Slipping on ice and other non-specific accidents are quite common this time of year and most often involve shielding yourself with an outstretched hand. We generally don’t think twice about injury, moving on instead to forget any embarrassment of the fall. These falls are common and generally insignificant with most wrist pain resolving rapidly and uneventfully.
Falls to an outstretched hand usually result in mild if any injury to the hand and wrist but a visit to the doctor usually only occurs with debilitating wrist pain, dysfunction or deformity. Scaphoid fractures are not too common but easily missed especially in young adolescent males and athletes. The typical presentation is a fall on an outstretched hand with a negative initial x ray and a persistent dull pain that is not debilitating. The key difference is the lack of follow up exam and a lack of knowledge on their treatment
The scaphoid bone is the cashew shaped wrist bone tucked into the middle of the wrist that serves as a mechanical extension to the thumb offering support to the entire wrist. Injury to the scaphoid is often missed due to a combination of factors that may include an initially normal x ray, a poor history and exam, a low index of suspicion and little to no pain or dysfunction to the wrist. Most commonly, the scaphoid fracture presents initially with mild wrist pain without knowledge of a fall or injury. The index of suspicion by the treating physician as well as a few simple exam requirements by an experienced physician is the key to getting an accurate diagnosis and the recommended treatment.
Easy to remember guidelines for wrist and possible scaphoid injury is to always seek treatment for wrist pain due to a fall resulting in pain and to follow up with the initial physician if the pain persists despite a negative x-ray. Consider the following symptoms as your guide to follow-up:
- Persistent dull wrist pain
- Loss of grip strength
- Pain with wrist flexion
These fractures when missed can result in years of chronic non resolved pain, weakness and arthritis often requiring surgery. Two weeks of persistent wrist pain despite a negative exam and x-ray merits a comprehensive wrist exam by a well-trained and knowledgeable clinician. Further testing may include splinting, MRI of the wrist and possible referral.