FOOSH!!

You may have read about or heard the term, but what exactly is a FOOSH injury?

FOOSH is an acronym which stands for:

Fall
Onto
Out
Stretched
Hand

We can all relate to this, as it is instinctive to try to protect yourself if you feel that you are falling.
As a result, we tend to put out our arm to break our fall and protect our head and face.
As we topple over, there are large forces which may potentially cause injury- we have the combination of our body weight and gravity meeting with an unforgiving (usually hard) ground.
So FOOSH doesn’t describe the specific injury- more it describes the mechanism of injury. Most often, it results in damage to the wrist, arm or shoulder region.

What are examples of FOOSH injuries?

1. Fractured metacarpal: one of the long thin bones in your hand. The ring and little finger (4/5) are most vulnerable to this, but any metacarpal can be involved. It is sometimes called a Boxer’s fracture, as it usually occurs if you fall onto a clenched fist, and the injury is similar to a punching impact injury- hence the name.

2. Fractured Scaphoid: one of the small bones within the wrist. This accounts for 70-80% of wrist fractures. The patient will feel pain at the base of their thumb between the two prominent tendons that stand to attention when you give the “thumbs-up” sign.

3. Colles Frcture: affects the end of the radius, one of the 2 forearm bones- most likely if the patient lands on the palm of their hand.

4. Smith Fracture: again a fracture of the end of the radius, but usually occurs if the wrist is flexed when landed upon (i.e. patient lands on the back of their hand).

5. Fractured elbow: may affect either of the forearm bones (radius and ulna) and/or the upper arm bone (humerus).

6. Fractured humerus: the bone at the top of your arm- usually gets broken at the top near the joint, so may cause shoulder-type symptoms and bruising may be evident in the patient’s trunk/ ribs as well as in the arm itself.

7. Shoulder dislocation: occurs when the joint between the ball and socket joint of the shoulder separate. If the bones remain out of place it is known as a dislocation but if is reduces spontaneously, it is known as a subluxation.

8. Fractured Clavicle: The collar bone at the front of the neck links the arm with the rest of the body, so absorbs a lot of shock. This bone is susceptible to fracture by a FOOSH and may result in bony deformity.

9. A/C Joint dislocation: Where the shoulder blade and collar bone meet, we have the “Acromio-clavicular” joint. A FOOSH injury may cause sufficient opposing forces for the joint to separate, and result in ligament injury affecting the stability of the joint. Often after injury, a step can be seen, this sometimes called a sprung clavicle"

10. Whiplash: Neck related pain from a heavy head falling at a faster rate than the rest of the body.

FOOSH Injury Symptoms

Symptoms include:
• Arm pain
• Arm stiffness
• Difficulty moving the neck/ shoulder/ elbow or wrist
• Upper back pain and/ or stiffness
• Swelling
• Bruising
• Bony deformity

FOOSH Injury diagnosis

Any physical therapist, such as an osteopath or physiotherapist, as well as a qualified medical practitioner will normally be able to diagnose the injury from the way you describe how the accident occurred, from your symptoms, and through a thorough physical examination.
If a fracture or dislocation is suspected, usually an X-ray will confirm the diagnosis.

FOOSH injury treatment
General advice for FOOSH injuries:

RICE (Protocol for any acute injury)
 Rest (immobilise)
 Ice- 5 minutes over the affected area every hour until the diagnosis is confirmed.
 Compress to minimise swelling.
 Elevate the limb if possible.
• Paracetamol- For an adult the maximum dose is two 500 mg tablets, four times a day.
• Anti-inflammatories- These may be used alone or at the same time as paracetamol. They include ibuprofen which you can buy at pharmacies or get on prescription. Other types such as diclofenac or naproxen need a prescription via your GP. Some people with stomach ulcers, asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers.
• A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol.
• Muscle relaxants such as diazepam are occasionally prescribed for a few days if your neck muscles become very tense and make the pain worse.

Please only take prescribed medication when it has been prescribed specifically for you by the GP, and if you use over the counter medication, always read the label.

If a fracture or dislocation is found, the patient may need the bones to be realigned (reduced), and they are then immobilised for 6 weeks (or more) in a splint, plaster cast or sling.
Occasionally surgery may be required to stabilise the bones in the correct position for healing to occur. This is called an “Open Reduction- Internal Fixation” repair.
Once out of plaster, rehabilitation with a physical therapist is suggested to restore normal function.

Osteopathic Management

Our osteopaths are able to offer various options for rehabilitation and to help symptoms to settle down. They may suggest massage, traction, manipulation, acupuncture etc.
Although it may take several weeks to achieve this, the main emphasis of their treatment will be to:
• Increase strength
• Increase joint range of motion
• Reduce pain
• Reduce swelling
• Reduce scar tissue
• Restore normal function
• Permit a return to regular activities and sports

If you have a problem you think we can help you with, please call us at the Bexleyheath Osteopathic Practice on 020 8298 7122, we look forward to hearing from you.


© Bexleyheath Ostepathic Practice 2013