Tenderness in the anatomical snuffbox is the most sensitive sign of a scaphoid fracture (0.87–1.00) but is not specific
After a fall it means "get it imaged", and a normal first X-ray does not close the question
Key Findings
Anatomical snuffbox tenderness (8 studies, 1164 patients) had a sensitivity of 0.87 to 1.00 and a specificity of 0.03 to 0.98.
Longitudinal thumb compression (8 studies, 961 patients): sensitivity 0.48 to 1.00, specificity 0.22 to 0.97.
Scaphoid tubercle tenderness: sensitivity 0.82 to 1.00; painful ulnar deviation: 0.67 to 1.00.
Combining tests raised specificity while keeping sensitivity high; heterogeneity prevented pooled estimates.
Practical Application
Pain in the hollow at the base of the thumb on the back of the wrist after a fall is treated as a possible scaphoid fracture until a clinician says otherwise.
A first X-ray can be normal: pain on the thumb side, or on the little-finger side of the palm, or pain on leaning on the hand (push-ups, the bars) that is still there after one to two weeks goes back for repeat or advanced imaging. A pisiform fracture after a bicycle fall was found only on CT at two weeks in a published case (Abulesz 2026, DOI 10.1155/cro/2097620).
Numbness in the ring and little finger with palm pain after an impact adds to the reason to be seen.
Limitations
High or unclear risk of bias in the included studies; abstract only was read.