Dr. Theodore Homa is an internist practicing in Arlington Heights, Illinois. Dr. Homa specializes in the medical treatment of adults. Internists can act as a primary physician or a consultant to a primary physician. They manage both common and rare diseases. Dr. Homa provides comprehensive care and manages treatment with... more
An Excerpt from Staying Alive – A Manual for Boomers
by Drs. Theodore M. Homa and Ben Gilmore
When a person falls with an outstretched arm, the hand is usually held in the normal or anatomical position. While falling, the hand is reflexively angled upward on the wrist. (Think of the wrist as a hinge here.) The wrist itself is tilted back. The palm of the hand usually opens in a functional posture of extension.
Upon impact, the force of the injury can result in any number of injuries. The simplest of these is a sprain. On impact, the sprain injury is to the supporting ligaments of the radial carpal (thumb side) joint. These injuries cause immediate pain and swelling and stiffness. There is usually normal range of motion. The majority of these will heal with ice, immobilization, and mild stretching exercises within two weeks. A sprain is a diagnosis that can be made by exclusion of a more serious injury. Therefore, both an exam and an X-Ray are necessary.
Scaphoid fractures can often be overlooked or mistaken for a common sprain. They are the most common of all wrist bone (carpal bone) fractures occurring from 60-to-70 percent of carpal fractures.
The risk of delayed diagnosis is the reason that sprain injuries require X-Ray. Standard X-Rays may not be enough to rule out a scaphoid fracture. Special scaphoid view films must be ordered. A delay in correct diagnosis can lead to avascular necrosis, or death, of the scaphoid bone and chronic wrist pain. The key to diagnosis is pain in a region called the anatomical snuffbox. This is an indentation that you can feel on the thumb side of the wrist as you look at the back of the hand just a little over an inch from the point of the angle made by the thumb and index finger. There will be tenderness and pain right at that spot.
Don’t be afraid to ask questions about getting the special scaphoid view while being X-Rayed. Proper immediate care by a primary caregiver should include concern about this common fracture, imaging to rule it out, immobilization, pain management, and referral to an orthopedic or hand surgeon for close follow up.