FOOSH is the nickname for an injury caused by having “fallen onto an outstretched hand.” These injuries are among the most common injuries affecting the hands and wrists that occur when trying to break a fall.
The severity of FOOSH injuries can vary greatly depending on various factors. These include:
- the force of your impact with the ground
- the type of ground you’ve fallen on
- the way in which you’ve fallen
- whether you have any existing health conditions or injuries affecting your hands and wrists.
Treatment of a FOOSH injury depends on its severity. Some cases of FOOSH may cause broken bones and send you to the emergency room, while others heal over a few weeks with stretching and rest.
FOOSH injuries often happen to people who participate in sports where falls are common, such as downhill mountain biking, skiing, and football.
Anyone can get a FOOSH injury if they fall on a hard surface and try to brace themselves with their hands or arms. Incorrect footwear can create tripping hazards and also lead to falls. A lack of balance or coordination, poor vision, or medications that cause drowsiness, may also cause falls with FOOSH injuries.
A scaphoid fracture is a break in one of the eight small bones that make up the wrist. It’s one of the most common FOOSH injuries. The main symptom is pain, with or without swelling or bruising, on the side of your thumb. You’ll notice this pain within a few days of your fall.
The injury is sometimes believed to be a sprain or strain because it does not usually cause a physical deformity. But putting off treatment for a scaphoid fracture may lead to future complications caused by incorrect healing.
Complications may include poor blood flow into your bones, bone loss, and arthritis. If you feel pain on the thumb-side of your wrist following a fall, see a doctor.
Treatment depends on its severity. Less severe fractures may be treated by putting your hand and wrist in a cast, while severe fractures require surgery to mend the broken scaphoid bone together.
Distal radius fracture
Distal radial fractures, including Colles’ and Smith fractures, are common FOOSH injuries. They affect your wrist where it meets your arm’s radius. The radius is the larger of the two bones in your forearm. Often this type of fracture will cause swelling, bone displacement, bruising, and extreme pain along your radius. You’ll also feel pain when you try to move your wrist.
If you have a minor fracture, your doctor may recommend you wear a light cast or a splint, and allow it to heal over time on its own. Before doing that, your doctor might have to straighten your bones forcefully into place by performing what’s called a closed reduction. A closed reduction can be done without cutting into your skin, but it can be very painful.
With more severe fractures, a doctor most often recommends surgical treatment followed by physical or occupational therapy.
Radial or ulnar styloid fracture
The radial styloid is a bony projection on the thumb-side of your wrist, while the ulnar styloid is a bony projection on the pinkie-side of the wrist. A FOOSH injury can fracture these bones on impact. The injury often only presents pain with no visual signs of injury like swelling and bruising.
It’s important to treat a styloid fracture as quickly as possible to avoid complications. Treatment depends on the severity of the injury. More serious injuries require more extensive treatments, like surgery. This injury often co-occurs with a scaphoid fracture, so a doctor should always thoroughly check that part of the wrist for injury.
Radial head fracture
The radial head is at the top of the radius bone, right below the elbow. Most people feel this injury first as wrist and elbow pain. It might hurt so much that it’s difficult to move.
An inability to move the elbow is a good indication of a possible radial head fracture. Radial head fractures don’t always appear on X-rays.
Treatment involves ice, elevation, and rest with either a sling or splint, followed by physical therapy. Controlled movement is important with this injury. Extensive radial head fractures where the bone has been damaged require surgery.
The scapholunate is a ligament (a tough band of tissue) in the wrist. Because it causes pain and usually no physical deformities, some people mistake this FOOSH injury for a sprain. However, unlike a sprain, this injury continues to cause pain over time and does not heal on its own.
If left untreated, a scapholunate tear can lead to a type of wrist degenerative arthritis called scapholunate advanced collapse (SLAC).
Treatment includes surgery followed by physical therapy and careful monitoring for complications. This injury does not always heal correctly, even with surgery. With this condition, it’s important to check your wrist for any other injuries that could have been sustained during your fall.
Distal radioulnar joint fracture
This joint is located at the wrist where the arm’s large bone, the radius, and its small bone, the ulna, meet. It’s made up of bone and a triangular web of soft tissues, ligaments, and cartilage. With this FOOSH injury, you will feel pain along the pinkie-side of your arm, especially when lifting. You may also hear a clicking noise or feel like your wrist is unstable when you’re pushing your hand against something.
Surgery is almost always needed to treat this injury, which can be challenging to put in the correct position for healing. Fast treatment can improve the outlook by minimizing the time needed for healing and maximizing the chances of your bones aligning correctly. If a doctor finds a distal radioulnar joint fracture, they should also check for signs of damage to the surrounding soft tissues and ligaments, which often co-occur.
Hook of hamate fracture
The hamate is a wedge-shaped bone on the pinkie-side of the wrist. A small projection on this bone is called the “hook of hamate.” People with this injury often experience numbness or tingling along the ring and pinkie fingers. That’s because the hook of hamate is located closely to the ulnar nerve.
Besides numbness or tingling, a person with a hook of hamate fracture will experience pain along the ulnar-side of the wrist, a weakened grip and pain when flexing the pinkie and ring fingers.
Treatment depends on the extent of the injury. If the fracture is mild, a short arm cast can be effective but close monitoring is necessary to ensure that the injury heals properly.
For more extensive fractures where the hook of hamate becomes displaced, it may be necessary to surgically remove the bone from the wrist. With this type of surgery, good physical therapy can help maintain a good range of motion and gripping ability.
A synovial joint is a joint where two bones connect at a cartilage-lined cavity that’s filled with fluid called synovial fluid. Synovitis is painful, abnormal swelling of a synovial joint that causes a limited range of motion.
While it’s seen as a FOOSH injury, synovitis may also be caused by arthritis or underlying autoimmune disorders. A doctor may review your medical history to uncover any underlying causes of synovitis.
It’s important to distinguish this injury from others that cause similar symptoms, such as fractures. Synovitis may occur along with infection, which can make swelling and pain worse.
Signs of fever indicate that you have an infection and you should seek emergency treatment to prevent blood loss to your fingers. Blood loss to your fingers could damage could require amputation and/or damage the other surrounding soft tissues. In cases of synovitis that do not involve infection, a doctor will perform a physical examination, some imaging tests, and possibly laboratory studies, to determine the best course of treatment. Usual treatment involves splinting the joint and taking anti-inflammatory medications to reduce swelling.
Cellulitis is a common type of bacterial skin infection that can occur at the site of FOOSH injuries. Mostly, this condition affects people who are older, who have weak immune systems, or who have large and contaminated wounds caused by falling.
Because bone infections can be very serious, it’s important for a doctor to perform imaging tests to rule out any internal bone injuries before starting treatment for the infection. If no structural injuries are found, the doctor will prescribe antibiotics to cure the infection.
With light falls or falls on soft surfaces, some people will only sustain some light bruising on the skin of their hands. Often a FOOSH causes bruising on the palms of the hands as you extend them in an attempt to break your fall. Bruises can cause discoloration, pain, and slight swelling on your skin.
Most bruises heal on their own without treatment in two to four weeks. You can apply a covered ice pack or bag of frozen food on the bruised part of your hand for 10 to 20 minutes at a time to help reduce pain. Anti-inflammatory pills may also help ease symptoms.
In cases of hard falls, bruises may be more severe and affect muscle and bone in addition to skin. These injuries require further treatment. Sometimes these bruises are not visually apparent. If you continue to feel pain on your hands where they made impact with the ground, you should see a doctor. They’ll check for damaged bones or muscles that may require surgical treatment.
Collarbone or shoulder injury
Though the collarbone and shoulder are located far from your hand or wrist, the impact of a fall on your hands may injure these parts of your body.
Collarbone fractures require a sling in less severe cases, and surgery in more severe cases. Shoulders sometimes become dislocated from falling onto your hand, and can be repaired by a doctor maneuvering your shoulder back into place. Fractures of the head of the humerus are not usual with this type of injury. All of these injuries are easily identified by pain and swelling, and also imaging tests.
A FOOSH injury can usually be diagnosed with a physical exam — in which a doctor will test your range of motion — in combination with imaging tests like X-rays, MRIs or CT scans. Some injuries may not appear in an imaging test, however.
Treatment of FOOSH injuries depends on the type of the injury and its severity. Most FOOSH injuries require some medical treatment, but after that, they can be managed with home care. Mild bruising caused by FOOSH is fully manageable with home care alone.
The best home remedy for any FOOSH injury is ice, elevation, and rest. If you suspect you have a FOOSH injury more severe than a light bruise from impact, you can splint the affected area until you can get medical care. A splint stabilizes any broken bones or torn ligaments and reduces pain by keeping your injury in a rested position.
Mild FOOSH injuries are treated by splinting, bracing, or casting the affected part of the hand, arm, or wrist for up to six weeks. It usually takes another six weeks for the affected part to begin functioning normally again.
Surgery is required for more severe FOOSH injuries. Most surgeries involve connecting the two fractured ends of a broken bone. This may involve bone grafting, use of metal rods, or other surgical techniques. In some cases, as with hook of hamate fractures, removal of bone is necessary.
During the healing process, the fine bones and ligaments of the hands and wrists may become stiff. Controlled movements through physical therapy can help strengthen them and make them fully functional again.
If you’re experiencing unbearable pain in your hand, wrist, or arm following a fall onto your outstretched hand or hands, you should schedule an appointment with a doctor or go to an emergency room. Consistent pain, swelling, bruising, clicking, fever, or a limited range of motion are all signs of an injury that requires medical treatment.
Bone and muscle bruises also need medical attention. If your pain doesn’t go away within a few weeks, you should see a doctor.
Recovery usually includes physical therapy to help you return to your everyday activities and restore your full range of motion. A physical therapist will show you the right way to wear supportive devices such as braces, splints, or slings while your injury is still healing. They’ll also teach you exercises to help you recover.
If you’re an athlete, you can prevent a FOOSH injury by wearing protective gear when participating in your sport. Know your physical limits when it comes to participating in athletic activities and know how to keep yourself safe when participating in any extreme sport.
During your everyday life, you can prevent FOOSH injuries by staying aware of your surroundings. Wear appropriate footwear for the weather and activities you take part in to prevent slipping or tripping. If you have vision problems, be sure to get them treated. Additionally, take precautions when walking if you take medication or have a health condition that makes you drowsy.
The severity of a FOOSH injury depends on the impact of your fall, whether you have existing health conditions, your current physical health, and the type of surface you fall on.
Most FOOSH injuries require some kind of medical treatment, and physical therapy can usually help you recover quicker and healthier. Follow your doctor’s instructions for the best possible outcome.