Patient information · Urgent care and orthopaedics
Wrist and scaphoid injury
why a normal X-ray does not always mean nothing is broken
Falling onto an outstretched hand is the classic mechanism for wrist injury. One small bone at the base of the thumb, the scaphoid, is notorious for not appearing broken on the first X-ray — which is why you may be splinted and asked to come back despite a normal result.
Seek urgent assessment if
- the wrist or hand looks bent, twisted or out of shape
- the hand or fingers are numb, tingling, pale, blue or cold
- there is a wound over the injury, or bone is visible
- you cannot move the fingers, or pain is severe and worsening despite painkillers
- swelling is severe and the skin feels tight and shiny
- pain in a plaster cast is increasing rather than settling, or is not relieved by elevation
Increasing pain in a cast, with tight swelling, numbness or pain when the fingers are straightened, can indicate dangerous pressure building in the limb. Do not wait for your next appointment. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
The scaphoid problem
The scaphoid is a small bone in the base of the thumb, tender in the hollow known as the anatomical snuffbox. Around one in four scaphoid fractures is invisible on the X-ray taken on the day of injury. Its blood supply enters from one end, so a missed fracture can fail to heal and the bone can die — leading to long-term pain and arthritis in an otherwise young, healthy wrist. This is why, if you are tender in that spot, you will be splinted and brought back for re-examination and repeat imaging at around 10 to 14 days, or offered an MRI, even when the first X-ray looks normal. Please do not skip that appointment because the wrist feels better.
In the first few days
- Elevate the hand above the level of your heart whenever you can — on pillows, or in a sling for short periods. This does more for swelling than anything else.
- Remove rings immediately, before swelling makes it impossible.
- Ice through a damp towel for 10 to 20 minutes, a few times a day for the first 48 hours.
- Keep the fingers, elbow and shoulder moving through their full range several times a day, even if the wrist is immobilised. Stiffness elsewhere in the limb causes more lasting trouble than the fracture.
- Take painkillers regularly for the first few days — paracetamol, with an anti-inflammatory if it suits you.
Looking after a cast or splint
Do
- Keep it completely dry — use a proper cast cover or a sealed bag for showering
- Keep the hand elevated, especially for the first few days
- Wiggle the fingers frequently
- Contact us if the cast cracks, softens, becomes loose or rubs
Do not
- Do not push anything down inside to scratch — it damages the skin and causes infection
- Do not trim or alter the cast yourself
- Do not use talc, creams or oils under the cast
- Do not drive while wearing a cast or splint on the wrist
Recovery
Once the cast comes off, the wrist will be stiff, weak and swollen, and the skin may be dry and flaky. This is normal. Movement and strength return with graded exercises rather than with rest, and hand therapy makes a substantial difference to the final result — particularly for grip strength and rotation.
Come back to us if
- pain over the base of the thumb persists beyond two weeks, whatever the X-ray showed
- the wrist is not regaining movement six weeks after the cast comes off
- the wrist looks deformed as swelling settles
- you develop burning pain, marked swelling, colour changes or excessive sensitivity of the hand — this needs prompt assessment
Book an appointment if you need an X-ray, a repeat scaphoid view, an MRI, a cast check, or hand therapy. Our orthopaedic and physiotherapy teams see hand and wrist injuries seven days a week without a referral, and we arrange X-ray and MRI quickly through our CQC-registered imaging partners.
Orthopaedics, physiotherapy and fast imaging
Same-day appointments most days, seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.