“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #8

Have a patient with an acute wrist or hand injury? You better check to see if they have “snuff box” tenderness. The snuff box is the depression made just proximal to the thumb when the thumb is extended.

Have the patient extend the thumb and then palpate deep into the “snuff box.” When you do this you are palpating the scaphoid bone. If there is pain, you need to rule out a scaphoid fracture.

If a scaphoid fracture is missed, it can cause significant disability. The risk of non-union of this fracture and avascular necrosis are relatively high. This can lead to chronic pain and grip strength deficits later in life.

So, what does this mean for you? If you miss it, you are negligent. Therefore if you were sued, you would likely lose. SO CHECK THAT SNUFF BOX!

2 Responses

  1. It’s also important to recheck plain film xray 2 weeks after, sometimes the fracture can’t be seen right away.

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