Management of Right Wrist Pain with Snuffbox Tenderness

Initial Imaging Approach

• Obtain radiographs immediately as the best initial study for wrist pain with snuffbox tenderness, including dedicated scaphoid views, according to the American College of Radiology 1, 2

Advanced Imaging for Occult Fractures

• MRI without IV contrast is the preferred next study when radiographs are nondiagnostic and occult scaphoid fracture is suspected, as recommended by the American College of Radiology 1, 3
• CT without IV contrast is an acceptable alternative to MRI, particularly useful in casted patients or those with MRI contraindications, though it has lower sensitivity for bone bruises, according to the American College of Radiology 1
• Bone scintigraphy can reliably exclude occult scaphoid fractures with high sensitivity but lower specificity than MRI or CT, as stated by the American College of Radiology 1

Alternative Diagnoses to Consider

• Consider de Quervain tenosynovitis, which can be evaluated with ultrasound, as suggested by the American College of Radiology 2
• Evaluate for other occult carpal fractures or ligamentous injuries with MRI, which accurately depicts bones, ligaments, TFCC, and soft tissues, according to Praxis Medical Insights 3
• Ganglion cysts are well-depicted with either MRI or ultrasound if a mass is palpable, as reported by the American College of Radiology 1, 2