January 18, 2021
Case: A 51-year-old woman, with no pertinent past medical history, presented to the Emergency Department (ED) complaining of right hand pain after a large fragment from a wooden cooking spoon penetrated her right palm approximately 1 week ago. She reported immediately removing the splinter and starting old, previously prescribed amoxicillin prior to her visit. She was prompted to visit the ED after her pain gradually increased, affecting her ability to flex and extend her right fourth digit.
On physical exam, the patient was afebrile with all other vital signs within normal limits. There was significant tenderness localized to the base of the right fourth digit near the proximal interphalangeal (PIP) joint, associated with edema, ecchymosis, and erythema. While the patient’s right hand remained neurovascularly intact, significant restrictions in passive motion, including flexion and extension, was noted to the right fourth digit. On visual inspection, no foreign bodies were appreciated.
A radiograph of the right hand was ordered, which was negative for any acute abnormalities, including foreign body. However, due to the patient’s clinical presentation and the potential radiolucency of the suspected foreign body, a point-of-care ultrasound was performed....Read More