Painful wrist, thumb laceration, painful foot and miscarriage advice.

Painful wrist.

Important to examine joint above and below injury.

Compare both hands.

Check which is dominant hand.

Protection

Rest

Ice

Compression

Elevate

Rehabilitation

Mechanical Causes of Wrist Pain

CAUSE CLINICAL PRESENTATION IMAGING

Fracture

History of trauma and bony tenderness

Radiography

Occult fractures identified with delayed radiography, CT, MRI, or bone scan

Nonunion of scaphoid or hook of the hamate

History of trauma with TTP at the anatomic snuffbox (scaphoid) and the proximal hypothenar area 1 cm distal to flexion crease of the wrist (hamate)

Radiography (“scaphoid view” [scaphoid] or the carpal tunnel and supinated oblique views [hamate])

MRI

Avascular necrosis of the scaphoid (Preiser’s disease) or the lunate (Kienböck’s disease)

Variable history of trauma with TTP at the scaphoid or lunate

Delayed radiography

MRI

Ligament tear

Triangular fibrocartilage complex

TTP in distal hollow between pisiform and ulnar styloid

MRI

Arthroscopy may be necessary to rule out a false-negative MRI

Distal radioulnar joint subluxation

Pain, instability with radioulnar “grind” test

Radiography (widened distal radioulnar joint space on PA view—usually normal)

MRI, cineroentgenography, or arthroscopy

Carpal instability

Midcarpal TTP with a painful and audible “clunk” on ulnar deviation

Cineroentgenography

Scapholunate dissociation

TTP at scapholunate interval

Radiography (“clenched-fist” and supinated oblique views)

De Quervain’s tenosynovitis

TTP along radial aspect of distal radius

Ultrasonography may show synovial thickening

Intersection syndrome

TTP and crepitus along dorsal aspect of distal radius

Neoplasm or ganglion

Mass and TTP

Ultrasonography


CT = computed tomography; MRI = magnetic resonance imaging; TTP = tenderness to palpation; PA = posterior-anterior. Information from references 1 through 11.

A Clinical Approach to Diagnosing Wrist Pain

Grind Test.

Finkelstein’s test

lunotriquetral shear test

Suppination lift test

Watson Test


Thumb Laceration

Check for bony injury

X Ray for possible bone involvement

May need antibiotics if bone involved.

Tetanus cover.

Painful Foot

Inversion injury- ? Painful base 5th metatarsal

Check pulses and sensation.

If eversion injury press for bony tenderness over lateral malleolus.

In this case very little swelling so unlikely fracture.

Weight bearing so not fractured tibia.

ankle-bones

 

 

ankle sprain

Miscarriage advice:

Usually 3 miscarriages before any investigations,

Need to take painkillers.

Return if any excess bleeding, smelly discharge or uncontrollable pain.

Miscarriage Association Website

Originally posted 2014-10-28 21:29:31. Republished by Blog Post Promoter

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