okay top three upper extremity conditions you don’t want to leave untreated. First of all all three things I’m going to mention are going to potentially masquerade as sprains times when you feel like you just tweaked your shoulder or tweaked your wrist or maybe it hurts a little bit you’re going to let it just get better on its own. I’ve seen many patients over the course of my career who come into me many months after the sprain only to find out that you have a fracture or a complete tear or a fracture dislocation.

So let me go through the list.

Acute Rotator Cuff Tears

acute rotator cuff tears now what is that that’s your rotator cuff that helps you elevate your arm. It hurts usually right over here if you injure it but if you have an acute rotator cuff tear from an injury whether it’s a dirt bike football basketball weekend warrior stuff that is something that you really want to know about as soon as possible.

The problem here is that if you have an acute tear and it’s retracted like I tell people like it’s like a garage door spring boink it pulls way away from the bone that is something we can repair right away. If it’s left untreated maybe say for 4 to 6 months that becomes increasingly harder to reattach. It starts to scar in, the muscle starts to get lazy fibrotic less elastic and all of a sudden now it’s going to be less likely that the Tenon is going to be repairable. You’ll end up potentially having a higher Reta rate from a surgery.

By the way when your rotator cuff is torn like that you’re going to have continued pain for a while so that’s really important to go see a doctor get a careful evaluation. And I usually will MRI patients with acute shoulder injuries like that right away, rule out that tear because you never know and you never want to miss that.

Scaphoid Fracture

okay number two scaphoid fractures. Now a lot of people who sprain their wrists probably never make it into my office. There are a subset of people who sprain their wrists who actually broke their scaphoid. The scaphoid is a small bean-shaped bone in the wrist and it’s a very important bone and when it’s broken the problem is it doesn’t have a great blood supply and so it takes a lot of time to heal and it requires immobilization right away.

So there are a lot of people who think they just tweak their wrist and the pain maybe gets better but never quite goes away and may come into me say four or 6 months after the wrist sprain and we get an x-ray and next thing you find out oh this was a break and it hasn’t healed and you’ve gone on to what’s called a scoid nonunion.

That is a harder thing to treat than an acute scoid fracture that sometimes can be even just treated in a cast. A scaphoid non-union definitely needs surgery. It needs sometimes bone graft; it might need other types of reconstructive considerations. Even with surgery sometimes it has a harder time to heal.

So really important if you sprain your wrist and it’s lasting more than a week or two come in get an x-ray get it checked out. You never want to miss a scaphoid fracture.

Finger Sprain

and number three a finger sprain. Now a lot of patients jam their fingers whether it’s playing basketball if they fall wrestling whatever the situation might be. If you have a sprain of your finger right in this finger joint here this pip joint every so often I’ll see patients who come in late where they have a fracture dislocation. Well not only is it broken but the joint is dislocated and when that happens that is something that when found early could be treated in a more limited often surgical way sometimes nonoperatively but sometimes surgically.

But if I find it late it’s going to require a more complex longer operation to reconstruct that joint getting it closer to normal. So if you jam your finger and haven’t reestablished all your motion within a week or two very important to come into my office get it checked out make sure nothing worse happened with respect to the joint the bone and you know worst case is the best case you came in wasted your time and found that everything’s normal.

So you know I highly recommend if anything’s lingering early in the process come in get an x-ray get it checked out and you know the worst case is the best case which is everything’s fine and there’s nothing to worry about. The best case is also sometimes the worst case but it’s also a good case because you found an injury that’s severe early in the process and so in order to treat a severe problem earlier always better than finding it late.

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If you have fallen onto an outstretched hand and are experiencing wrist pain, a scaphoid fracture could be the culprit. Sometimes confused for a sprain, this type of wrist injury requires skilled medical treatment to heal properly.

Learn more about the causes, symptoms, treatment, and recovery for scaphoid fractures below:

Understanding Scaphoid Fractures

Eight carpal bones make up the human wrist, which connects the hand and forearm. The scaphoid is a boat-shaped carpal bone located on the thumb side of the wrist that articulates with the radius (one of the forearm bones) as well as four other carpal bones (the trapezoid, trapezium, lunate, and capitate). The scaphoid is important for both the movement and stability of the wrist joint.

Definition

A scaphoid fracture is a type of broken wrist that occurs when the scaphoid bone fractures or breaks.

Types

A scaphoid fracture may occur at or near one of the ends of your scaphoid or in the center (known as the waist). Determining exactly which part of your scaphoid has been injured will allow your doctor or surgeon to move forward with the most appropriate treatment plan.

• A distal pole fracture describes a fracture near the end of the scaphoid closest to your hand and fingers.
• A proximal pole fracture describes a fracture near the end of the scaphoid closest to your forearm.
• A waist fracture describes a fracture located in the middle third of the scaphoid bone. Waist fractures account for about two-thirds of all scaphoid fractures.

Scaphoid fractures can also be classified as displaced or non-displaced. A displaced fracture describes a fracture where the bone pieces have become misaligned; a non-displaced fracture describes a fracture where the bone pieces have remained in proper alignment.

Causes

Scaphoid fractures are often caused by a fall onto an outstretched hand but can also be the result of a car accident, sports injury, or other high-impact event. This injury can affect people of all ages, but is most common in young adults (children and elderly patients are more likely to sustain a distal radius fracture). People with Osteoporosis are at increased risk of bone fractures, including scaphoid fractures.

Symptoms and Diagnosis of Scaphoid Fractures

Because scaphoid fractures are not always associated with visible deformities or severely restricted range of motion, proper diagnosis of this injury is sometimes delayed. Unfortunately, such delays can contribute to sub-optimal healing.

Symptoms and Clinical Presentation

If you have sustained a fall onto an outstretched hand and are experiencing any of the following symptoms, seek medical attention to received a conclusive diagnosis and proper treatment as soon as possible:

• Wrist pain (sometimes described as a dull ache)
• Swelling
• Tenderness to touch on the thumb side of the wrist
• Localized bruising
• Decreased mobility in the wrist joint
• Visible deformity of the wrist

Diagnostic Procedures

After physically examining your wrist, your doctor or surgeon will order an X-ray of the area if a scaphoid fracture is suspected. If more diagnostic information is required (for instance, if the fracture is complex or didn’t show up clearly on the X-ray), further imaging tests such as a CT scan or MRI may also be ordered.

Treatment and Management

The goal of scaphoid fracture treatment is to align your bone and immobilize it to promote proper healing. Your personal treatment plan will take into account your medical history as well as the severity of your injury.

Conservative Treatment Options

If a scaphoid fracture is mild and the bone pieces have remained in alignment (non-displaced), conservative treatment with a splint or cast may be all that is required. Splinting or casting usually lasts between three and eight weeks, depending on the circumstances.

Serial X-rays or CT scans may be taken throughout the healing process to ensure that proper anatomical alignment is being maintained.

Surgical Treatment

Surgical treatment for a scaphoid fracture may be indicated in cases with severe displacement or where the bone has broken into more than two pieces. Surgery may also be used to treat scaphoid fractures that are healing slowly or failing to heal at all (known as non-union fractures). Non-union fractures can lead to long-term issues such as post-traumatic arthritis.

The most common scaphoid fracture surgery is open reduction internal fixation (ORIF) and involves reducing (realigning) the fracture through an incision and then placing screws as internal hardware to maintain proper anatomical alignment. Bone graft may or may not be used to augment healing.

Physiotherapy and Rehabilitation Approaches

No matter the treatment plan, strict immobilization throughout the healing process is critical for scaphoid fractures. Once the bone is completely healed (which may be confirmed with a CT scan), patients will begin physiotherapy exercises to regain strength and full range of motion.

Living With Scaphoid Fractures

Recovery Expectations

Because the scaphoid has relatively few blood vessels and they are often damaged during injury, scaphoid fractures often take longer to heal than fractures in many other bones. The exact length of time your recovery will take will depend on the severity of the injury, your overall health and wellness, and how well you follow your treatment plan. In general, scaphoid fractures may heal in as little as six weeks, but often take much longer.

Most patients make a full recovery from a scaphoid fracture and are able to resume all activities once healing is complete.

Prevention Strategies

Lower your risk of scaphoid fractures by maintaining a healthy diet and lifestyle, avoiding risky physical activities, always wearing a seat belt, and wearing proper protective equipment during sports and athletics.

Consulting Your Doctor

At Modern Orthopaedics of New Jersey, our award-winning surgical team is always ready to diagnose and treat your wrist pain with the utmost skill and professionalism. Book your appointment today!