You have been diagnosed with a scaphoid fracture (in the hand/wrist), or you suspect that you broke your scaphoid bone? I will answer the most frequently asked questions of people with this carpal bone fracture : healing and recovery time, treatment, pain, driving…
To answer these questions, I rely on:
👩⚕️ my experience as a physiotherapist since 2009;
📚 extensive research in international scientific literature. All references are provided at the end of the article.
Enjoy your reading! And feel free to leave a comment if you have any questions or comments 🙂!
Last update: July 2023
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- The scaphoid bone
- What is the diagnosis?
- Not visible on X-ray?
- Scaphoid pain but no fracture
- Fracture without swelling?
- What is the treatment?
- Conservative: immobilization, cast or splint
- How to heal scaphoid fracture faster?
- Physical therapy
- What happens if a scaphoid fracture is left untreated?
- Scaphoid fracture: pain level
- How long does it take to heal?
- When can you resume sports?
- Can you drive with a scaphoid fracture?
The scaphoid bone: in the hand and foot
When we talk about the scaphoid bone, we are usually referring to a bone located in the hand/wrist. Scaphoid fracture is classified as a wrist fracture and is the most commonly fractured bone in the wrist.
You may sometimes hear about the scaphoid bone in the foot, or tarsal scaphoid. This is the former name of a bone in the foot, which is now called the navicular bone.
In this article, we are only discussing fractures of the scaphoid bone located in the wrist.
How to diagnose a scaphoid fracture?
Here are the different elements used to diagnose a scaphoid fracture (sometimes referred to as a crack or fissure).
I also address the questions that arise for individuals experiencing pain in the area of the scaphoid bone without an identified fracture.
Symptoms of broken scaphoid
The following symptoms are assessed through questioning and a clinical examination:
- Pain in the wrist, on the thumb side (like a broken thumb)
- Falling on an outstretched hand, twisting of the wrist
- Pain when moving the thumb or pressing on the area of the scaphoid and thumb
- Decreased range of motion of the thumb
If all these signs are present within 24 hours after the injury, they are 100% sensitive. This means that if someone has all these symptoms, the diagnosis is certain.
However, their specificity is 74%, indicating that the diagnosis may be negative in about 1/4 of individuals who actually have a fracture, hence the potential need for further diagnostic tests.
The presence of bruising, hematoma, or swelling is not a definitive sign, as they can be caused by a simple blow or sprain.
📚 Suh 2017
Examinations: X-ray for scaphoid fracture
X-ray is the most commonly performed examination to confirm the diagnosis. It is done as soon as you seek medical attention for your wrist pain, following a questioning and a clinical examination.
Broken scaphoid not visible on X-ray?
Sometimes, the clinical examination strongly suggests a scaphoid fracture, but the X-ray does not show any fracture. This occurs in approximately 1/4 of cases (Suh 2017). In such cases, additional imaging tests may be performed:
- CT scan
- Bone scintigraphy: This is the most confirmatory test for diagnosis. However, it is also the most invasive and has a higher risk of overdiagnosis (111 people treated unnecessarily for scaphoid fracture per 1000 undergoing the test).
In some cases, a fracture may be detected through these additional tests.
If the X-ray did not show anything and you did not undergo any other imaging tests, it is likely because the clinical signs were not suggestive enough of a scaphoid fracture. Your medical team deemed it unnecessary to proceed with further tests, which can also come with their own set of issues (overdiagnosis, radiation exposure, stress, etc.).
Scaphoid pain but no fracture
What causes scaphoid pain in the hand without a fracture?
Some people may experience pain in the scaphoid area without a diagnosed fracture. However, pain in this area can be caused by several factors, including:
- Direct impact or trauma.
- Sprain: Ligament injury in the scaphoid region.
- Tendinopathy/Tendonitis: Inflammation or irritation of the tendons that pass through the area, such as the thumb tendons.
- Carpal tunnel syndrome: A condition characterized by compression of the median nerve as it passes through the carpal tunnel.
These issues require different forms of treatment than a scaphoid fracture.
Fracture without swelling?
Can one have a scaphoid fracture without swelling? Yes, it is entirely possible to have a fracture without swelling. Swelling is not a clinical sign used to diagnose a scaphoid fracture.
Therefore, the presence of swelling in the wrist and thumb area does not determine whether it is a fracture or not.
What is the treatment?
Once the diagnosis is confirmed, the healthcare team taking care of you will generally discuss the two possible treatment options:
- Conservative treatment: You will only be immobilized for a certain period.
- Surgical treatment: You will undergo surgery promptly, followed by potential immobilization, typically for a shorter duration.
Each treatment has its advantages and disadvantages. If the fracture is minor, surgical treatment may not be proposed, while in severe cases, it may be necessary.
It is worth noting that people with a scaphoid fracture, whether or not they undergo surgery, do not show significant differences in terms of:
- Treatment satisfaction
- Upper limb functionality
📚 Li 2018
The purpose of this section is to provide an overview of these two treatments, as well as the frequencies of complications and success rates associated with each (when known). However, specific details regarding your situation can only be provided by the healthcare team responsible for your care.
Conservative treatement: immobilization, cast or splint
Immobilization is commonly recommended for non-displaced fractures, where the two bone fragments are not significantly separated. This treatment typically lasts for 8 to 12 weeks.
Immobilization can be achieved using:
- A wrist splint (with or without thumb support)
- An arm splint
- A cast. Scaphoid fracture cast time typically lasts 8 to 12 weeks.
There is no conclusive data indicating the superiority of one type of immobilization over another.
Often, a follow-up X-ray will be scheduled around 4-8 weeks after the injury to assess the early stages of bone healing. If consolidation is observed, immobilization can be discontinued earlier.
Some medical teams may prioritize maximum healing by opting for a cast, even if it carries the risk of wrist stiffness. Others may prioritize mobility and recommend a simple splint, which may be worn for a shorter duration, potentially leading to a delayed consolidation.
Complications (rare) that may arise include:
- Non-union (pseudarthrosis) occurring in 2 to 5% of cases
Keep in mind that these complications occur very rarely. Furthermore, when they do occur, they may not necessarily have a significant impact on daily life. For reassurance, you can look at the rates of returning to sports after a scaphoid fracture.
📚 References: Suh 2017; Jørgsholm 2020
When the scaphoid fracture is displaced (with a significant gap between multiple bone fragments), surgery is usually recommended. The surgical team realigns the fracture, meaning they put the displaced bone fragments back in the correct position.
Subsequently, internal fixation (such as screws) is used to prevent the bone fragments from shifting again. This procedure is called osteosynthesis and promotes bone healing.
Possible complications (rare occurrences) include:
- Non-union (less frequent than with immobilization)
- Surgical site infection
- Symptoms related to partial tolerance of the hardware
- Neurovascular injury
- Healing problems
These side effects need to be weighed against the benefits of faster recovery and healing time.
📚 Reference: Li 2018
Even after scaphoid surgery, immobilization of the wrist with a cast or splint may sometimes be recommended, typically for a shorter duration (6 weeks).
How to heal scaphoid fracture faster?
When it comes to healing a scaphoid fracture, there is no specific medication or physiotherapy technique that can significantly accelerate the bone healing process. The body has its natural healing mechanisms, and allowing them to function without interference is crucial.
You can support your body’s natural healing process and take steps to optimize your overall health and well-being. Here are some strategies to consider:
- Quit smoking: Smoking can impede the healing process by reducing blood flow and oxygen delivery to the fractured bone. Quitting smoking can help improve circulation and promote faster healing.
- Maintain a healthy lifestyle: Adopt a balanced diet rich in nutrients. Regular exercise can also support overall health and healing.
- Follow proper immobilization: Ensure that you properly immobilize the fractured wrist as instructed by your healthcare provider. This may involve wearing a cast, splint, or brace (see on Amazon) to stabilize the fracture and prevent further damage.
Physical therapy after broken scaphoid
You will often be prescribed physiotherapy sessions. It may be recommended to start them after the immobilization period. However, I recommend discussing with a physiotherapist in the first few days following the fracture. This initial consultation will not necessarily involve starting rehabilitation, but rather ensuring that:
- You understand what you can and cannot do during the recovery period after a scaphoid fracture, such as positions, arm or neck movements, sports activities, driving, etc.
- You have no unresolved concerns or questions.
- You know when to seek professional help if needed.
Your physiotherapist may schedule a follow-up appointment a few weeks later to assess your progress after the immobilization period. Based on this assessment, further physiotherapy sessions may or may not be necessary to gradually regain range of motion and muscle strength. Personalized exercises may be recommended.
Afterward, the focus will be on gradually reintroducing exercice that put more strain on the wrist, such as certain sports or carrying weights.
What happens if a scaphoid fracture is left untreated?
If a scaphoid fracture is left untreated, several potential complications can arise. Here are some possible consequences:
- Delayed or non-union: The fracture may not heal correctly or at all. This can result in a delayed union, where the bone takes an extended time to heal, or a non-union, where the bone fails to heal completely. These conditions can lead to persistent pain, instability, and limited function in the wrist.
- Avascular necrosis: The scaphoid bone has a tenuous blood supply, and if the fracture disrupts the blood flow to the bone, it can lead to avascular necrosis. This occurs when the bone tissue dies due to insufficient blood circulation. Avascular necrosis can cause severe pain, limited wrist movement, and may require additional surgical interventions.
- Osteoarthritis: Untreated scaphoid fractures can increase the risk of developing post-traumatic osteoarthritis in the wrist joint. The irregular healing process, combined with potential joint instability, can lead to joint degeneration over time, resulting in pain, stiffness, and reduced function.
It can be challenging to determine whether inadequate treatment is the sole cause of scaphoid fracture complications. Even if a fracture has been left untreated or complications have occurred, remember that rehabilitation and recovery can still be pursued for months or even years.
Consulting with a physiotherapist can help assess any problems and explore potential solutions or strategies to improve function and quality of life.
Scaphoid fracture: pain level
It is common to experience pain in the days (sometimes weeks) following a fracture, even if the wrist has been immobilized or operated on. This is not a sign of severity or that something is wrong. It is simply due to tissue damage.
The pain gradually subsides over time, regardless of what you do. Here are some things you can do to find relief while it fades away:
- Ensure better positioning: adjust your brace and use cushions when sitting or lying down.
- Continue with your usual activities as much as possible to distract yourself. Engaging in physical activity, such as walking, can release hormones that promote physical and mental well-being.
- Explore medication or non-medication-based pain management therapies.
- Seek guidance from healthcare professionals (doctors, physiotherapists) who are involved in your care.
It is common to experience pain in the days or even weeks following a fracture. This in itself is not a sign of complications.
How long does scaphoid bone take to heal?
The healing time depends on various factors. You can influence at least one of them: tobacco consumption. By limiting or quitting smoking, you increase your chances of achieving faster consolidation.
Other factors include your age, overall health status, or genetics.
📚 Reference: Suh 2017
See also: Wrist Fracture: Healing Time
Nevertheless, we have some data on the average recovery and healing time for non-displaced scaphoid fractures treated with a cast: 53-65 days (approximately 2 months).
FAQ on scaphoid fracture recovery time
What is the recovery time after scaphoid screw removal?
The recovery time after scaphoid screw removal can vary, but it generally takes a few weeks for the incision to heal and for full hand function to return. Physical therapy may be recommended to aid in the recovery process.
How long does it take for a scaphoid fracture to heal after the cast is removed?
The healing time for a scaphoid fracture after the cast is removed depends on various factors, but it typically takes several weeks to a few months for the bone to fully heal. Rehabilitation exercises and a gradual return to activities may be necessary.
What is the recovery time after scaphoid bone graft surgery?
The recovery time after scaphoid bone graft surgery varies, but it generally takes several weeks for the graft to integrate and the bone to heal. Physical therapy and restricted activities may be advised during the recovery period.
How long does it take for a nondisplaced scaphoid fracture to heal?
The healing time for a nondisplaced scaphoid fracture can vary, but it typically takes around 8 to 12 weeks for the bone to heal. It is important to follow the prescribed treatment plan and avoid activities that may hinder the healing process.
What is the recovery time after scaphoid fracture surgery?
The recovery time after scaphoid fracture surgery depends on the specific procedure performed, but it generally takes several weeks to months for the bone to heal completely. Physical therapy and gradual resumption of activities may be necessary for optimal recovery.
When can you resume sports?
Scaphoid fracture is the most common wrist fracture among athletes. It is particularly common in basketball, soccer, and rugby. Therefore, we have a significant amount of data regarding the return to sports: How many people resume sports? Which sports? When?
This information is reassuring for people eager to resume their athletic activities.
For people who did not undergo scaphoid surgery:
- 90% resume sports.
- 88% resume at their pre-injury level of activity.
- On average, sports are resumed after 13.9 weeks (3 months).
In studies conducted over 30 years ago, some people immediately resumed sports while wearing a splint or cast. However, 15% of these people experienced non-union fractures. That is why this practice is not recommended nowadays. Additionally, in such cases, the cast was worn for a much longer duration, typically 3 to 6 months.
For people who underwent surgery:
- 98% resume sports.
- 96% resume at their pre-injury level of activity.
- On average, sports are resumed after 7.3 weeks (less than 2 months).
📚 Reference: Goffin 2019
On average, sports are gradually resumed 2 to 3 months after a scaphoid fracture.
Can you drive with a scaphoid fracture?
You will find varying opinions regarding the resumption of driving a car after a scaphoid fracture.
The specific laws regarding this matter may differ in the United States. It is the responsibility of the driver to ensure that their condition is compatible with safe and responsive driving.
There is no formal contraindication to driving with a wrist or arm splint or cast. However, in theory, you must ensure that you are as responsive as you would be in a normal state.
If the act of turning the steering wheel is no more painful than at rest, there is little risk that driving will aggravate the pain, provided you start with short distances (a few minutes).
In general, the patients I have cared for after a scaphoid fracture resumed driving anywhere from immediately to 6 weeks after the fracture.
One study found that plaster casts for scaphoid fractures hindered driving ability, and therefore it was not recommended to drive with such a cast (Blair 2022). Only 9% of individuals wearing a cast after a scaphoid fracture reported driving with the cast, and 87% of all respondents considered it dangerous (Edward 2009).
Here’s what I wanted to tell you about this! I wish you a very good recovery! Do you have any comments or questions? Your comments are welcome 🙂 !
If you feel the need to learn more about the recovery period after this type of fracture, I wrote this guide in eBook format:
You may also like:
Suh N, Grewal R. Controversies and best practices for acute scaphoid fracture management. J Hand Surg Eur Vol. 2018 Jan;43(1):4-12. doi: 10.1177/1753193417735973. Epub 2017 Oct 13. PMID: 29027844.
Mallee WH, Wang J, Poolman RW, Kloen P, Maas M, de Vet HCW, Doornberg JN. Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD010023. DOI: 10.1002/14651858.CD010023.pub2. Accessed 25 September 2022.
Li H, Guo W, Guo S, Zhao S, Li R. Surgical versus nonsurgical treatment for scaphoid waist fracture with slight or no displacement: A meta-analysis and systematic review. Medicine (Baltimore). 2018 Nov;97(48):e13266. doi: 10.1097/MD.0000000000013266. PMID: 30508914; PMCID: PMC6283056.
Cohen A, Hoogendam L, Reijman M, Selles RW, Hovius SER, Colaris JW. Patient-reported physical functioning and pain improve after scaphoid nonunion surgery: A Cohort Study. Injury. 2021 Oct;52(10):2952-2958. doi: 10.1016/j.injury.2021.06.016. Epub 2021 Jun 25. PMID: 34253353.
Jørgsholm P, Ossowski D, Thomsen N, Björkman A. Epidemiology of scaphoid fractures and non-unions: A systematic review. Handchir Mikrochir Plast Chir. 2020 Sep;52(5):374-381. English. doi: 10.1055/a-1250-8190. Epub 2020 Sep 29. PMID: 32992390.
Reprise du sport
Goffin JS, Liao Q, Robertson GA. Return to sport following scaphoid fractures: A systematic review and meta-analysis. World J Orthop. 2019 Feb 18;10(2):101-114. doi: 10.5312/wjo.v10.i2.101. PMID: 30788227; PMCID: PMC6379737.
Blair S, Chaudhri O, Gregori A. Doctor, can I drive with this plaster? An evidence based response. Injury. 2002 Jan;33(1):55-6. doi: 10.1016/s0020-1383(01)00141-3. PMID: 11879834.
Edwards MR, Oliver MC, Hatrick NC. Driving with a forearm plaster cast: patients’ perspective. Emerg Med J. 2009 Jun;26(6):405-6. doi: 10.1136/emj.2008.062943. PMID: 19465608.
By Nelly Darbois
I love to write articles that are based on my experience as a physiotherapist and extensive research in the international scientific literature.
I live in the French Alps 🌞❄️ where I work as a physiotherapist and scientific editor for my own website, where you are.