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Sprain vs. Fracture

by Russ Overy, PT, DPT, FAAOMPT

FOOSH – or “fall on an outstretched hand,” something I experienced first hand in October while mountain biking. I have fallen before while biking (many times), onto my hand, but this was different. The impact was greater and the landing was on rock, not dirt. I have sprained my wrist before in similar falls, but no fractures. This time my wrist motion was quickly limited, however, my sense of denial was stronger. I ignored the pain and limited motion and continued to ride. I went to work the next day and treated patients. Finally after poking around on my wrist I gave in (and after lectures form colleagues) and called a physician. Diagnosis: Fracture of the left triquetral bone (2nd most common fracture of the carpal bones) and immobilization for 6 weeks. So much for that first cross race that I registered for.

What was different this time?

  1. More pain after impact.
  2. Pain at end range continued.
  3. Significant tenderness on the bone.

Without confirmation of the fracture I would have done exactly what I tell my patients not to do: push through and continue activities. Cross racing is probably not the best activity to do on a fractured wrist. More importantly, treating patients with a fractured wrist is challenging.


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