Dynamic Palpation for Diagnosing Clinically Covert Scaphoid Fractures

The scaphoid is the most fractured carpal bone. In the initial workup, various clinical examinations are performed. However, the diagnosis can be confounding in the setting of clinically covert fracture cases. Routine physical examination findings may be equivocal in cases of proximal or distal pole fractures. Moreover, many commonly performed clinical tests are high in sensitivity but lag in specificity. Incorrect diagnosis can lead to overtreatment or undertreatment of this injury. To enhance the reliability of physical examination, dynamic palpation may be combined with static palpation. This report presents dynamic palpation at various wrist positions, based on cadaver anatomy studies of scaphoid and pain provocation manoeuvres of the wrist and hand as observed in various clinical studies. Tenderness thus elicited through these methods may help to confirm the diagnosis in the setting of clinically covert scaphoid fracture, where routine palpation findings are equivocal.