Scaphoid Fracture in a Tennis Pro

Posted On: May 12, 2017

This is the sixth case review of interesting cases from my past practice. I am Dr. David Johnson the director of North Shore Spinal and Sports Rehabilitation. I practice physical therapy in Highland Park and physical therapy in Lake Bluff. Additionally I have practiced as a chiropractor in Highland Park and Lake Bluff for years.

This case is that of tennis pro who was in her late twenties. She was a talented collegiate player playing in the Big 10. She became a tennis pro to teach her passion to others.

She was distraught as the result of having injured her right wrist in a fall on the outstretched hand two days prior to her coming in. She couldn’t hold a racquet well because of her pain and every time she hit a ball in tennis.

Her wrist was not frankly swollen. Grip strength was slightly diminished on the right. She had full ranges of motion. She had frank tenderness over the area of the anatomic snuff box,, so much so that when I touched it directly with my finger tip she winced, withdrew her hand and turned white.

I told her we needed x-rays and maybe an MRI. I was concerned with the possibility of a scaphoid fracture. We took the x-rays first and as luck would have it there was a crack in the scaphoid.

I showed her the results and advised she go to the orthopedic surgeon to have her wrist cast in a thumb spica cast (a thumb up position cast).

She was upset as she was uninsured at the time and she couldn’t afford the surgeon. She asked if I could cast her fracture. I told her I literally just learned how to cast and that scaphoid fractures are prone to non-union and potential bone death (osteonecrosis). I asked her again if she would go see the orthopedic surgeon. She said no, that if I couldn’t do it she would just go to the pharmacy and get a brace.

I conceded and made the cast. The cast I made was a short arm thumb spica cast which leaves one in a thumbs up position to help the scaphoid fracture heal.

She wore the cast for twelve weeks. I cut the cast off and x-rayed the wrist and the fracture had healed. I made sure to take the exact same x-rays that I had originally identified the fracture on. I examined the wrist and the tenderness was gone as well.

We followed up with physical therapy of the wrist and hand. I mobilized the wrist to restore proper movement as well. She then integrated back into teaching tennis. Subsequent to this episode she has taught many a student in the game she loves, tennis.

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