Flags

In the outpatient department on rural placement, i had a young patient present with a 9 month history of left wrist pain. She described the pain as a constant throb that occasionally increased suddenly to a sharp stabbing pain (about once a month) which takes 20 min to half hour to settle. As far as she is aware the onset was insidious but does have a history of multiple wrist fractures (ie. 5 on left and 3 on right). Her last set of xrays were 2004. There are no aggrevating factors or easing factors she is aware of.

Objective assessment showed normal ROM with P1 at EROM for wrist flexion and extension. She had pain on resisted supination at EROM but nothing reproduced the symptoms she experienced. She then mentioned her "party trick" which consisted of subluxing her distal radio-ulnar joint - bringing on her sharp pain immediately.

I consulted with the senior physiotherapist and she too agreed that something was not normal. We decided to refer her to see the orthopaedic surgeon for further review (who was conveniently in town that week). We explained the situation to her and she was happy to have further investigations done. We also gave her some tubigrip for extra support and advised she avoided her "party trick". Is there anything else we could have done?