Diagnosing Hand Sprains & Strains

The hand has many small bones and joints that are susceptible to injury. They are supported by ligaments, muscles, and tendons, which provide stability and movement. When these parts of the hand are injured, they can become sprained or strained.

Although many people use the words “sprain” and “strain” interchangeably, they have different meanings. NYU Langone doctors are experienced in diagnosing and managing both types of injuries.

A hand sprain is an injury to a ligament, the strong tissue that connects bones. In a hand sprain, the ligament has been stretched or torn. This commonly occurs when a person falls on his or her outstretched hand.

Sprains often occur in the ligaments of the proximal interphalangeal joints in the middle of the fingers—hinge joints that help the fingers bend. The ligaments of the thumb’s metacarpophalangeal joint, or knuckle, can also become sprained, especially during a fall in which the thumb is pulled away from the body.

A hand strain is a stretching or tearing of fibers in muscles or tendons, the tissue that anchors muscle to bone. Strains often occur in tendons that connect the muscles of the forearm to bones in the fingers. These tendons are used to either straighten or bend your fingers and thumb.

Although many hand strains occur during sports, such as skiing, everyday activities can cause strains. People who spend a lot of time typing or working with their hands often develop strains.

Hand sprains and strains are classified in degrees, depending on the severity of the injury. If you develop a first-degree injury, you may experience bruising and mild pain, which can affect your ability to perform usual activities. In a second-degree injury, you may notice prolonged pain, swelling, weakness, and a change in the range of motion at a nearby joint, such as the wrist. In a third-degree injury, the ligament, muscle, or tendon tears completely, causing pain and limited range of motion. You may even hear a “pop” as it happens.

You should consult a doctor if you experience severe pain, if any pain lasts for more than several days, or if you have trouble using your hand.

Diagnostic Tests for Hand Sprains and Strains

Your NYU Langone doctor performs a physical examination, moving the hand to check for sensitivity and discomfort and to determine whether your range of motion is impaired. Your doctor may ask questions about your ability to perform tasks that involve the affected hand, your symptoms, and any prior hand injuries.

One or more of the following tests may also be recommended.

X-rays

Your doctor may recommend an X-ray to check for a fracture or the dislocation of a joint. X-rays can also detect changes caused by arthritis, including bone spurs—small bony knobs that can form in joints when the ends of bones rub together. These conditions can cause symptoms similar to a sprain or strain.

MRI Scans

If your doctor doesn’t see signs of a sprain, strain, or other injury on an X-ray but notices the injured joint is unstable, an MRI scan may be recommended to help pinpoint the cause of your symptoms. During an MRI scan, magnetic fields and radio waves are used to create images of muscles, bones, and tissue in the hand.

An MRI can help to show if a tendon or ligament has torn partially or completely. This imaging test can also help your doctor to determine if other injuries are causing your symptoms. Injuries that may be mistaken for a sprain or strain include a bruised bone or a tiny break or fracture in a bone that may not be visible on an X-ray.

Ultrasound

Doctors at NYU Langone sometimes use ultrasound to diagnose hand injuries, particularly tears in tendons. Ultrasound uses high frequency sound waves to create images of tendons and other soft tissue. X-rays cannot produce images of soft tissue.

CT Scans

Your doctor may recommend a CT scan if he or she suspects you have a fracture in the scaphoid bone of the wrist, which is located near the thumb. X-rays typically cannot reveal this type of injury.

In CT scans, a series of X-rays are used to create detailed images of the hand and wrist. People with pacemakers and others who cannot have an MRI can instead have a CT scan.