UMEM Educational Pearls

Category: Orthopedics

Title: Snuff Box Tenderness

Keywords: Scaphoid Fracture, CT (PubMed Search)

Posted: 10/17/2009 by Michael Bond, MD (Updated: 4/20/2024)
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Snuff Box Tenderness:

It has become the standard of care that individuals with snuff box tenderness, or pain with axial loading of the thumb, be placed in a thumb spica splint for 1-2 weeks until follow up x-rays can be done.  This is done to rule out an occult scaphoid fracture.  However, this practice can be hugely inconvenient to the patient and result in some atrophy of their forearm.

An alternative approach is to obtain a CT scan through the wrist to look specifically at the scaphoid bone.  If the CT scan is negative you can send them home with some pain control, RICE (Rest, Ice, Compression, Elevation) treatment and let them use thier thumb.  No splint is needed.  If it is positive then you can splint them and have them follow up with orthopedics or hand surgery.