Clinical examination of scaphoid fractures.

Undetected scaphoid fractures may lead to complications, including nonunion, malunion, avascular necrosis, and wrist arthritis. A competent physical examination is essential for the diagnosis of scaphoid fractures in the setting of occult fractures presenting with normal radiographs. The differential diagnosis of occult scaphoid fractures includes acute tears of the scaphoid-lunate ligament, Kienbock's disease, occult ganglion, nondisplaced radial styloid fractures, and injury to the radial aspect of the radio-scapho-capitate ligament. All of these may have normal plain radiographs but often can be distinguished based on physical examination findings. The 2 key points of such an examination include the exact location of point tenderness and provocative special tests. Although Watson's scaphoid shift test is classically described for scaphoid instability, we highlight its significance in the setting of scaphoid fractures.