Abstract: A screw insertion/extraction device is disclosed that is useful as a tool for screw insertion and extraction procedures. The device includes a shaft sleeve that is formed to define a passage for accommodating the shaft of a wrench. In an exemplary embodiment, the shaft sleeve has a proximal portion and a distal portion interposed by an intermediate portion, where the proximal and distal portions extend along opposite sides of a central axis of the wrench shaft passage and the intermediate portion extends both along and about the central axis to connect the proximal and distal portions. A shoulder portion extends inwardly from the distal end of the shaft sleeve for engaging the base of a screw head such that the screw head can be captured between the distal end of a wrench and the shoulder portion of the shaft sleeve.