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sprained wrist still hurts after 6 weeks

Wrist sprain six months ago. New patients can schedule an appointment online and fill out your patient information to save time. Pain still and wrist weak. If pain and swelling persist for more than 48 hours, however, see a doctor. Use two hands to lift and hold heavier objects. Put heat on your wrists for 15-20 minutes. Mild wrist sprains will usually improve with home treatment that includes the RICE protocol: Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, can help reduce pain and swelling. Rotator Cuff and Shoulder Conditioning Program. Sprains, Strains and Other Soft-Tissue Injuries. Dr. Miller: And there are certain parts of the wrist that become fractured, the back, the front, one of the particular bones. Icing and compressing the injured area will reduce swelling. Apply heat to your wrists if the pain continues. Therapy without wires or standalone electrodes, Home Hand/Wrist 4 Things NOT to Do When You Have a Sprained Wrist. Xrays and MRIs are normal but still swelling. A mild wrist sprain can be treated in urgent care facilities using home care treatments. This is especially important if the injury causes persistent wrist pain. All Rights Reserved. The pain occurs in the location of the injury and is often felt in multiple locations around the joint. So maybe for those who wonder if it's fractured they should just have that checked out. 2018American Society for Surgery of the Hand. Even if it is just a sprain, its important to allow it to properly heal before resuming normal activity. According to the American Academy of Orthopaedic Surgeons, some other symptoms of a sprained wrist can include: These symptoms are similar to those of other, and sometimes more severe, injuries that require medical attention. Strengthening the muscles surrounding the wrist joint may help maintain alignment, and stretching may help prevent overstretching in the surrounding muscles and ligaments. This is usually a break of the distal radius, which is one of the two bones in the forearm. Start by clicking on the image below. A grade III sprain - completely torn or ruptured ligament. Daughters wrist swollen for 2 wks 3 days Drs said its sprain then hand & fingers swelled 2 days ago. A fall, a sudden movement, or twisting could cause either injury. They will likely examine the persons wrist and have the person perform movement tests to check for pain and mobility issues. For potential or actual medical emergencies, immediately call 911 or your local emergency service. Most wrist sprains have a positive prognosis. After discussing your medical history and general health, your doctor will ask about any previous injuries to your hand or wrist. Learn about sprained fingers, an injury that causes pain in one or more of the fingers. Instead, healthcare providers sometimes call it the David Letterman sign or Madonna sign. However, in many cases the wrist looks pretty normal, maybe a little bit swollen and it's not as clear. In this case, your surgeon will make a cut in the back of your wrist. Staying in the game: Preventing common hand and wrist injuries in basketball [Blog]. Heart failure: Could a low sodium diet sometimes do more harm than good? We're going to talk about that next on Scope Radio. I tried catching myself with my hand and I think my wrist stretched too far forward. It's on the thumb side of the wrist and about an inch or so right before your wrist bends. Minor sprains can heal in as few as 2 weeks. If the injury involves the tendons that cross the wrist joint or structures deep within the joint, further imaging may be needed such as a magnetic resonance image (MRI) or ultrasound. updated: May 18, 2018 Existing patients, click here. Is it swollen? Dont play through the pain if your wrist hurts during or after physical activity. It will fully heal in 1 or 2 weeks. However, if they cannot tell whether the person has broken or sprained their wrist, they will likely order an imaging test, such as an X-ray. Dont rush your recovery. By using our website, you consent to our use of cookies. Ligaments of the wrist are injured with a sprained wrist. Anyway, I sprained my wrist falling off my longboard about 6 weeks ago. In work-related activities, the highest proportion of people with wrist injuries are in service industries, manufacturing, construction laborers, carpenters, etc. In other words, a person should avoid using their wrist, use an ice pack regularly, compress the wrist, and keep it elevated as much as possible. In the case of a severe wrist sprain with either a partial or complete ligament tear, it is important that the patient is referred to a specialist, particularly a hand and wrist surgeon. Dr. Miller: Is the distal radius closer to the thumb or the little finger? I landed on my hands while goalkeeping. This is risky because it allows you to use your wrist when you should be resting it, potentially making the injury worse. Broken?Sprained?treat? Will I need to immobilize my wrist? Dr. Miller: If you're in an area where a general orthopedic surgeon is available but they don't have a hand surgeon, I don't imagine that some places have access to hand surgeons, is it a good idea to proceed to see a hand surgeon at some point? The ligaments in the wrist help to keep the bones in proper position and stabilize the joint. You need to be evaluated with xrays, because several things could have happened. The wrist is a joint that comprises the carpal bones. That is, could you ice it? These symptoms include: bruising. They will also ask about how the injury . Surgery is followed by a period of rehabilitation that includes exercises to strengthen your wrist and restore range of motion. Resting the wrist by reducing normal activity using the injured arm relieve pain. Continuing to use your wrist after it is sprained may prolong your injury and lead to more pain and discomfort. Never disregard or delay professional medical advice in person because of anything on HealthTap. Could you take ibuprofen or aspirin? Feb 23, 2023. The duration of the swelling will depend upon how. The Terry Thomas sign is a nickname for the extra space that opens between your wrist bones after some types of sprains. In an arthrogram, a special dye is injected into the wrist joint. Appointments 216.444.2606 Appointments & Locations This may involve a wrist brace or a cast for 2-6 weeks, minimizing activity that causes pain such a tight gripping or pushing, and anti-inflammatory medications such as ibuprofen. If you put too much stress on your wrist before its healed, you can reinjure it and have a higher risk of complications and other injuries. Although the ligament usually heals in 8 to 12 weeks, it can take from 6 to 12 months for a full recovery. Reddit and its partners use cookies and similar technologies to provide you with a better experience. Wrist sprains are common during snowfall or ice storms. How do you know if you have a sprained thumb? Most wrist sprains are minor injuries after your wrist ligaments are stretched further than their limit. Would you fall on an outstretched hand? Or can these fractures be handled by a general practitioner? What are the common ways that we get wrist fractures? Wrist sprains are common injuries. I think it's important to know that wrist fractures in general are very common as are wrist sprains. With mild injuries, stiffness is normal once the ligament begins to heal. Can I have done other damage? It's not swollen, and she has full rom. Moving the fingers may help prevent them from becoming stiff. Doctors typically provide answers within 24 hours. As always, discuss your options with your healthcare professional. I injured my wrist a week ago and it still hurts. Sprained wrist symptoms. Diagnosis Your doctor will examine your wrist to see where it hurts and to check how it moves. Tenderness in certain areas may also be consistent with a broken bone. Dr. Tyser: That's a great question. An x-ray showing a gap between the scaphoid and the lunate from a sprained wrist (right) and a normal x-ray of the opposite wrist (left). Wrist jumped on with cleats. The primary cause of a wrist sprain is from a fall on an outstretched hand. I now almost have complete use of my wrist. Visit a healthcare provider if youre experiencing wrist pain and other symptoms that dont get better after a few days of at-home treatments. Privacy Policy. Pain and swelling can develop over several days and may last anywhere from a few days to six weeks. We look at symptoms, treatment, and how to feel more comfortable during, Wrist pain is a common complaint that can have many causes. A wrist sprain occurs when the strong ligaments that support the wrist stretch beyond their limits or tear. Sometimes, a small piece of bone can be pulled off one of the wrist bones, called an avulsion. Created for people with ongoing healthcare needs but benefits everyone. There are eight (8) carpal bones in the wrist and these bones are arranged in two rows. A wrist sprain can occur when the ligaments that stabilize the wrist bones become stretched beyond their normal elastic limit. Dr. Tyser: About six weeks. Never disregard or delay professional medical advice in person because of anything on HealthTap. I am afraid that it is more then just a sprain. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. I went to express care and they took x rays of my wrist they said it was sprained and put me in a brace i think it is broke or fractured because it still hurts and i can kinda move my hand in the brace but it still hurts ? Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Theyll set your bones (place them into their correct position) and repair your damaged ligaments. Cool down and stretch after physical activity. Which is really the most important thing., Hand and Wrist Institute. Orthopedic surgeon and hand specialist Dr. Andrew Tyser lends his expertise on this episode of The Specialists, and explains what to look out for when it comes to wrist injuries. This list of four things to avoid doing when you have a sprained wrist is a good starting point, but as with any other type of injury, follow your doctors recommendations. When a person visits their doctor for wrist pain or a suspected sprain or break, the doctor will likely ask questions to learn more about what happened to cause the pain. Get useful, helpful and relevant health + wellness information. Now, it's probably a 2 on the pain scale. The length of the recovery process and your outcomes will depend on the severity of the sprain. There are eight (8) carpal bones in the wrist and these bones are arranged in two rows. There may be bruising. originally published: April 3, 2016. Doctors typically provide answers within 24 hours. In that case it's pretty obviously going to be a wrist fracture. But if the fall or accident that sprained your wrist caused other injuries, you might need surgery to repair the damage. It definitely hurts and there will be prolonged pain and swelling. The bones of the wrist are held together by cartilage and ligaments these are dense fibrous connective tissues. It may not be possible to prevent all cases of sprained wrists. I went to express care and they took x rays of my wrist they said it was sprained and put me in a brace i think it is broke or fractured because it still hurts and i can kinda move my hand in the brace but it still hurts ? This information is provided as an educational service and is not intended to serve as medical advice. However, if you choose not to seek a diagnosis from a doctor, its important not to underestimate the seriousness of your injury. For example, a person may wish to squeeze a stress ball or other semisoft ball for 1520 seconds and repeat this three times per day to help strengthen the wrist. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Try not to do activities that involve your. That said, this time frame can change based on the severity of the injury or tear. How to Treat a Sprained Wrist Dr. Miller: If you've fallen on your wrist and you think it may just be a strain, is there anything you should be doing between the time you decide that you need to see the doctor? It seems to be a commonly fractured area of all ages. Talk to your provider before resuming physical activities or playing sports. While your body is mending, there are things you can do to help speed up the healing process, and there are also activities you should try to avoid. There's popping too. The wrist may look like it's not straight. Because immobilization may cause some stiffness in your wrist, your doctor may recommend some stretching exercises to help you regain full mobility. Is this a sprain? Wrist sprains usually take from 2 to 10 weeks to heal, but some take longer. Wrist sprains are common injuries that are usually caused by falls or sports injuries. It is very important that the doctor rule out confounding diagnosis since wrist sprain shares similar symptoms with other hand injuries. Wrist pain is often caused by sprains or fractures from sudden injuries. This occurs when the wrist is bent or twisted forcefully, such as caused by a fall onto an outstretched hand. You can usually treat a sprained wrist at home. Inflammation (swelling) is a common symptom of all wrist sprains, as well as wrist fractures, but it varies significantly according to the severity of injury. Fortunately, the solution to this is simply to keep slowly working with the wrist and trying to use it. I tried catching myself with my hand and I think my wrist stretched too far forward. Some may heal with rest, while others may need treatment and/or be chronic issues that have the potential to cause long-term pain in the wrist. During surgery, the hand surgeon will reconnect the ligament. I saw the doctor the day after I hurt my wrist. If you have sprained your wrist, consider renting a cold therapy system for home use. Keep your arm elevated and take over-the-counter anti-inflammatory medications like ibuprofen (Advil) or acetaminophen (Tylenol). We do not endorse non-Cleveland Clinic products or services. How should i treat my sprained hand/wrist after 6 weeks it is still very painful? 14,608 satisfied customers. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, http://blog.handcare.org/blog/2020/10/12/how-to-know-if-you-have-a-sprained-wrist/, https://www.nebh.org/blog/staying-in-the-game-preventing-common-hand-and-wrist-injuries-in-basketball/, https://www.ncbi.nlm.nih.gov/books/NBK551514/, https://ehs.ucsc.edu/programs/ergo/wrist.html, https://www.assh.org/handcare/condition/sprained-wrist, https://www.assh.org/handcare/condition/wrist-fracture, https://orthoinfo.aaos.org/en/diseases--conditions/wrist-sprains/, Cardiovascular health: Insomnia linked to greater risk of heart attack. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Ligaments form the connections between the different bones in the wrist (Figure 1). If left untreated, the fracture may not heal properly and the patient could require a surgery that might have been avoided with early, appropriate treatment. X-rays. Advertising on our site helps support our mission. Is the ketogenic diet right for autoimmune conditions? Proper diagnosis and treatment of wrist injuries is necessary to avoid long-term problems, including chronic pain, stiffness, and arthritis. My 12 year old daughter hurt her wrist in gym class. Have sprained wrist in the past few years. Ligaments are strong, fibrous tissues that connect bones to other bones. People can also take steps to prevent wrist sprains by avoiding walking on icy or slippery surfaces and by wearing appropriate wrist guards when engaging in activities that may injure the joint. I sprained my wrist over a month ago, I have been using a wrist splint but it still hurts extremely bad. 22 Female White 90 lbs 4 foot ten Inches tall I have bipolar disorder, taking prozac and lamictal Anyway, I sprained my wrist falling off my longboard about 6 weeks ago. Someone slamed a door on my wrist my wrist went back a little and doctors said its sprained been 2 weeks now still hurts bad and it pops bad? Knowing what to do, and what not to do, after sustaining this type of injury may help you heal faster and help prevent future injuries. If not a lot better in 7-10 days seek medical attention and demand an xRay. Dr. Miller: Now there are many bones in the hand and sometimes if you have a fracture it may not be quite obvious and I think that's one of the things you were saying. Is this still a sprain? Some specific causes of sprained wrists can include: According to the American Academy of Orthopaedic Surgeons, outdoor activities and sports are common causes of injuries to the wrists. I dont often write reviews for Doctors offices..But this office is really exceptional in terms of service and my wrist is now great! Although x-ray will not show the ligaments, it can be used to rule out other diagnoses. Consider immobilizing your wrist with a brace or splint to prevent movement in the joint. Cookie Notice If more information is needed, a magnetic resonance imaging (MRI) scan, computerized tomography (CT) scan, or arthrogram may also be ordered. Ice: Fill a bag with ice and put it on the . In some cases, if a sprained wrist does not improve after a period of waiting, your doctor may order additional imaging to see if there are injuries that cannot be seen on x-ray or during a physical exam. Dr. Tyser: I think typically for people that do have a wrist fracture who initially don't realize it, they'll come to realize that within the first few days, within a week I would say. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Ask your provider how often you should wear a brace or splint, and how long youll need to wear it. Redness and warmth are often observed in recently sprained wrists. It will fully heal in 1 or 2 weeks. Dr. Tyser: I would and I think that's a good summary of the recommendations. That is, could you ice it? Wrist injuries are common and can happen to anyone during everyday activities. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Get answers from Hand Surgeons and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. Treatment for a wrist sprain depends upon the severity of the injury. If you dont, you may prolong the discomfort and possibly worsen the injury. Surgery may involve a minimally invasive procedure called arthroscopy. What is the long term consequence of that? The pain occurs in the location of the injury and is often felt in multiple locations around the joint. Falls (especially catching yourself from a fall with outstretched hands). When the cast comes off, it is very common to have significant weakness and stiffness. According to the American Society for Surgery of the Hand, the two most common ligaments that people sprain are the scapholunate ligament (which is located in the middle of the wrist) and the triangular fibrocartilage complex (which is located near the outside of the wrist). Hi, I'm Dr. Tom Miller and I'm here with Dr. Andrew Tyser and he is an orthopedic surgeon specializing in hand care and hand surgery. Is exercise more effective than medication for depression and anxiety? A physical and occupational therapist can help patients who have undergone surgery for wrist sprain to recover fully. However, if a persons symptoms do not improve within around 6 weeks, they should talk with their doctor. What would you recommend? Specifically: A grade 3 tear requires medical attention. Other tests. You might also need magnetic resonance imaging (MRI) or a computed tomography (CT) scan. Dr. Miller: And how would you get that fracture? Dr. Miller: How would somebody know if they might have a wrist fracture versus a sprain of the wrist? A sprain is a partial injury to a ligament. Usually in that case, if the pain subsides over the next few days, it's typically considered a wrist fracture. For most people, a sprained wrist is both inconvenient and uncomfortable. Wrist injuries are common and can happen to anyone during everyday activities. Antetokounmpo mostly refrained from playing . Ignoring continued pain can lead to severe issues. A wrist sprain is often characterized by pain, tenderness, swelling, and stiffness of the wrist joint. These provide stability to the joint and also aid movement of the wrist. What you should do instead: Rest your body, especially your wrist, and stop any activity that causes pain. X-ray imaging will show bone fractures and wrist bones alignment. You may sprain your wrist if you fall onto an outstretched hand. First, it may occur after a lifetime of normal every-day use of the hand. This injury can sometimes destabilize the wrist. Symptoms such as pain, swelling, bruising and loss of strength or stability are common with mild (grade 1) to moderate (grade 2) wrist sprains. What you should do instead: Perform stretches and strengthening exercises to help prevent future wrist sprains. Often, treatment can consist of applying ice, resting, and taking over-the-counter pain relief medications. The primary cause of a wrist sprain is from a fall on an outstretched hand. Look for inflammation. Most sprains heal without any problems in six to twelve weeks. According to the American Academy of Orthopaedic Surgeons, a person does not typically need to undergo surgery for a wrist sprain. During sports or other physical activities: Follow these general safety tips to reduce your risk of an injury: You should expect to make a full recovery after a sprained wrist. Theyll insert tiny instruments to repair the wrist joint and its ligaments. Carpal tunnel syndrome causes aching, numbness and weakness. For athletes, sprains and other injuries to the wrist or hand account for 3% to 9% of all sports . You can treat most wrist sprains at home with rest, ice and over-the-counter (OTC) medicine. Or if it's not a bad fracture sometimes just a splint placed and are advised to follow up with an orthopedic hand doctor. Find a doctor or location close to you so you can get the health care you need, when you need it. Many general orthopedic surgeons are more than qualified to take care of the routine, distal radius and other wrist fractures. Some patients have reported a popping sound in the wrist. All rights reserved. How do I treat my sprained hand/wrist? It might be hard to move or use your affected wrist. Once the pain went down, I discontinued the wrist brace, advised that I needed to give my wrist movement and use to rebuild muscle. The doctors said it will pass and it isn't broken-just by looking at it. MRI scan and CT scan aided by an arthrogram, a special dye that can be injected into the wrist joint to assess ligament tears, can be used to obtain accurate pictures of the wrist and ligaments. Created for people with ongoing healthcare needs but benefits everyone. The purpose of the exam and x-rays is to make sure there are no broken bones, dislocated joints, or signs of a full ligament tear (Figure 3). Wrist Sprain., www.health.harvard.edu/a_to_z/wrist-sprain-a-to-z, Sprained Wrist Treatment, Symptoms & Prevention.. Your body needs time to heal. Articular cartilage and ligaments allow the bones of the wrist to slide along each other while in a proper position. If symptoms do not improve after a reasonable period of time, additional imaging may be ordered to look for a more serious injury. Ice and a splint or gentle wrap may be helpful for the first few days after a wrist sprain. Talk to a healthcare provider before taking pain relievers for more than 10 days in a row. Could it be more than a sprain? Call your doctor or 911 if you think you may have a medical emergency. How to know if you have a sprained wrist. When I fell my right wrist hurt like crazy as well and could hardly move it or grip stuff or turn taps/bottles etc for about 2 weeks. The most common causes include: Its much less common, but certain health conditions can put enough pressure on your wrist ligaments to stretch them and cause a sprain, including: The most common complications are other injuries that happen when you sprain your wrist, including: A healthcare provider will diagnose a sprained wrist with a physical exam. Wrist tendonitis is the inflammation of a tendon within the wrist. In total, the wrist joint links fifteen (15) separate bones. Rheumatoid arthritis, gout and other forms of arthritis can make wrists tender and swollen. There are many ligaments in the wrist that can be sprained. To learn more, please visit our, , ligamentous damage, inflamed tendons.Usually diagnostic studies such as x-ras and. I can't use the wrist/hand to support weight, like I can't use it to support my weight if I were trying to get up from a sitting position. American Society for Surgery of the Hand. Ligaments are bands of tissue that help connect bones, joints and organs and hold them in place. A grade II sprain - more serious but still incomplete ligament tear, with some joint looseness. Make sure your home and workspace are free of clutter that could trip you or others. In this weather condition, the ground is slippery and the chance of a slip is high. Created for people with ongoing healthcare needs but benefits everyone. Your symptoms like pain and swelling should improve as soon as you start treatment. Most home care treatment will aim to reduce symptoms of the injury until the ligament heals naturally. Kimball, H. (2015). Your provider will diagnose your injury and suggest treatments thatll get you back to your usual activities as soon as possible. And many of these fractures are able to be treated with conservative measures, such as casting or even splinting. For severe wrist sprain involving a partial or a complete tear of the wrist ligament, an orthopedic surgeon will perform surgery on the wrist. 1998-2023 Mayo Foundation for Medical Education and Research. Symptoms of a broken wrist are the same in both children and adults. Many problems can cause wrist pain. However, there are some steps a person can take to reduce their risk of injury. In order to treat a wrist sprain correctly, the doctor must determine the grade or severity of the sprain. Symptoms of a wrist sprain are: Pain Swelling Tenderness and warmth around the injury Feeling a popping or tearing in the wrist Bruising Loss of motion Weakness To diagnose a wrist sprain,. Consultant Cardiologist. If the pain persists for more than a few days or if your medication isnt helping, talk to your doctor to ensure you have been properly diagnosed. What is the latest research on the form of cancer Jimmy Carter has? I do also have hypermobility in both of my wrists. Although an x-ray will not show the ligaments themselves, it can suggest a ligament injury if the wrist bones do not line up correctly. The wrist is usually bent backwards or into an abnormal position. How do you treat sprained hands and wrists? About 3% to 9% of sport-related injuries are wrist or hand injuries. from the American Academy of Orthopaedic Surgeons, A feeling of popping or tearing inside the wrist. There are 20 ligaments in your wrist that support your eight wrist bones. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Located out of the area? The most common symptoms of a sprained wrist include: Anything that puts enough force to stretch or twist your wrist ligaments too far can cause a wrist sprain. (2020). No. Sprains are usually painful. A doctor will assess the wrist, looking for swelling, bruising, deformity, tenderness, pain in movements, etc. Two weeks ago I had a cycling accident to which I fell off and knocked my on hand hard on the ground. What is your thought about that? When can I resume physical activity or play sports again? Go to the emergency room if you experience trauma or think you have a broken bone. A sprained wrist is usually treated without surgery. Other symptoms may include: Even a wrist injury that seems mild with minimal swelling could still involve a torn ligament and require surgery to avoid long-term problems. By contrast, a sprained wrist affects a persons ligaments. Get news & offers from Mayo Clinic Sports Medicine, Mayo Clinic Orthopedics and Sports Medicine. Sprained finger: Everything you need to know. Often, the cause of a sprain is a sudden twist, impact, or movement that overstretches or pushes the wrist in a direction that it does not typically go. My wrist hurts when I put weight on it, particularly when it's bent backwards. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. ">, DNV GL Public Information Policy Statement. For these, please consult a doctor (virtually or in person). This is true of all orthopedic injuries. Nerve or blood vessel damage. Sprains can range in severity. It hurts, mildly, if I bend it in any direction. A wrist sprain is often characterized by pain, tenderness, swelling, and stiffness of the wrist joint. Surgery involves reconnecting the ligament to the bone or using a tendon graft to reconstruct the injured ligament. Wrist sprains are common injuries. I think it really depends on the community and also the training of the person taking care of the fracture. Since most wrist sprains are due to falls, slippery floors, age, muscle weakness, poor eyesight, poorly fitting footwear, trauma, and wrist overuse predispose people to damage the ligament that holds the wrists. If it's not, that may be a good time to get evaluated. This is especially true for athletes who do repetitive motions or other activities that strain the wrists. All material on this website is protected by copyright. X-rays are often taken. According to one article, a doctor may be able to diagnose the issue with an examination.

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