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Join date : 2013-12-26

PostSubject: AMC Clinical exam preparation   Sat Dec 28, 2013 1:44 pm

amc clinical exam

A young student with painful wrist after fall.

Task- P/E , Management

Me- Hello, do you want any pain relief ? ( 2 Panadols given )

Me- Hand washed . Can I examine your hand ? I will try to be as gentle as possible throughout examination but please let me know if you are uncomfortable at any stage.

Examination: ( Both hands on pillow exposing up to elbow)

Look- No swelling , no deformity, no colour changes, no redness, no open wound, no muscle wasting. ( Both palmar and dorsal aspect )

Feel- Wrist- NAD,
Dorsum of hand- Tender over scaphoid bone.
Pulse and capillary refill- Normal
Median, ulnar, radial nerve function- Normal ( It was not needed actually. I did thumb abduction, extension, adduction and little finger ab/ adduction and sensation briefly but it wasted time a lot as she was not instructed at all about that. I realized only after starting)
Movement- Wrist and finger movements all normal.
X ray- Examiner handed to me.

Me- Miss X, here are the two arm bones. Both are fine. These are the small bones of the hand. I can’t see any fracture. But you are sore here ( pointing out to scaphoid bone) . In many cases , fractures can not be seen until two days after injury.
With you, I would like to treat you as fracture as there is risk of shortage of blood supply to the upper half of this bone if it is really broken. So, I would put your arm in special plaster cast that includes your lower portion of thumb , knuckles extending to just below elbow. The reason is just to immobilize the bone in case it is broken and the healing comes itself.
I will review you tomorrow for Plaster check but if you feel soreness, numbness or if you develop swelling or blisters, pls just come back immediately.
If you are fine with plaster tomorrow, I will see you again in 2 weeks time.
I will examine you again removing the plaster that time and if you are not sore anymore, you don’t need plaster anymore.
If you are still sore , I will do X ray and if fracture is seen, you will be with Plaster for 4 to 6 weeks.
If you are still sore but I can’t find any fracture that time, I will put you in plaster and refer to Orthopaedic specialist for further imaging and opinion.
Overall, the result is excellent.
I will refer you to Physiotherapy to teach you simple exercise of your fingers and elbow.
You can take Panadol if you feel pain.

Any other concerns ?
RP- No
Feedback- Be confident to skip examinations that is unnecessary ( nerve function in this case )
Examiner asked me “ Which is scaphoid bone ? “

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