Orthopedics Book



Scaphoid Fracture Signs

Aka: Scaphoid Fracture Signs, Snuffbox Tenderness, Scaphoid Tubercle Tenderness
  1. Exam: Pain over anatomic snuffbox
    1. Technique
      1. Palpate anatomic snuffbox on dorsal wrist
      2. Findings
        1. Localized tenderness
        2. Localized swelling may be present
      3. Exacerbating factors (increase Specificity)
        1. Wrist pronation
        2. Wrist ulnar deviation
    2. Efficacy
      1. Test Sensitivity: 90%
      2. Test Specificity: 40%
      3. Negative Likelihood Ratio: 0.15 (if Scaphoid tenderness absent)
  2. Exam: Pain over Scaphoid Tubercle
    1. Technique
      1. Extend affected wrist with one hand
      2. Palpate Scaphoid tubercle with other hand
        1. Proximal wrist crease and
        2. Extensor carpi radialis
    2. Efficacy
      1. Test Sensitivity: 87%
      2. Test Specificity: 57%
  3. Exam: Pain over First Metatacarpal
    1. Technique
      1. Pain on axial pressure of First Metacarpal bone
    2. Efficacy
      1. Test Specificity: 48%
  4. Exam: Resisted Supination
    1. Technique
      1. Examiner supinates patient's wrist against their resistance
    2. Efficacy
      1. Negative Likelihood Ratio: 0.09 (if pain is absent)

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