Question of the Week # 162

162) A 42 year old man is evaluated in your office for pain in his left hand. He has a chronic history of biciptal tendinopathy in his left upper extremity and Gastro-esophageal Reflux disease. He denies any history of recent trauma. He reports sudden onset of pain in his left hand that is associated with burning sensation. On physical examination, the left hand is swollen, pal, cool and tender to touch. Radial and ulnar pulses are intact. The image of his hands is shown below:

The cornerstone of the treatment modalities in this condition:

A)  Encouraging normal use of the limb

B)  Immobilization in plaster cast

C) Surgical decompression

D) Arterial Bypass surgery

E)     Prevention of exposure to cold temperatures

7 Responses

  1. c??

  2. ccc

  3. A
    Physical and occupational therapy should be started as early as possible. Starting an exercise program and learning to keep joints and muscles moving may prevent the disease from getting worse and help you perform everyday activities.

    Medications may be used, including pain medicines, steroids, certain blood pressure medicines, bone loss medications (such as bisphosphonates like Fosamax and Actonel), and antidepressants.

  4. decompression surgery. He has compartment syndrome. that’s a medical emerrgency.

  5. A, (my answer) for CRPS, every single finding fits the diagnostic criteria for CRPS.
    B, I don’t know what we are trying to do here? Maybe, we are trying to treat an underlying closed fracture?, but with swelling, cast is contraindicated until swelling subsides? No where in the history is it mentioned that this patient sustained a closed fracture. Even then, this is not the treatment.
    C, Compartment syndrome? Diagnostic criteria are not satisfied without pain on movement. ( flexion of the fingers, for Hand CS and extension of the rest for Antebracheal CS)
    D, acute arterial occlusion, swollen hand and tenderness to touch are very non-traditional. How many times have we seen acute arterial occlusion with swelling and this in a patient who shouts every time you touch his hand? It will be very unusual to see this unless it is reactive hyperrhemia in which case, the limb will not be cold and what exactly dislodged the occlusion without surgery? Where did the atheroma go?
    E, Raynaud’s phenomenon, tender to touch? No. Reactive hyperrhemia, tender to touch, yes. But the latter will lead to a red warm hand, not a cold pale hand.

    My answer is A.

  6. what is the answer Dr Red??????

  7. pt is suffering from scleroderma, has ranauds phenomenon so answeris E

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