Recurrent Scaphoid Fracture: Wrist Pain and Treatment Options

Recurrent injury of scaphoid bone fracture?

Hello, doctor.
I've been experiencing wrist pain for a while now.
I initially thought it was due to overuse, but as it became increasingly uncomfortable, I decided to see a doctor.
The doctor mentioned that I have a cyst on my wrist, but since it's small, we would just monitor it for now.
After some time, I started having difficulty writing, couldn't grip tightly, and my hand began to feel weak and numb.
Later, I went to a larger hospital for a consultation and had an X-ray done, which revealed that I had previously fractured my scaphoid bone.
However, the doctor said that the bone appears to be fine now and has healed.
It seems to be a recurrence of an old injury, and I was advised to undergo rehabilitation.
The problem is that the area below my thumb has now swollen, and it hurts when I press on it.
I still can't grip tightly, and my hand lacks strength.
What should I do?

Niming, 30~39 year old female. Ask Date: 2017/07/28

Dr. Chen Yongxue reply Orthopedics

Hello, if there is a scaphoid fracture, it is not easy to heal.
Your letter did not mention whether there was a prior injury or if a cast was applied after the injury.
If neither of these occurred, the diagnosis of a scaphoid fracture may need to be reconsidered.
As for the wrist cyst, it is possible that it could cause the symptoms described.
Please visit an orthopedic clinic for further examination.
Thank you.

Reply Date: 2017/07/28

More Info

Recurrent scaphoid fractures can lead to significant wrist pain and functional impairment, as you are experiencing. The scaphoid bone is one of the carpal bones in the wrist and is particularly susceptible to fractures due to its location and the mechanics of wrist movement. When a scaphoid fracture occurs, it can sometimes go undetected on initial X-rays, leading to complications if not treated properly.
From your description, it seems that you initially had a scaphoid fracture that may have healed improperly or led to complications such as avascular necrosis (death of bone tissue due to a lack of blood supply) or nonunion (failure of the bone to heal properly). The presence of a cyst or swelling in the area below your thumb could indicate a ganglion cyst, which is a common occurrence in individuals with wrist injuries. These cysts can form due to irritation or injury to the joint or tendon, and they can cause pain and discomfort, especially when pressure is applied.

Given your symptoms of pain, weakness, and numbness, it is crucial to follow up with a healthcare provider who specializes in hand and wrist injuries. Here are some treatment options and considerations:
1. Physical Therapy: Engaging in a structured rehabilitation program can help improve strength, flexibility, and function in your wrist. A physical therapist can design a program tailored to your specific needs, focusing on exercises that promote healing and reduce pain.

2. Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage pain and inflammation. If your pain is severe, your doctor may prescribe stronger medications or recommend corticosteroid injections to reduce inflammation.

3. Immobilization: Depending on the severity of your symptoms, your doctor may recommend wearing a wrist brace or splint to immobilize the wrist and allow it to heal. This can help alleviate pain and prevent further injury.

4. Surgical Intervention: If conservative treatments do not provide relief, or if there is evidence of a nonunion or other complications, surgical options may be considered. Surgery can involve removing the cyst, repairing the scaphoid, or addressing any other underlying issues that may be contributing to your symptoms.

5. Regular Monitoring: Since you have a history of scaphoid fracture, regular follow-ups with your healthcare provider are essential. They may recommend periodic imaging studies, such as X-rays or MRIs, to monitor the condition of your wrist and ensure that no new issues arise.

6. Activity Modification: It may be necessary to modify your activities to avoid exacerbating your symptoms. This could involve avoiding repetitive wrist movements or heavy lifting until your wrist has fully healed.

In conclusion, recurrent scaphoid fractures can lead to chronic pain and functional limitations if not addressed properly. It is essential to work closely with your healthcare provider to develop a comprehensive treatment plan that addresses your symptoms and promotes healing. If your symptoms persist or worsen, do not hesitate to seek further evaluation or a second opinion from a specialist in hand surgery or orthopedics.

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