I couldn’t make this post part of the “CSI Whitecoat” series because there was no crime committed. But figuring out what was wrong with this patient took a little bit of observation and some detective work. So everyone can play “House, MD” from the emergency department.
A 76 year old nursing home patient was brought into the emergency department for evaluation of swelling from the forearm to the fingers for the prior 3-4 days. The nurse sent the patient for an x-ray of her wrist from triage. AP and lateral views are shown below.
The patient’s physical examination was unremarkable except for the swelling about her distal forearm and hand as shown. She had normal sensation, normal motion, and normal circulatory examinations.
Why is the patient’s arm swollen? Answer in the comment section.