Q: I am a 35-year-old man. I fell and injured my wrist a few weeks ago playing a sport. It didn’t appear to be broken as there was no discolouration and little swelling, and I didn’t feel anything “crunch,” so I presumed it was just a sprain and bandaged it up. However, it is still painful to use my right hand. Do you think I should get an X-ray to see if there is a fracture?
A: A doctor would ask you to describe exactly how you fell, as this is important in determining whether you have a fracture and where it might be. Most adults fall with their hands stretched out to save themselves. Although this manoeuvre does protect the head and face from injury, sometimes it is better to let yourself sprawl flat on the ground.
Read Also
Rural emergency room closures continue to be vexing problem
Staffing issues are at the root of disruptions and closures in hospital emergency departments, both in rural and urban Canadian locations.
Putting all of your weight on an outstretched hand can lead to a Colles fracture of the wrist. This is a break in the lower end of the radius bone of the arm at the wrist. Typically with this injury there is what is known as a “dinner fork” deformity, as the arm bone arches up like the back of a fork. This is due to the bones overlapping after they break. As a result, the doctor would have to reduce the fracture by pulling the bones straight. You cannot do this yourself as it requires some degree of expertise, and an anesthetic is needed. Really severe fractures may even require pins to be placed to hold the pieces of bone together. A splint or cast is used to hold the bones in position until they heal, which takes about six weeks.
Since you do not describe any obvious wrist deformity or swelling, I believe you may have suffered a fracture of the scaphoid bone. It is quite common for a person to attribute this injury to a sprained wrist.
The scaphoid bone is one of many small bones in the wrist and is located just below the base of the thumb. A break of this bone accounts for more than half of all wrist fractures and is a common sports injury in young men. Falling on the outstretched hand also causes this, but the wrist must be bent at a 90-degree angle or greater for this bone to break. If the angle is less than 90 degrees, the radius (arm bone) will break instead.
Typically, the pain goes away after a few hours and then returns as a dull ache. Gripping anything will be painful. The doctor can cause pain by pressing on the area on the thumb side of the wrist just between two tendons of the thumb and forefinger.
Scaphoid fractures can pose problems because they do not always show up on an X-ray. In your case, it should show up by now. Such breaks can also be slow to heal because the blood supply to this bone is not good. Your wrist should be immobilized in a cast or splint for a week or two because an untreated scaphoid fracture can lead to arthritis later on.
Clare Rowson is a medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
