A wrist break that may not show up on the first X ray
How a hand surgeon checks for a possible scaphoid fracture
A wrist that seems only sprained after a crash may hide a broken bone. The scaphoid is a small bone in the wrist near the base of the thumb. Force through the hand in a crash can break it. An X ray taken early can miss the break. [1]
A missed break is a concern because some scaphoid fractures heal slowly or not well. The risk is higher when part of the bone gets a limited blood supply. [1]
Stick with follow up care if a break is suspected
Tell your doctor if pressing on the hollow just below your thumb hurts or if gripping still hurts. Ask whether your exam points to a scaphoid fracture even though the first images looked normal. [1]
You may wear a splint or cast while the diagnosis is sorted out. More X rays, an MRI or a CT scan may be considered. Do not take off your splint or cast just because the first report found no fracture. [1]
Where the break is changes the treatment
If a break is confirmed, ask which part of the scaphoid is involved and whether the pieces have moved. These details affect how likely it is to heal. They also affect whether a cast or surgery is advised. [1]
Ask when scans will show healing. Find out when you can go back to gripping, lifting and work. Your wrist may still need protection even when it feels less sore. [1]
Tell your team about wrist or splint problems
Call your care team if pain on the thumb side lasts past your planned checkup. Also call if your splint rubs or gets loose, or if you still can’t move the wrist well. Get urgent care if your fingers turn cold or pale, go numb for the first time or keep swelling. A new pattern of severe pain also needs to be checked. [1]
- When and how will you rule out a hidden fracture?
- If the bone is broken, which part is affected?
- What needs to happen before I can stop wearing the splint?
Book your next scan before you go
Before you leave, put the date of your repeat imaging or specialist visit on your calendar. [1]
Sources and further reading
This general overview comes from a hand surgery perspective. Thumb side wrist pain that lingers after an injury needs follow up care. That holds even if an early X ray was read as normal.
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