Board of Certification for the Athletic Trainer (BOC) Practice Test

A patient presents with pain and swelling in the anatomical snuff box. What condition should the athletic trainer suspect?

1. Swan-neck deformity

2. Scaphoid-navicular fracture

3. Lunate dislocation

4. Capitate dislocation

The correct answer is: Scaphoid-navicular fracture

The presence of pain and swelling in the anatomical snuff box is a classic indicator of a scaphoid-navicular fracture. The anatomical snuff box is an area located on the radial side of the wrist and is bordered by the tendons of the abductor pollicis longus and extensor pollicis brevis, with the extensor pollicis longus running along its ulnar border. When a scaphoid fracture occurs, particularly from a fall onto an outstretched hand, it typically presents with tenderness and swelling in this specific area. This is particularly crucial to identify as scaphoid fractures can be easily overlooked, and failing to treat them properly can lead to complications such as avascular necrosis due to the vascular supply of the scaphoid. In contrast, other conditions mentioned, such as lunate dislocation and capitate dislocation, may cause pain in the wrist, but the precise location of swelling and tenderness distinctively relates to a scaphoid fracture. Swan-neck deformity is not associated with acute injuries in this context but rather represents a chronic condition that affects finger positioning. Thus, from a clinical perspective, the symptoms aligning with a scaphoid-navicular fracture make it the most probable diagnosis