Case Study – Declan McNamara
Last November I fell on my wrist playing indoor soccer. I felt a sudden sharp pain over my snuff box.
Later that day I went to the Emergency and it was suspected that I had fractured my scaphoid. I received an x-ray and was placed in a cast. The x-ray was inconclusive so I was instructed to get a CT scan which also was inconclusive.
3 weeks later I had a repeat x-ray and it was confirmed that I had a fracture through the waist of the scaphoid.
I was instructed to remain in the cast for a further 6 weeks to immobilise the wrist to allow the bone to heal.
After 6 weeks wearing a cast I was sent for another CT scan. Which showed the fracture had not healed and there was early signs of avascular necrosis. I was then recommended to have surgery.
At the beginning of February I had an open reduction internal fixation procedure and had a plate attached to my scaphoid to stabilse the bone and allow the bone to heal properly.
Currently it is 6 weeks post surgery and I have my follow up appointment next week where I will receive further scans that hopefully say the wrist has healed. Following this I will commence physiotherapy.
What is a scaphoid fracture?
The scaphoid is the cornerstone of the wrist and is integral to the proper functioning of the wrist. The scaphoid is a small bone located in the wrist and is commonly fractured with a fall onto an outstretched hand.
The main symptoms are pain, tenderness and swelling located over the area just below the base of the thumb (anatomical snuff box).
Depending on the severity of the fracture treatment can range from casting to surgery.
Due to the poor blood supply to the proximal portion of the scaphoid the healing process can be slow and can even lead to death of the bone (avascular necrosis).
If you have fallen on your wrist and you have persistent pain over the snuff box area it is important to seek medical advice and get an x-ray!!
In some cases scaphoid fractures do not show up initially so if your physio or doctor suspects there is a fracture it is recommended that you wear a cast for 2 weeks and then have a follow up x-ray.
The length of healing time depends on the location of the fracture in the scaphoid. Distal scaphoid fractures (closer to the thumb) can heal much quicker (6 weeks) however fractures in the proximal aspect of the scaphoid (further away from the thumb) can take much longer (3 months or more) to heal.
If the doctor suspects that your scaphoid fracture is displaced or at risk of avascular necrosis then they may recommend surgery.
Should you have concerns about a recent or even long standing wrist injury that is still given you discomfort, Chelsea Longbeach Physiotherapy can help.
We can refer you for an XRay immediately or provide advice on which surgeon to see.
Please contact our lovely administration staff on 9772 0672.
Physiotherapist Declan McNamara