Wrist Pain In A Confused Farmer

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Wrist Pain In A Confused Farmer - Page #3

Lab Studies: His complete blood count revealed a leukocytosis, with white blood cell count of 14 (normal 4.4 - 8.1). Uric acid was 6.9 mg/dL (normal 2.5 - 7.0). C-reactive protein 91mg/dL (normal Other Studies: X-ray (3 view) of the right hand Case Photo #1 : Mild-moderate degenerative changes of proximal and distal interphalangeal joint representing osteoarthritic changes, moderate-severe degenerative at metacarpophalangeal joints. Scapholunate joint space widening and ligamentous calcification with cystic changes among carpals as well as triangle fibrocartilage chondrocalcinosis. No acute fracture or subluxation/dislocation. Computed Tomography Hands Case Photo #2 Case Photo #3 Case Photo #4 : Significant degenerative changes of bilateral wrists and metacarpophalangeal joints (worse in right 1st, 2nd, and 3rd, and left 1st and 3rd). Bilateral carpal bones with multiple subchondral cysts. Bilateral radiocarpal joint with triangular fibrocartilage calcification (left greater than right). Diffuse swelling and inflammatory stranding with subcutaneous edema throughout soft tissue (right worse than left), no subcutaneous gas. Soft tissue swelling and subcutaneous edema bilateral consistent with cellulitis. Consultations: The Hand Surgery team evaluated the patient and did not feel comfortable performing arthrocentesis secondary to possible inoculation of the joint from superficial cellulitis. They recommended advanced computed tomography imaging for further evaluation and antibiotics. Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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