NRNP 6531 iHuman Case Hand Pain Week 9
Chief Complaint
Hand pain
History of Present illness
A 16-year old otherwise healthy male presents to the clinic with 8/10 sharp, achy pain and swelling without flexion deformity of the 5th metacarpal bone 2 hours after punching a cement wall after the loss of an important soccer match at school. Movement hurts; ice and keeping the hand still and cradled by the other minimizes pain. He has not taken any medications for pain. He reports bruising, denies chills, fever, laceration or abrasion, punches to other players especially at the mouth or teeth, numbness, tingling, pallor, pain at other joints in the hand, at wrists, elbows, shoulders, or lower extremities.
Case Findings
- 16 year old male
- Recent intentional punch to wall
- Pain over 5th right metacarpal
- Swelling over 5th right metacarpal
- Ecchymosis over 5th right metacarpal
- Denies punch to mouth or face of another person
- Denies numbness, tingling, or other joint pain
- Negative personal history of sarcoma or genetic conditions
- Negative family history of sarcoma or genetic conditions
- Tobacco use
- Occasional alcohol use
- Ecchymosis, swelling, and point tenderness over 5th right MC
- No other joint tenderness
Case Problem Statement
A 16-year old otherwise healthy male presents to the clinic with 8/10, sharp, achy, right hand pain, erythema, edema, and ecchymosis for 2 hours since punching a wall after losing a soccer match. Reports tobacco and alcohol use. He denies fever, laceration, abrasion, punches to teeth, pallor, numbness, or other joint pain. Physical examination shows stable vital signs, erythema, edema, ecchymosis, and point tenderness at the 5th metacarpal with severely limited active range of motion at R hand and wrist due to pain. Bilateral elbow, L wrist, and L hand nontender with 5/5, full, and painless active and resisted range of motion, bilateral sensation intact to pain and light touch at fingers, capillary refill brisk and radial pulses 2+ bilaterally.
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