From the Research
Snuff box tenderness is a clinical sign that warrants further investigation for potential scaphoid fracture or de Quervain's tenosynovitis, and initial treatment should involve immobilization and pain management with NSAIDs, such as ibuprofen 400-600mg every 6-8 hours or naproxen 500mg twice daily 1, 2. The clinical presentation of snuff box tenderness typically includes pain when pressure is applied to the anatomical snuff box, a triangular depression on the lateral aspect of the wrist, and may be accompanied by swelling, decreased grip strength, and pain with wrist movement, particularly extension. Some key points to consider in the diagnosis and treatment of snuff box tenderness include:
- The importance of combining 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, to improve diagnosis of scaphoid fractures 3
- The use of immobilization with a thumb spica splint or cast for suspected fractures, even if initial X-rays are negative, as scaphoid fractures can be radiographically occult
- The potential for de Quervain's tenosynovitis, a stenosing tenosynovitis of the first dorsal compartment of the wrist, to cause snuff box tenderness, and the effectiveness of local corticosteroid injections in treating this condition 1, 2
- The need for follow-up imaging, such as repeat X-rays, MRI, or CT scan, if X-rays are negative but clinical suspicion remains high, to confirm or rule out a scaphoid fracture
- The importance of prompt treatment to prevent complications, such as avascular necrosis or nonunion, which can occur if scaphoid fractures are left untreated or undertreated 4, 5