Pain in the wrist after a fall with outstretched hand: Possible scaphoid fracture.

Dear Ask The Doctor:  I fell down a flight of stairs 3 1/2 weeks ago landing on my hand, and went to A&E as my wrist was very painful, particularly under the thumb. I was x-rayed for a suspected scaphoid fracture but as nothing showed up I was given a wrist and thumb velcro splint and asked to return in 2 weeks for further x-rays. I returned only a week later due to pain in my wrist and tingling and numbness in my thumb and index finger. I was then put into a scaphoid cast for the pain and told to return in a week. The following week the cast was removed and I was re x-rayed. Again no fracture was seen and I was diagnosed with a sprain and given another wrist splint (no thumb). I saw my my GP shortly afterwards (for an unrelated issue) and was advised to rest the wrist and take ibuprofen for the swelling and pain. My parents then insisted I see a second GP back at home, who advised me to use the wrist more and try some home physiotherapy exercises (flexion-extension, side-to-side, rotation). I have tried this for a few days but am still in pain and have occasional tingling down the outer side of my thumb. What should my next action be? 

Dear Patient:  Sometimes the scaphoid fractures are really hard to see in the X-rays, so the best imaging study to visualize them is the CT scan. In your case the way you fell, your age, and the pain under the thumb, is typical of an scaphoid fracture, and most of the orthopedic surgeons treat such cases as the mentioned fracture even with x rays showing no fracture, and they order CT scan right away or after 2 weeks of the trauma. I suggest that you get an evaluation by an orthopedic surgeon or a hand specialist.

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