The scaphoid bone is one of eight small bones that form the hand skeletal structure or the carpal wrist portion.

Carpal bones are structured in two rows, one close to the lower arm (proximal row), and the other, which is closer to the fingers (distal row). The scaphoid bone has a unique function, as it joins both the proximal and distal bones. A poor anatomic position, poor blood circulation and mechanical stress make it prone to damage. Hence, most finger fractures occur in that position. Osteonecrosis (avascular necrosis) is one of the most frequent complications occurring after a scaphoid bone fracture.

Causes and symptoms
The condition appears when the shape of bones is altered, the cartilage is worn out and joints begin to touch, which leads to inflammation (arthritis) and pain. The flow of blood stops and necrosis sets in.
Studies have shown that ten to fifteen percent of patients with a fractured proximal one-fifth of the scaphoid bone develop osteonecrosis, usually only in the proximal area. Although osteonecrosis of the entire scaphoid bone can be seen in the early stages of aseptic necrosis (Preiser disease), osteonecrosis of the distal part of the scaphoid is uncommon.

Diagnosis and treatment
An MRI scan can uncover early stages of osteonecrosis, while an RTG examination and ultrasound can detect the later stages. Sleep, painkillers, kinetic therapy, and surgical intervention are all recommended as methods of treatment. After surgical treatment, it is necessary to begin circulation exercises as soon as possible during the 3-6 week recovery period. This kind of passive rehabilitation with a gradual introduction of actively aided and active exercises help to heal the atrophied musculature and restore the normal function of the hand. Electrotherapy (IFC, DDS, TENS…), ultrasound therapy, laser therapy, magnet therapy, are all implemented in order to alleviate pain and accelerate tissue regeneration.
Apart from these, our centre includes Bemer therapy, which can also improve microcirculation and lead to recovery.

Miloš Paunović
Chartered physiotherapist
Licensed Mulligan physiotherapist