Wrist injury
Wrist injury after a motor accident
Wrist injuries range from a sprain to fracture, ligament rupture, carpal instability or nerve injury. The assessment should identify the injured structure and measure the active movements needed for gripping, typing, steering and tool use.
Motor accident injury
How can this injury happen?
Car or passenger collision
Bracing on the steering wheel can force the wrist into extension, while direct impact can fracture the distal radius or carpal bones.
Motorcycle accident
An outstretched-hand fall commonly causes distal radius, scaphoid or ligament injury.
Pedestrian or cyclist impact
A fall or direct blow can produce fracture, triangular fibrocartilage or carpal instability.
Injuries that can occur
- distal radius, ulna, scaphoid or other carpal fracture
- scapholunate or other ligament injury
- triangular fibrocartilage complex injury
- carpal instability or post-traumatic arthritis
- median, ulnar or radial nerve injury
Symptoms and functional problems
- pain with gripping, pushing or weight-bearing through the hand
- reduced flexion, extension or deviation
- clicking, instability or loss of endurance
- numbness or altered sensation in the hand
Seek urgent medical assessment
Deformity, increasing swelling, absent pulse or worsening finger numbness requires urgent assessment.
Clinical evidence
What findings matter?
Fracture union, carpal alignment, ligament stability, active motion and nerve findings should be recorded. Clause 6.66 requires carpal-instability radiographs to be considered only if available and with clinical signs.
| Record or examination | What it may establish | What it cannot prove alone |
|---|---|---|
| X-ray, CT or MRI | Shows fracture, union, carpal alignment, ligament or TFCC pathology. | Imaging alone does not establish instability WPI. |
| Active wrist ROM | Measures flexion, extension, radial deviation and ulnar deviation. | Deviation must be rounded as clause 6.55 requires. |
| Stability and nerve examination | Tests carpal instability and median, ulnar or radial nerve distribution. | Clicking or numbness alone does not establish the method. |
Movement in daily life
How movement affects real activities
Wrist flexion and extension position the hand for gripping and pushing. Radial and ulnar deviation affect tool use, typing and steering. Each active plane has a separate figure.
Flexion and extension
Typing, gripping, pushing up from a chair and positioning the hand for work.
Figures 24 to 26 address active wrist flexion and extension.
Radial deviation
Moving the hand towards the thumb side for tool and steering tasks.
Clause 6.55 requires measurement rounded to the nearest 5 degrees and Figure 29.
Ulnar deviation
Moving the hand towards the little-finger side for gripping and lifting.
Figures 27 to 29 address deviation and require reliable active measurement.
Threshold injury is a separate question: a wrist sprain may be threshold. Fracture, nerve injury or partial/complete ligament or cartilage rupture may be non-threshold if medically established.
Part 6 permanent impairment
How is CTP WPI assessed?
Active wrist ROM uses Figures 24 to 29. Carpal instability may involve AMA4 Table 26, but clause 6.66 requires radiographs and clinical signs; exact row values are not published without the readable AMA4 chapter.
Measurement rules that apply
- Clause 6.50 requires active, not passive, range of motion for the impairment calculation. A goniometer should be used where clinically indicated, and unreliable movement should be repeated consistently before it is accepted.
- Clauses 6.51 and 6.52 permit a contralateral baseline only where the uninjured joint is a fair estimate of pre-accident mobility. The total upper-extremity impairment for each comparable joint is subtracted before conversion to WPI.
- Clause 6.67 prohibits upper-limb strength evaluation and AMA4 Table 34. A genuine peripheral nerve or muscle-bulk injury must use another permitted method without double counting.
| Method | CTP source | When it is relevant | Important limit |
|---|---|---|---|
| Wrist ROM | Figures 24-29; clauses 6.50 and 6.55 | Permanent flexion, extension or deviation loss. | Only reliable active movement is used. |
| Carpal instability | Clause 6.66; AMA4 Table 26 | Clinically and radiographically supported instability. | The exact table row must be verified from readable AMA4. |
| Peripheral nerve method | Clauses 6.58-6.60 | Separate median, ulnar or radial nerve injury. | Table 16 is prohibited. |
- Follow Figure 1 for conversion through hand and upper extremity.
- Apply contralateral comparison only when justified.
- Do not use grip strength Table 34.
What cannot be combined?
- nerve and wrist values unless separate injuries
- instability and ROM for the same consequence without authority
- grip strength impairment
What does not establish WPI by itself?
- MRI ligament signal
- wrist clicking
- pain on loading
- weak grip
Motor accident examples
Distal radius fracture with extension loss
The healed fracture does not set WPI; reliable active wrist movement may quantify the residual impairment.
Suspected carpal instability
Clause 6.66 requires available radiographs to be considered with clinical signs rather than relying on symptoms alone.
Claim file preparation
Evidence checklist
Assessment source
Wrist WPI source
Assessment source: Motor Accident Guidelines v10.1 clauses 6.47-6.60, 6.66-6.67; AMA4 Figures 24-29, Table 26, Figure 1 and Table 3.
Threshold injury: Fracture, nerve injury or verified ligament/cartilage rupture may be non-threshold; uncomplicated wrist sprain may remain threshold.
What the assessor checks
- wrist ROM figures
- deviation rounding
- carpal instability evidence rule
- nerve method
What does not establish the result by itself
- scan signal
- clicking
- pain
- grip weakness
Official sources
Related NSW CTP guides
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Frequently asked questions
- How is wrist deviation measured?
- Clause 6.55 requires radial and ulnar deviation to be rounded to the nearest 5 degrees and read from Figure 29.
- Does an MRI prove carpal instability?
- No. Clause 6.66 requires available radiographs to be considered together with clinical signs.
- Can grip weakness be rated?
- Not under Table 34, which clause 6.67 prohibits.
- Does a scaphoid fracture have fixed WPI?
- No. Union, movement, arthritis and any separate impairment must be assessed by a valid method.
- Can nerve impairment be combined?
- Only where the nerve injury is separate and the upper-extremity combination rules permit it.