Scaphoid Fractures

Key differences: Dorsal wrist pain rather than snuffbox pain, no clear tenderness over the scaphoid tubercle, pain more central in the wrist, and usually less pain with axial loading of the thumb. Because the Watson scaphoid shift test has variable sensitivity, a fall on an outstretched hand with persistent wrist pain still warrants imaging before settling on a sprain diagnosis.

Key differences: Dorsal or volar tenderness over the distal radius rather than the anatomical snuffbox, often with a visible deformity or marked swelling. Mechanism is similar, a fall on an outstretched hand, which is why imaging should always include dedicated scaphoid views in addition to standard wrist views.

Key differences: Gradual onset radial-sided wrist pain rather than acute post-traumatic pain, positive Finkelstein's test, tenderness over the first dorsal compartment rather than in the floor of the snuffbox, and no history of a significant fall.

Key differences: Pain more distal at the base of the thumb rather than in the snuffbox, tenderness with thumb CMC grind testing, radiographic joint changes in an older population, and no clear inciting fall or trauma.

Key differences: Point tenderness directly over the radial styloid rather than in the scaphoid tubercle or snuffbox floor, often with localised swelling and bruising. Radiographs clarify the distinction, and I would not accept a styloid contusion label unless the scaphoid has been imaged adequately.

Key differences: Burning or tingling over the dorsoradial hand rather than deep snuffbox pain, often with a positive Tinel sign over the nerve at the radial forearm, and pain that does not change meaningfully with axial loading of the thumb.