title: The Palpable Scaphoid Surface Area in Various Wrist Positions.
abstract: OBJECTIVE
  To determine the theoretical amount of surface area available for palpation of the scaphoid in various wrist positions and to provide a guide depicting which wrist position will expose proximal pole, waist, and distal pole fractures.
  
  
  METHODS
  Using 3 fresh-frozen male cadaver wrists, we digitized palpable surface areas (dorsal, volar, and snuffbox) of the scaphoid in several wrist positions. The entire scaphoid was then excised and a digitized 3-dimensional reconstruction of the entire scaphoid was obtained. The 2 images were superimposed and the surface area was calculated
  
  
  RESULTS
  The maximum palpable area of the scaphoid was achieved with the wrist in neutral extension and maximum ulnar deviation and the wrist in maximum flexion and neutral deviation. Neutral wrist extension and ulnar deviation exposed all but the most proximal portion of the proximal pole and the distal pole, which made this the ideal position to detect tenderness from a scaphoid waist fracture and larger proximal pole fractures. Maximum wrist flexion with neutral wrist deviation exposed the entire proximal pole, which made this the ideal position to detect tenderness from a proximal pole scaphoid fracture.
  
  
  CONCLUSIONS
  Wrist position influences the amount of scaphoid surface area available for palpation and should be considered when examining a patient with a suspected scaphoid fracture.
  
  
  CONCLUSIONS
  The scaphoid should be palpated in 3 anatomic regions with the wrist placed in different positions to maximally expose the anatomical region being palpated.
authors: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: Giugalejm@upmc.edu.
authors: Juan M
authors: JM
authors: Giugale
authors: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors: Daniel
authors: D
authors: Leigey
authors: Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA.
authors: Kyle
authors: K
authors: Berkow
authors: Department of Orthopedic Hand and Upper Extremity Surgery, Orthopedic and Sports Medicine Clinic, Springfield, OR.
authors: David M
authors: DM
authors: Bear
authors: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors: Mark E
authors: ME
authors: Baratz
mesh_terms: D000328:Adult; D001830:Body Surface Area; D002102:Cadaver; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011403:Pronation / Q000502:physiology; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D021361:Scaphoid Bone / Q000033:anatomy & histology* / Q000000981:diagnostic imaging* / Q000601:surgery; D012680:Sensitivity and Specificity; D013484:Supination / Q000502:physiology; D014953:Wrist / Q000502:physiology* / Q000601:surgery
keywords: Scaphoid fractures; scaphoid anatomy; scaphoid exam