From the Guidelines
Pain in the left anatomical snuffbox after an injury should be treated as a potential scaphoid fracture until proven otherwise. Initial treatment includes immobilization with a thumb spica splint or cast to prevent movement of the scaphoid bone, application of ice for 15-20 minutes several times daily during the first 48 hours to reduce swelling, elevation of the wrist above heart level when possible, and pain management with acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) 1. Medical evaluation is essential, including X-rays, though these may initially appear normal even with a fracture. If pain persists despite normal X-rays, follow-up imaging such as an MRI or CT scan may be necessary 10-14 days after injury. Scaphoid fractures require proper treatment to avoid complications like avascular necrosis or nonunion due to the bone's limited blood supply. Even if imaging is negative, continued pain in this area warrants medical attention as some fractures may not be immediately visible on initial X-rays. The choice of analgesics should consider the type of injury, pain severity, and patient’s clinical features, with multimodal analgesia being an effective approach in managing acute pain 1. In cases where opioids are necessary, they should be used with caution, especially in elderly patients, due to the risk of serious cardiovascular events, acute dyspeptic syndrome, and respiratory failure 1. Regular intravenous administration of acetaminophen every 6 hours, unless contraindicated, is effective in traumatic pain relief, and NSAIDs should be used with caution in elderly patients due to potential adverse events 1. Locoregional anaesthesia may also be considered, depending on the accessibility of the puncture site and the moment of its realization 1. Overall, the management of pain in the left anatomical snuffbox after an injury requires a comprehensive approach, including immobilization, pain management, and medical evaluation to prevent complications and ensure proper healing.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diagnosis and Treatment of Scaphoid Fractures
The left snuff box is a common area where pain is experienced after a scaphoid fracture. To diagnose and treat this condition, the following points should be considered:
- The diagnosis of scaphoid fractures can be challenging, and clinical signs such as tenderness in the anatomical snuff box, tenderness over the scaphoid tubercle, pain on longitudinal compression of the thumb, and range of thumb movement should be combined to achieve a more accurate diagnosis 2.
- If initial radiographs are negative, a supplementary MRI or CT scan should be carried out within three to five days to confirm the diagnosis 3.
- The treatment of scaphoid fractures depends on the type and severity of the fracture, with options including conservative management, cast immobilization, and internal fixation 4, 5, 3.
Treatment Options
The following treatment options are available for scaphoid fractures:
- Conservative management with cast immobilization for non-displaced or minimally displaced fractures 3.
- Prolonged cast immobilization for fractures with moderate displacement 3.
- Internal fixation for fractures with dislocation ≥ 1.5 mm or proximal scaphoid fractures 3.
- Surgical fixation, including open reduction internal fixation and percutaneous screw fixation, may be necessary in some cases 6, 5.
Postoperative Care
After surgical treatment, vigilant postoperative care is necessary to monitor for signs of nonunion and to regain motion and strength in the injured wrist 6.