What can detect a scaphoid fracture better, an x-ray or an MRI?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hi doctor,

I have been feeling wrist pain for a few weeks now. No recent injury, but I had an injury a few months back. I had foot surgery and fell off my scooter, and landed on my wrist. I was on crutches and needed my wrists, so I dealt with the pain, which was very painful. The pain went away and just resurfaced. It is on both sides (palm and dorsal), and it hurts in extension (more pain), flexion, and ulnar deviation (more pain). I have been wrapping it daily and even have a wrist brace, but it is not getting better. Pain is A 4-4 constant dull ache, and when moving, I got sharp shooting pains of like 7 on the pain scale. Currently, I have Ibuprofen and Tylenol occasionally.

Answered by Dr. Anuj Gupta

Hi,

Welcome to icliniq.com.

The area (attachment removed to protect patient identity) you have marked is an area of the scaphoid bone. Do you have any X-rays or other investigations?

Patient's Query

Hi doctor,

Thank you for your reply.

I do not have the X-ray. I have not gotten it looked at yet.

Thank you.

Answered by Dr. Anuj Gupta

Hi,

Welcome back to icliniq.com.

I think you should get an X-ray done of your wrist area. Sometimes there will be a fracture of the scaphoid bone, which manifests later. You might need MRI (magnetic resonance imaging) also. I request you to read about scaphoid bone fracture online.

I hope this was helpful.

Patient's Query

Hi doctor,

Thank you for your reply.

Fine, what should I do in the meantime? Should I keep wearing the brace? Is this something that is going to need a cast for an extended period?

Answered by Dr. Anuj Gupta

Hi,

Welcome back to icliniq.com.

Yes, use a thumb spica brace to restrict movements of the thumb. This fracture requires a long period of casting and may even require surgery and bone grafting. It has been two days. Have you not got your X-rays done?

Kindly follow up with the reports.

Patient's Query

Hi doctor,

Thank you for your reply.

I got them today. No fracture seen now, but I guess I have calcium deposits.

Answered by Dr. Anuj Gupta

Hi,

Welcome back to icliniq.com.

Well, I do not think the second point is that significant. Sometimes the scaphoid fracture is not seen on X-rays, and you need to get an MRI (magnetic resonance imaging) for that, as I have said earlier. So you should approach your orthopedic surgeon, and he will advise you MRI after the examination. Do not worry about the second point. It is normal.

Patient's Query

Hi doctor,

Thank you for your reply.

So the calcium deposits would not be causing pain. And should I continue thumb spica till I see an orthopedic doctor? How often should I wear it? All the time, even while sleeping? Or what would you advise your patients in this situation? I was not informed of this today as the nurse practitioner was not very helpful or compassionate. He said there was no fracture, dismissed my pain, and said, you do not need a brace, but I will give you one. He did not even tell me to follow up. I am glad that I consulted you and did some research of my own.

Answered by Dr. Anuj Gupta

Hi,

Welcome back to icliniq.com.

Yes, some calcification is normal. So nothing to worry about that. You should wear a thumb spica as per your pain. If pain is more, then wear it most of the time, and if it is bearable, you can use it when you are doing some heavy activities, which might increase your pain. So the decision is yours. Well, I feel chronic pain in that area, especially after a history of fall on outstretched hand should be investigated for scaphoid fracture. It might be possible that your MRI comes out normal, but ideally, it should be done.

Thanks.

Patient's Query

Hi doctor,

Thank you for our reply.

So with still a suspicion of the scaphoid, should I try to keep it immobilized all the time except showing? Or is it fine since the fall was a while ago? I have an appoinment with a local orthopedician, and I am sure she will advise for an MRI.

Thank you.

Answered by Dr. Anuj Gupta

Hi,

Welcome back to icliniq.com.

So basically, the purpose of the splint is to prevent pain that is bothering you. Suppose you are comfortable with that pain, then no need to use it. If not, then you should use it. Fracture has nothing to do with a splint. Would you please let me know whatever comes in the MRI?

Thanks.

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Answered by Dr. Anuj Gupta

Medically reviewed by Dr. Preetha. J

November 6, 2021

February 5, 2024

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