Scaphoid Fracture in a Recreational College Student

Objective: To describe the evaluation, diagnosis, and progressive treatment for a student who sustained a scaphoid fracture while mountain biking.

Background: Scaphoid fractures are often difficult to diagnosis due to the inconsistency of symptoms compared to other types of fractures. Moreover, additional radiographic imaging may be necessary to identify a scaphoid fracture.

Treatment: Immobilization of the wrist followed by rehabilitation for structural integrity, pain-free range of motion, and muscular strengthening for the forearm and wrist muscles.

Differential Diagnosis: Muscle strain, wrist sprain, scaphoid dislocation, arthritis, De Quervain’s syndrome.

Conclusion: Scaphoid fracture are a common sports injury, and the most common carpal fracture in the wrist. Scaphoid fractures often are left undiagnosed or misdiagnosed due to the lack of signs and symptoms typically present with a bone fracture. Due to this, referral for x-rays or MRIs is important for a proper diagnosis and rehabilitation plan.

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The scaphoid is one of the eight carpal bones in the wrist. It is bordered distally by the triquetrum, trapezoid and capitate, medially by the lunate, and proximally by the styloid process of the radius. It can be found by palpating the anatomical snuffbox on the hand, or the area on the lateral wrist formed by the extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus, and styloid process of the radius.

Case Report

On September 18th, a 20-year-old male NMU ROTC student presented to the clinic with pain in his right wrist. The patient reported no previous injury to his right wrist or right arm. The onset of injury occurred a month early in late August, and the mechanism of injury was falling on his outstretched hand on to a stationary rock while mountain biking. During the evaluation, the patient reported a dull, achy pain with a four out of ten at rest on the pain scale and an eight out of ten in use. The patient also reported a sharp pain when performing activates, such as push-ups, twisting a doorknob and shaking hands. An objective assessment of the patient’s right wrist revealed mild swelling and abrasion over the right thenar eminence. Point tenderness was reported over the right scaphoid, trapezoid, capitate, and lunate along with the thenar eminence. Range of motion tests where diminished for active movements for all wrist motions, especially with radial deviation, and only extension improved with passive movements. Pain was present with all movements.

Special tests performed did not initially indicate a fracture in the wrist.