Scaphoid Fracture Diagnosis

Carpal scaphoid fracture diagnosis can be a somewhat difficult process in some cases. Excluding instances in which there is obvious evidence on routine x-rays, visualizing the fracture line in this carpal bone can often be troublesome, especially in the acute or “fresh” injury.

As we briefly discussed on the Scaphoid Fracture page, many of these injuries are mistaken for wrist sprains and as a result, delays in initial diagnosis, and ultimately treatment, often occur.

In these instances, if months have elapsed since initial injury, it is not uncommon to see x-ray evidence of the body’s attempt to heal the fracture, as well as occasional evidence of some level of avascular necrosis, or bone death if the fracture was displaced to any real extent.

When a patient presents in the physician’s office with complaints of wrist pain secondary top a fall or other wrist injury, getting a clearer picture of the exact location of the pain is a great start. Palpation (physically pressing upon) the area near the base of the thumb and wrist joint called the “anatomic snuffbox” can produce localized pain over the scaphoid.

Another diagnostic tool is the x-ray. There are special “navicular views” that are obtained to provide maximum visibility of the bones of the hand. The x-rays are designed to show multiple views of the irregularly-shaped scaphoid, so it can be evaluated from different angles.

For fractures that are more questionable or difficult to identify, CT and MRI scans can prove to be quite valuable. These studies can show the more difficult to see fracture lines because of how tissue is scanned and interpreted by the respective machines.

In cases where a definitive diagnosis cannot be made, prophylactic (preventative) immobilization; typically casting, can be utilized to put the extremity to rest for a few weeks. If, after cast removal, pain is gone…well, better to be over-treated than under-treated.

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