EpistemisSwelling of the anatomical snuffbox
Specialty: Musculoskeletal.
Why it occurs
- De Quervain's tenosynovitis with severe effusion in the synovial sheath
- Reactive synovitis of the trapeziometacarpal joint (active rhizarthrosis)
- Synovial or ganglion cyst originating in the scapholunate or trapeziometacarpal joint
- Displaced carpal scaphoid fracture with local hematoma
- Rheumatoid arthritis or gouty arthritis located in the lateral carpus
- Tenosynovitis of the extensor pollicis longus tendon (compartment 3)
Initial workup
AP, lateral and oblique wrist radiography (with specific views for scaphoid) | High-resolution musculoskeletal ultrasound (allows us to determine whether the swelling is liquid, synovial, cystic or corresponds to a hematoma) | Wrist MRI.
red flags
Painful swelling in the anatomical snuff box after trauma, which associates coldness and paleness of the thumb, paresthesias and absence of a palpable radial pulse or slow distal capillary pulse (compartment syndrome of the hand or arterial injury, surgical emergency).
Standard management
- Dexketoprofen — 25 mg every 8 hours orally for 5 days to control pain and inflammation
- Paracetamol — 500 mg combined with tramadol 37.5 mg orally every 8 hours if there is severe post-injury pain
- In case of symptomatic ganglion: ultrasound-guided puncture and aspiration followed by infiltration of 10 mg of methylprednisolone into the remaining recess if clinically indicated.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 3