Scaphoidhandout

Scaphoid Fracture
Modality Options (Bracciano, 2008)

NSAIDs or Opioid Based Meds for pain management
Warm water whirlpool
Done in the beginning stage of therapy
To reduce joint stiffness and increase active range of motions
Transcutaneous Electrical Nerve Stimulation (TENS)
For pain management at the end of the treatment session
Non-Thermal Ultrasound
Delivered at 20% duty cycle 0.2 W/cm2 will provide the non-thermal, mechanical effects and
will clinically facilitate tissue healing
The applicator should be moved in a circular motion in an area equal to twice the size of the
sound head
Duration of ultrasound treatment will be shorter on the first use then it will be on subsequent
treatments.
Ultrasound should be used in conjunction with other treatments, and should never be the only
treatment the patient receives at the time the ultrasound is administered
Functional Electrical Stimulation (FES)
Can be used in conjunction with bracing in order to increase the motor control of muscle groups
and to increase occupational function.
Splinting Considerations
May have been placed in a full arm cast with elbow casted in flexionMay need ROM exercises in elbow
May begin treatment before cast removal: E-STIM and digit ROM exercises can be implemented
to assist with bone growth and insuring no loss of ROM in digits
May be in cast when first in clinic
Will remove cast if client is ready for removal
Palpating the scaphoid for pain and tenderness will assess whether the bone has
healed or not https://www.youtube.com/watch?v=EvT2KUWF6xw
Pain should decrease with treatment indicating bone healing
Measure edema by circumferential measurement once a week
Edema may need to be taken into consideration when customizing a splint- wider trough and
Scaphoid Fracture
Velcro straps
Forearm thumb Spica with thumb at neutral in palmar abduction and wrist at neutral
Prefab, precut, and custom options are available
Provides protection and stability while bone finishes healing process
Wearing schedule
Because of risk of nonunion, the splint will be worn continuously with exception of HEP and
self-care tasks
Depending on union, the splint will most likely be worn for 2 weeks or more
Intervention/Home Exercise Program
Stretching- Perform after cast is removed before ROM exercises, for 15 to 30 seconds, 3 times
on each hand.
Precautions- Perform stretches within clients pain tolerance.
Range of motion- Client is instructed to hold each position for 5 seconds, while completing 3
sets of 10, every hour or every other hour.
Scaphoid Fracture
Precautions- Avoid pronation and supination untill obtained consent from clients physician to
avoid damage to bone or surrounding tissues.
Scaphoid Fracture
Strengthening- Client is instructed to perform 3 sets of 10 every hour or every other hour, while
gradually increasing the weight.
Precautions- Avoiding strengthening untill clients physician cleared them for such activities to
decreases chances of re-fracturing the area.
Scaphoid Fracture
Terminology
Definition
Implication
Displaced Fracture
Bone fragments have moved

out of position with >1mm
of
step-off
Surgery required
High incidence of delayed/nonunion
Non-displaced
Fracture
Bone fragments have NOT

moved out of position
8-12 weeks in Colles cast

May not be seen on X-ray
Waist Fracture
A fracture occurring through

the waist of the scaphoid
bone
10-12 weeks healing time

Recommended operative fixation because of
common nonunion
Proximal Pole
Fracture

the proximal pole of the
scaphoid bone

Recommended operative fixation because of
common nonunion
Least likely to heal correctly because of blood
supply interruption
Tuberosity Fracture

the scaphoid tuberosity

Cast immobilization for 4 weeks
Non-Union/Delayed
Union
The fracture fails to heal or

has a delay in the healing
process
Results from failure to immobilize, misdiagnosis,

mistreatment, vascularity issues
Causes arthritis, severe pain, weakness
Important to ask about previous trauma to the
wrist so that practitioner does not treat a
nonunion as if it was an acute fracture
Decreased ROM in wrist extension
Malunion
The scaphoid fails to

reposition appropriately
Leads to humpback deformity
Blood Supply
Radial Artery
Volar branch supplies 20% of scaphoid

Dorsal branch supplies 80% of scaphoid
(supplied proximally)
Avascular Necrosis
(AVN)
Death of bone tissue due to

lack of blood supply
Common in proximal pole fractures

Increased pain and stiffness of wrist
Non-operative treatment methods include rest,
splinting, and electric stimulation
Scaphoid Fracture
Rehab Timeline
1-3 weeks after injury

AROM/PROM of the digits that are free from casting
AROM of the shoulder and elbow (if free from casting)
Isometric exercise to biceps, triceps, and deltoid
Elevation to treat edema
May have supination/pronation precautions
At 2 weeks, may need bone or CT scan if pain and tenderness with snuffbox palpation
4 weeks after injury
Continue exercises
Limit pronation supination
May be changed from long arm cast to short arm cast
6 weeks after injury
Remove cast if radiography and clinical observation shows healing
Provide a wrist splint for protection and stability
Continue elbow and shoulder exercises
Gentle AROM of wrist and gentle opposition and flexion/extension of thumb
8-12 weeks
If no evidence of union is noted by 8 weeks, consider electrical stimulation and possibly bone
graft surgery
Advance therapy with gentle AROM of wrist and thumb exercises
Begin grip strengthening with silicone putty (or similar exercise) at 10 weeks
Advance as tolerated to resistive exercises
References
Scaphoid Fracture
American Occupational Therapy Association. (2014). Occupational therapy practice framework:
Domain and process, 3rd edition. American Journal of Occupational Therapy, 6, 625-683
Bracciano, A. (2008). Physical agent modalities: Theory and application for the occupational
therapist (2nd ed., pp. 136-137; 188). Thorofare, NJ: SLACK.
Cheing GL, Wan JW, Kai Lo S. Ice and pulsed electromagnetic field to reduce pain and swelling
after distal radius fractures. J Rehabil Med. 2005;37(6):372-7. Retrieved
fromhttp://www.medicaljournals.se/jrm/content/?doi=10.1080/16501970510041055
Dodds, H. A., Hackney, S. D. (2011) Assessment of Scaphoid Fracture Healing. Musculoskeletal
Medicine, 4(1). pp. 16-22.
Green, D. P., Rockwood, C. A. (2006) Fractures and Dislocations of the Carpus. In C. Gaebler
(Ed.), Rockwood & Greens Fractures in Adults. (pp. 858-906) Philadelphia, PA:
Lippincott Williams & Wilkins.
Laker, S. R., (2014). Scaphoid Injury Treatment & Management. Emedicine.medscape.com.
Retrieved from: http://emedicine.medscape.com/article/328658-treatment [Accessed 7
Sep. 2014].
Parvizi J, Wayman J, Kelly P, et al. Combining the clinical signs improves diagnosis of scaphoid
fractures. A prospective study with follow-up. J Hand Surg 1998;23-B:324327.
Rouzier, P. (2014). Navicular (Scaphoid) Fracture. 3rd ed. The Sports Medicine Patient Advisor.
San Fransisco, CA: McKessen Corporation, pp.1-3. Retrieved from
http://www.orlandohealthdocs.com/kidsbones/files/2011/10/Scaphoid-Fracture.pdf
[Accessed 7 Sep. 2014].
Vinnars, B., Pietreanu, M., Bodestedt, A., Ekenstam, F., & Gerdin, B. (2008). Nonoperative
Compared with Operative Treatment of Acute Scaphoid Fractures. A Randomized
Clinical Trial. The Journal Of Bone And Joint Surgery, 1176-1185.
Waitayawinyu T, McCallister WV, Nemechek NM, Trumble TE. Scaphoid nonunion. J Am Acad
Orthop Surg. 2007;15(5):308-20. Retrieved
fromhttp://www.jaaos.org/content/15/5/308.long

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Scaphoid Fracture

Modality Options (Bracciano, 2008)

Bone fragments have moved

Bone fragments have NOT

8-12 weeks in Colles cast

A fracture occurring through

10-12 weeks healing time

A fracture occurring through

12-20 weeks healing time

A fracture occurring through

4-6 weeks healing time

The fracture fails to heal or

Results from failure to immobilize, misdiagnosis,

The scaphoid fails to

Leads to humpback deformity

Volar branch supplies 20% of scaphoid

Death of bone tissue due to

Common in proximal pole fractures

1-3 weeks after injury

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