HPI: Young male presents after a fall while skiing with right shoulder and wrist pain.
PE: Obvious deformity of the right wrist. No abrasions or ecchymosis. Full thumb abduction, able to flex at DIP and PIP joint of all 5 fingers, full abduction of all 4 palmar fingers, 5/5 strength to finger grip. Unable to range wrist, elbow or glenohumeral joint secondary to pain. Normal sensation to pinprick and two point discrimination of all five fingers. 2+ radial pulse with normal cap refill.
- Normal wrist anatomy consists of two rows of bones:
o Proximal row: Scaphoid, lunate, triquetrum, pisiform
o Distal row: trapezium, trapezoid, capitate, hamate
- Ligaments of the wrist:
o Interosseous ligaments run between the carpal bones and stabilizes proximal carpal bones.
o Intrinsic ligaments insert and originate among the carpal bones to internally stabilize them.
o Extrinsic ligaments connect radius and ulna to the carpus.
How to make diagnosis:
o Require emergent closed reduction and splinting into sugar tong splint.
CMC ER Residents
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