ID: 38 y/o ♂ otherwise healthy, came in with Rt wrist pain.
HPI: pain started gradually yesterday a few hr after moving heavy timber, no restricted ROM yesterday; woke up this am with significant Rt wrist pain; unable to move Rt wrist due to significant pain; no recent trauma; reports weak grip; no fever/chills; no previous Rt upper extremity injuries; mild swelling; no bruising or colour changes; no deformity; no numbness/tingling.
PMH: ⊘
All: NKDA
E/O: A+O ✗ 3 - NAD - ⊘ ill/toxic
VSSA
Rt upper extremity: shoulder, elbow, MCP, and PIP joints are unremarkable.
Wrist mildly edematous; ⊘ color/temp ▵s; significantly reduced active/passive ROM due to pain; no anatomical snuff box tenderness; severe tenderness on the ulnar aspect of the wrist; weak grip; neuro-vascular exam Ⓝ;
X ray wrist ➜ ⊘ #
U/S wrist jont ➜ ⊘ effusion, possible TFCC tear.
I/P: 38 y/o ♂ with acute Rt wrist pain most likely caused by TFCC (Triangular Fibro-Cartilage Complex) tear.
RICE (Rest, Ice, Compression, Elevation), NSAIDs, protective bracing, physiotherapy; discharge home w F/U precautions;
Discussion(1):
TFCC consists of, triangular fibrocartilage, ulnar meniscus homolog, ulnar collateral ligament, carpal ligaments, extensor carpi ulnaris tendon sheath
Mechanism of injury: compressive loads to the wrist esp. if accompanied by ulnar deviation; can also be injured in distal radial/ulnar #s or disruption of the distal radio-ulnar joint; arthroscopy can be done for Dx or Rx purposes.
Tenderness on the dorsal ulnar aspect of the wrist; pain on resisted dorsiflexion and ulnar deviation; Press test +ve;
Reference:
1. Brukner, P., Brukner, P., D.R.C.O.G, & Khan, K. (2009). Clinical sports medicine. North Ryde, N.S.W: McGraw-Hill.
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