I-HUMAN CASE STUDY FOR A 16 YEARS OLD BOY
WITH HAND PAIN — WEEK 9 FOR WALDEN
UNIVERSITY LOCATION :OUTPATIENT CLINIC
WITH X-RAY, ECG, AND LABORATORY
CAPABILITIES FULL CASE STUDY WITH A SOAP
NOTE
Learning objectives: recognize common adolescent hand trauma; perform
focused HPI & neurovascular exam; interpret hand X-rays; decide between
conservative vs operative management; plan analgesia, immobilization, and hand
therapy; counsel on red-flag signs.
,1. Patient Information
Age: 16 years
Sex: Male
Race/Ethnicity: Not specified
Encounter Setting: Outpatient primary care clinic
Date of Encounter: Week 9 simulation
Source of History: Patient and parent (mother present)
Reliability: Reliable historian; coherent and consistent responses
Case Overview (brief)
16-year-old male presents to urgent care/ED with acute right hand pain after
punching a wall during an argument earlier today. Localized pain and swelling of
the ulnar aspect of the hand, decreased grip strength, and pain on passive
movement of 4th/5th fingers. No loss of consciousness, no other injuries.
2) Chief Complaint & summary (brief)
CC: “My right hand hurts after I punched a wall.”
One-line summary: Teen male with acute right ulnar-hand pain and swelling after
an axial load/impact to a closed fist — high suspicion for 5th metacarpal neck
fracture (Boxer’s fracture) versus soft-tissue injury, phalanx fracture, MCP
dislocation, or tendon/nerve injury.
, 3) History of Present Illness (HPI) + associated systemic symptoms
Onset: Today, 3 hours prior to presentation.
Mechanism: Direct blow with a closed fist to a wall while punching during
an altercation. Immediate pain noted at the time of impact.
Location: Ulnar aspect of the right hand over the 5th metacarpal neck; pain
radiates minimally to ring finger.
Duration: Constant since injury.
Characteristics: Sharp, localized; worse with movement of the 4th and 5th
digits and with grip.
Aggravating/relieving: Aggravated by grip, finger flexion/extension;
slightly relieved by ice and immobilization.
Timing: Constant; severe initially (8/10), now 6/10 with ice and splinting.
Severity: 6/10 currently, 8/10 at worst.
Associated symptoms: Mild swelling, bruising; decreased grip strength;
denies numbness or tingling at rest but reports transient numbness around
the little finger when squeezing tightly. No fevers, no chills, no open wound.
Denies neck/shoulder pain or other trauma. No vomiting, dizziness.
Red flags asked and negative: No open wound (no penetrating injury), no loss of
distal pulses, no severe bleeding, no pale/cold fingers.
WITH HAND PAIN — WEEK 9 FOR WALDEN
UNIVERSITY LOCATION :OUTPATIENT CLINIC
WITH X-RAY, ECG, AND LABORATORY
CAPABILITIES FULL CASE STUDY WITH A SOAP
NOTE
Learning objectives: recognize common adolescent hand trauma; perform
focused HPI & neurovascular exam; interpret hand X-rays; decide between
conservative vs operative management; plan analgesia, immobilization, and hand
therapy; counsel on red-flag signs.
,1. Patient Information
Age: 16 years
Sex: Male
Race/Ethnicity: Not specified
Encounter Setting: Outpatient primary care clinic
Date of Encounter: Week 9 simulation
Source of History: Patient and parent (mother present)
Reliability: Reliable historian; coherent and consistent responses
Case Overview (brief)
16-year-old male presents to urgent care/ED with acute right hand pain after
punching a wall during an argument earlier today. Localized pain and swelling of
the ulnar aspect of the hand, decreased grip strength, and pain on passive
movement of 4th/5th fingers. No loss of consciousness, no other injuries.
2) Chief Complaint & summary (brief)
CC: “My right hand hurts after I punched a wall.”
One-line summary: Teen male with acute right ulnar-hand pain and swelling after
an axial load/impact to a closed fist — high suspicion for 5th metacarpal neck
fracture (Boxer’s fracture) versus soft-tissue injury, phalanx fracture, MCP
dislocation, or tendon/nerve injury.
, 3) History of Present Illness (HPI) + associated systemic symptoms
Onset: Today, 3 hours prior to presentation.
Mechanism: Direct blow with a closed fist to a wall while punching during
an altercation. Immediate pain noted at the time of impact.
Location: Ulnar aspect of the right hand over the 5th metacarpal neck; pain
radiates minimally to ring finger.
Duration: Constant since injury.
Characteristics: Sharp, localized; worse with movement of the 4th and 5th
digits and with grip.
Aggravating/relieving: Aggravated by grip, finger flexion/extension;
slightly relieved by ice and immobilization.
Timing: Constant; severe initially (8/10), now 6/10 with ice and splinting.
Severity: 6/10 currently, 8/10 at worst.
Associated symptoms: Mild swelling, bruising; decreased grip strength;
denies numbness or tingling at rest but reports transient numbness around
the little finger when squeezing tightly. No fevers, no chills, no open wound.
Denies neck/shoulder pain or other trauma. No vomiting, dizziness.
Red flags asked and negative: No open wound (no penetrating injury), no loss of
distal pulses, no severe bleeding, no pale/cold fingers.
