Questionnaire/history:

Fall on an outstretched hand (FOOSH) (compression during wrist extension)?

Past medical history?

Drug allergies?

Known drug allergies?

Investigations:

Acute imaging has poor sensitivity for scaphoid fractures, so that patients are often referred to a review or fracture clinic 1-2 weeks later for subsequent X-rays or CT or MRI

Examination:

Tenderness of the snuffbox?

Tenderness on longitudinal compression of the thumb?

Tenderness of the scaphoid tubercle (on the volar side of the wrist)?

Management:

If any of the above present, treat as a scaphoid fracture (risk of avascular necrosis and long-term pain and loss of function)

X-ray, if positive cast, if negative, splint and review or fracture clinic 1-2 weeks later for subsequent X-rays or CT or MRI

Delayed presentation (eg 1 week after trauma): referral to A&E for same-day imaging and assessment

Resource(s):

Krastman et al (systematic review of scaphoid diagnosis) 2020 

RCEM 2013