Limited Time Offer: i-Human Week #9
Package (NR ): 16-Year-Old
Male Hand Fracture – Full Case + SOAP
Note + Treatment & Education.
,Comprehensive Clinical Assessment: 16-Year-Old Male
with Right Hand Pain
Chief Complaint (CC): "My right hand hurts near my
thumb, especially when I move it or put pressure on it."
History of Present Illness (HPI): A 16-year-old right-
hand-dominant male presents with 4-day history of right
hand pain. The pain began after a fall while skateboarding,
where he reports landing on an outstretched right hand
(FOOSH injury). He describes the pain as a deep, aching
throb localized to the "snuffbox" area (anatomic snuffbox)
of the dorsal radial hand. Pain is rated 6/10 at rest,
worsening to 8/10 with gripping, writing, or any wrist
movement. He notes mild swelling but no obvious
deformity, bruising, or laceration at the time of injury. He
has been self-treating with ice and over-the-counter
ibuprofen (400mg) with partial relief. Denies any
numbness, tingling, or color changes in the fingers.
Past Medical History (PMH): Healthy. No chronic
illnesses. No prior surgeries.
Medications: Ibuprofen 400mg PRN for pain.
Allergies: NKDA.
Social History: High school sophomore. Active in
skateboarding and basketball. Non-smoker, denies alcohol
or illicit drug use.
Family History: Non-contributory.
,Review of Systems (ROS):
• General: Denies fever, chills, fatigue.
• Musculoskeletal: As per HPI. Denies other joint pain,
swelling, or recent injuries.
• Neurological: Denies radicular pain, paresthesia, or
weakness in the arm.
• Integumentary: Denies open wounds, rashes, or
infection at the site.
Focused Physical Examination:
• Vital Signs: BP 118/72, HR 68, RR 16, Temp 98.6°F,
SpO2 99%.
• Inspection: Mild soft tissue swelling noted in the
anatomic snuffbox. No ecchymosis, deformity, or skin
breakdown.
• Palpation: Tenderness to palpation is exquisitely
focused in the anatomic snuffbox. No tenderness
over the distal radius, ulnar styloid, or metacarpals.
Mild tenderness at the scaphoid tubercle volarly.
• Range of Motion (ROM): Active and passive wrist
extension/flexion are limited by pain. Radial and ulnar
deviation reproduce significant pain, especially radial
deviation. Pain with resisted thumb extension.
• Special Tests:
o Scaphoid Compression Test ("Long Bone
Pressure"): Positive (axial compression of the
, thumb metacarpal elicits sharp pain in the
snuffbox).
o Finkelstein Test: Negative (no pain with ulnar
deviation while thumb is clutched in fist—rules
out de Quervain's tenosynovitis).
• Neurovascular: Capillary refill <2 seconds in all
fingers. Radial pulse 2+. Sensation intact to light
touch in radial, median, and ulnar nerve distributions.
Motor function intact (5/5 strength) with pain
limitation.
Differential Diagnoses (in order of likelihood):
1. Scaphoid Fracture (Waist): The classic FOOSH injury
with snuffbox tenderness is a scaphoid fracture until
proven otherwise. This is the primary concern due to
risk of avascular necrosis and non-union.
2. Distal Radius Fracture (Occult): A non-displaced
Salter-Harris type I fracture or buckle fracture could
present similarly, though tenderness is usually more
proximal.
3. Scapholunate Ligament Sprain: Can occur with
FOOSH, causing pain and instability, but tenderness is
often more dorsal.
4. De Quervain's Tenosynovitis: Less likely given acute
traumatic onset and negative Finkelstein test.
5. Simple Wrist Sprain (Strain): A diagnosis of
exclusion after ruling out bony injury.
Package (NR ): 16-Year-Old
Male Hand Fracture – Full Case + SOAP
Note + Treatment & Education.
,Comprehensive Clinical Assessment: 16-Year-Old Male
with Right Hand Pain
Chief Complaint (CC): "My right hand hurts near my
thumb, especially when I move it or put pressure on it."
History of Present Illness (HPI): A 16-year-old right-
hand-dominant male presents with 4-day history of right
hand pain. The pain began after a fall while skateboarding,
where he reports landing on an outstretched right hand
(FOOSH injury). He describes the pain as a deep, aching
throb localized to the "snuffbox" area (anatomic snuffbox)
of the dorsal radial hand. Pain is rated 6/10 at rest,
worsening to 8/10 with gripping, writing, or any wrist
movement. He notes mild swelling but no obvious
deformity, bruising, or laceration at the time of injury. He
has been self-treating with ice and over-the-counter
ibuprofen (400mg) with partial relief. Denies any
numbness, tingling, or color changes in the fingers.
Past Medical History (PMH): Healthy. No chronic
illnesses. No prior surgeries.
Medications: Ibuprofen 400mg PRN for pain.
Allergies: NKDA.
Social History: High school sophomore. Active in
skateboarding and basketball. Non-smoker, denies alcohol
or illicit drug use.
Family History: Non-contributory.
,Review of Systems (ROS):
• General: Denies fever, chills, fatigue.
• Musculoskeletal: As per HPI. Denies other joint pain,
swelling, or recent injuries.
• Neurological: Denies radicular pain, paresthesia, or
weakness in the arm.
• Integumentary: Denies open wounds, rashes, or
infection at the site.
Focused Physical Examination:
• Vital Signs: BP 118/72, HR 68, RR 16, Temp 98.6°F,
SpO2 99%.
• Inspection: Mild soft tissue swelling noted in the
anatomic snuffbox. No ecchymosis, deformity, or skin
breakdown.
• Palpation: Tenderness to palpation is exquisitely
focused in the anatomic snuffbox. No tenderness
over the distal radius, ulnar styloid, or metacarpals.
Mild tenderness at the scaphoid tubercle volarly.
• Range of Motion (ROM): Active and passive wrist
extension/flexion are limited by pain. Radial and ulnar
deviation reproduce significant pain, especially radial
deviation. Pain with resisted thumb extension.
• Special Tests:
o Scaphoid Compression Test ("Long Bone
Pressure"): Positive (axial compression of the
, thumb metacarpal elicits sharp pain in the
snuffbox).
o Finkelstein Test: Negative (no pain with ulnar
deviation while thumb is clutched in fist—rules
out de Quervain's tenosynovitis).
• Neurovascular: Capillary refill <2 seconds in all
fingers. Radial pulse 2+. Sensation intact to light
touch in radial, median, and ulnar nerve distributions.
Motor function intact (5/5 strength) with pain
limitation.
Differential Diagnoses (in order of likelihood):
1. Scaphoid Fracture (Waist): The classic FOOSH injury
with snuffbox tenderness is a scaphoid fracture until
proven otherwise. This is the primary concern due to
risk of avascular necrosis and non-union.
2. Distal Radius Fracture (Occult): A non-displaced
Salter-Harris type I fracture or buckle fracture could
present similarly, though tenderness is usually more
proximal.
3. Scapholunate Ligament Sprain: Can occur with
FOOSH, causing pain and instability, but tenderness is
often more dorsal.
4. De Quervain's Tenosynovitis: Less likely given acute
traumatic onset and negative Finkelstein test.
5. Simple Wrist Sprain (Strain): A diagnosis of
exclusion after ruling out bony injury.
