Scaphoid Fracture Tests

Scaphoid fracture is the most common fracture at the wrist joint. accounting for up to 15% of acute wrist injuries.

Scaphoid fracture tests include many sings and examination procedures that may include:

1. Snuffbox tenderness,
2. Pain with supination against resistance,
3. Pain with longitudinal compression of thumb,
4. Scaphoid tubercle tenderness,
5. Scaphoid compression tenderness.

See Also: Wrist and Hand Movements

Snuffbox tenderness

The examiner palpates anatomic snuffbox of the injured hand.

The test is positive if pain is elicited.

Pain with supination against resistance

Pain with supination against resistance is another Scaphoid Fracture Test, where the examiner holds patient’s hand in handshake position and directs patient to resist supination of forearm.

This test is positive if pain is elicited.

Pain with longitudinal compression of thumb

The examiner holds patient’s thumb and applies a long axis compression through metacarpal bone into scaphoid.

The test is positive if pain is elicited.

A study on 85 patients presenting to emergency department with mechanism of injury suggesting possible scaphoid fracture, the sensitivity for Snuffbox tenderness, Pain with supination against resistance and Pain with longitudinal compression of thumb was: 100%, 100%, 98%, alternatively. While the specificity was 98% for each test.

Scaphoid tubercle tenderness

In Scaphoid tubercle tenderness, the examiner applies pressure to scaphoid tubercle.

This test is positive if pain is elicited.

Scaphoid compression tenderness

The examiner holds patient’s thumb and applies long axis compression through metacarpal bone into scaphoid.

It’s positive if pain is elicited.

A study on 221 patients with a suspected scaphoid injury, the sensitivity for the Scaphoid tubercle tenderness and Scaphoid compression tenderness was 83% and 100%, alternatively. While the specificity was 51% and 80%, alternatively.

Scaphoid Anatomy

Approximately 75% of the Scaphoid bone is covered by articular cartilage.

Main blood supply to the Scaphoid comes from a dorsal branch of the radial artery, enters at dorsal ridge just distal to waist, and flows in retrograde fashion toward proximal pole. Additional branches off superficial volar branch of radial artery enter at distal tubercle and perfuse distal third.

Tenuous vascular anatomy renders waist and proximal pole fractures at risk for nonunion and posttraumatic osteonecrosis.

See Also: Wrist Anatomy

References

1. Waeckerle JF. A prospective study identifying the sensitivity of radiographic findings and the efficacy of clinical findings in carpal navicular fractures. Ann Emerg Med. 1987 Jul;16(7):733-7. doi: 10.1016/s0196-0644(87)80563-2. PMID: 3592326.
2. Grover R. Clinical assessment of scaphoid injuries and the detection of fractures. J Hand Surg [Br]. 1996;21:341-343.
3. Netter’s Orthopaedic Clinical Examination An Evidence-Based Approach 3rd Edition Book.