Rubbed The Wrong Way - Page #1

Author: Jeffrey Ham, DO
Co Author #1: Jeffrey C Ham, DO
Co Author #2: Glenn Gaston, MD
Co Author #3: Jacquelyn Murray, MD
Editor: Drew Duerson, MD
Senior Editor: Kristine Karlson MD

Patient Presentation:
32 year old professional defensive football tackle presents with acute onset radial sided wrist pain after practice.

Patient has had chronic wrist pain for the last several years. Pain typically improves with rehab and he has not missed any playing time. This is a new acute worsening of a similar pain. He felt a pop during practice that progressed to 10/10 sharp pain localized to the volar aspect of the wrist. Pain became more of a dull ache. Pain was worse than previous episodes. He also described immediate swelling after practice and was unable to flex his wrist. Movement and palpation of the wrist made pain worse. Previous routine PA/lateral and oblique views of the wrist two months ago for a same sided wrist sprain were read as normal.

Physical Exam:
General: Large athletic male in mild distress
Skin: No ecchymosis is present
Swelling noted from just distal to wrist crease to mid forearm, no masses appreciated.
Pain to palpation in volar wrist, point of maximal tenderness in distal forearm. No snuffbox tenderness.
Decreased range of motion with 30 degrees of active flexion and 35 degrees of active extension. Almost full passive flexion; however, positive pain near terminal extension.
Strength: 2/5 wrist flexion, 5/5 wrist extension; 5/5 testing to FPL, intrinsics.
Watson test negative.
Radial pulses: 2/4.
Two point discrimination: intact to ulnar, median, and radial nerve distribution.

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