The ‘Query Scaphoid’ Injury

The scaphoid is the most commonly injured bone within the wrist, but frequently difficult to assess on X-rays. In addition, other damaged or bruised structures around the wrist can give similar symptoms. The term “query scaphoid” injury is a term given when symptoms and signs are consistent with a scaphoid fracture, but the X-ray does not show a fracture.

The Scaphoid Bone
Normal Wrist Xray

What is injured?
The common causes of wrist pain with a “query scaphoid” diagnosis following injury are:

1) Ligament Sprain – this means a stretch or small tear or one of the wrist ligaments
2) Bruising of the cartilage or bone
3) Occult fracture – This is a fracture which is not seen on xrays.

These are all STABLE injuries. This means that the injury will generally heal in exactly the same position as normal.

The problem is that scaphoid fractures carry a risk of non-union (where the bone does not heal), and this risk is believed to be increased if the wrist is not immobilised early. For this reason, splinting of this injury is recommended until pain settles or such time that ongoing splinting does not influence outcome (usually by around 6 weeks).

What are the symptoms?
The symptoms from all these injuries are pain and swelling over the thumb side of the wrist, and difficulty using the wrist. These symptoms can be severe to begin with but improve with time.

How long will it take to heal?
Mild injuries often resolve within a couple of weeks, but more severe injuries such as an occult fracture can take many weeks or sometimes months to heal. Smoking can delay this process, and is one factor that increases the risk of non-union of the scaphoid. Generally, symptoms follow a pattern:

Two weeks after the injury, the wrist may still be swollen, but should feel comfortable in a splint.
By four weeks, the swelling should have gone down, and the splint should no longer be required except for periods of heavy activity.
Six weeks after the injury, normal function should have returned.
If the symptoms do not follow this pattern, then usually a repeat clinical examination with further xrays or a scan is recommended.

What should I do with my wrist?
• Aim to start moving the fingers as soon as possible after the injury within the splint.
• The splint can be removed after 2 weeks to begin gentle movement in the wrist. If pain and swelling are continuing to be a problem at this stage, leave the splint in place for a further week or two, and then try again.
• If comfortable, you can remove the splint at night, but if the wrist remains sore or very swollen, then keep the splint on.

When am I safe to go back to work?
If 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 6 weeks as a manual worker, then further clinical assessment is recommended.

Are there any risks from this injury?
Non-union of the scaphoid is the main risk from this type of injury, affecting around 1 in 300-500 patients who present initially with a “query scaphoid” injury. This can be treated with surgery in appropriate cases.

If you feel that you need further help with your injury, then please contact us.

© Fife Hand Service 2020

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