FOOSH stands for “fall on an outstretched hand,” and it’s one of the most common injury mechanisms seen in emergency rooms. It happens exactly the way it sounds: you trip, slip, or lose your balance, and you instinctively throw your hands out to catch yourself. The force of your body weight travels from your palm up through your wrist, forearm, elbow, and sometimes all the way to your shoulder, potentially breaking bones or tearing soft tissue at any point along the way. The most common result is a fracture at the end of the forearm bone near the wrist, called a distal radius fracture.
How the Force Travels Through Your Arm
When your hand hits the ground with your arm extended, the impact doesn’t stay in your palm. The force transfers up through the small bones of your wrist, into the two long bones of your forearm, through the elbow joint, and into the upper arm and shoulder. Where the injury actually occurs depends on several factors: the angle of your wrist at impact, whether your arm was fully locked out, how fast you were moving, and the strength of your bones. A younger person with strong bones might sustain a ligament tear, while an older adult with lower bone density is more likely to fracture.
The Most Common Wrist Fractures
A Colles’ fracture is the injury most closely associated with a FOOSH. It’s a break in the radius (the larger forearm bone) about an inch and a half above the wrist joint, with the broken fragment angling toward the back of the hand. On an X-ray, the wrist takes on a shape sometimes called a “dinner fork” deformity because of the way the end of the bone juts backward. This happens when you land with your palm flat and your wrist bent backward, which is the natural position most people fall into.
A Smith’s fracture is essentially the reverse. Instead of the broken fragment tilting toward the back of the hand, it angles toward the palm side. This typically happens when you fall onto the back of your hand rather than your palm, or take a direct blow to the back of the wrist. It’s sometimes called a “reverse Colles'” and produces a different deformity on X-ray, described as a “garden spade” shape. Smith’s fractures are less common but require different management because the displacement goes in the opposite direction.
Scaphoid Fractures: The Sneaky One
The scaphoid is a small, cashew-shaped bone on the thumb side of your wrist, and fracturing it is a particular concern with FOOSH injuries because it’s easy to miss. Up to 25% of scaphoid fractures don’t show up on initial X-rays. The bone is small, oddly shaped, and partially hidden by surrounding structures, so early fractures can look completely normal on standard imaging.
The hallmark sign is tenderness in the “anatomical snuffbox,” a small hollow on the back of your wrist at the base of your thumb that becomes visible when you extend your thumb outward. Pain in that spot, especially when you tilt your wrist toward your pinky finger, strongly suggests a scaphoid fracture. Another reliable test involves squeezing the scaphoid between a thumb and finger placed on either end of the bone. If that pressure reproduces your pain, a fracture is likely.
Because these fractures hide on X-rays, the standard approach when there’s strong suspicion but a normal initial image is to immobilize the wrist in a splint or cast for one to two weeks, then repeat imaging. If the follow-up X-rays are still negative but symptoms persist, an MRI is the next step. MRI picks up scaphoid fractures with roughly 98% sensitivity and near-perfect specificity, and it can also reveal ligament damage or bone bruising that X-rays miss entirely.
Getting a scaphoid fracture diagnosed matters. The scaphoid has a limited blood supply, and if a fracture goes untreated, the bone can lose its blood flow entirely, leading to a condition where the bone tissue dies. This complication makes treatment significantly more difficult and can lead to chronic wrist problems.
Soft Tissue Injuries at the Wrist
Not every FOOSH injury involves a broken bone. The force can also tear ligaments and cartilage in the wrist. One common soft tissue injury is a tear of the triangular fibrocartilage complex, a disc of cartilage and ligaments on the pinky side of the wrist that acts as a cushion and stabilizer. Symptoms of this type of tear include pain along the outer edge of the wrist near the pinky finger, clicking or popping sounds when you rotate your forearm, weak grip strength, and difficulty turning doorknobs or wringing out a towel. These injuries are diagnosed through physical examination and often confirmed with MRI.
Injuries Beyond the Wrist
If the force of impact isn’t fully absorbed by the wrist, it continues traveling up the arm. At the elbow, this can cause fractures of the radial head, the rounded top of one of the forearm bones that fits into the elbow joint. You’ll typically feel sharp pain on the outer side of the elbow and have difficulty rotating your forearm.
At the shoulder, a FOOSH can cause fractures of the upper arm bone near the shoulder joint. These proximal humeral fractures are most commonly sustained when someone tries to catch themselves during a fall from standing height. The force drives the arm bone upward, impacting the shoulder socket and potentially producing fractures of the upper arm, the shoulder socket, or both. Strong muscle contractions during the fall can add rotational forces that make the injury pattern more complex.
When Surgery Becomes Necessary
Many FOOSH fractures heal well with a cast or splint alone. For distal radius fractures, the bone is typically realigned (if needed) and immobilized. You may wear a splint for the first few days to a week to allow swelling to go down, followed by a cast for four to six weeks.
Surgery becomes the better option when the fracture is unstable or significantly displaced. The American Academy of Orthopaedic Surgeons identifies specific thresholds for patients under 65: if the bone is shortened by more than 3 millimeters, tilted backward more than 10 degrees, or if the fracture extends into the joint surface with a step-off greater than 2 millimeters, surgical fixation produces better outcomes. Surgical recovery takes longer than cast treatment, though exact timelines vary with the procedure and the patient.
Recovery and Rehabilitation
After cast removal, expect the wrist to feel stiff, weak, and a bit swollen. Full return to normal activities generally takes about three months or more after a nonsurgical wrist fracture, though lighter daily tasks become possible sooner. Rehabilitation exercises are a key part of recovery and typically start gentle before gradually increasing in intensity.
Early exercises focus on restoring basic range of motion. One common exercise involves resting your forearm on a table with your hand hanging over the edge, then slowly bending your wrist up and down while making a fist at the top and relaxing your fingers at the bottom, holding each position for about six seconds. Hand flips, where you rest your forearm on your thigh and alternate between palm-up and palm-down, help restore the forearm rotation that stiffens quickly after immobilization. Side-to-side wrist movements rebuild the ability to angle your wrist toward your thumb and pinky. These exercises are typically done in sets of 8 to 12 repetitions, and the key guidance is to ease off if you start having pain rather than pushing through it.
Grip strength is usually the last thing to return fully. Even after range of motion feels close to normal, you may notice weakness when opening jars, carrying bags, or doing push-ups for several weeks or months after the cast comes off.