Hand Pain

HISTORY:

‍RightLeft hand pain for ‍ ‍hoursdays

Onset: ‍gradualsuddentraumatic, following ‍ ‍

Location: ‍diffuse

Radiation: ‍none

Severity: ‍mildmoderatesevere, ‍012345678910 / 10

Type: ‍dullaching

Pattern: ‍constantintermittent, ‍worse at night

Worsening factors: ‍none

‍weakness

‍numbness

‍tingling

‍stiffness

‍swelling

‍redness

‍fever, up to ‍°, over ‍ ‍hoursdays

Treatments tried: ‍none, ‍effectiveineffective

Occupation: ‍

Dominant hand: ‍rightleftboth



EXAM:

Hand: ‍rightleft

- Inspection: ‍normal

- Palpation: ‍no tenderness on ‍dorsal aspectvolar aspect of the ‍1st2nd3rd4th5th finger(s)

- Range of motion: ‍full

- Strength: ‍intact 5/5, except ‍4/5 on ‍1st2nd3rd4th5th finger(s) ‍ ‍due to pain, grip ‍intact

- Neurovascular: ‍intact, cap refill ‍< 3> 3 sec, sensation ‍intact



ASSESSMENT:

‍Mechanical pain ‍likelysuspectedpossible

DDx: ‍



PLAN:

- X-ray of the hand

- MRI of the hand

- Blood work: ‍CBC, ‍CRP, ‍ESR, ‍RF, ‍ANA, ‍anti-CCP, ‍uric acid

- Nerve conduction study

- ‍Acetaminophen

- ‍NSAIDs

- Physical therapy

- Occupational therapy

- Wrist splint for carpal tunnel syndrome

- Referral to orthopedic surgeon

- Referral to hand surgeon

- Referral to rheumatologist

- Referral to neurologist

- Follow-up in ‍ ‍weeksmonths

- Return if pain worsens, if new symptoms develop such as weakness or numbness, or if symptoms do not improve with treatment