AdultPediatric
Cannot miss / life threats
Cannot miss / life threats
Diagnostic flow — check first
Diagnostic flow — check first
- Snuffbox tender after FOOSH → splint as scaphoid even with normal XR.
- Severe trauma + median nerve symptoms → look for perilunate dislocation.
- Hot swollen wrist + fever → aspirate before antibiotics.
- Fight bite over MCP → assume joint penetration → IV abx + hand surgery.
Differential diagnosis — checklist
0/13
Check off each diagnosis as you consider it. Tap the name for unique exam, lab/imaging clues, first-line confirmatory test, and management.
Fracture / dislocation0/5
Soft-tissue / nerve0/4
Inflammatory / infectious0/4
Initial ED workup
Bedside0/4
- Vitals; check for systemic signs
- Inspect deformity, swelling, ecchymosis, snuffbox
- Assess median, ulnar, radial nerve function
- Check radial + ulnar pulses, capillary refill, Allen test
Labs0/2
- CBC, CRP/ESR, urate if infection/inflammation
- Joint aspiration if effusion + fever
Imaging0/3
- PA + lateral wrist XR; scaphoid view if snuffbox tender
- MRI wrist (without contrast) if occult scaphoid fracture suspected
- US for tendon / ganglion
Initial management0/4
- Splint (thumb spica for scaphoid, sugar-tong for distal radius, ulnar gutter for boxer's)
- Ice, elevation, NSAID + acetaminophen
- Reduce angulated/displaced fractures
- Emergent hand surgery for septic joint, open fracture, NV compromise
Pearls / pitfalls
Pearls
- Scaphoid fractures are notorious for negative initial XR — splint and reimage.
- Perilunate dislocations are easy to miss without a true lateral wrist view.
- Boxer's fracture with rotational deformity needs reduction; pure angulation up to 40° is acceptable.