Scaphoid Tenderness

Historical Overview

• Scaphoid tenderness is indicative of a scaphoid fracture.
• After examining a patient with pseudarthrosis, Struthers published the earliest report of scaphoid fracture in 1873¹.

Description

• Scaphoid tenderness at the anatomical snuffbox is a highly sensitive sign of scaphoid fracture (sensitivity, 87–100%²).
• Although sensitive, the sign has wide variations in specificity. A recent review of 8 studies reported specificity values ranging from 3–98%.²

Pathophysiology

• Scaphoid fracture is a common injury, accounting for more than 80% of carpal fractures,³ generally resulting from a fall on an outstretched hand with radial deviation. Undisplaced fractures, which are common, are difficult to diagnose.
• A scaphoid fracture may result in swelling of the anatomical snuffbox, which has greater specificity than tenderness alone (37–72%²).

Instructions

1. Take patient history
2. Apply pressure to the anatomical snuffbox on the radial side of the wrist

Variations

• Palpate the scaphoid tubercle just proximal to the thenar eminence on the palmer side of the wrist

Related Signs and Tests

• The poor specificity of the standard anatomical snuffbox test combined with the frequency of the injury and the limited usefulness of x-ray workups for undisplaced fractures has encouraged the consideration of other clinical signs.²
• Several of these signs are listed below along with their reported (sensitivity and specificity)²:
  • Hematoma (22–46% and 76–77%)
  • Longitudinal thumb compression test (48–100% and 22–97%)
  • Clamp sign (26% and 79%)
  • Pain with resisted supination (83–100% and 38–98%)