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Forum Name: Bone trauma and fractures

Question: Scaphoid problem? Injury from one week ago-not better


 shel - Thu Jan 01, 2009 12:57 am

Seven days ago I fell on a icy step and hurt my wrist. It became very swollen and bruised. I figured it wasn't broken, maybe sprained and there is no bone deformity. By the next day the pain was worse so I went to the ER. They took an xray of the scaphoid and top of wrist. Xrays showed no fractures. ER doctor gave me pain meds, told me not to use my wrist. That is all that was said and I left. No splint applied ( I figured if there isn't a fracture they would likely not splint it anyways).

Time has passed and I still have a lot of pain, bruising and swelling. The majority of pain is in the scaphoid area. My neighbour told me that if there is a problem with the scaphoid such as a fracture, they don't always show up on an xray, hard to diagnose.

Injury is to my right wrist, my dominant hand. If I try to grip a pencil it hurts in that area. Pressing in that area causes pain ( I don't make a point of pressing there, just testing pain area a few times).

Should I wait this out longer, for another week or more or should I be seen by someone else soon?

I don't see any deformity except I am guessing swelling is causing my whole hand (when you look at it palm side up)to curve somewhat to the left.

I keep it elevated and applying ice packs.

Thanks for your help
 Tom Plamondon PA-C - Sat Jan 03, 2009 1:49 pm

User avatar You are doing the right things by keeping the hand elevated and ice packs. Limited use of the hand according to pain level is also important. An ACE wrap or splint would help support the hand and control swelling.

Scaphoid fractures are notorious for hiding. A repeat xray or an MRI will be needed.
Scaphoid fractures are also notorious for not healing (depending on where the break is).
So it is important to follow up in a week unless the hand becomes cold and numb in which case see physician ASAP.

Keep us posted.
 shel - Wed Jan 07, 2009 9:43 pm

Thank you for your response.

I headed to a travel/sports medicine clinic. Xray was taken. Doctor said I may have a crack in scaphoid but he isn't one hundred percent sure and gave explanation about the difficulty of the bone, hiding etc. He decided to put a plaster cast on me for three weeks and then I will have follow up xray. He said if follow up xrays don't show break, still in pain,scaphoid symptoms he may put me in a splint.

I was wondering why this bone is difficult to heal? Location or size of it?
 Tom Plamondon PA-C - Thu Jan 08, 2009 7:17 pm

User avatar Hello,
The scaphoid is located in the hand near the base of the thumb. Notoriety for poor healing with this bone depends on where the break is. Nearest to the thumb the bone has good blood supply so heals well. Breaks in the middle of the bone or farthur from the thumb has poor blood supply so does not heal well.
Hope this helps.
Let us know how it turns out.
 shel - Sun Jan 11, 2009 3:55 pm

Update..

I'm not sure if what I'm experiencing is normal. I have pins n' needles sensations in my thumb, index, middle finger for the past few days. My plaster cast isn't too tight. I can stick a finger underneath the top of it near knuckles and base area which is my forearm area easily. I have slight swelling but nothing that is uncomfortable. What could be causing this and is it normal with this type of injury?
 Tom Plamondon PA-C - Mon Jan 12, 2009 7:25 pm

User avatar Hello,
Pins and needles in the first three digits is not necessarily the result of a scaphoid fracture.

It is important to maintain mobility in the elbow, shoulder and neck. Wearing a cast and/or arm sling can cause strain on these areas and potentially neurological problems (such as pins and needles).

Have a physician look at your neck and make sure the arm reflexes, sensation, and neck posture, strength and mobility are not compromised.

Keep us posted.
 shel - Mon Jan 19, 2009 8:28 pm

Update..

The pins n' needles became worse and all my fingers, thumb were afffected. I contacted the doctor who treated me. I came in and he said that he wanted the cast changed but I would have to go elsewhere since he is limited in supplies. Figured another cast clinic would have fibre glass casts etc. I phoned one place and they needed a referral. He wrote me one that basically said date of injury, he had strong suspicion of scaphoid fracture despite normal xrays and to please change the cast.

I made an appointment with this other clinic and gave them the referral note. They removed the cast, took xrays. The orthopaedic doctor on duty asked me how it was injured, I explained what happened, where the pain is, casted for past two weeks etc. The referral letter was in front of him which he looked at quickly. He looked at the xrays and said hmm can't see anything, hard to say. The ortho started to walk out of the room and said 'no need to see me again' and was gone. Didn't see him around to ask anymore questions. I mentioned to the cast technician in the hallway about getting the cast replaced according to the doctor referral note which is on my chart. He said if the doctor didn't mention a cast change I guess he doesn't want it done. The doctor had already left for the day.

I contacted the doctor who originally saw me. He is away on holidays and I do have an appointment that was booked a few weeks ago to see him next week.

So basically I have nothing on my wrist. I don't want to wear a cast if I don't need it but at the same time if something is going on like a scaphoid problem I'm a bit worried.

Is there anything I should do? I have pain in the scaphoid area and take tylenol 3 when needed, try to avoid using wrist too much.
 Tom Plamondon PA-C - Wed Jan 21, 2009 12:07 pm

User avatar Hello,
Did the pain, pins and needles, change after removing the cast?

Again, it is important to consider the entire limb and neck to screen for any musculoskeletal or neurological problem.

Keep us posted.
 shel - Wed Jan 21, 2009 5:02 pm

After the cast technician removed the cast I notice a positive difference with the pins n' needles sensations while waiting to see the doctor. Cast technician said cast was likley tight and if another one is put on he will make sure it is not too tight. Since it has been off for the past few days, pins n ' needles are gone. But I do have pain in the scaphoid area.
 Tom Plamondon PA-C - Mon Jan 26, 2009 11:30 am

User avatar Hello,
Thanks for the update. Sounds like the cast may have been causing the tingling.

So another 3 weeks of caution with this hand and then a re-xray would be appropriate. Maintain range of motion in the digits (gently opening and closing hand) with the wrist in neutral is important.

Some contrast baths may also help with the pain. 10 sec in warm water then 10 sec in cold water. Alternate for 10-15 minutes. Promotes circulation and pain control.

Keep us posted.
 shel - Tue Feb 03, 2009 10:14 pm

I headed to a different clinic today and was xrayed again. The doctor said it appears my scaphoid is fractured. Looks like a hairline/crack. I'm in a cast for three weeks and go back for a follow up.

Someone said a hairline of the scaphoid is more serious compared to hairlines of other wrist bones because of the type of bone it is, location and blood vessels around it? I'm not worried, just more curious whether this is true or not?
 Tom Plamondon PA-C - Wed Feb 04, 2009 7:16 pm

User avatar Hello,
Fractures of the scaphoid closest to the thumb heal better due to better blood otherwise the bone has poor blood supply thus potential for poor healing.
Keep us posted.

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