Wrist pain after a fall on an outstretched hand - Emergency Department

CurtinYear 410 min + 2 min readingMusculoskeletal & rheumatologyStandardClinical years
  • Focused history
  • Focused examination (wrist and hand)
  • Request investigations: Other imaging
  • Dx
  • Initial Mx

Ready

2 min reading, 10 min station, warning at 2 min

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Station - Instructions for candidate

You are a medical student on placement in the Emergency Department of a Perth metropolitan hospital.

Ayen Deng, a 17-year-old student, was brought to the Emergency Department by their parent. They have pain in the wrist after a fall, which occurred 45 minutes ago. Initial imaging has been done and the triage nurse has taken their observations. You have been asked to assess the injury.

Triage observationsHR 88 regular, BP 118/76 mmHg, RR 16, SpO2 99% on room air, temperature 36.8 C, pain score 6/10

Results provided:

Wrist X-rays (three standard views)

No break is visible on these views. The bones are normally aligned. No other bony abnormality detected.

imaging other - read aloud by the examiner

Three views of the right wrist. The bones are clearly outlined and normally aligned. The carpal bones and metacarpals are in normal position.

Look up an example image: Radiopaedia wrist fracture normal X-rays

Your tasks are to:

  1. Take a focused history of the wrist injury.
  2. Perform a focused examination of the wrist and hand. Describe to the examiner what you would like to examine and the relevant findings will be provided to you.
  3. Request any appropriate imaging investigations. Results will be provided by the examiner if appropriately indicated and then state your most likely diagnosis.
  4. Outline your initial management plan, including immobilisation, analgesia, and follow-up arrangements.
  • You do NOT need to summarise your findings to the examiner before giving your diagnosis.
  • The examiner will provide examination findings as you request them.
  • Findings will be provided by the examiner on request.

This is a 10-minute station, with 2 minutes of reading time.

Ask the examiner

Solo practice: say out loud what you would ask for, then choose the category. Names appear only after you commit, and a result is revealed only when you ask for it.

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