What is a Scaphoid Bone?
The Scaphoid bone is one of the wrist bones. It lies within the circled area. It lies directly under the snuff box of the wrist at the carpometacarpal joint.
When looking just at a picture of the bones, it is seen in red.
Quickcare or ER?
A fractured scaphoid needs to be adequately splinted and the pain needs to be controlled.
It has been my experience that this can be done in a Quickcare clinic.
The ER would be appropriate if there was an open wound. That is, the skin is cut over the fractured bone.
What was your experience with a broken scaphoid fracture?
What will your doctor ask?Your doctor will want to know your description of your condition. These are your SYMPTOMS. This is YOUR story.
Your doctor will want to know the following:
What happened? Did you fall or did you punch something?
Where is the pain?
What makes the pain better?
What makes the pain worse?
Do you have associated numbness?
What is the pain like? Sharp, dull, throbbing?
Typical scaphoid fracture symptoms include local sharp severe pain at the wrist that increases with movement.
What will your doctor look for?Your doctor will look for objective findings during the examination. These are called SIGNS.
I first look for any open wounds. A cut over a broken bone has a greater chance for infection.
I then look for another serious complication called compartment syndrome. This a swelling within an enclosed space which then leads to cutting off the blood and nerve supply.
During my exam, I then move on to evaluations that can collectively called scaphoid fracture tests.
First, let’s start with the anatomy.
The scaphoid bone is directly under the snuff box of the wrist
- Part of the exam is palpation over the snuff box. This suggests a fracture of the scaphoid bone.
- Then I push directly on the tip of the thumb which pushes on to the scaphoid bone. Again, it suggests a fracture.
After the exam, I will do an X-ray.
As seen in the X-ray below, a hairline fracture is evident
This can be tricky!!! Scaphoid fractures may NOT show up on the first X-ray. Thus, a repeat X-ray in two weeks may be need if their is high suspicion of a fracture. An alternative is an MRI or bone scan.
What is your doctor thinking?Your doctor will create a mental list of the possible reasons for your signs and symptoms. This list is called a differential diagnosis.
When looking at a swollen painful wrist, I cannot tell what is damaged inside. It may be just a sprain.
I keep it simple. My differential diagnosis includes BROKEN BONES and DISLOCATIONS
BROKEN BONES include:
1.Colles Fracture (Distal radius bone fracture that is angulated backward)
2.Smith fracture (Distal radius bone fracture that is angulated forward)
3.Bartons fracture (Fracture and dislocation at the distal radius bone)
4.Triquestrum fracture ( A chip fracture on the back of the wrist)
1.Scapholunate (ligament is torn between the Scaphoid and Lunate bone)
2.Perilunate (Capitate Displaced, Lunate bone is ok)
3.Lunate(Capitate is ok, Lunate is displaced)
What is the treatment of a Scaphoid Bone Fracture?
A broken wrist is bad. But a scaphoid fracture is even worse. A scaphoid fracture is serious. It needs to be splinted with a unique type of splint called a Thumb-Spica splint.
Why? THE BLOOD SUPPLY of the scaphoid bone IS UNIQUE. That is, its vessels actually pass up the bone then feed into it from furthest location. The blood needs to flow to the entire bone or avascular necrosis may develop.
As you can see from the video, the thumb has to be immobilized.
How will long will I need to be treated for a Scaphoid Bone Fracture?
Once a fracture is noted in the ER or Quick care, I refer to an orthopedic doctor or hand specialist. They will convert the splint to a more permanent cast which is to be worn for at least 6 weeks.
Again, the initial X-ray may be negative. Thus, an MRI may be ordered.
Physical therapy may follow.
Let me tell you a Story
Most times a job fits a person and person fits the job. After years on the job, the worker just looks like role he or she is playing.
I once went in the room to see Lourdes who had been injured at the local packing plant. The job entails making boxes with a large stapler. All day long, boxes are hand made for the abundant vegetables grown locally. Our area is so rich, the local vegetables gets shipped to the entire country.
Lourdes did not seem to fit in. Her make up and clothes were very stylish. They had an Eastern flair instead of California casual. She looked like she should be in sales selling Mary Kay or Jafra.
I just had to ask,”Hasn’t anyone ever told you that you should be in sales…or… in business. I mean. You have a decent job but you appear to have so much more to give.”
“My sister tells me that all the time. She said that I am wasting my life making boxes all day,” she said.
I was relieved to know that a relative had the same observation. My question to her could have been misinterpreted. I was only trying show her that I saw something that she did not see in herself.
She was holding her wrist and grimacing. Probably bad timing on my part. That is, I was becoming a guidance counselor at the wrong time.
Her X-rays were negative but two weeks later, a fracture was obvious. Thank God I splinted her in a thumb spica splint.
Lo and behold, something I had said to her stuck with her. Four months later, she dropped by the clinic to help her daughter sell Girl Scout cookies.
I looked at Lourdes.”I know. I know. I am learning from her. I am up next,” she said.
I hope this helps.