pain control, as recommended by the American Heart Association 7

Gradually transition from complete rest to controlled movement to prevent stiffness, as recommended by the American Academy of Orthopaedic Surgeons 6, 7
Continue with intermittent ice application as needed for pain and swelling, and begin gentle range of motion exercises when pain allows 7, 8

The American College of Radiology recommends considering MRI or ultrasound to evaluate for occult fractures or soft tissue injuries in cases with persistent symptoms despite conservative management 1, 5

Gradual return to daily activities as symptoms improve, and return to sports or heavy manual labor should be delayed until no pain with resistance is achieved, as recommended by the American Heart Association 7

Failure to obtain appropriate imaging to rule out fractures, as recommended by the American College of Radiology 1, 2
Prolonged immobilization leading to stiffness and contracture, and returning to activities too soon, which may lead to prolonged symptoms or reinjury, as warned by the American Heart Association 7