Diagnosing Scaphoid Fracture
The most common carpal bone fracture is the scaphoid. The mechanism of injury is commonly a fall on an outstretched hand. Unfortunately sometimes symptoms may not be severe enough to bring the patient in for medical help until some time down the road. A delayed diagnosis can be detrimental due to the fact that the blood supply to the scaphoid can be compromised after a fracture, potentially leading to necrosis of the bone (1). Therefore, it is imperative that clinicians are able to detect and recommend appropriate treatment on the first visit to prevent further complications.
A prospective study looked at scaphoid fractures and concluded that 4 clinical tests had 100% sensitivity for detecting a fracture when performed together (2).
Clinical Tests:
1) Anatomical snuff box tenderness
2) Tenderness over the scaphoid tubercle
3) Pain on longitudinal compression of the thumb
4) Pain with active range of motion of the thumb
If all 4 tests are positive then imaging is required.
Following successful diagnosis and casting of a scaphoid fracture, the patient will have post immobilization stiffness and muscle weakness. Physiotherapy will aim to mobilize and strengthen the wrist and should begin immediately after cast removal.
Reference:
1) Brukner P & Khan K. Brukner & Khan’s Clinical Sports Medicine 4th ed. Sydney: McGraw-Hill;2012.
2) Parvizi J et al. Combining the clinical signs improves diagnosis of scaphoid fractures. A prospective study with follow-up. J Hand Surg Br. 1998 Jun;23(3):324-7.