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Scaphoid Injuries: What You Need to Know About This Small Wrist Bone
- 18 hours ago
- 5 min read
If you've ever fallen onto an outstretched hand and ended up with pain around the thumb side of your wrist, you may have wondered if you've simply sprained your wrist. While that may be the case, one injury that is important to consider is a scaphoid injury or fracture.
The scaphoid is a small bone, but it plays an important role in how your wrist moves and handles load. Scaphoid fractures can also be a little tricky to diagnose, which is why getting the right assessment early on is important.
What is the scaphoid?
The scaphoid is one of eight small bones that make up the wrist. It sits on the thumb side of your wrist, between the radius and the other carpal bones. If you look at the base of your thumb and move toward your wrist, the scaphoid sits underneath an area known as the anatomical snuffbox.
The scaphoid connects the two rows of small bones in the wrist and helps them move together. It also plays an important role in wrist stability and in transferring forces through the wrist and hand. This means the scaphoid is involved in many things we do every day, from gripping and lifting to pushing ourselves up from a chair or putting weight through our hands.
Why is the blood supply important?
One of the reasons scaphoid fractures can be more complicated than other wrist injuries is the bone's blood supply. The blood supply to the scaphoid is somewhat unusual. Much of the blood enters the bone toward the end closest to the thumb and travels toward the part of the bone closest to the forearm. This means that a fracture can potentially interrupt the blood supply to part of the bone, particularly when the fracture occurs closer to the proximal end of the scaphoid.
If the blood supply is disrupted, the fracture may have a harder time healing. This can lead to delayed healing or non-union, where the fracture doesn't heal properly. In more serious cases, a loss of blood supply can result in avascular necrosis, where part of the bone tissue essentially dies.
Over time, an untreated scaphoid fracture that doesn't heal properly can also contribute to changes in the wrist joint and arthritis. This is why it's important not to ignore ongoing wrist pain after an injury. Early assessment and appropriate management can help reduce the risk of complications.
How do scaphoid injuries happen?
The most common way to fracture the scaphoid is through a fall onto an outstretched hand. When you put your hand out to catch yourself, the wrist can be forced backward and a large amount of force is transferred through the scaphoid. This can happen during everyday falls, but it's also common in sports and activities such as cycling, skiing, skating and contact sports.
A direct blow to the wrist or another high-impact injury, such as a motor vehicle accident, can also cause a scaphoid fracture. Of course, not every fall that causes pain on the thumb side of the wrist is a scaphoid fracture. You could also be dealing with a wrist sprain, ligament injury or bone bruise. This is where a proper assessment becomes important.
What does a scaphoid injury feel like?
Scaphoid fractures don't always look particularly dramatic. You may not have much swelling or bruising, and you may still be able to move your wrist. This can make it tempting to assume you've just sprained it.
Some common symptoms include:
Pain on the thumb side of the wrist
Tenderness in the anatomical snuffbox
Swelling or bruising around the wrist
Pain with wrist or thumb movement
Pain with gripping, pinching or pushing
Reduced wrist or thumb movement
One of the things we look for during an assessment is tenderness directly over the scaphoid, particularly in the anatomical snuffbox. If you've had a fall or impact and have ongoing pain in this area, it's worth getting it checked out.
How is a scaphoid fracture diagnosed?
Diagnosis starts with a physical assessment and a discussion about how the injury happened. Your healthcare provider will look at your wrist movement, strength, swelling and areas of tenderness.
X-rays are usually the first step when a scaphoid fracture is suspected. However, this is where things can get a little tricky: a scaphoid fracture doesn't always show up on an initial X-ray. If there is still a strong suspicion of a fracture despite a normal X-ray, your wrist may be placed in a splint or cast while you have further imaging or follow-up. A repeat X-ray may be taken after some time has passed, or an MRI or CT scan may be used to get a better look at the bone.
This is another reason why getting assessed relatively quickly after the injury is important. If a fracture is missed and the wrist continues to be used normally, there is a greater risk of the fracture not healing properly.
What does treatment look like?
Treatment depends on the location of the fracture, how severe it is and whether the pieces of bone have moved out of position. For stable, non-displaced fractures, treatment typically involve wearing a cast or splint to keep the wrist immobilised while the bone heals. Depending on the location of the fracture, this may also include immobilising the thumb. A typical timeline is 4–6 weeks in a cast for a simple fracture, although most wrist fractures may require up to 10 weeks of immobilization.
Fractures closer to the proximal end can be more challenging because of the limited blood supply to this area. Some fractures require surgery, particularly if the bone has shifted out of position, the fracture is unstable, or it isn't healing as expected. Surgery may involve realigning the bone and securing it with a screw or other fixation. Your doctor or an orthopedic surgeon will determine the most appropriate treatment based on the specific fracture.
Where does physiotherapy fit in?
Physiotherapy usually becomes more important once the bone has had enough time to heal and your healthcare provider has cleared you to start moving and loading the wrist. After spending several weeks in a cast or splint, it's very normal for the wrist and hand to feel stiff and weak. You may also notice that everyday tasks such as opening jars, lifting things or putting weight through your hand don't feel quite the same.
Physiotherapy can help you gradually work back toward normal movement and function. This may include restoring:
Wrist and thumb mobility
Grip and forearm strength
Tolerance to loading and weight-bearing
Hand and wrist function
Confidence using the wrist again
Your rehabilitation will be progressed based on how the fracture is healing and what you need to get back to. Someone returning to a desk job will have different demands than someone who needs to lift heavy equipment, play a sport or put a lot of weight through their hands.
For other scaphoid-area injuries that aren't fractures, such as a wrist sprain or bone bruise, physiotherapy may be able to play a role earlier in the recovery process by helping manage symptoms, prescribing a suitable brace and gradually restore movement, strength and function.
Don't ignore wrist pain after a fall
A scaphoid fracture can be easy to mistake for a simple wrist sprain, particularly when there isn't much swelling and the initial X-ray looks normal. But because of the scaphoid's blood supply and its role in wrist movement and stability, it's an injury that's worth taking seriously.
If you've fallen onto your hand and have persistent pain around the base of your thumb or tenderness in the anatomical snuffbox, get it assessed rather than simply waiting for it to go away. The sooner you know what you're dealing with, the sooner you can make sure you're taking the right steps to help your wrist heal properly.
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