Scaphoid pain - what do I have?

introduction

Wrist pain is common and can be the result of overuse or fractures. Often the one in particular hurts Ball of the hand, under which the so-called scaphoid bone, or os scaphoideum, lies. The scaphoid bone is one of 8 carpal bones that make the connection between Cubit and spoke, and form the metacarpal bone. Because of his elevated position the scaphoid bone is particularly often affected by injuries.
In the event of a fall on the palm of the hand, the lower-lying, neighboring ones usually become less frequent bone injured, but most often the scaphoid bone, which absorbs most of the energy when falling. Pain in the navicular bone is especially after Fall frequently. Unfortunately, the blood supply to the scaphoid bone is - unlike usual - from the direction of the finger. In addition, the supplying vessels of the scaphoid do not form anastomoses (connections) with one another.
This leads to complicated Operations, and complex healings.

Causes of scaphoid pain

The most common cause of scaphoid pain is falls on the palm of the hand. This can happen both in sport and in old age. It is a natural protective mechanism of the body to protect the head and neck, so we reflexively stretch out our arms when we fall.

A broken scaphoid bone is often accompanied by a distal radius fracture, the most common fracture in the human body. The parts of the spoke near the wrist break, with or without involvement of the adjacent wrist. Such a fracture with a fall on the outstretched hand is called a Colles fracture.

Fractures of the scaphoid typically cause only mild pain and tenderness, but not the severe pain one is used to from fractures. Because of this, scaphoid fractures are often ignored and "eaten out".
As long as the fracture fragments are still correctly positioned on top of each other, it is also possible to regain freedom from symptoms. However, if the fragments grow together crookedly, this can lead to permanent pain in the navicular bone and restricted mobility. An operation is then very difficult because the newly grown piece of bone must be separated again and properly aligned.
Anyway, the treatment of a scaphoid fracture is a particular challenge: Due to the complicated vascular supply, abortions are difficult to treat. In many cases, the supplying vessel is also damaged and can no longer supply the fragment. Many scaphoid fractures therefore do not heal completely. This is known as pseudoarthrosis.
Especially in the wrist, pseudoarthroses result in a change in the force exerted by the muscles on the wrist as a whole. This can result in a so-called SNAC wrist syndrome, from the English: SNAC: Scaphoid Nonunion Advanced Collaps, freely translated: Extended collapse [of the wrist] after the scaphoid bone has not healed.
So it can come to a collapse of the wrist statics as a result of the changed forces. If left untreated, the SNAC wrist syndrome can lead to osteoarthritis, i.e. premature, excessive joint wear.

Cyst in the navicular bone

All cavities and dissolutions of the bone are summarized as a bone cyst. A common mechanism of development is a growing ganglion that originates from a tendon or ligament of the wrists.

In the case of minor irritations and inflammations of a tendon, the surrounding mucous membranes form increased lubricating fluid that cannot drain through the tendon sheaths and the wrist structures. In many cases, the tendon sheaths bulge, which can lead to an externally visible ganglion and bump on the wrist. In rare cases, however, the fluid presses on the bone and steadily erodes it. The fluid-filled cyst can vary in size and thus be treated differently. Smaller cysts pose no threat and do not require further treatment. Above a certain size, however, the stability of the bone is significantly reduced, which can easily lead to fractures of the bone.
To treat the cyst, the bone can either be stabilized with a nail or filled with cement. This prevents complications of a scaphoid fracture.

For more information, read on here: Ganglion.

Scaphoid necrosis

Scaphoid necrosis is the destruction of the bone due to poor blood supply to the bone. The blood flow to the wrist is ensured by small and fragile vessels that can be damaged in the event of injuries and heavy loads on the wrist. A permanent load from jackhammers, which leads to the slow decline of the navicular bone, is typical.

A typical symptom of scaphoid necrosis is wrist pain on the thumb side. In the long term, pain and restricted mobility can occur in the wrist. Many conservative and surgical procedures can be considered for treatment. For this purpose, the wrist can be immobilized for several weeks with subsequent exercise therapy. In many cases, however, the necrosis is so advanced that the wrist must be partially stiffened in order to ensure painless mobility of the wrist in the long term.

Scapholunal dissociation

SLD is scapholunal dissociation, which can occur after an injury to the wrist with a tear in the SL ligament. The navicular and lunar bone slide apart and can be dislocated from their anatomical position.
There are several grades for the staging of SLD, depending on the extent of the malalignment of the carpal bones and the accompanying injuries.

The pain and movement restrictions in the wrist can be considerable. Conservative or surgical therapy can be chosen depending on this. Conservative therapy consists of repositioning the bones and immobilizing them for several weeks. In many cases, however, the SLD has to be treated surgically, by fixing the bones in their original position and suturing the torn SL ligament. In the case of advanced damage, partial stiffening of the wrist may have to be carried out in order to achieve the best possible pain-free mobility of the wrist.

Find out more about the topic here: Scapholunal dissociation.

diagnosis

Scaphoid pain from scaphoid fractures is often not recognized because it is difficult to see on ordinary X-rays. CT cross-sectional imaging is therefore used to reliably exclude or diagnose a scaphoid fracture.

The clinical signs are usually relatively difficult to interpret because there is neither severe pain nor an obvious deformity. The anamnesis, i.e. the patient's description of the course of the accident, can provide information. If the pain in the navicular bone appeared for the first time together with a specific event, the suspicion that it could be a fracture is obvious. However, permanent incorrect stress, for example from a lot of writing on the PC, can lead to irritation or overstretching of the ligaments. In case of doubt, the CT provides clear information.

Appointment with a hand specialist?

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
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In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
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therapy

The therapy for scaphoid pain depends on the type of injury. Scaphoid fractures are either treated conservatively with a plaster splint. The splint takes place for 6-8 weeks, which many patients find relatively uncomfortable.

An alternative is surgical treatment using wires ("Kirschner wires"), in which the individual fracture fragments are pulled against each other and thus heal more quickly under pressure. However, splinting is also necessary here, as is removal of the wires after 6 weeks.

Only osteosynthesis using a plate or screw offers faster therapy, but these represent a somewhat larger intervention. The plate is made of titanium and is usually left in the hand permanently. Rehabilitation can begin immediately after the operation.

If it can be proven that there is no fracture, the exact cause of the pain in the navicular bone must be identified. If the reason is a one-off event, such as falling on the ball of the hand, it is sufficient to protect the hand for a while. If a chronic process is the trigger, it is advisable to avoid such movements in the future. It is possible that harmful movement patterns have already crept in and must first be unlearned.
Medical therapy therefore goes hand in hand with physiotherapy and occupational therapy

forecast

The prognosis for pain in the navicular bone cannot be determined uniformly: If it is a fracture, the therapy is complicated and can take 2-3 months.
Some scaphoid fractures never heal completely and remain permanent. Surgical treatment using screws and plates is promising, since long periods of immobilization with accompanying muscle wasting can be avoided.
As with all bone fractures, conservative therapy takes at least 6-8 weeks for the bone to heal again.

If there is no fracture of the scaphoid bone, a pain-free state can be restored within a few days by immobilization and, if necessary, administration of painkillers. Bruises or strains still take some time to heal. During this time, the hand should be spared as much as possible. The pain usually subsides quickly in the days after the injury, although it usually only disappears completely after 1-2 weeks.

prophylaxis

In elderly patients is one Fall prevention not least because of more serious injuries. This includes eliminating everyone "Stumbling blocks" in the home, the correct setting of visual acuity when using visual aids, as well as the correct dosage of medication.

For sports such as snowboarding, the use of special is recommended Wrist protectorsthat are specially reinforced with a plastic rail at the ball of the hand. Snowboarders in particular are for Radius fractures and fractures in the hand area, as they often fall forward. Correct falling is therefore the first thing to be trained in beginner courses.
For all other groups of athletes, general caution should be exercised and, for example, not jogging in the dark stretches of the forest or overexerting oneself, as this increases the risk of injury.

If the pain persists for more than a week, an introduction should be made to one Orthopedists done to rule out a fracture.