Scaphoid fractures - diagnostic tests and clinical reasoning
The purpose of this study was to identify clinical tests for scaphoid fractures and to determine their diagnostic accuracy, as there is no current agreement on a gold standard for detecting a scaphoid fracture.
The review assessed and described four clinical tests (“clamp” sign, scaphoid compression test, anatomical snuffbox (ASB) tenderness test, and scaphoid tubercle tenderness test), eight clinical assessment techniques (thumb movements, resisted supination, wrist flexion, wrist extension, grip strength, assessment of ulnar deviation, and assessment of swelling in the snuffbox) and seven descriptive factors (male, female, simple fall, fall from height, unknown mechanism of injury, other mechanism of injury and sport injury).
The review revealed that the ASB tenderness test, scaphoid compression test and scaphoid tubercle tenderness test did demonstrate statistical significance, they also indicated that each test was of questionable clinical usefulness when used in isolation for discriminating between the presence and absence of a scaphoid fracture. Therefore the clinical significance of these tests used in isolation is questionable.