Rosh Review EM Scholar Monthly Question

An 85-year-old man presents for evaluation of left wrist pain. Last night, he missed the last step while descending the stairs at his house. He fell and landed on his hands and did not have other injuries. Acetaminophen and ibuprofen have not alleviated his pain. X-ray imaging is shown below. His physical exam reveals limited left wrist flexion and extension. There is no obvious deformity, weakness of his intrinsic hand muscles, or wrist drop. His pain is out of proportion to his exam. Which of the following nerves is most likely injured?

  1. Axillary
  2. Median
  3. Radial
  4. Ulnar

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References

  1. Guo RC, Cardenas JM, Wu CH. Triquetral fractures overview. Curr Rev Musculoskelet Med. 2021;14(2):101–106. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991068/
  2. Skalski M. Triquetral fracture – pooping duck sign. Radiopaedia website. Accessed June 22, 2023. https://radiopaedia.org/cases/triquetral-fracture-pooping-duck-sign?lang=us

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)

Cite this article as: Rosh Review Author Team, "Rosh Review EM Scholar Monthly Question", REBEL EM blog, September 18, 2023. Available at: https://rebelem.com/rosh-review-em-scholar-monthly-question-5/.

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