The scaphoid is one of the small carpal bones of the wrist and is the most commonly broken carpal bone, responsible for 60–70 per cent of all carpal fractures. It is commonly fractured after a fall on an outstretched hand.Scaphoid fractures account for 10% of all hand fractures, with the average age of patients being in their early Twenties. This is more commonly seen in males due to a fall, sporting injury or car accident.

Bones of the wrist showing scaphoid

Symptoms of scaphoid fractures:

  • Deep dull ache and tenderness at the base of the thumb that may also radiate into the wrist.
  • The intensity of pain increases with movement of the thumb and with gripping something.
  • A decrease in grip strength of up to 50% when compared to the other hand.
Anatomical snuff box in the scaphoid area

The anatomical snuff box

The location of pain is in the hollow at the base of the thumb known as the ‘anatomical snuff box’. This can be felt by making a thumbs up and then feeling in the hollow that forms.

Diagnosing a scaphoid fracture

If a scaphoid fracture is suspected, an X-ray will be done. Often, unfortunately, the initial X-ray doesn’t show the fracture, so if the symptoms persist another X-ray should be taken after 10 days. If a fracture is picked up on the X-ray it can be classified as ‘displaced’ or ‘non-displaced’.

Non-displaced scaphoid fracture

Treatment for scaphoid injuries:

Once the fracture is diagnosed, the treatment may with be conservative or surgical. Non-displaced fractures usually have conservative treatment. Conservative treatment involves a below elbow cast that includes the thumb worn for + 6-12 weeks.

If the fracture is displaced then surgical intervention may be needed to stabilise the fracture. This involves inserting screws or wires to hold the bone in place as it heals. Thereafter the wrist and thumb will be immobilised in a cast as shown below.

Scaphoid fracture plaster cast

Post-surgery scaphoid X-rayHow can Physio help you?

The area of the fracture will be immobilized by the cast, but we still need to maintain the strength and range of motion of the joints above and below. Your physio will give you exercises for the fingers and elbow as well as the shoulder if your arm is held in a sling.

We can also do isometric exercises of the muscles underneath the cast. This involves activating the muscles without moving the joint. To prevent excessive muscle wasting while the wrist is immobilised.

Once the cast is removed:

The wrist will be very stiff. The Physio will use manual therapy to help mobilise the joints and will help you return to your normal range of wrist movement.

After immobilisation, even with isometric exercises the wrist will be weak. Therefore it is very important to see your physiotherapist for strengthening exercises to help you regain your functional strength.

This article was submitted by Kirsty Mackay from the Fourways Practice of Lamberti Physiotherapy. To discuss scaphoid injuries with her or any of our qualified physiotherapists, use the handy appointment form.

References:

  1. Choose Physio for a scaphoid fracture: https://choose.physio/your-body/wrist/scaphoid-fracture
  2. Scaphoid Fractures: https://www.uptodate.com/contents/scaphoid-fractures
  3. Scaphoid Fracture:  https://www.physio-pedia.com/Scaphoid_Fracture
  4. Scaphoid fracture of the wrist: https://orthoinfo.aaos.org/en/diseases–conditions/scaphoid-fracture-of-the-wrist (picture 1,3 and 4)
  5. Bone Broke: https://bonebroke.org/2013/12/24/palpable-anatomy-the-anatomical-snuffbox (Picture 2)