What primary symptom would lead you to suspect a scaphoid fracture in a patient?

• A. Wrist swelling
• B. Tenderness in the anatomical snuff box
• C. Loss of wrist motion
• D. Pain in the forearm

Answer: (B)

Tenderness in the anatomical snuff box is a classic symptom that strongly suggests a scaphoid fracture. The anatomical snuff box is a depression located on the radial side of the wrist, and it is bordered by the first dorsal extensor compartment (which contains the abductor pollicis longus and extensor pollicis brevis) and the extensor pollicis longus tendon. The scaphoid bone is situated beneath this area, and when it is fractured, it often presents with localized tenderness that can be elicited during a physical examination. This finding is quite specific to scaphoid fractures and can help guide further imaging or treatment decisions.

While wrist swelling can occur with many wrist injuries, it is a nonspecific symptom that does not distinguish scaphoid fractures from other types of injuries. Loss of wrist motion is also a common symptom associated with various wrist injuries but is not exclusive to scaphoid fractures. Pain in the forearm can be seen in several conditions, including distal radius fractures or other wrist injuries, but it lacks the specificity needed to pinpoint a scaphoid fracture. Therefore, tenderness in the anatomical snuff box serves as the most indicative sign leading to suspicion of such an injury.