Sports Medicine
Sports Injury Prevention & Rehabilitation

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Scaphoid Fracture

(Also known as a Fracture of the Scaphoid)
What is a scaphoid fracture?

A scaphoid fracture is a relatively common condition characterized by a break in one of the small bones of the wrist known as the scaphoid).
The wrist comprises of eight small bones situated between the forearm bones (radius and ulnar) and the bones of the hand. The scaphoid bone lies in a space between the radius (outer arm bone) and the base of the thumb.
During certain activities such as a fall on the outstretched hand, stress is placed on the scaphoid bone. When this stress is traumatic and beyond what the bone can withstand a break in the scaphoid may occur. This condition is known as a scaphoid fracture.

Cause of a scaphoid fracture
A scaphoid fracture most commonly occurs due to a traumatic weight bearing force through the wrist such as a fall onto an outstretched hand. This may occur with any fall, but is particularly common in sports such as skateboarding or snowboarding (particularly in icy conditions) where a fall onto a hard surface is unforgiving.

Signs and symptoms of a scaphoid fracture
Patients with this condition typically experience significant wrist pain at the time of injury. Pain is usually felt on the thumb side of the wrist and can occasionally settle quickly leaving patients with an achiness of the wrist that is particularly prominent at night or first thing in the morning. Patients with a scaphoid fracture may also experience swelling and pain on firmly touching the scaphoid bone on the thumb side of the wrist. Other symptoms associated with this condition may include reduced grip strength and pain on weight-bearing through the affected wrist.

Diagnosis of a scaphoid fracture
A thorough subjective and objective examination from a physician is essential to assist with diagnosis of a scaphoid fracture. Investigations such as an X-ray, MRI, CT scan or bone scan are usually required to confirm diagnosis.

Treatment for a scaphoid fracture
Treatment for a fractured scaphoid typically involves an initial 8 week period of immobilization in a plaster cast. Following removal of the cast, re-evaluation of the fracture clinically and with investigations such as X-rays is essential to ensure healing. This is particularly important as blood supply to the scaphoid may be damaged during a fracture resulting in significant complications with fracture healing (e.g. delayed healing, non-healing or death of the scaphoid bone due to lack of blood supply). Once healing is confirmed, rehabilitation can begin as guided by your physical therapist.
One of the most important components of rehabilitation following a scaphoid fracture is that the patient rests sufficiently from activities that increases their pain. Activities placing large amounts of stress through the scaphoid should also be avoided particularly weight bearing or pushing activities through the wrist. Resting from aggravating activities allows the healing process to take place in the absence of further damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated. This should take place over a period of weeks to months with direction from the treating physical therapist.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to cause further damage and may slow healing or prevent healing of the scaphoid fracture all together. Immediate, appropriate treatment in all patients with this condition is essential to ensure an optimal recovery.
Patients with a fracture of the scaphoid should perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. The treating physical therapist can advise which exercises are most appropriate for the patient and when they should be commenced.

Physical therapy for a scaphoid fracture
Physical therapy treatment is vital in all patients with this condition to hasten healing, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:
  • soft tissue massage
  • joint mobilization
  • electrotherapy (e.g. ultrasound)
  • taping or bracing
  • exercises to improve strength and flexibility
  • education
  • activity modification
  • a graduated return to activity plan

Other intervention for scaphoid fracture
Despite appropriate physical therapy management, some patients with this condition do not improve and require other intervention to ensure an optimal outcome. The treating physical therapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, extended periods of plaster cast immobilization or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the scaphoid fracture. Occasionally, patients with this condition may require surgery to stabilize the fracture and a bone graft to aid fracture healing.