Many common wrist injuries occur due to a fall onto an outstretched hand.
This mechanism can cause numerous injuries, including fractures, ligament sprains and cartilage injuries.
One of the most critical types of injuries to diagnose is a scaphoid fracture. Scaphoid injuries make up 15% of acute wrist injuries and 60% of all carpal fractures.
These can be difficult to differentiate from a distal radius fracture but are essential to diagnose due to the possible severe implications of a missed diagnosis!
What is a scaphoid fracture?
The scaphoid bone is the foundation of the wrist. A scaphoid fracture occurs when the scaphoid bone, one of the eight carpal bones in the wrist, breaks. The scaphoid is the most frequently fractured carpal bone. The scaphoid is the largest bone in the proximal row of carpal bones and forms the radial portion of the carpal tunnel. The scaphoid has a poor blood supply even without injury. Therefore, they can result in avascular necrosis if not managed appropriately with a specific immobilising cast or splint. In this condition, the bone does not receive enough blood to heal correctly, resulting in non-union and possible death of the fractured areas of bone.
Numerous ligaments attach to the scaphoid bone to provide intrinsic support for the wrist. A scaphoid fracture can also cause damage to these ligaments, which can cause scapholunate instability or dissociation.
This can result in long-term wrist instability, loss of range and strength and decreased function without appropriate treatment.
3 Types of scaphoid fractures
The scaphoid can be fractured in three places: at the distal pole, waist, or proximal pole.
The most common type of scaphoid fracture is a scaphoid fracture at the waist, which occurs approximately 70% of the time. This is because most of the force from a fall accumulates at the centre of the scaphoid, causing it to fracture most frequently here.
A proximal pole fracture occurs 20% of the time, while a distal pole fracture occurs 10% of the time.
Common symptoms of a scaphoid fracture
Pain in the wrist and tenderness just below the thumb are common symptoms of a fresh fracture of the scaphoid bone. Swelling around the wrist is also possible. Blood from the fractured bone fills the wrist joint, causing swelling.
The symptoms of scaphoid bone non-union are more subtle. When you use your wrist, you may experience pain. However, the discomfort may be minimal. Doctors frequently see scaphoid bone non-union on X-rays when the patient has no memory of an injury.
These people most likely sustained a wrist injury years ago that they mistook for a simple sprain. However, a gradual increase in pain is the most common symptom of a non-union. Non-union can cause degenerative arthritis in the wrist joint over time.
Physiotherapy treatment for scaphoid fractures
Physiotherapists use specific clinical tests to determine if a scaphoid fracture has occurred, such as palpation of the scaphoid and the scaphoid compression test. If a scaphoid fracture is a potential diagnosis, a referral will be made for a X-Ray or CT scan to confirm the injury.
Management can be non-surgical or surgical. Non-surgical management is used for stable scaphoid fractures and involves cast immobilisation using a short-arm cast. Surgical management is typically only required for unstable and displaced fractures and involves the insertion of a screw or pin to stabilise the fractured area.
If you have a scaphoid fracture, you can benefit from physiotherapy by:
- Cast or splint: Your physiotherapist can fit you with a plaster cast or a thermoplastic splint.
- Rehabilitation: After your cast is removed or after surgery.
- Exercise: Your physiotherapist will be able to provide you with individually designed exercises to help you regain full movement and wrist strength.
- Mobilisation and soft tissue techniques: If you have had limited movement due to a cast or splint during this time, mobilisation and soft tissue techniques will be required.
Final thoughts on physiotherapy for scaphoid fractures
Scaphoid fractures are frequently misdiagnosed as simple wrist sprains at first.
Since the risks of non-union are high (14% to 50% if displaced), this misdiagnosis can result in increased morbidity for the patient.
If untreated, arthritis, deformity, decreased grip strength and range of motion, and instability can develop within five years, resulting in significant disability.
Since these injuries frequently occur in young, active patients, the morbidity and cost implications of disability are significant.
