A scaphoid fracture is a break to one of the small bones in the wrist. The fracture typically occurs after a hard fall on an outstretched arm in an awkward position. Most commonly pain will be immediate with tenderness local to the area. The symptoms may be made worse when trying to activate then muscles and with movement at the wrist. Treatment for this injury is based on the position of the bone post fracture and the section of the scaphoid where the fracture is located. Some parts of the scaphoid have very restricted blood supply therefore commonly healing can be disrupted in some cases.
Anatomy of the hand
The diagram shows the anatomy of the hand. There are two bones in the arm (radius, ulna) that connect with carpals of the hand to create the wrist joint. The scaphoid bone is located at the thumb side on the hand just at the base of the thumb, the scaphoid is important for both stability and motion in the wrist.
Types of fracture
Scaphoid fractures often result in two types of fracture, depending on what category of fracture you have will determine your treatment.
- Non-displaced fracture
Bones stay in correct alignment with the fracture present
- Displaced fracture
Bones of the wrist may have moved slightly with the force of impact. There may be uneven gaps between structures in the hand.
If you are suffering with a scaphoid fracture you will usually have immediate pain and swelling around the base of the thumb on the back of your hand, the pain will be made worse by squeezing, gripping or twisting movements of the wrist and hand. Occasionally pain is not severe and you may mistake a fracture for other wrist pain. If the pain is persistent and does not go away within a day or two it is likely you have a fracture. Early diagnosis and treatment of a scaphoid fracture will help to avoid potential complications.
Top symptoms to look out for:
- Persistent pain for more than 24 hours
- Loss of motion
Treatment and Recovery
Due to the delicate nature of the scaphoid bone with or without surgery you may have to wear a splint or a cast for 6 weeks after injury. This process allows the bone healing to be completed so that range of movement exercises and strength work can begin.
Below is a list of activities that unless told to continue by your doctor you should avoid:
- Participating in contact sports
- Throwing or overhead activities with the uninjured arm
- Using heavy machinery
- Smoking and alcohol use (delayed healing)
- Lifting, carrying, pushing or pulling more than 1kg
Your physiotherapist will provide you with an exercise programme that will allow you to maintain strength and range of motion at the wrist and hand for the duration of recovery. This is important to maintain throughout the whole period as if left, it can cause complications later on in the treatment process.