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Old 04-25-2012
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Rheumatology/Orthopedics Anatomic Snuffbox Extreme Tenderness

A 15-year-old soccer player runs into a goal post, protecting his body with an outstretched left hand. After the game he complains to his father that his wrist hurts and they stop by the local emergency department. The boy screams in pain when the emergency physician palpates the floor of the anatomic snuffbox. X-ray of the left wrist and hand shows no fracture.
What is the best next step in management?

(A) Operative exploration for the source of pain
(B) Removable plaster splint and physical therapy
(C) Rest, ice, and non-steroidal anti-inflammatory medications
(D) Short arm cast and physical therapy in 4–6 weeks
(E) Thumb spica cast and repeat x-ray films of the left wrist and hand in 2–3 weeks
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Old 04-26-2012
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(E) Thumb spica cast and repeat x-ray films of the left wrist and hand in 2–3 weeks
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Old 04-26-2012
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He most likely has fracture of Scaphoid which won't show up on x-ray for few days. So, E is the right answer.
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Old 04-26-2012
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(E) Thumb spica cast and repeat x-ray films of
the left wrist and hand in 23 weeks..is the answer
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Old 04-26-2012
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sports person cant wait 2-3 weeks...should be MRI to be certain for # but not in choices. so i go for A...

please tell the ans.
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Old 04-26-2012
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Sounds like dequervains tenosinovitis..
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Old 04-26-2012
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Answer is E
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Old 04-26-2012
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The correct answer is E.
The scaphoid is the most commonly fractured carpal bone. It articulates with the distal radius, trapezium, and capitate, and is restricted from motion during radial deviation and dorsiflexion (outstretched arm). Thus, any forceful stress exerted on the scaphoid in this position results in fracture.
Tenderness, swelling, or bruising in the anatomic snuffbox, a triangular depression on the dorsal aspect of the hand bordered by the extensor and abductors of the thumb, can be highly indicative of a scaphoid fracture. Initial plain film radiographs do not always detect scaphoid fractures, especially in nondisplaced fractures.
Thus, as a general rule, a patient with a clinically suspected scaphoid fracture but negative initial x-ray is treated with a short arm thumb spica splint and reevaluated in 2 weeks. Repeat x-ray films are important to detect fractures of the proximal third of the scaphoid, which are associated with avascular necrosis. Failure to accurately diagnose and treat a scaphoid fracture may result in a variety of adverse outcomes including nonunion, delayed union, decreased grip strength, decreased range of motion, and OA of the radiocarpal joint.
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