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There’s a wide range of potential injuries to the hand, wrist, elbow or shoulder associated with this type of fall. Many of these injuries are minor, causing only temporary discomfort and requiring no special treatment. Some injuries are clearly more significant resulting in a broken bone or worse. But there’s a large middle ground, and it can be difficult to determine the significance of an injury.

In all ages, falls onto the hand most commonly cause wrist injuries. Elbow injuries and shoulder injuries may also occur, particularly in older age groups. Initial treatment almost always includes ice and relative immobilization—the rest and ice part of RICE.

When there’s an obvious injury—significant swelling, bone out of alignment—or the discomfort continues for a substantial time, you should seek medical attention.

The Wrist

Of the over 300 joints in the body, your wrist is one of the most complex structures, capable of moving in many directions. The two large bones in the forearm (the radius and ulna) join with eight smaller bones (the carpal bones). Most of the up and down motion of the wrist happens at this junction. Some motion occurs between the small carpal bones as well.

Rotating the hand from a palm up to palm down position occurs with motion between the radius and ulna. The bones on either side of every joint are connected by fibrous ligaments. In the wrist, these are specially shaped to allow motion in some directions, but to restrict motion in other directions. The joint surfaces in the wrist are lined with smooth cartilage to allow easy motion.

Different Ages, Different Breaks

In children, a fall onto the hand will often produce a minor break or “buckle fracture” of the radius near the wrist (fracture is the medical term for broken bone). There may not be obvious injury but there is tenderness at the site of injury. An examination and x-ray are needed for an accurate diagnosis. Treatment is usually simple—a cast or brace for a few weeks.

Another common wrist injury in children is a fracture through the growth plate at the end of the radius. This area is where immature bone is forming rapidly and so is more easily broken. This injury is more likely to show some obvious deformity and is also more likely to require correction or manipulation by the doctor. Correction usually involves administering an anesthetic and manually straightening out the bone before applying a cast, in a process called reducing the fracture.

Adults have a wide spectrum of possible wrist injuries. A broken wrist (fracture of the end of the radius) is more likely to produce an obvious deformity and may require surgical correction, using metal pins or plates to maintain the corrected position while healing occurs. This surgery is usually performed on an outpatient basis. Advances in both hardware and surgical technique in the last 20 years have improved outcomes for patients with this surgery.

Breaks of the smaller bones of the wrist (carpal bones) can also occur in adults. These injuries can be hard to diagnose. Although initially the x-rays may appear normal, it may be helpful to repeat the x-rays after seven to ten days, or to perform special tests such as CT scan or MRI to verify the diagnosis. Most carpal bone fractures can be treated with immobilization, but in some cases surgery is recommended to speed recovery.

Wrist Sprains

A FOOSH injury can also cause a wrist sprain—an injury to the ligaments holding the bones together at that joint. Sprains can be minor, recovering gradually over weeks. Sprains can also be quite significant, with complete disruption of the ligaments, allowing the carpal bones to shift abnormally.

Most sprained wrists will appear normal on an x-ray. Additional imaging, particularly with an MRI, can be helpful in making a diagnosis. Sometimes a diagnostic surgical procedure called arthroscopy is required to determine the extent of the injury. In severe sprains, surgical reconstruction of ligaments may be needed.

Other Injuries

A fall onto the hand may also cause injury to the elbow. The most common such injury is a break of the radial head, a part of the radius near the elbow joint. This injury can often be treated with rest followed by early range of motion exercises, starting with pain free motion. More severe injuries often require surgical correction.

In older age groups, a fall onto the hand can also produce injury to the long bone of the upper arm (the humerus) just below the shoulder (fracture of the humeral neck). A fracture here can often be managed simply with a sling. For severe injuries, as with the elbow and the wrist, surgical correction may be an option.

Recovery and Prevention

While children usually recover from wrist injuries quickly and rarely require any formal therapy, adults are more likely to benefit from formal hand therapy. A hand therapist can direct range of motion exercises and strengthening programs and may provide custom splinting. The therapy can often help speed recovery and allow faster return to work and play.

And prevention—wearing wrist braces with risky activities and improving balance—may help you avoid a second FOOSH.

Robert Huxster, M.D.
This article was also featured in the March 2018 issue of County Lines Magazine.

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Pain Management with Heat & Cold Therapy

Using heat and cold therapy is one of the best ways for you to manage your pain right from the comfort of your home. In addition to avoiding the side effects of over the counter pain relievers, this kind of therapy can help the healing process move along faster by lowering inflammation for new injuries and improving range of motion for older injuries.

Whether you use heat or cold to treat your pain depends mostly on one thing: when the injury occurred. If you’re experiencing acute pain or you have a new injury that is swollen or inflamed, then cold therapy will work best for you. If you’re experiencing chronic pain or your injury is more than a day old, then heat therapy will work best for you. Of course, these are not hard and fast rules. So if you try either of these out and it is unpleasant, switch to the opposite to try to find some relief.

Cold Therapy Reduces Inflammation

Using ice on a fresh injury is not a new idea. In fact if you’ve ever fallen hard as a child, an adult likely immediately gave you an ice pack. This is to reduce the inflammation, swelling, pain, and redness associated with the injury. These are natural reactions to your body experiencing pain, however in excess these processes compress local tissue and cause more pain.

Using cold therapy not only reduces the pain by numbing the injury, but it also slows the blood vessel and reduces the fluid buildup at the site of the injury. By controlling the swelling, you will not only find that the injury is numbed, but you might find that it can help your injury heal a bit faster.

Cold therapy (also known as Cryotherapy) can be used to relieve the pain of an injury or to help speed the recovery of a rigorous exercise such as after a long run, swim, hike, or even sports play.

Heat Therapy Stimulates Blood Flow

Unlike cold therapy, heat therapy speeds up the blood flow and can be a gentle suggestion to your body to begin the healing process. You might find that heat therapy helps sooth sore muscles and relax muscle spasms especially with an older injury.

Using heat therapy reduces the pain by not only relaxing your muscles, but also by increasing the flow of lactic acid. This fluid often slows down in areas with decreased blood flow, but its removal is necessary for improving range of motion and decreasing pain. Paired with hydration, heat therapy can help you heal from pain from an ongoing injury or to relax sore muscles and stiffness from the body.

If the injury causing pain is severe, be sure to talk to your orthopaedic specialist to ensure that a more active approach to your pain management isn’t necessary.

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Clavicle

The clavicle, or collarbone, rests between the upper ribcage and the shoulder blade. As the bone that connects the arm to the body, the clavicle serves an important function but also is easy to break because of its position and slender shape. Fractured clavicles can happen in infants passing through the birth canal; during sports, especially ones that don’t involve padding; and car accidents. Typically, a bump will develop and the arm won’t work properly. A broken clavicle usually is treated with an arm sling.

Arm

When you trip and fall, it’s your first instinct to stretch out your arms to catch yourself. However, when your arm breaks your fall, it sometimes breaks as well. Both adults and children are susceptible to arm fractures, though children typically break their lower arms as opposed to their upper arms. It’s possible to break the upper arm (humerus) or the two bones in your lower arm (radius and ulna). In the case of an arm fracture, it’s important not to move your arm. Keep it stable until you can have it professionally treated to prevent further damage.

Wrist

If your arm doesn’t break when you trip and fall, there’s a good chance that your wristwill break. In addition to falls, physical activities such as biking or skiing can lead to wrist fractures. Your wrist is comprised of eight bones plus two bones in the forearm. People often don’t realize that their wrist is broken when they hurt it, so it’s crucial to seek medical attention if you experience significant pain the wrist area.

Hip

A fractured hip drastically inhibits a person’s mobility. This type of fracture occurs in the femur, which becomes weaker with age and therefore more vulnerable to fractures. The hip is the most frequently broken bone for people over the age of 65 and typically occurs because of falls and conditions such as arthritis and vision impairment. When someone breaks their hip, they’ll experience immobility and severe pain.

Treatment for a hip fracture typically involves surgery and requires the use of screws or even a hip replacement. Recovery from a hip fracture is lengthy and requires extensive rehabilitation. These are the most commonly fractured bones in the body. If you’re experiencing pain in one of these areas, it’s important that you seek medical attention as soon as possible.

For more information about fracture care, click here to download our free eBook,Understanding Fracture Care: Causes, Diagnosis, and Treatment.

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