Hard To Grasp: A Unique Case Of Finger Pain

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Hard To Grasp: A Unique Case Of Finger Pain - Page #1

Author: Jeremy Swisher, MD Co Author #1: Zachary Sitton, MD Co Author #2: Neil Sparks, DO Senior Editor: Jessalynn Adam, MD Editor: Daniela Mehech, MD Patient Presentation: 26-year-old female with right fifth finger pain. History: A 26-year-old right hand dominant female employed by a minor league baseball team with no past medical history presented to the sports medicine clinic with right fifth digit pain and swelling that she rated as 3/10. She was wringing out a large sponge 3 days prior to prepare a wet field for play, when her finger slipped off the sponge. She felt a pop and had sharp, non-radiating pain followed by swelling. On presentation she noted mild improvement in edema but persistent pain and decreased range of motion of the fifth digit. She had tried ibuprofen and ice, which did not provide much relief. She denied any fever, chills, numbness or tingling, weakness, prior injury, or history of malignancy. Physical Exam: VITALS: BP 122/83 \| Pulse 86 \| Ht 5'7 \| Wt 153 lb \| BMI 23.96 INSPECTION: There was no gross deformity, angulation or malrotation of the fifth phalange. There was mild edema with ecchymosis at the palmar aspect right fifth metacarpophalangeal joint. PALPATION: She exhibited tenderness to palpation from the fifth metacarpophalangeal joint to the proximal interphalangeal joint with mild tenderness to palpation to the fifth metacarpal. There was no tenderness to palpation of the distal radius or ulna. RANGE OF MOTION: She was unable to make fist due to pain at the metacarpophalangeal joint. There was full range of motion in supination and pronation. STRENGTH: Right grip strength was limited due to pain. There was 5/5 strength in supination, pronation, radial & ulnar deviation. NEUROVASCULAR: There was 2+ radial and ulnar pulses. Capillary refill was less than three seconds with no deficits in sensation. SPECIAL TESTS: She had negative Phalen, Tinel, and Finkelstein signs. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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