My most interesting and mildly challenging evaluation I have ever done was on a middle school basketball player’s wrist. He had tripped and fallen on an out-stretched hand. He came in really calm and his complaint was that his wrist would click every time he bent it and that it hurt to move. Immediately I knew I had to rule out a fracture. I did palpations and felt crepitus around his lunate. I then did Range of motion and a mobility for all of his carpals. His range of motion was normal, but as he stated, there was a pop every time he flexed and extended his wrist. At this point I was a bit confused. I thought there may have been a dislocation because of how mobile his carpals were, but then I checked them bilaterally; while there was a bit more mobility on the injured side, it seemed relatively normal for him. Then I went into some special tests. I did a couple of percussion tests, but it was hard to isolate the carpals. I also did a squeeze test on his forearm which was positive. I was stuck between a radial ulnar sprain, a lunate fracture, and a lunate dislocation. At this point is when my preceptor helped me think through the process. He reminded me of his age and how we need to be worried about growth plate injuries and greenstick fractures. He also stated how when we are young our joints are very loose which explains the amount of mobility I saw in his wrist. What I learned from this evaluation is that sometimes there are parts of the history you don’t ask, but you need to take into account. In this instance, obviously I see a young boy and an injury around the joint, but I didn’t think of it as a factor that would play into the evaluation. Maybe because I’m more used to an older population, this just slipped my mind. Now I know for the future I will need to be more cognizant of age and other factors that are implied but not asked.
This week I had 12 attempts and 0 masteries in my clinical packet.
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This is where I do my weekly clinical blog assignment. There is either a prompt I am responding to, or I just talk about something exciting I saw during the week.
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April 2019
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