Wrist and hand
Anatomical snuffbox palpation
- What you examine
- Scaphoid fracture after a fall on the outstretched hand.
- Procedure
- Extend and abduct the thumb: a hollow appears between the extensor pollicis longus tendon on one side and abductor pollicis longus and brevis on the other. Palpate in it, and also on the scaphoid tuberosity on the palmar side.
- Positive when
- Tenderness in the hollow between the thumb tendons, on the tuberosity, or pain on axial compression of the thumb.
- What the test is worth
- Snuffbox tenderness has a sensitivity around 0.90 but a specificity of only 0.40. The three findings together raise specificity substantially.
- Caution
- A scaphoid fracture is often invisible on the first radiograph. With tenderness and a negative film the suspicion stands: immobilise and reassess after ten to fourteen days.
- Body region
- Wrist and hand