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Endgames Spot Diagnosis

Wrist pain that should not be missed

BMJ 2021; 373 doi: (Published 12 May 2021) Cite this as: BMJ 2021;373:n1067
  1. Kunal Kulkarni, specialty registrar in trauma and orthopaedics,
  2. Aqua Asif, medical student,
  3. Joseph Dias, professor of hand and orthopaedic surgery
  1. AToMS-academic team of musculoskeletal surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
  1. Correspondence to: K Kulkarni kunalkulkarni{at}

A man in his 20s presented with generalised wrist pain one day after he tripped while playing football and landed on his outstretched and extended right hand. No deformity was found on examination, but he had mild swelling and generalised tenderness around the wrist, particularly at the anatomical snuffbox and scaphoid tubercle. Wrist movement was painful (particularly ulnar deviation) as was axial loading of the thumb. As a scaphoid fracture was suspected, a series of “scaphoid view” wrist radiographs was requested. These usually consist of posteroanterior without (fig 1) or with ulnar deviation (fig 2), lateral, semi-pronated oblique, and posteroanterior 20o beam (elongated scaphoid) views.1

Fig 1

Posteroanterior radiograph of …

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