Suspected Scaphoid Injury

You will have been directed to this page because you have injured your wrist, but your X‑rays didn’t show a clear fracture (break).

You should have been given a splint to wear on your wrist. It is important to wear this while you have pain.

What is likely to be the problem?

Most of the time, wrist pain after an injury is caused by a ligament injury, known as a sprain.

• The main symptoms from a sprain are pain and swelling.
• These can be severe to begin with but generally improve over 2-6 weeks.
• Some sprains can still take a long time to recover, even though there is no fracture.

Could it be anything else?

In older people, arthritis in the wrist or thumb may be aggravated by the injury. This should be straightforward to diagnose but the pain can take a long time to settle. It is not uncommon for people to have had no pain from the joint before the injury, despite the arthritis being apparent on the X-rays.

Other structures, such as tendons can cause pain following a wrist injury. The pain will often improve with rest but if not, it can always be treated later. However, in the wrist there is a bone called the scaphoid, which can break following an injury. This can be difficult to diagnose and delay in treatment can cause problems.

Unfortunately, X rays only show about 70-80% of scaphoid fractures. Undisplaced fractures are especially hard to see and are only seen on 60% of X-rays.

Although undisplaced fractures generally heal well, around 10% do not heal, even if the wrist is immobilised in a splint or plaster. If the wrist is not immobilised, a scaphoid fracture is unlikely to heal.

What happens if a scaphoid fracture doesn’t heal?

This is known as non-union of the scaphoid and can be treated with surgery. Early surgery is more successful, so it is important to diagnose the fracture as soon as possible.

If the non-union is not treated, the wrist will eventually develop arthritis, though it may only cause few symptoms and may not develop for several years. Read more about scaphoid non-union.

Many patients with wrist injuries and normal X rays are referred for follow up in case they might have a fracture – the so-called “query scaphoid fracture”.

• However, only 1 in 20 of these patients has a scaphoid fracture, and those that do can be treated simply by wearing a wrist splint for 6 weeks.
• Non-union is possible but rare - it affects around 1 in 300-500 patients who are referred with a possible scaphoid fracture.

What should I do with my wrist?

• You should wear the splint all the time (apart from washing) for 2 weeks.
• From 2-4 weeks, gradually reduce using the splint. If you have any pain, continue to wear the splint full time until this improves.
• From 2 weeks, remove the splint three times a day to move your wrist as pain allows (up and down and from side to side) and avoid undue stiffness.
• You should move your fingers as soon as possible and you can use them for light activities (for example, typing).
• You can drive wearing the splint when you feel you are in full control.

When am I safe to go back to work?

It is safe for most non-manual workers to return to work with a splint on and to use the hand as normally as possible with the splint.

For manual workers, light duties using the splint are recommended until pain subsides and grip strength returns. This is very variable, but if you are unable to work normally by six weeks as a manual worker, then you should contact us to arrange an appointment (see below).

When and how should I arrange a review in clinic?

Your wrist should recover according to the following:

By 2 weeks

• You are comfortable in the splint

By 4 weeks

• You are able to do most activities comfortably in the splint

By 6 weeks

• You are pain free and functioning normally without the splint
• You have full wrist movements
• You are able to push up on your hand without pain

If this is not the case, please contact the Trauma Assessment Unit on 0300 422 6726 (8am-7pm) or ghn-tr.traumaassessmentunit@nhs.net who will make you a clinic appointment.