Anatomical snuffbox tenderness
For: Scaphoid fracture (occult)
A break in the scaphoid, a small wrist bone at the base of the thumb, that is not visible on the first X-ray. Usually from a fall on an outstretched hand.
Treat with caution (see below)LR+ calculated from the pooled sensitivity and specificity; LR− as published.
Its negative likelihood ratio reaches the usual rule-out threshold, but the book does not count it as a reliable rule-out test.
Caution: Figures are for occult fracture (initial X-ray normal).
What the numbers mean
- Positive result: barely informative: a positive result changes little.
- Negative result: see the caution above before relying on this result.
Source
Coventry L, Oldrini I, Dean B, Novak A, Duckworth A, Metcalfe D. Which clinical features best predict occult scaphoid fractures? A systematic review of diagnostic test accuracy studies. Emerg Med J. 2023;40(8):576-582. PubMed · systematic review
Figures as they will appear in Rule It In, Rule It Out (Trokos, forthcoming). If a newer or better study changes them, this page changes with the book. Figures last updated from the book on 2 October 2026.
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