Scaphoid Fracture

Pathophysiology

The scaphoid is one of the small carpal bones located in the first row of carpal bones, on the thumb side of the hand. This can be triggered by trauma e.g. falling onto an outstretched hand or a direct blow. Occasionally stress fractures can occur but these are generally in high level athletes e.g. gymnasts and shot-putters.

Symptoms

  • Specific pain over the scaphoid near the base of the thumb
  • May have swelling or bruising

Management

  • Activity modification
  • Ice or heat
  • Pain relief
  • Physiotherapy including range of movement, strengthening exercises and splinting
  • Orthopaedic options include immobilisation and surgery

Investigations

  • X-ray to identify fracture will often not be seen straight away after trauma
  • If scaphoid fracture is suspected further imaging may be done such as CT and MRI scans 

Colles Fracture

Pathophysiology

A colles fracture is a break of the radius, one of the bones in the forearm near the wrist. This is often a result of falling onto an outstretched hand and is the most common type of radial fracture. This is more common in those with osteoporosis due to the decreased bone density and in younger populations is more likely to be due to high impact trauma e.g. contact sports, skiing or horse riding.

Symptoms

  • Pain at the wrist following trauma
  • Deformity of the wrist
  • Once fracture has healed- may have stiffness and reduced range of movement of the wrist
  • Pain at end of range movements
  • Loss of strength e.g. picking up kettle, turning keys
  • Pain when weight-bearing through the wrist

Management

  • Activity modification
  • Ice or heat
  • Pain relief
  • Orthopaedic options include plater casting, pins or plates depending on the level of displacement
  • Physiotherapy treatment once cast removed or after 6 weeks to include range of movement and gradual strengthening programme

Investigations

  • X-ray initially to confirm fracture initially and repeated in fracture clinic to monitor healing

Exercises to try:

Thumb Extension

Thumb Extension

With your thumb facing upwards

Lift your thumb away from your fingers and up towards the ceiling

Thumb Abduction

Thumb Abduction Exercise 

With your hand sideways and supported

Keep your fingers still and straight

Take your thumb sideways away from the fingers and then return to the starting position

Wrist extension

Wrist Extension Exercise 

Sitting next to a table with your forearm supported 

Your wrist and hand should be over the edge (with or without a weight)

Palm facing downwards

Slowly raise your wrist up and return to the starting position

Elbow

Wrist Flexion Exercises 

With your forearm rested on a table and wrist/hand over the edge 

With your palm up to the ceiling (with or without a weight)

Bend your wrist up and slowly return to the starting position

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