Wrist Pain after a Fall on an Outstretched Hand (FOOSH)

A traumatic fall on an outstretched hand, commonly referred to as a FOOSH injury, can result in a wide range of wrist injuries. While distal radius fractures are among the most recognized injuries following a FOOSH and are typically identified and treated first, other injuries may be less obvious and present later as persistent pain, weakness, or loss of function.

Healthcare professionals may encounter patients who continue to report wrist pain even after a fracture has been ruled out or initial treatment has been completed. Recognizing the clinical signs associated with common ligamentous, bony, and soft tissue injuries can help guide further evaluation and treatment.

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Common FOOSH Wrist Injuries

Scaphoid Fractures

Scaphoid fractures can occur when a fall forces the wrist into hyperextension, often with radial deviation. Located on the radial side of the wrist near the base of the thumb, the scaphoid can be palpated within the anatomical snuffbox.

One challenge with scaphoid fractures is that they may not be visible on initial radiographs, making clinical assessment particularly important when symptoms persist.

Clinical signs that may indicate a scaphoid fracture include:

Localized tenderness over the anatomical snuffbox or scaphoid
Pain with axial compression of the thumb
A history of a fall onto a hyperextended wrist
Persistent radial-sided wrist pain despite normal initial imaging

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Scapholunate (SL) Ligament Injury

The scapholunate (SL) ligament may be injured when the wrist is subjected to a sudden load, including during a FOOSH. Patients with SL ligament injuries commonly present with dorsal-radial wrist pain, swelling, and discomfort with loading or wrist motion.

Clinical findings that may suggest an SL ligament injury include:

Sharp, localized pain with palpation just distal to Lister’s tubercle on the dorsal radius
A positive scaphoid shift (Watson) test
Pain or symptoms with wrist loading

To perform the scaphoid shift test:

1. Apply pressure to the volar prominence of the scaphoid while moving the wrist from ulnar deviation to radial deviation with slight wrist flexion.

2. A painful clunk with symptom reproduction when pressure is removed is usually indicative of a ligament injury, but be sure to check the non-involved side for baseline ligament laxity information.

Triangular Fibrocartilage Complex (TFCC) Injury

A TFCC injury may occur during a FOOSH involving excessive forearm rotation and is a common source of ulnar-sided wrist pain.

When TFCC injury is suspected, two commonly used clinical tests include:

1. Ulnar Fovea Sign

Apply pressure between the ulnar styloid process and the flexor carpi ulnaris tendon, as well as between the ulnar head and pisiform.
The test is considered positive when palpation reproduces the patient’s characteristic pain.

2. TFCC Load Test

Place the wrist in ulnar deviation and apply an axial load.
Move the wrist through volar and dorsal motion while maintaining the load.
Reproduction of the patient’s pain or symptoms may indicate TFCC involvement.

Support Options for FOOSH-Related Wrist Pain

Following a FOOSH injury, patients may require wrist support as part of conservative management, post-operative rehabilitation, or following immobilization or casting.

The 3pp Wrist Wrap NP and the 3pp Wrist POP are examples of wrist supports designed to help stabilize the wrist while allowing functional movement during recovery.

3pp® Wrist Wrap NP

The 3pp Wrist Wrap NP provides adjustable compression and support for patients experiencing wrist pain associated with strains, sprains, overuse, or post-injury recovery. A removable stay allows the level of support to be adjusted as symptoms and functional needs change.

3pp^® Wrist POP Splint

The 3pp Wrist POP Splint provides targeted support designed to help reduce stress on painful or unstable wrist structures. Its adjustable compression makes it particularly useful when managing ulnar-sided wrist pain and TFCC-related symptoms while maintaining functional wrist and hand use.

Supporting Recovery After a FOOSH Injury

Persistent wrist pain following a FOOSH should not be overlooked simply because an initial radiograph is negative or a fracture has healed. Scaphoid fractures, ligament injuries, and TFCC involvement can contribute to ongoing pain, weakness, and instability if they are not recognized.

A thorough clinical evaluation—including the location of pain, mechanism of injury, palpation findings, provocative testing, and functional limitations—can help identify structures that may require further assessment.

When appropriate, timely intervention, supportive bracing, and progressive rehabilitation can help protect healing structures, improve function, and support a safe return to daily and occupational activities.

For Patients and Consumers

If you’re experiencing wrist pain after a fall or injury, wrist braces may help provide comfort, support, and stability during recovery. Learn more on our consumer site OMA.