From the Guidelines
The anatomical snuff box is clinically significant for both the assessment and diagnosis of scaphoid fractures and as a potential site for vascular access creation, particularly for arteriovenous fistulas in patients requiring dialysis. This triangular depression on the radial aspect of the wrist contains important structures including the radial artery and the scaphoid bone. Tenderness in the snuff box is a classic clinical sign of scaphoid fracture, which is the most commonly fractured carpal bone 1. When examining a patient with wrist trauma, direct palpation of this area is essential, as scaphoid fractures can be easily missed on initial radiographs and may lead to avascular necrosis if untreated due to the bone's retrograde blood supply.
Clinical Significance in Vascular Access
The anatomical snuff box is also a site for creating a snuff-box fistula, an autologous fistula constructed between a branch of the radial artery and an adjacent vein in the anatomic snuff box of the hand, as recommended in clinical practice guidelines for vascular access 1. According to the 2019 update of the KDOQI clinical practice guideline for vascular access, the snuffbox or distal radiocephalic location is considered for arteriovenous fistula (AVF) creation in the forearm 1. This approach is part of a stepwise strategy to vascular access creation, aiming to preserve future sites for access and provide functional use for the patient.
Assessment and Diagnosis
During physical examination, having the patient extend their thumb while the examiner palpates the depression between the tendons helps to properly identify and assess the anatomical snuff box. The radial artery passes through the snuff box, making it an alternative site for pulse assessment when the conventional radial pulse site is inaccessible. The superficial branch of the radial nerve also traverses this region, and compression or injury here can cause sensory disturbances. Given the most recent and highest quality evidence available, the anatomical snuff box should be considered both for its role in orthopedic assessment and its potential as a vascular access site, prioritizing patient outcomes in terms of morbidity, mortality, and quality of life 1.