Scaphoid fractures and Importance of X-Rays

In the world of athletic training especially in the high school setting, there is always the dilemma on when to send an athlete for x-rays after an injury.  I am specifically going to talk about wrist injuries, the scaphoid bone in particular. The wrist joint consists of 8 small carpal bones and two forearm bones (the radius and ulna).  The highest incidence of wrist injuries are usually non-traumatic and diagnosed as a sprain or strain, but because of the mobility and small bones that make up the joint it becomes a more complex injury to evaluate. Some athletes will come into the office or training room complaining of falling on their wrist or getting slashed across the wrist with a lacrosse or hockey stick. They will present with evident abrasion of skin or redness but not swelling and full range of motion (ROM).  What you have to think about is because it presents as more of a sprain/strain there could be more serious issues going on that only an X-ray will reveal.

I am speaking from personal experience having a wrist injury as an athlete that may not have been so severe if an x-ray had been done initially and treated soon after.  From my experience, most of the wrist injuries I treated happened from a fall during competition and landing on the hand/wrist forcing into extension.  The mechanism of injury for my wrist injury was playing football and I was tackled by the opponent, some part of his facemask smashed into my left wrist joint right below the base of the thumb. This specific region of the wrist is called the “Anatomical Snuffbox”. It consists of tendons called the extensor pollicis brevis, extensor pollicis longus and abductor pollicis longus. When the thumb is extended and abducted with resistance the tendons will pop up forming somewhat of a triangle. Beneath this “snuffbox” lies the scaphoid bone, one of the most injured wrist bones in the joint.  In my case, I had limited ROM in my wrist with extension but regained motion soon after. I did not have significant amount of swelling so I had figured an x-ray was not necessary.

Six years pass with on and off pain in left wrist (snuffbox) region with certain motions, mainly in my backswing when golfing. It was to the point where a shooting pain would radiate from my wrist down my forearm and I would drop the golf club in mid swing.  At this point I was ready to get an x-ray and saw an orthopedic hand/wrist specialist and gave me the news that I had a fracture in my scaphoid bone. Due to vascularity of the bone, if the fracture was not repaired, it would become necrotic and arthritic changes would progress quickly.  Because I had waited so long to get an x-ray, surgery was now recommended.  I needed an ORIF (open reduction internal fixation) procedure where a bone graft was taken from my radius and inserted between the fracture.  I was put in a long arm cast right after surgery and a forearm cast for two months.

Physical therapy was done for a couple months to regain strength and ROM.  It really took a full year to not have any restrictions in my wrist when performing activities of daily living, golfing, push ups, etc. but today I have no issues with strength or ROM.  Here in Kailua, our physical therapists are able to provide you with a personalized treatment plan in order to get your wrist back to normal as soon as possible.

X-rays are an important diagnostic to rule out problems that may seem minor at the time but can cause more damage in the long run. Here at Oahu Spine and Rehab, we provide x-ray services at  your convenience. If you or someone you know is suffering from an injury, call now and schedule a complimentary consultation at 488-5555.

References: www.aafp.org, www.mayoclinic.org/carpalbones, www.teachmeanatomy.info

 

 

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