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Scaphoid Fractures

Posted Tuesday, 15 September 2020

Date issued: October 2023

For review: October 2025

Ref: A-410/MY/Physiotherapy/Scaphoid Fractures v3

The scaphoid is one of the eight small bones in your wrist. It is located on the thumb side of your hand.

Usually occurs from a fall onto an outstretched hand.
Not always clear on initial x-rays whether it is broken or not. MRI can be considered as per NICE guidelines.
Symptoms include pain at the base of the thumb, which is worse with use of the hand. Swelling and bruising at the injury site is normal and may or may not occur.
The fracture is normally treated with a below-elbow cast or removable Velcro wrist splint, for 5-6 weeks.
During this period, you may use the injured hand for light tasks, and you should move your wrist and fingers within your pain tolerances straight away.
It is important that you follow the exercises on the following pages to prevent your wrist and hand becoming stiff.
You should avoid heavy tasks with your injured hand for six weeks.
Surgery may be needed if the bone has moved, or if the blood supply is affected.

It is important to take regular pain relief throughout the day, as guided by the doctor.

You will be referred to Fracture Clinic and be asked to attend this appointment as an Outpatient.
They may refer you to the hand specialist physiotherapy and/or occupational therapy team for on-going management of the injury.
You should keep the splint on at all times, if you have been given one, even at night. It can be removed for hygiene reasons.
Elevate your hand above heart level to help reduce swelling.
Remove any rings or jewellery on the affected hand.
If there are still high levels of pain after 6 weeks, the Doctor may choose to investigate further. Avascular necrosis is a rare side-effect of a scaphoid fracture that has disrupted the blood supply and not healed properly. You will be checked for this.

You may find now that you have broken your scaphoid that you struggle with some of your normal daily activities.
This can affect you more if you have fractured your dominant wrist. For example preparing and eating meals and getting washed and dressed may become more challenging.
You may benefit from some equipment to help you in the home. The Occupational Therapist can assess you for this.
Following assessment by the therapists it may be agreed that you would benefit from additional support at home. The Occupational Therapist can assist in arranging this for you.
If you normally use a walking aid to assist your mobility, then the Physiotherapist will check that you can still do so.
If you are a car driver, you will need to take a break from driving. You can seek more guidance on this from the DVLA or on the DVLA website.

These exercises are important, as they will make sure your unaffected joints do not become stiff and will help maintain good circulation in your arm.

The exercises below can be performed 4 times daily.

Shoulder: standing or sitting in an upright position, slowly lift your affected arm up towards the ceiling (elbow straight) and then lower again. Repeat 5 times.
Elbow: Sitting in an upright position, slowly bend your affected elbow do your hand moves towards your shoulder and then fully straighten your elbow. Repeat 5 times.
Thumb: Bend the thumb joints as far across the cast as possible towards your little finger, then straighten it as far as possible.
Fingers (fist): start with all your fingers straight and then bend all your fingers to make a fist.
Fingers (salute): start with all your fingers straight and then bend the knuckle joints of all your fingers, keeping the fingers straight.