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Wrist injuries are prevalent in the winter months because of slipping on the ice and other sports involving falls. A fall on an outstretched hand (FOOSH) can result in a fracture of the scaphoid. The scaphoid bone is located on the thumb side of the wrist and spans across the 2 rows of eight carpal bones found in your wrist. Because of its position, it is the most commonly fractured bone in the wrist. It can be a particularly difficult fracture to not only diagnose, but to heal, due to compromised blood flow to this area.
Symptoms of scaphoid fracture could include:
• A deep, dull ache in the radial part of the wrist.
• Aggravated pain by pinching and gripping.
• Edema and bruising.
• Decreased ROM and strength.
A x-ray, MRI, or CT can be used to diagnose this fracture. It is not uncommon to miss a scaphoid fracture upon initial evaluation, due to the subtleties of the fracture.
Conservative treatment involves casting to immobolise the fracture site, and the length of time in a cast can vary. Surgery may be indicated if the scaphoid does not heal. Surgery is dependent on the degree of the displacement, the angle of the fracture, the type of fracture, if the fracture is in the proximal pole, and if there is ligamentous damage.
Once the orthopedic physician deems that the scaphoid has healed, and the fracture is considered stable, a referral to occupational therapy (OT) can be indicated. Wrist injuries will be stiff, painful, and weak. The goals of OT are to educate the patient regarding precautions of this injury, to decrease pain and edema, to improve ROM, to eventually improve strength, and ultimately to help the patient get back to the things that they enjoy when the time is right. The most important aspect of therapy is to honor the healing time of the scaphoid, starting with baseline functional movements and building up to normal activities, guided by the physician.
At Missoula Bone & Joint the Hand & Microvascular Team comprises of doctors Nicholas Beck, Andy Puckett, and Charlie Sullivan. Our Occupational Therapy Team comprises of Kristin Biggins and Theresa Murray Brooke.
Clementson, M., Björkman, A., & Thomsen, N. (2020). Acute scaphoid fractures: guidelines for diagnosis and treatment. EFORT open reviews, 5(2), 96–103.