Wrist Pain in a Collegiate Golfer

Abstract

HISTORY: year-old right-handed senior male golfer presented with right wrist pain. History was significant for 4 months of pain that worsened after striking a tree root while playing golf in the spring. He was evaluated and radiographs were negative at that time. His pain subsided with 3 weeks of rest. He returned to his home in Europe for summer vacation, and had increasing pain with golfing activity over 6-8 weeks. An MRI in Europe was reported to show edema in scaphoid, and a CT scan reportedly showed a non-displaced healing scaphoid fracture. He was treated with relative rest and physiotherapy for 6 weeks. At his follow-up visit upon returning to school for the fall, he reported improvement in symptoms. He was able to do normal daily activities without pain, but still had some pain with weight-bearing activities. PHYSICAL EXAMINATION: Examination of his right wrist revealed normal alignment without deformity, ecchymosis, erythema or swelling. He had no pain to palpation over the anatomic snuffbox. He had full range of motion and normal strength of his right wrist to flexion, extension, ulnar deviation, radial deviation, pronation, and supination without pain. He had normal grip strength. He had mild discomfort on the radial side of his right wrist with weight-bearing on his right hand. Neurovascularly intact in his right upper extremity. DIFFERENTIAL DIAGNOSES: Scapholunate ligament injury Kienbock’s disease Scaphoid impaction syndrome Scaphoid fracture De Quervain’s tenosynovitis TESTS AND RESULTS: X-ray of right wrist: --Scaphoid waist fracture with evidence of healing CT of right wrist: --Scaphoid waist fracture with evidence of partial non-union along the volar margin FINAL WORKING DIAGNOSIS: Partial union of mid waist scaphoid fracture TREATMENT AND OUTCOME: Initially, immobilization in an Exos thumb spica splint. Bone stimulator twice daily for 20 minutes. Gradually progressed him back to golfing activity starting with chipping and putting. He was still healing as of last set of X-rays at 8 week follow-up. He progressed through putting and chipping without pain. We cleared him to start full golf activity.