FOOSH Injury

Posted On: September 27, 2017

This is the twentieth case review from my past practice. I am Dr. David Johnson a chiropractor and physical therapist in Highland Park and Lake Bluff. I am the director of North Shore Spinal and Sports Rehabilitation. I started as a chiropractor in Lake Forest, Il in 1988. I integrated physical therapy into my practice in 1990.

This is a case to help people understand the scope and breadth of what a chiropractor who is board certified in orthopedics can do in Illinois. Most people do not know that in Illinois chiropractors are licensed as chiropractic physicians under the Medical Practice Act (the same act that licenses medical doctors). The chiropractic physician has the ability to treat and diagnose in Illinois. A chiropractor cannot prescribe drugs or perform surgery.

This is a case where a woman in her late thirties came to me after falling on the outstretched hand when roller blading without wrist guards. A classic injury, in medicine, known as a FOOSH injury. She had wrist pain but not a lot of swelling. There was no visible bony deformity. She could flex and extend her wrist fully though she had some pain with extension. When I palpated her wrist she had exquisite tenderness at the base of her thumb in an area known as the anatomic snuff box.

I explained to her that she may have broken her wrist, to which she exclaimed, “no way.” I told her that we will take x-rays but in this type of injury that it only reveals a fracture 50% of the time. I told her if the x-ray was negative that an MRI is warranted to rule out a specific type of fracture. We took the x-rays and they were negative for fracture. I placed her in a thumb spica immobilizer and scheduled an MRI.

A couple of days later when she had the MRI, I got a call from the radiologist confirming my suspicion that she had a scaphoid fracture. He asked me if I was going to send her to an orthopedic surgeon. I told him that I knew how to cast and I would give her the option of either going to the surgeon or having me do it. She chose the later. I put her in a short arm thumb spica cast and monitored with serial x-rays until we had signs of bony heeling on x-ray.

In ten weeks she had early signs of healing so I removed the cast and examined her wrist. She no longer had he scaphoid area tenderness but she had a very stiff wrist and a good amount of forearm atrophy. She was placed back in thumb spica immobilizer and physical therapy was started.

After a month or so of physical therapy, she had regained full pain free function of her wrist. All in all it was a good outcome and the patient was able o return to he active lifestyle.