Pain During Delivery Is Equal To How Many Bones Breaking


Pain During Delivery Is Equal To How Many Bones Breaking

Does giving birth hurt more than a broken bone?

Worried about the pain of labor and delivery? It’s not as bad as you think! News May 07, 2018 CHICAGO – Few things are more daunting for first-time moms than the prospect of childbirth. They wonder: Will my baby be OK? What will labor and delivery be like? How painful will it be, and can I handle it? Moms who have been there offer the low-down on labor and delivery and their message is comforting.

Yes, childbirth is painful. But it’s manageable. In fact, nearly half of first-time moms (46 percent) said the pain they experienced with their first child was better than they expected, according to a nationwide survey commissioned by the (ASA) in honor of Mother’s Day. The survey findings suggest that being proactive in managing pain with your physician anesthesiologist is important, whether laboring moms demand an epidural right away, choose other medical pain management methods, use complementary techniques only or opt for a combination.

Nine out of 10 women said pain management was effective, no matter what method they chose. () But the survey also revealed that many first-time moms held some false beliefs about labor pain management before they experienced childbirth: • 74 percent thought you couldn’t have an epidural after a certain time in labor (you can have one up until the baby’s head begins emerging, known as crowning) • 44 percent feared pain at the epidural injection site would last for a prolonged time • 26 percent believed an epidural slows labor • Most concerning, 20 percent believed only one pain management option could be provided during labor and 16 percent thought about it but didn’t know Expectant mothers should work with their health care providers, including their physician anesthesiologist, to discuss what pain management methods may work best for them.

They should talk to their physicians to find out who will administer their anesthesia if they decide to have pain medication during labor. Anesthesia care should be led by a physician anesthesiologist, a medical doctor specializing in anesthesia, pain and critical care medicine, who will work with all of the mother’s physicians to develop and administer her pain management plan.

“First-time mothers need to know that a wide variety of options exist to manage pain, from epidural to massage, nitrous oxide to breathing techniques and that it’s acceptable to change methods or use a combination during nearly every stage of labor,” said ASA President James D.

When it hurt most and what it was like Health and safety are top of mind So, what pain management did they choose? In the future For more information about pain management during labor and delivery and the importance of seeing a physician anesthesiologist, visit, The American Society of Anesthesiologists

While slightly more than half said having contractions was the most painful aspect of delivery, about one in five noted pushing or post-delivery was most painful. Moms 18 to 39 were more likely to say post-delivery pain was the most painful aspect than those 40 and older.

The most common description of the level of pain experienced was extreme menstrual cramps (45 percent), while 16 percent said it was like bad back pain and 15 percent compared it to a broken bone. It’s no surprise that when choosing a pain relief option, nearly all mothers (99 percent) said the health and safety of themselves and the baby was an important factor in their decision.

Not far behind was making sure the pain relief option didn’t delay the labor process (86 percent) as well as being able to enjoy the labor and delivery experience (84 percent). But the importance of other factors diverged depending on the pain method chosen.

Having no pain during labor was very or somewhat important to women who chose medical methods (epidural, medication delivered through an IV or injection, spinal block or nitrous oxide) only (79 percent) compared to women who opted for complementary methods (breathing, water birth, massage, visualization or hypnosis) only (37 percent).

Being able to move around during labor was important to 90 percent of moms who only had complementary methods, while just 60 percent of moms who had medical methods only agreed. While the epidural reigned supreme as the most common option, chosen by 73 percent, 40 percent of women used complementary methods.

Additionally, pain management during labor and delivery may not be “one size fits all,” with 31 percent having used both medical and complementary methods. More than half used medical methods only and 9 percent chose complementary methods only. Sixty-five percent of women who had medical options only said they were very effective in managing pain, while 39 percent who had complementary methods only said they were very effective.

And while nitrous oxide has received a lot of attention recently, the survey results suggest it’s rarely used. Only 2 percent of moms had nitrous oxide, and none 40 and older or who lived in the Midwest used it to manage labor pain. Before childbirth, slightly more than 1 in 10 thought nitrous oxide relieved pain and 63 percent didn’t think about it at all.

  1. This suggests that despite the buzz, nitrous oxide may not be widely available yet, or that mothers aren’t convinced it would be very helpful,” said Dr. Grant.
  2. If they were to give birth again, most moms would choose the pain management method, whether medical and/or complementary, they originally chose during their first childbirth, with the majority (60 percent) opting again for an epidural to manage their pain.

Women were split on the pain management advice they would give to first-time prospective moms – 21 percent would recommend getting an epidural as fast as possible, while 20 percent say try complementary methods first and if they don’t work, try other options.

  1. However, 43 percent of mothers agree that choosing one’s pain management method is a personal decision and you need to opt for those that work best for you.
  2. Every woman’s pain during labor is different and talking with your health care provider and physician anesthesiologist can help you decide which pain management method will give you the best labor and delivery experience,” said Dr.

Grant. “Women may choose to use none, some or more than one pain management method depending on how labor progresses.” The 10-question ORC International CARAVAN® Omnibus Survey was conducted online April 3-11 among 912 mothers (18 years or older) of children ages 0-8, whose first child was born either via vaginal childbirth or Cesarean section (C-section) after the onset of labor.

Ultimately, 73 percent had a vaginal childbirth. Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring that physician anesthesiologists evaluate and supervise the medical care of patients before, during, and after surgery to provide the highest quality and safest care that every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at, To learn more about the role physician anesthesiologists play in ensuring patient safety, visit, Like ASA on ; follow on Twitter. # # # : Worried about the pain of labor and delivery? It’s not as bad as you think!

How painful is childbirth on a scale of 1 to 10?

Non-medicated birth – Although labor and delivery can be intensely painful, not all parents will opt for medical pain management. Even if a parent declines medicated pain relief options, that doesn’t mean no pain management is involved. With no epidural or narcotics on board, most birthing parents rate active-phase labor a 10 on the pain scale of 1 to 10.

Breathing techniquesRelaxation techniquesMassageHypnosisAssistance from a trained doula or coaching from a birthing partner

Many pain management options available don’t require medication intervention. Talk to your provider about the options that will best for you.

What is the pain of delivering a baby equal to?

Early labor – In the early stages of labor, contractions will increase in intensity and frequency as they fall into a steady pattern. Early labor contractions will usually cause the abdomen to feel tight to the touch. You may also experience a dull backache, feelings of pressure in the abdomen and pelvis, and sensations similar to those of intense menstrual cramping.

Is childbirth the most painful experience?

BACKGROUND: – Labor pain is one of the most severe pains which has ever evaluated and its fear is one of the reasons women wouldn’t go for natural delivery. Considering different factors which affect experiencing pain, this study aimed to explain women’s experiences of pain during childbirth.

What hurts worse than a broken bone?

When you’re hurt in an accident, you can usually tell the general location of the injury, but often cannot diagnose the exact injury type or extent without medical attention. Severe pain after an accident could be the sign of a fractured bone, or it may be the result of a soft tissue injury like a sprain or tear of the muscles, tendons, or ligaments.

  1. While some people may automatically assume that injuries like broken bones or fractures are more painful and severe than soft tissue injuries, this is not always the case.
  2. Sometimes, soft tissue injuries can be more painful and require a longer recovery time than broken bones, depending on their nature and severity.

If you’ve suffered a broken or fractured bone or a soft tissue injury in an accident that was not your fault, you could be owed compensation for your medical expenses and other damages from the responsible party. After an accident, you should seek immediate medical attention to get a professional diagnosis and treatment, and you should contact a personal injury attorney to discuss your rights and legal options.

What is the most painful bone to break in body?

What are the most painful bones to break? – While the previous breaks we’ve mentioned might sit as the easiest bones to break, not all of them fall under the range of most painful bones to break. Some bones are so important that when we break them our body tells us immediately, but for others, it’s simply difficult not to apply pressure to them whilst they’re healing.


The Femur is often put at the top of the most painful bones to break. Your Femur is the longest and strongest bone in your body, running from your hip to your knee. Given its importance, it’s not surprising that breaking this bone is an incredibly painful experience, especially with the constant weight being put on it.

What is the pain scale in labor?

When laboring women request epidural analgesia, many expect complete pain relief. Despite best intentions and great efforts by anesthesia providers, this expectation often is unmet, and breakthrough pain on the labor and delivery unit is common. Rapid and accurate diagnosis and targeted treatment of breakthrough pain are cornerstones of high-quality obstetric anesthesia care; however, it can be tempting to dismiss women with breakthrough pain as unrealistic, naive, or “high-maintenance.” Sadly, unmet expectations for pain relief appear to be most acute among nonwhite women with low levels of education, literacy, and numeracy.1 The importance of effective treatment for breakthrough pain has been obscured by the fact that pain control in labor is only moderately predictive of maternal satisfaction with childbirth.2 Provided that neonatal outcome is good, maternal satisfaction is often high irrespective of labor pain scores or analgesia provided.

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Personal expectations, caregiver-patient relationships, peripartum support, and patient involvement in decision making often override the influence of pain when women evaluate their childbirth experience.3 Indeed, for a subset of women with robust coping skills, self-efficacy, support, and a strong desire to avoid neuraxial analgesia, pain scores and the quality of any pain relief bear little relationship to satisfaction.4, 5 In fact, many women seeking unmedicated birth prefer if clinicians not even ask about pain.6 For laboring women who desire complete pain relief, the quality of analgesia achieved bears a more direct relationship with maternal satisfaction with analgesic services.2 For example, among women receiving epidural analgesia, breakthrough pain requiring top-ups by the anesthesiologist is among the strongest predictors of dissatisfaction with analgesic services.7 Earlier requests for analgesia and greater analgesic requirements in early labor, however, have been associated with dysfunctional labor and eventual need for cesarean delivery.8 Maternal requests for epidural rescue boluses also may predict future failed epidural anesthesia top-ups for cesarean delivery.9 One of the real barriers to effective diagnosis and targeted treatment for breakthrough pain is an absence of high-quality labor pain measurement tools.

Analog pain intensity scores such as the verbal rating scale (none, mild, moderate, and severe), numerical rating scales (NRS 0–10, 0 = no pain and 10 = worst pain imaginable), and visual analog scales (0–100, presented as a 100-mm long line, from 0 = no pain to 100 mm = worst pain imaginable) are used ubiquitously in a clinical and research settings to measure labor pain and determine analgesic efficacy.10 Despite their widespread use, particularly the NRS, these scales are unidimensional, measuring only the intensity of pain, and lack many characteristics of an ideal psychometric pain instrument in a labor setting.

The dynamic and progressive nature of labor pain is poorly captured by analog pain intensity scales.11 Mathematical analysis of pain scores in the first stage of labor indicates a sigmoidal relationship between cervical dilation and reported pain scores but with substantial intersubject variability.12 It is possible that this sigmoidal relationship is an artifact of the tool used to measure pain rather than characteristic of the underlying phenomena it seeks to describe.

As labor progresses and the true magnitude of pain is revealed, women’s understanding of “severe” or “worst pain imaginable” often shifts. These scales have an inherent “ceiling” because of the 10- or 100-mm limit, and women in qualitative studies have called for the ability to rate pain that is beyond “worst imaginable.” Because of constraints within the 11-point NRS, the calibration of each incremental increase in analog score becomes increasingly distorted.

  1. Specifically, pain ratings close to the 10- or 100-mm limit increase by a smaller amount than pain scores further down the scale, and pain beyond the original score or scale limit still get recorded as 10 or 100 mm.
  2. Translation of these continuous analog scores to categorical descriptors (eg, none, mild, moderate, and severe pain) also may vary significantly among individuals.

In one study, patients’ 95% confidence interval ranking of moderate and severe pain was 15 to 83 mm and 39 to 100 mm, respectively.13 The experience of childbirth pain is multidimensional and complex. Analog pain intensity scales do not account for interactions among the intensity of contraction, the presence of any rest between contractions, the relative duration of that rest, the total duration of labor pain, and the influence of coping, intrapartum support, and sleep deprivation.

Laboring and recently delivered women place more importance on pain intensity than duration (eg, stating that pain intensity of 5/10 for 2 hours is preferable to 10/10 for 1 hour).14 Cognitive and emotional factors, including women’s expectations and fears surrounding pain relief, impact both the experience of labor pain and the use of pain measurement instruments.15 For the purpose of diagnosing and optimally managing breakthrough labor pain, it is particularly problematic that analog scales do not differentiate the nature or location of pain.

Labor pain may change from intermittent visceral cramping pain with uterine contractions to sharp and/or continuous somatic pain closer to delivery.16 Given all the aforementioned limitations of analog pain scales, we are encouraged that this edition of Anesthesia and Analgesia includes a publication by Angle et al 17 in which they examine the Angle Labor Pain Questionnaire (ALPQ) during initiation of epidural analgesia in early active labor.

These authors have developed and validated a multidimensional psychometric questionnaire that measures the most important dimensions of women’s labor and childbirth pain experiences. The ALPQ measures 5 key dimensions (enormity of the pain, fear/anxiety, uterine contraction pain, birthing pain, and back/long haul pain) previously found to be important in the childbirth pain experience.

The scale appears to be sensitive to change after epidural analgesia pain relief, showed no floor or ceiling effects, and demonstrated internal consistency, reliability, and concurrent validity.17 Unfortunately, even with the help of experienced investigators, the ALPQ took 3.5 minutes for the average laboring women to complete before induction of epidural analgesia and 2 minutes to complete after induction of epidural analgesia.

Demographic characteristics of the participants reflected a population that should have the least trouble with such an instrument (ie, white, college-educated English speakers). Half of the women approached for the study also refused to participate, many because of pain. The relative complexity of this measurement tool will likely limit the use of this pain questionnaire in routine clinical practice.

The widespread appeal of the NRS 0 to 10 relates to its simplicity and how rapidly it can be understood and performed for people in pain. Even among analog scales, the NRS is associated with better compliance, applicability, and responsiveness compared with the visual analog scale 0 to 100 mm, a slightly more cumbersome scale.18 The McGill Pain Questionnaire (MPQ) was developed similarly to improve on analog pain intensity scales.19 In addition to pain intensity, the full MPQ presents 78 adjectives clustered in 20 categories, including verbal pain descriptors and affective components related to pain.

  • The lack of widespread clinical and research application of the MPQ in a labor setting is likely because of its inherent complexity and time-consuming nature.
  • Many of the 78 adjectives bear little relationship to most women’s experience of labor pain.
  • The scoring system (the total number and rank order of adjectives selected) offers little information about potential solutions to improve analgesia and treat labor pain.

In contrast, the ALPQ has several characteristics that suggest its added complexity might be useful. Of the 28 items on the ALPQ, 13 adjectives also are included on the MPQ, including all items within the subscales for uterine contraction pain and the enormity of pain.

  • The instruments diverge within subscales of fear/anxiety, back pain/long haul, and birthing pain, which are domains and specific items that were derived from years of qualitative work with delivering women at Sunnybrook Health Sciences Center.
  • Used in combination with the Angle Pictoral Pain Mapping and Pain Ranking Tools, 17 it is possible that this instrument, despite its complexity, will help women communicate what exactly is driving their NRS of 9 or 10.

It is, however, also possible that women whose pain is out of control will lose the capacity to interact with an instrument this complex. The use and utility of the ALPQ in vulnerable populations (ie, those who speak languages other than English, those with low education, literacy, or numeracy) also must be explored further.

Ultimately, for the ALPQ to find a place in clinical medicine, future studies will need to demonstrate a relationship between use of the pain questionnaire and important clinical outcomes. If the ALPQ improves diagnosis and treatment of breakthrough pain, helps better maintain optimal labor analgesia, or enhances maternal experience of analgesic care, then women’s and clinicians’ tolerance for a more time-consuming and complex pain questionnaire will be extended.

In conclusion, we want to congratulate Angle et al 17 on the development and implementation of the ALPQ. This multidimensional psychometric questionnaire is an improvement over the analog pain intensity scores that dominate labor pain assessments, and address important dimensions of women’s labor and childbirth pain experiences.

  1. The complexity and time needed to administer the ALPQ will likely limit implementation, and its fate may be restricted to a research tool much like the MPQ.
  2. Measuring labor pain accurately is important to optimize the care of women and facilitate appropriate analgesic use, as well as allow different analgesic techniques, drugs, and doses at different stages of labor to be compared.

A simple and easy-to-perform pain measurement tool that correlates with meaningful obstetric outcomes and maternal satisfaction with obstetric analgesic services is needed. Whether the ALPQ meets these objectives remains to be determined. Regardless, we wholeheartedly agree about the urgent need to move beyond analog pain scores and embrace all the dimensions of the labor and childbirth experience to improve maternal satisfaction and obstetric outcomes.

What is more painful than natural childbirth?

– The triangle icon that indicates to play Consumed by thoughts that I was just being a wuss, I reached out to Beth Darnall, Ph.D., a pain psychologist at Stanford University. She explained that “how we experience pain is a very personal and very relative.” When I asked if men experience any pain similar to labor, she called it an “age-old question, and I don’t think you’re going to settle it.

But I don’t think there’s an exact equivalent to pushing a human being out of your vagina.” “However,” she said, “one person’s kidney stones could be as severe as another person’s childbirth.” The neurological process involved in pain is pretty similar regardless of your gender—find out —but there is one important difference.

“Pain is just more painful for women,” said Dr. Darnall. “Men experience pain at a lower intensity.” So if the experience itself is equal—whatever it is that’s causing the pain—women will feel it more acutely than men. As for original question, Dr. Darnall recommended that I “find a woman who’s had both a baby and kidney stones and ask her.” Conveniently, I have a sister who’s experienced both, and she didn’t hesitate when I asked.

Idney stones, absolutely,” my sister said. “But labor was a bitch, too.” And kidney stones, as it turns out, isn’t the only pain experience that’s competitive with childbirth. Here are five others that are in the same pain ballpark as labor, and sometimes surpass it. Cluster Headaches Dr. Paul Christo, a pain specialist at Johns Hopkins Hospital and host of the syndicated radio talk show Aches and Gains, calls this “probably the worse pain imaginable.

I’ve had patients say it’s worse than labor pain or burns.” This kind of headache is focused on one side of the head, usually around the eyes, and can last up to 3 hours or more. And while headaches are equal opportunity oppressors, Dr. Christo says that cluster headaches tend to “affect men more than women.” Trigeminal neuralgia Also known as Fothergill’s disease, this is a neuropathic disorder caused by inflammation of the trigeminal nerve, “which is located in the head, and from the eye down to the jaw,” says Dr.

Darnall. She calls it “a very exquisite type of pain. That kind of pain where you feel like a knife stabbing in.” And unlike labor pain, how much you endure isn’t up to you. “Treatment options are limited,” says Dr. Darnall. “There is no epidural coming. There are people who have suicidal ideation or who do commit suicide because of it.” Complex Regional Pain Syndrome “A fascinating pain condition that occurs typically following an injury, and it could begin after surgery,” says Dr.

Darnall. “Instead of healing, the pain suddenly blossoms out of control.” The hallmark symptom, she says, is “sharp, debilitating pain. It can be so severe for some people, they can come into a doctor’s office and ask to just amputate their arm.” Which, believe it or not, is occasionally the best option for treatment.

Severe Burns And not just third-degree burns. Any kind of burn can be excruciating and ongoing. “It’s comparable to labor pain,” says Dr. Christo. “The post burn care process is grueling because it requires wound debridements, dressing changes, skin grafting, and skin stretching.” Pudendal Neuralgia A fancy name for a severe pain in the butt.

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It can be caused by something as simple as falling down, and while it’s problematic for anyone, it’s especially so for men “because it can affect the penis,” Dr. Darnall says. How so? This condition can cause penis and scrotum numbness, and what a 2010 report in the Journal of the Canadian Chiropractic Association described as “insidious constant penis pain.” Those are two adjectives you definitely don’t want in front of a diagnosis of penis pain: “Insidious” and “constant.” (You want to talk about pain endurance?,

Is it possible to give birth without pain?

8 ways to prepare for natural birth: Easing labor pain without an epidural About 73% of U.S. women who give birth use an epidural for pain relief. However, natural birth – choosing vaginal delivery without pain medications or other routine interventions – is becoming more common.

Are babies awake during labor?

Do babies sleep during labor? – During labor, just as in pregnancy, your baby still experiences periods of sleep. A typical sleep cycle will generally last somewhere between 20 and 40 minutes, but usually no longer than 90 minutes. These patterns will be evident during your labor. You might be aware of periods of activity, and other times when your baby is still.

What is the hardest part of labor?

Transition phase of labor – The end of active labor is sometimes referred to as the transition to the second stage of labor. It’s when the cervix completely dilates to a full 10 centimeters, and is the shortest – but generally considered the hardest – part of labor.

  • Pressure in the lower back and rectum
  • An urge to push (tell your care provider if you do, as they’ll want to make sure you’re fully dilated first)

What is more painful childbirth or kidney stones?

It blocks the flow of urine in the kidney, and it causes backup. And it’s an excruciating pain. A lot of people do describe it as worse than childbirth.

What bone is least likely to break?

Fracture Trends Sylvia I. Watkins-Castillo, PhD The total number of fractures of the upper and lower extremities treated in physician offices, emergency departments, and hospitals, while fluctuating from year to year, has varied between 12 million and 15 million from 1998 to 2010.

Upper limb fractures, including those of the arm, forearm, wrist, hand, and fingers, have accounted for slightly more than one-half of all fractures, with a range of 52% to 59%. Fractures of the upper arm, or humerus, are the least common. In recent years, upper arm fractures have accounted for about 20% of total upper limb fractures.

Fractures of the wrist, hand, and fingers occur slightly more often than fractures of the forearm. Lower limb fractures, which include those of the hip and upper leg (femur), lower leg, ankle, foot, and toes, are reported in similar numbers to upper limb fractures, ranging from 11 million to 15 million.

Between two-third and three-fourth of lower limb fractures occur in the ankle, foot, and toes. Breaks of the lower leg (tibia and fibula) are the least common overall. The majority of fracture care episodes, 65% to 73%, occurred in a physician’s office. Fewer than one in ten fractures (8% or less) were treated with inpatient hospitalization in any given year.

However, it is possible that initial care for a fracture was either at the ED or in a hospital admission, with follow-up visits associated with a physician’s office visit. It is, therefore, likely each individual fractures may have been associated with multiple episodes of care. : Fracture Trends

What is the weakest bone in your body?

The clavicle, or collar bone, is the skin’s softest and weakest bone.

What is the hardest bone to heal?

Fractures of the scaphoid, a bone in your wrist, are not to be taken lightly. This is the only bone of the body that I know of that has an entire book written about how hard it is to diagnose and treat scaphoid fractures, and what to do when a fracture does not heal! Most of the time, a broken bone is obvious.

  1. The area around the break may be painful, swollen or deformed.
  2. But sometimes a bone can break without your realizing it.
  3. That ‘ s can happen to the scaphoid (pronounced “skaf’-oyd”).
  4. Some doctors call this bone the “navicular”, but this is an older, out of favor term.
  5. Many people with a fractured scaphoid think they have a sprained wrist instead of a broken bone because there is no obvious deformity and very little swelling.

If you’ve fallen and think you’ve sprained your wrist, call Dr. Bernstein for an appointment as soon as possible. Rest your wrist until you get seen. The scaphoid bone is located on the thumb side of your wrist, close to the lower arm bones. It is shaped like a cashew, which makes it hard to visualize on the x – ray.

The reason scaphoid fractures have a hard time healing is due to the anatomy of the blood supply to the bone. The blood supply is what keeps the bone alive and allows it to heal. Most of the bone is covered with cartilage, the smooth shiny material that forms the joints and allows the bones to move. Blood vessels cannot enter through the cartilage; they enter only through the bone.

Since the scaphoid is mostly covered in cartilage, there is a limited area for the arteries to enter the bone. In the scaphoid, the blood supply to the bone enters from the distal end, that is, the end toward your fingers. This can be a problem for healing, since most fractures occur in the middle or lower portion of the bone.

  1. The blood supply to the proximal fragment, that is, the piece that is toward your elbow, may not have any blood supply.
  2. Without a blood supply, the bone cannot heal and that fragment may die.
  3. Who Gets Scaphoid Fractures? Scaphoid fractures account for about 60 percent of all wrist (carpal) fractures.
  4. They usually occur in men between ages 20 and 40 years, and are less common in children or in older adults.

The break usually occurs during a fall on the outstretched hand. It’s a common injury in sports and motor vehicle accidents. The angle at which the hand hits the ground determines the injury. The following is a very rough “rule of thumb”: If the wrist is bent at a 90 – degree angle or greater, the scaphoid bone will break; if the angle is less than 90 degrees, the lower arm bone (radius) will break.

Pain and tenderness on the thumb side of the wrist. Motion (gripping) may be painful. May be some swelling on back and thumb side of wrist. Pain may subside, and then return as a deep, dull aching. Marked tenderness to pressure on the “anatomical snuffbox,” (a triangular-shaped area on the side of the hand between two tendons that lead to the thumb.)

Diagnosis The diagnosis is based on a history of trauma to the wrist (usually a fall or accident), a clinical exam that shows tenderness in the region of the scaphoid and a painful Watson test (a maneuver in which the wrist is moved back and forth, with the examiner’s thumb on your scaphoid; it is just slightly painful), and x – rays that show a fracture.

Sometimes, the x – ray does not show a fracture. In some cases other X – rays are needed to diagnosis the problem. Usually, with a supportive history and clinical exam, the diagnosis will be made of a probable scaphoid fracture. Treatment Treatment is determined by the fracture site, the degree of displacement, any associated injuries, and the patient’s occupation and desires.

Cast Treatment : Many scaphoid fractures are treated with immobilization in a cast that immobilizes the elbow, wrist, and thumb, for six weeks, and then only the wrist and thumb for an additional six weeks. Healing time, however, can range from six weeks for fractures in the top portion (toward the fingers) to six months or longer for fractures in the lower portion (toward the wrist).

  1. The cast must be checked regularly to make sure that it fits properly and prevents movement.
  2. After the cast is removed, a rehabilitation program helps restore range of motion and strength.
  3. Surgical Treatment : Some fractures are displaced by 1 mm or so.
  4. These usually need surgical treatment.
  5. Scaphoid fractures that are accompanied by other injuries, usually a distal radius fracture, also need surgery.

Also, with newer techniques, the risks of surgery are reasonably low that some patients choose surgery, because it usually means the patient does not need to we are a cast at all, just a splint. Over the last few years through a limited approach we can address scaphoid fractures and avoid cast immobilization.

Via a small incision, I can introduce a screw into the scaphoid and minimize the time in a cast. As with any surgery there are risks with this procedure, there is still no guarantee that the scaphoid will heal and there are risks to the wrist and tendons. The pros and cons are something that we can talk about in the office.

Not all scaphoid fractures will heal properly. The usual causes are delay in treatment or too short a time in a cast that is too short. Smoking also interferes with bone healing. However, the scaphoid is rather famous for not healing, even when everything is done properly.

Surgery is usually recommended when the scaphoid fails to heal (non – union). Surgery for non – union is successful in approximately 75 percent of cases. Sometimes a bone graft is used to promote healing. There are two types of bone grafts. One is using your own bone, often times from the radius bone of the forearm.

This can bring in new bone cells to help fill the gap. The other type of bone grafting is taking a segment of bone from the radius and moving it to the scaphoid attached to a microscopic blood vessel. There are certain times to do one or the other that we can discuss in the office.

Which gender is more likely to break a bone?

Where Are We Now? – What are the differences in the rates of fracture and prevalence of osteoporosis between older men and postmenopausal women? Are there differences in bone size, geometry, and strength between men and women? What are the differences in outcomes after fracture between men and women? Are there differences in the treatment of osteoporosis between men and women? Are there differences in the awareness and knowledge of osteoporosis between men and women? Bone mineral density (BMD) from dual-energy xray absorptiometry (DXA) scans is used to screen for and diagnose osteoporosis in both men and women.

  1. Women have lower levels of BMD and a higher prevalence of osteoporosis than men.
  2. A t score is used to diagnose osteoporosis and is calculated from an individual’s areal BMD level and a reference value.
  3. The t score is the number of SDs an individual’s BMD is from a young reference value,
  4. A negative t score indicates the individual’s BMD is lower than the reference.

A person is said to have osteoporosis if the t score is −2.5 or less, representing a BMD that is at least 2.5 SDs less than the young reference value. Low bone mass, sometimes referred to as osteopenia, is present if the t score is between −2.5 and −1.0, and normal bone mass is −1.0 or more.

  • The World Health Organization recommends the femoral neck as the anatomic region of interest, while the International Society of Clinical Densitometry (ISCD) and the NOF guidelines diagnose osteoporosis at the femoral neck, total hip, or lumbar spine.
  • There is some controversy about whether a young female reference value or a gender-specific reference value should be used to calculate the t score in men and women,

Some professional societies, such as the ISCD, recommend a young female reference be used to calculate t scores, This means the same absolute BMD level is used to diagnose osteoporosis in men and women. However, other groups, such as the NOF, suggest a young reference value of the same gender be used to diagnose osteoporosis,

  • If gender-specific young reference values were used to calculate t scores, men would be diagnosed with osteoporosis at a higher absolute BMD level than women, since men have a higher peak BMD than women.
  • Therefore, use of gender-specific reference values would result in a larger number of men being diagnosed with osteoporosis than if using a female reference value.
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Women also have a higher fracture risk than men. The lifetime risk of fracture for a 60-year-old woman is approximately 44%, nearly double the risk of 25% for a man of the same age, In 2005, there were approximately 1.45 million fractures in women older than 50 years in the United States, compared with 594,000 fractures in men of the same age,

Even though men account for only 29% of fractures, the medical costs associated with fractures in older men are still sizeable, totaling $4.15 billion of $16.9 billion in costs for both genders in 2005, Even after accounting for age and body size, women have a two times higher risk of nonspine fracture than men,

Although this difference between men and women may be lower in nonwhites and different geographic regions, studies show women have no increased fracture risk compared to men in parts of Asia, Vertebral fractures are not as well studied as nonspine fractures, partially because not all of these fractures come to clinical attention.

Despite limited data, it appears older men and women have a similar prevalence of vertebral fracture at age 65 years, but the incidence of new vertebral fracture in older women is almost double compared to older men, There are few reports regarding the potentially differential relationship between BMD and fracture risk in men and women.

Three studies suggest the relationship between hip BMD and nonspine fracture risk is similar in men and women, The association between hip areal BMD and fracture risk may be stronger in men, although this gender difference becomes less pronounced with advancing age,

Regardless of whether men and women fracture at the same areal BMD level, areal BMD is strongly predictive of nonspine fracture in both genders. Differences in fracture risk between men and women are due not only to differences in areal BMD but also to differences in bone size, bone geometry, and bone strength.

However, few studies have explicitly described these differences. Two cross-sectional studies, one in older Icelandic men and women and one in older residents of the Rochester, MN, area, described age-related changes in bone strength. Both studies demonstrated men have a greater cross-sectional area of bone than women, as assessed by quantitative CT,

They also showed older women have lower levels of volumetric bone density than men, and both genders’ bone size increases with age, resulting in bone strength that worsens more in women than in men as age increases. Such changes in bone strength may, in part, explain the differences between men and women in fracture risk.

While fractures are more common in women, men tend to have worse outcomes after fracture. A meta-analysis of 24 studies, including data from 578,436 women and 154,276 men, estimated the excess mortality risk after hip fracture for both men and women,

  • The 1-year excess mortality in men after hip fracture at age 80 years is 18%, more than twice the excess mortality in women (8%) of the same age at fracture.
  • While most of this excess mortality risk occurs in the first few months after fracture, a small but statistically significant increased risk of mortality persists 10 years after the fracture event in both genders.

Data from the prospective Baltimore Hip Fracture study confirmed men are more likely to die after hip fracture than women; however, among survivors, no difference is seen in functional recovery after fracture. Since fractures are less common in men, all major pharmaceutical interventions for primary prevention of fractures were exclusively tested in postmenopausal women, with more than 40,000 women included in these studies,

  1. A smaller study involving men established the effectiveness of these therapies on surrogate markers, such as increased BMD and bone turnover.
  2. This study’s results are in line with the large trials for fracture outcomes in women.
  3. The small study (n = 241) designed to evaluate the effect of alendronate on BMD changes in men demonstrated treatment improved BMD compared to placebo,

The study also demonstrated men receiving alendronate had a reduced incidence of vertebral fractures, even though the study was not initially designed to detect such an effect. The cost-effectiveness of osteoporosis screening with DXA assessment and subsequent treatment is established in women.

  1. Universal screening of women aged 65 years and older is well under the quality-adjusted life year (QALY) threshold of $50,000,
  2. This indicates such universal screening is cost-effective, and the cost per QALY gained decreases with increasing age in women; universal screening becomes more cost-effective as age increases,

In men, screening and treatment are not as cost-effective as in women. However, in certain subgroups of men, screening and treatment are cost-effective. In an analysis that assumed costs of bisphosphonate therapy were $500 a year, the costs per QALY gained were less than $50,000 for men aged 65 years and older with a prior fracture and all men older than 80 years (regardless of fracture status).

Lower costs of bisphosphonates, which are now available generically and on which the cost-effectiveness results heavily rely, result in decreased cost per QALY estimates and make screening and subsequent treatment more cost-effective for both genders. While undertreatment of osteoporosis is a problem in both genders, men are much less likely to receive treatment for osteoporosis or after a hip fracture,

In a recent large study (n = 51,346) of adults admitted to hospitals in North Carolina with a hip fracture, osteoporosis treatment was broadly defined as receipt of calcium plus vitamin D and antiresorptive or bone-forming medications, Men were about 75% less likely to receive osteoporosis treatment during the hospital stay than women; only 2.2% of men received any osteoporosis treatment, compared to 8.9% of women.

  • In another study of treatment in a Texas hospital, only 27% of men with hip fracture reported receiving treatment 1 year after the fracture, compared with more than two-thirds (71%) of women reporting treatment,
  • Of the men who received treatment, two-thirds received calcium and vitamin D (compared to 32% of the treated women), rather than an antiresorptive or bone-forming agent.

Unfortunately, treatment rates do not appear to be improving, although very recent data about such trends are not available. Specifically, one study from 2004 examining treatment rates after fracture from 1998 to 2001 in older men enrolled in a health maintenance organization noted treatment after fracture does not improve over time; only 7.1% of men in general and 16% of men with a hip or vertebral fracture receive medication,

  1. Only 1% of the population has BMD assessed.
  2. Even men who experience two consecutive fractures within a short period of time (less than 1 year) do not receive treatment.
  3. A report from Australia noted the treatment rate among this high-risk group is only 24.1%,
  4. Finally, a study of nearly 50,000 Canadian adults receiving home care noted, even though men with a history of fracture are less likely to be treated, treatment in the presence of a diagnosis of osteoporosis is similar in men and women,

Among older men and postmenopausal women, as well as healthcare providers, there is evidence that both awareness of osteoporosis and knowledge about the disease are lacking, It is unclear whether knowledge of osteoporosis differs between men and women; however, it is clear knowledge of osteoporosis among older men is poor.

For example, a study of more than 1500 community-dwelling older men noted, on average, only 39% of six male osteoporosis knowledge questions are answered correctly. These data suggest additional education regarding osteoporosis in men is needed. Several studies determined the effectiveness of intensive intervention programs to increase treatment and/or screening of older men and women after fracture.

A randomized study of 220 Canadian patients with hip fracture allocated individuals to either usual care (receipt of printed educational materials) or assignment of an osteoporosis case manager, The case manager educated patients about osteoporosis, arranged BMD tests, provided prescriptions, and communicated with the patient’s primary physician.

The primary end point of the study was bisphosphonate use 6 months after the fracture. The intervention group had a much higher treatment rate (51%) than the usual-care group (22%), and BMD tests were completed in 80% of the intervention group compared to only 29% of the usual-care group. The cost of the intervention averaged $50 per patient, which suggested the relatively low-cost intervention improved screening and treatment rates.

Another Canadian study of 272 wrist fracture patients (men and women with a distal forearm fracture, regardless of cause) who were randomly selected for either usual care or a multifaceted intervention (telephone-based education to patients and their physicians) also increased treatment in the invention group,

However, treatment rates in the intervention group remained suboptimal; only 30% of the intervention group (compared to 7% of the usual-care group) received bisphosphonate treatment within 6 months of the fracture, and more than half of the intervention group did not receive appropriate care after the wrist fracture.

Thus, although intensive intervention improves treatment and screening, it does not guarantee all individuals at risk of subsequent fracture are screened or treated. Other interventions, such as the development of an osteoporosis exemplary-care program that identified, educated, evaluated, referred, and treated patients at risk of fracture through coordination among orthopaedists, a metabolic bone disease clinic, and nuclear medicine, have had more success; a study of 430 Canadians found nearly 96% receive appropriate attention after a fracture,

  • Another model for osteoporosis disease management is the Healthy Bones program of Kaiser Permanente Southern California (Kaiser SCAL), a health maintenance organization (HMO),
  • Aiser SCAL has an electronic medical records (EMR) system that can track DXA scans, fractures, and medication use.
  • The Healthy Bones program makes use of this EMR system, with the orthopaedic surgeon and the nurse practitioner having major roles in identifying and treating those with osteoporosis and a high risk of fracture.

Between 2002 and 2007, this program dramatically increased the DXA screening rate (263% increase in women and 914% increase in men) and the number of patients receiving antiosteoporotic medication (a 153% increase). These improvements in screening and treatment resulted in a hip fracture rate between 2002 and 2007 that was 38% lower than what would have been expected had the program not be initiated.

Thus, the use of an EMR system of reminders to healthcare providers for screening and treatment of at-risk patients is another model that could improve osteoporosis care. The role of the orthopaedist in screening and treating patients with hip fracture was evaluated. One study of 171 orthopaedic surgeons in Utah, Idaho, and Wyoming noted, although 63% of the respondents agree or strongly agree that it is appropriate to expand orthopaedic practice to include prescription of pharmacologic agents for treatment of osteoporosis, nearly 50% are concerned about adverse events of these medications and would avoid prescribing such treatments.

The study concluded, although most orthopaedists agree with expansion of care, many do not initiate treatment, mainly because they believe it is something that should be covered by the primary care physician. Therefore, one barrier to care is the incomplete integration of treatment and screening of osteoporosis across orthopaedics and primary care.

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