Scaphoid Fracture Nonunion

Common Symptoms

• Persistent wrist pain, typically on the thumb side, following a fracture that hasn't fully healed
• Pain with gripping or wrist loading
• Reduced grip strength
• Wrist stiffness
• Sometimes a history of a fall onto an outstretched hand that wasn't initially recognized as a fracture

Why It Happens

The scaphoid's blood supply enters mostly from one end, so a fracture — particularly through the middle (waist) of the bone — can cut off blood flow to part of the bone, impairing healing. Fractures that are missed initially (scaphoid fractures don't always show up clearly on first X-ray) or inadequately immobilized are more likely to progress to nonunion.

Why It Can Become Persistent

Without adequate blood supply, bone simply can't heal on its own the way better-vascularized bones can — this is a structural, biological problem, not something that resolves with rest alone, which is why nonunion typically requires surgical intervention.

Who Commonly Gets It

Scaphoid fractures are common after a fall onto an outstretched hand, particularly in younger, active adults; nonunion is more likely when the initial fracture was missed, inadequately immobilized, or involves reduced blood supply based on its location within the bone.

How It Is Usually Diagnosed

Diagnosis involves X-ray, and often CT or MRI, to assess whether the fracture has healed and to evaluate blood supply to the bone fragments — this imaging assessment is central to surgical planning.

Traditional Treatment Options

• Bone grafting with screw or plate fixation: The standard surgical approach for scaphoid nonunion, restoring blood supply and stabilizing the bone.
• Vascularized bone graft: Used in cases with more significantly compromised blood supply.
• Immobilization (casting): May be tried for select fresher or more favorable nonunions before surgery is pursued, guided by a hand specialist.

Why Someone Might Start Looking for Another Option

Even with appropriate surgical fixation, scaphoid nonunion doesn't always heal reliably, which has led hand surgeons to study adjuncts — including shockwave therapy — used at the time of surgery to improve healing rates.

Where Shockwave Therapy May Fit

Two studies from the same Austrian hand-surgery research group found that adding intraoperative shockwave therapy alongside standard bone graft and screw or plate fixation was associated with favorable healing rates and, in one study, lower pain scores compared with fixation alone. This is real, physician-directed evidence — but it's specifically about shockwave therapy as a surgical adjunct, not a stand-alone treatment, and it comes from a limited number of studies from one research group rather than a broad, independently replicated evidence base.

How Shockwave Treatment Works for This Area

This practice does not perform scaphoid fracture surgery. If your hand surgeon identifies intraoperative shockwave therapy as an appropriate adjunct to your surgical plan, that would be coordinated and performed as part of your surgical care — this is not something pursued independently of that surgical evaluation and treatment.

What the Treatment Feels Like

Not applicable outside of a coordinated surgical care plan.

What Happens During Your First Visit

Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.

Who May Not Be Appropriate

• Anyone with a suspected or confirmed scaphoid fracture who has not yet been evaluated by a hand or wrist specialist
• Anyone seeking this as a stand-alone alternative to surgical fixation for an established nonunion
• Active infection at or near the treatment site

This list is not exhaustive. Your provider will screen for contraindications during your evaluation.