Scaphoid Fracture

The catch is that you can usually still move your wrist. The pain is often not severe, and it's worse with gripping and pinching ⁶. Retained movement is why this gets written off as a sprain, and it rules nothing out. Nor can you check it yourself: "the scaphoid bone is not simple to examine and without specialist training you will be unable to check it for yourself" ².

Three clinical tests are commonly used, and what they can't do matters as much as what they can:

• Anatomical snuffbox tenderness: about 86% sensitive, but only about 30% specific ³
• Scaphoid tubercle tenderness: the most accurate of the three, at around 95% sensitivity and 74% specificity ³
• Scaphoid compression test: the weakest, at about 43% sensitivity and 29.6% specificity ³

They're good at raising suspicion and poor at confirming, which is why imaging and precautionary immobilisation follow instead of a confident "it's just a sprain."

The same fall can also produce a distal radius fracture, another fracture or dislocation in the wrist ⁶, or a scapholunate ligament injury ⁵. If yours came on gradually instead, the Hand section of our Injury Finder covers conditions that fit better.

A suspected scaphoid fracture follows a set pathway, and a clear first X-ray doesn't end it. Your clinician asks how the injury happened, then checks for tenderness directly over the scaphoid, along with swelling, bruising and lost movement ⁶. X-rays come next.

If the wrist is tender over the scaphoid but nothing shows, it's splinted and you're brought back, typically 10 to 14 days later, to be re-examined and to decide whether another X-ray is needed ². Still suspected at that review? An MRI is arranged, or a CT scan when MRI isn't suitable ¹.

The scans, splint, cast and any decision about surgery belong to your emergency department, GP or orthopaedic team, not to us. What we do is everything after: rebuilding a wrist, hand and arm immobilised for six weeks or more. That follows a clear order ¹⁰:

• Restoring movement first: active and active-assisted range for the wrist and thumb, plus the fingers, elbow and shoulder, which all stiffen in a cast and get forgotten. Swelling is settled alongside this, not waited out.
• Hands-on joint work: mobilisations to the radio-carpal, radio-ulnar and carpal joints when range doesn't return with exercise alone.
• Rebuilding grip and wrist strength: the step most often skipped. Even with therapy, some people don't get back the range and strength they had before the injury ⁶.
• Back to the actual task: the grip you need for work, the load you need for sport, built around your goals rather than a generic timeline.

To be upfront, there's no trial-level evidence for this sequence specifically: a literature search returned nothing at that level. It reflects established NHS rehabilitation advice ¹⁰, which is a reasonable basis for treatment but isn't a randomised trial, and we won't pretend otherwise.

A scaphoid fracture follows The Well Motion Recovery Path™ but your fracture team runs the first phase. You move up when the bone and the wrist are ready, not on a date.

• Reset: the splint or cast, or the weeks after surgery. Your ED, GP or orthopaedic team runs it. Keep every joint outside the splint moving ^1,2. Expect a stiff, weak wrist when the cast comes off. You move on when your doctor clears the fracture.
• Rebuild: where we start. Wrist and thumb movement first, hands-on joint work if range stalls, then grip and wrist strength ¹⁰. Expect movement back before strength. We move you on when the hand does what your daily tasks ask of it.
• Return: the grip your job needs, or the load your sport puts through the wrist. We test those tasks at the weight and speed you use them. You leave with a strength program.

How long it usually takes. About 90% of waist fractures that have not shifted unite after 6 weeks in a cast ⁵. Fractures nearer the thumb need 4 to 6 weeks, moderately displaced waist fractures 8 to 10 ⁵. Across 11 studies of athletes, return to sport averaged about 7 weeks after surgery and 10 with a cast ⁹. Rehabilitation after the cast has not been timed in trials, so we give no number for it.

Two things have been measured here: what protects a wrist in a fall, and what gets in the way of this bone healing.

• Wear wrist guards for board and skate sports. Pooled studies of snowboarders found wrist fractures were about 70% less likely in riders wearing guards ⁷. That figure is for wrist fractures of all kinds. Nobody has counted scaphoid fractures separately. Guards are advised for inline skating and skateboarding too ⁶.
• Smoking counts against healing. A 2025 review of four studies of fresh scaphoid fractures found smokers were about 1.7 times as likely to end up with a bone that didn't unite ⁸.
• Stay out of sport and the gym until you're cleared. While a fracture is suspected, the advice is no sport, no gym and no manual work with the injured hand ¹.
• Keep the splint on and keep your review. Wear it day and night, taking it off only to wash ², until your scan results have been discussed with you ¹.