07/05/2025
Case of the week:
One of our regular patients, Mrs E , came to see us last week for a check-up - this usually involves an examination of her spine and relevant treatment to areas of concern. During her session, she happened to mention that her right thumb was still quite painful, having highlighted low level thumb pain a couple of months prior and been given advice and an exercise to do. Further probing uncovered that she had had a fall onto her front jus a few weeks back, but Mrs E was certain she had grazed her left hand, and did not recall hurting her right hand at the time.
A couple of quick orthopaedic tests demonstrated extreme tenderness to palpation in the area of the anatomical s***f box of the right hand, and notable tenderness to the scaphoid tubercle. Compression down the shaft of the thumb was painful whilst mild swelling was noted about the base of the thumb on her palm aspect (thenar eminence).
We were concerned about the possibility of a Scaphoid Fracture - a break in one of the small bones in the wrist, often occurring after a fall on an outstretched hand. Prompt diagnosis and treatment are crucial, as delayed or missed fractures can lead to complications like non-union and avascular necrosis, which is where the blood supply to the bone is compromised resulting in potential long term issues.
Mrs E was asked to attend the Small Injuries Unit at the Royal South Hants Hospital to have her hand checked, and after an X-ray it was confirmed that she had a hairline fracture to her Scaphoid bone. She has been referred to Orthopaedics for further assessment and management, and should make a good recovery now that she has been sent down the proper care pathway.
This was a nice catch, and the case highlights the value of a detailed hands-on examination of a joint complaint, whilst being mindful of any recent injuries that may require onward referral for imaging and subsequent care pathways.
