1. Imaging Findings

The patient is a 64-year-old female who sustained trauma when she fell and tried to break the fall with her hand. Initial X-rays showed no obvious sign of fracture, but given her history and physical examination, there was a high suspicion of a scaphoid fracture. A subsequent MRI revealed an abnormal signal in the proximal scaphoid, suggesting disruption of the cortical continuity or bone marrow edema, consistent with an occult scaphoid fracture. MRI, with its high sensitivity and specificity for diagnosing scaphoid and other carpal bone fractures, clearly demonstrates subchondral fracture lines and bone marrow edema.

2. Potential Diagnoses

1. Scaphoid Fracture: Due to the typical mechanism of injury (fall on an outstretched hand), the scaphoid’s position in the wrist that often absorbs impact, along with MRI findings indicating a fracture signal or bone marrow edema, plus clinical symptoms consistent with this injury, scaphoid fracture remains the primary consideration.
2. Soft Tissue Injury or Wrist Sprain: Negative X-ray results could indicate simple soft tissue contusion or ligament injury. However, MRI can reveal a hidden fracture and help rule out or confirm ligament injuries.
3. Other Carpal Bone Fractures: Such as lunate, triquetrum, or minor distal radius articular surface fractures. Nonetheless, clinical signs and MRI findings here point toward the scaphoid region.

3. Final Diagnosis

Combining the mechanism of injury (fall on an outstretched hand), wrist pain and localized tenderness (commonly in the anatomic snuffbox area), initially negative X-ray findings, and MRI indications of a scaphoid fracture, the definitive diagnosis is:

Occult Scaphoid Fracture (Right or Left wrist, depending on the patient’s actual condition).

4. Treatment Plan and Rehabilitation Program

Based on the fracture type, stability, and risk assessment, the following treatment and rehabilitation plan is recommended:

1. Initial Treatment:
   • If the fracture is stable with no significant displacement, conservative treatment may be considered: a cast or removable splint for 6–8 weeks (which may be extended to 8–12 weeks, taking into account the patient’s age and the scaphoid’s blood supply).
   • Regular imaging follow-up (X-ray or MRI) is recommended to monitor fracture healing.
   • For unstable or significantly displaced fractures, surgical fixation should be evaluated.
2. Rehabilitation and Exercise Prescription:

   After immobilization or surgery, progressive wrist rehabilitation exercises should be initiated based on the patient’s condition.

   • Immobilization Phase (first 1–2 weeks): Focus mainly on simple active movements of the elbow and shoulder, avoiding weight-bearing and large range-of-motion activities for the wrist.
   • Early Mobilization Phase (2–6 weeks): Once the splint or cast is reduced or temporarily removed, gentle wrist flexion and extension exercises can be done 2–3 times a day, for about 5–10 minutes each session, keeping the movements small and slow, and avoiding significant pain.
   • Progressive Recovery Phase (6–12 weeks): With evidence of fracture healing, gradually increase the range of motion and strength training for the wrist. This may include grip exercises (e.g., gently squeezing a ball or using mild resistance with a band) 2–3 sets at a time, 10–15 repetitions per set.
   • Comprehensive Stabilization Phase (after 12 weeks): Gradually resume daily activities and light weight-bearing. If needed, continue proprioception and coordination training under the guidance of a rehabilitation specialist.

   These exercises should follow the FITT-VP principle (Frequency, Intensity, Time, Type, Volume/Progression), with adjustments based on the patient’s tolerance for pain and functional progress, ensuring avoidance of overuse.

   If osteoporosis or other factors (e.g., diabetes) that affect healing are present, ensure adequate nutrition, monitor vitamin D and calcium intake, and follow medical advice for monitoring fracture recovery.

5. Disclaimer

This report is a reference analysis based on clinical information and imaging findings, and does not replace an in-person consultation or a professional physician’s opinion. Specific diagnosis and treatment plans require comprehensive evaluation and decision-making by a specialist according to the patient’s actual condition.