Distinguishing a sprained wrist from a fractured scaphoid

I'm looking for some internet doctor help.

I was handjamming a horizontal crack when I heard my right wrist crack. Sounded like you cracked a bunch of knuckles. Pain was pretty mild at the time of the incident and the rest of the day. I woke up the following day with pretty serious pain on the thumb side of my wrist. The pain is worst in the the wrist is pushed backward, like in a push-up position. I believe that's called supine, but I could be wrong. The layman description is it hurts when I use my wrist to make a motion like a revving a motorcycle.

Good news is that today is 2 days after the initial injury and it is much better. No bruising or swelling and the pain is greatly reduced. That said, I'm a bit paranoid since fractured scaphoids can be somewhat asymptomatic but cause problems down the road. I've read there is a pretty clear test, putting pressure somewhere on the wrist, that is a good indication of a fractured scapula. Anyone have any insight on this? Furthermore, are there any other somewhat reliable methods for differentiating between a sprain and a fracture? The cracking at the time of the injury has me concerned, but the significant improvement in pain reduction has me optimistic. Also, I have full ROM and there is no crepitus (cracking or snapping) following the injury.

Are you a doctor? Did you stay at a Holiday Inn Express last night? Feel free to chime in.

I broke my scaphoid (hairline fracture) in high school playing hockey. I had the same pains you described from the same motion in wrist (supine). The pain was not that bad at first and the original doc missed the fracture on the x-ray. Long story short after not getting better (still had pain, limited range of motion) after 6 weeks of PT, they x-rayed again, found the fracture and I ended up having to get surgery to get it fixed.

If the pain sticks around don't mess around. Go get an x-ray to figure out if you broke something. If the pain goes away in the next few days then you probably just tweaked it.

You're probably thinking of point/focal tenderness in the snuff box as a quick & dirty check -- maybe not the scapula, but could be better used for the scaphoid. The mechanism doesn't really match up, though.

Well a sprained wrist can be more serious than a fracture.Don't go testing it every hour for pain as this is a good way to turn a mild sprain into a more serious one (good advice for any injury). Your in a good position to make a drs appointment for a week or 2 out and cancel if not needed. I'm usually not that smart and end up in the ER after I realize that it's been a month and I'm trying to turn the can opener with my teeth because I can't use one of my wrists.

Only an Xray (or an mri or ct, which would be massive overkill in this situation) can get you any kind of reassurance here. Physical exam is not adequate to rule it out. And yes, I am a doctor (really).

Edit: I should say that by the mechanism of injury, a fracture would be kind of surprising. If I had to bet, I'd bet on a ligamentous injury.

The mechanism of injury does not sound like it would cause a scaphoid fracture.

If YOUR DOCTOR suspects a scaphoid fracture he can order a scaphoid SERIES of x-rays to isolate the scaphoid bone. Scaphoid fractures are often difficult to accurately diagnose from traditional wrist x-rays.

It sounds like your wrist injury may be ligament-related, in which case a MRI would be needed to accurately diagnose. Your next step should be to see an orthopedic physician that specializes in upper extremities.

What should matter more is the treatment plan , not type of injury in your case. My advice: RICE ! ...and lay off cracks for a while. Oh, I am not a doctor, just a person with common sense.

vivica jones wrote:What should matter more is the treatment plan , not type of injury in your case. My advice: RICE ! ...and lay off cracks for a while. Oh, I am not a doctor, just a person with common sense.

No offense meant, but diagnosis should precede treatment. Your advice is good for a sprain for sure, but not for a fracture. As someone else suggested, probably he should just sit down and talk it over face to face with a doctor.

Optimistic wrote: No offense meant, but diagnosis should precede treatment. Your advice is good for a sprain for sure, but not for a fracture. As someone else suggested, probably he should just sit down and talk it over face to face with a doctor.

The question is : in this particular case does it matter if its a fracture or a sprain or maybe both? Open and displaced fracture would require different treatment. In THIS case it's RICE. ...or if you have extra cash go see a doc.

Yes, it does matter.

If it's a sprain RICE is an effective means to reduce inflammation as the injury heals (although heat actually promotes healing whereas ice, by virtue of constricting vascularity, delays healing). If it's a fracture surgery may be warranted... But you won't know until you diagnose the extent of the injury.

Can't you read? He does not have a displaced fracture. They will not put a rod in his wrist for a hair line fracture. He is moving the wrist. If it was badly fractured he would not be able to do so. Heck, just let them take the whole arm and replace it with a prosthesis....or a hook?

vivica jones wrote: The question is : in this particular case does it matter if its a fracture or a sprain or maybe both? Open and displaced fracture would require different treatment. In THIS case it's RICE. ...or if you have extra cash go see a doc.

Yes, it matters a lot. Like I said he probably doesn't have a fracture, but no one here, doctor or not, has the information to diagnose that. However, as you probably are aware, the treatment for a wrist fracture is usually, but not always, a cast, not ice. In unusual selected cases, particularly involving the scaphoid, surgery is needed.

That's why I said DIAGNOSIS FIRST!

Optimistic wrote: Yes, it matters a lot. Like I said he probably doesn't have a fracture, but no one here, doctor or not, has the information to diagnose that. However, as you probably are aware, the treatment for a wrist fracture is usually, but not always, a cast, not ice. In unusual selected cases, particularly involving the scaphoid, surgery is needed. That's why I said DIAGNOSIS FIRST!

People you all are supposed to be "hardened mountain foulk" here but acting like a bunch of pea princesses. Go pay a doc 10,000 for MRI,serial CT scans, orthopod consult, neurologist consult, physiatrist consult....heck add it all.
Or just man up and lay off climbing for a while and go work a job.

Perennial Orthopedic Test

Does it move?

No -- should it? No -- no problem
No -- should it? Yes -- WD40

Yes -- should it? No -- duct tape
Yes -- should it? Yes -- no problem

Maybe Rock and Resole could do something for it. Anyone have their number?

Like Optimistic, I really am a doctor. And you really need someone who is to poke at your wrist a bit and tell you what they think. That said, a scaphoid fracture with that mechanism would be so unusual that it would merit a medical journal case report. More likely a ligamentous injury, but don't think that means trivial. Some ligamentous disruptions in the wrist can be much trouble indeed.

Based on what I know from experience all of the advise is decent, however...and you know that just takes it all away....
Depending on IF there is a scaphoid fracture there might be a need for surgical intervention in the form of a screw or two.

The fractures come in a few types, and they usually do not show on initial x-rays (takes about two weeks to see them).
most will heal on their own without any type of treatment.
OTHERS do require treatment or surgery.

They DO lead to problems down the road if not treated and you CAN still move your hand and be a normal human being with the ones that require surgery (even if you are they A type personality that doesn't go to the doc until the bone is sticking out...)

Based on my personal experience, I had one that required surgery, and I let it go for ten years with just twinges which I wrote off to simple sprains....doctor gave me the option of wrist fusion or total reconstruction...if that didn't look good when he opened me up he was going to fuse the wrist (and he gave me a choice of positions it would be fused in)

RICE is nice, but get the opinion and save yourself the trouble of reconstruction down the road.

You know where the carpal tunnel leads to right? And why the Scaffoid is shaped like it is?
I'm asking because in this case missing a fracture can be a real problem - IE partial paralysis of the hand if you disrupt it.
It's not the odds it is the consequence, in this case. Break the triquetrum or something and miss it, it is probably less severe, but the scaffoid is a problematic area.
Xrays are something to buck up for, in this case...

I'd forgotten about this! How did everything turn out Birdman? Hope you healed up!