The term FOOSH stands for “fall on an outstretched hand.” It usually happens when an individual tries to break a fall by straightening the arm while reaching down.
It is the most common injury of the arm, and it usually occurs in the elderly and in individuals who engage in high-impact activities.
Causes of FOOSH Injuries
FOOSH injuries are a result of accidental slipping or falling. It is common among individuals who participate in sports in which falling or slipping frequently happens, such as skiing, football, soccer, and cheerleading.
Individuals who have poor eyesight, have vertigo, and wear ill-fitting shoes have a high chance of tripping on their feet and falling; thus, they are also prone to obtaining FOOSH injuries.
Common Types of FOOSH Injuries
FOOSH could result in different injuries of the arm. Some of the most common are as follows:
Colle’s Fracture
Colle’s fracture is a fracture that occurs when the individual falls with the hand extended and the palm is touching the surface. It affects the larger bone of the forearm (called the radius) near the wrist.
It is a complete fracture in which the broken end of the bone near the wrist tilts upwards. Elderly women who have osteoporosis are prone to obtain this type of fracture.
Smith’s Fracture
Smith’s fracture, also called Goyrand fracture, happens when the individual falls with a flexed hand, such that the back of the hand is touching the surface. The fracture also occurs at the end of the radius near the wrist, and the broken end of the bone near the wrist tilts downward.
It is the opposite of Colle’s fracture is often known as the reversed Colle’s. Aside from FOOSH, it can also occur when there is a forceful blow at the back of the wrist.
Boxer’s Fracture
A Boxer’s fracture affects the fifth or the fourth metacarpal, which connects the bone of the little finger or the ring finger to the wrist.
It is sometimes called a Brawler’s fracture and usually happens after punching a hard object or landing with the hand clenched or fisted on the ground to catch a fall.
Shoulder Dislocation or Fracture
The shoulder joint is a ball and socket joint made of 3 bones [ Humerus (arm bone), scapula(shoulder blade), and clavicle(Collarbone)]. The upper end of the arm bone is shaped like a ball that fits the scapula’s socket and allows rotational arm movements.
Falling with arms outstretched could displace the ball out of its socket. Individuals with fragile bones, such as those with osteoporosis, the upper end of the shoulder could also get fractured.
Elbow Dislocation or Fracture
The upper end of the radius bone where it meets the arm to form the elbow joint could also get dislocated due to FOOSH. If the elbow becomes very painful with movement, it could indicate an elbow dislocation or fracture of the radius.
Collar Bone Fracture
The collar bone or the clavicle connects the shoulder to the upper part of the breast bone. A fracture in the collar bone is commonly seen among children and young adults. When there is force or pressure on the bone, it can snap into two or break into pieces making it very difficult and painful for the individual to move the shoulder.
Bruising
Light falls or falling on soft, padded surfaces may only cause bruising. It is characterized by skin discoloration, minimal to moderate pain, and slight swelling at the part of the hand that contacted the surface.
Cellulitis
Cellulitis is a skin infection from bacteria or fungi which occurs when there is an open wound in the area that contacts the surface during a fall. Individuals who are immunocompromised or have a weak immune system are prone to having cellulitis. If left untreated, it could pose a serious threat to the health of the individual.
Diagnosis
A detailed history taking and physical examination is needed to determine which type of FOOSH injury was sustained by the patient. Often, multiple injuries are present in a single FOOSH accident.
The doctor will ask about how the injury occurred, if it was a high or low impact fall, or if it occurred during a sports activity or during a car accident. Further, a previous injury to the affected arm, such as previous falls, fractures, or surgery, will also be asked.
It is also important for the doctor to know if the patient is suffering from any medical condition such as osteoporosis and autoimmune disease or is taking any medication that could make the bones brittle, which could predispose him/her to musculoskeletal injuries.
Musculoskeletal injuries are injuries to the body’s soft tissues due to an impact, a fall, or an imbalance that could damage the muscles, nerves, blood vessels, and other soft tissues.
Physical Examination
The doctor will observe and palpate the affected arm to determine the location of the pain and the presence of tenderness, swelling, bruises, lacerations, deformities, and open wounds.
Aside from this, the doctor will also evaluate the range of motion of the fingers, wrist, elbow, and shoulder and the strength of the hand, wrist, and arm muscles.
Lastly, the doctor will examine the integrity of the patient’s nerves, blood vessels, and other soft tissues of the arm.
Imaging Tests
An X-ray will be ordered to check for any fractures. The presence of extreme pain, obvious deformity, and difficulty moving the injured area are clear indications of a fracture. Because the wrist has several small bones and a complex joint structure, the doctor may order multiple X-rays to check all the small bones of the wrist thoroughly.
A magnetic resonance imaging (MRI) scan or a computerized tomography (CT) scan may be required to obtain more detailed information of the arm’s soft tissues and check for other suspected injuries.
Home Remedies
A FOOSH injury that resulted only in mild bruising can be easily managed at home and heal in a few days or weeks. Resting the injured arm, avoiding heavy lifting and extreme movements, elevating above the heart level, applying alternate ice and warm compress are the remedies that can be done at home.
If there is inflammation and severe pain or suspected fracture or dislocation, the patient may use a temporary splint using common household items until medical care is given.
A splint provides stabilization to a fractured or dislocated bone or a torn ligament to limit movements by placing the area in a safe, resting position which could help reduce pain and swelling.
Treatment
The treatment will depend on the type and severity of the FOOSH injury and if multiple injuries are involved. Splinting, casting, physical therapy interventions, and surgery are some of the treatment options given to a patient who sustained a FOOSH injury.
Mild injuries are usually treated with splinting, casting, or bracing to correct the position of the bones and allow them to heal, including the soft tissues affected.
- The doctor usually recommends wearing either of them for four to six weeks.
- It will take another four to six weeks before the affected arm could function normally again.
Severe injuries are usually treated with surgery.
- The fractured bones will be connected using a bone graft, metal rods, or other techniques.
- After surgery, the injured arm will be placed in a splint or a sling to facilitate healing and prevent unnecessary movements.
Any treatment that limits movements such as splinting, casting, bracing, or surgical intervention can make the involved joints stiff and difficult to move. Therefore, early physical therapy intervention is necessary to minimize the pain and swelling and provide mild and controlled strengthening and range of motion exercises.
Studies have shown that movement aids in healing as it allows the delivery of necessary nutrients to the injured area. However, it is important to note that movement should always be controlled and guided by pain. Painful movements will not only retard healing but will also result in possible reinjury.
Any open wound, large or small, must be cleaned and treated immediately to prevent the spread or to worsen the infection, especially when the patient has a weak immune system.
A wound left untreated and becomes worse could result in cellulitis and osteomyelitis, a condition where bacteria or fungi invade the bone or the bone marrow through the bloodstream resulting in infection and inflammation of the bone.
If osteomyelitis is suspected, the doctor must ensure that there is no internal bone injury or fracture. Both cellulitis and osteomyelitis can be managed through antibiotics or anti-fungal medications.
Prevention
Accidents are unpredictable, and FOOSH is not an exemption. However, the risks can be reduced by doing the following preventive actions:
- Free the home from clutter and remove obstacles in areas where one frequently walks to avoid tripping.
- Be aware of one’s surroundings by visually observing the ground surface and taking note of possible obstacles encountered while walking or running.
- Wear appropriate shoes and consider the weather when performing activities outside. Rain or snow could make the ground slippery; thus, wearing the wrong footwear could result in a fall or trip.
- It is recommended for athletes to wear protective gear during sports activities to provide additional support and lessen the shock during an impact.
- Athletes are advised to perform based on their capacity and avoid working beyond their limits to keep them safe and avoid injury, especially those involved in extreme sports.
- Perform exercises always to keep the body conditioned in preparation for any sports or recreational activity.
- For elderly individuals, grab bars and be installed, especially in the bathroom, to assist in maneuvering and transferring, maintain standing and walking, and avoid slips and falls.
- For individuals experiencing dizziness, consult a doctor to check for vertigo or problems with eyesight.
- For those with health issues that affect one’s balance, consider having a walking aid.
When to See a Doctor?
It is relatively easy for an individual to dismiss a slip or a fall. Although a simple injury could heal on its own through home remedies, the following may indicate possible severe injuries which will have to be seen by a trained physician to prevent the injury to worsen:
- Extreme or unbearable pain on the hand, wrist, elbow, shoulder, or collar bone.
- Fever following a fall.
- Consistent swelling or swelling that worsens.
- Difficulty or limited movements such as clenching the hand or bending the wrist, elbow, or shoulder.
- A wound that does not heal.
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Aarti Nehra, MD
Dr Aarti is an MBBS (Bachelor of Medicine and Surgery) from Baroda Medical College (The Maharaja Sayajirao University, Baroda). Dr. Aarti has also completed her Masters of Medical Science and Technology from the prestigious Indian Institute of Technology, Kharagpur.
