Can you put your finger on it?

Author: Claire O’Doherty, Mohamed Abdelrehim, Priyadarshini Marathe / Editor: Steve Corry-Bass / Reviewer: Sandi Angus / Codes: ELP3, SLO1, SLO2, SLO4, TC2, TP7, VC1 / Published: 04/12/2020 / Reviewed: 27/12/2024

A 76-year-old lady has been brought to the Emergency Department (ED) following a fall a few hours ago. She waited on the floor until her cleaner arrived and was subsequently brought to the ED.  At triage she was complaining of an injury to her left upper limb, with pain in her left shoulder and arm. 

Presently, she doesn’t report any head, neck, chest, abdominal or lower limb injuries / pain.  She can rotate her neck 45 degrees left & right. 

Past Medical History includes bilateral total knee replacement (TKR), gout, atrial fibrillation (AF), hypertension and gastroesophageal reflux.

Drug history as per online GP records: Amlodipine, Bisoprolol, Allopurinol, Omeprazole, Furosemide and Dabigatran. However, the patient states that she stopped Dabigatran two weeks prior, due to heartburn.

On examination the arm seems to be painful along its entire length, but maximal tenderness is over the left elbow and forearm. There is reduced movement in the wrist and fingers. The forearm is not swollen, but the patient reports reduced sensation to sharp and light touch from fingertip to mid-forearm. Her radial pulse is weak. Observations and bloods (full blood count, urea and electrolytes, liver function tests and clotting profile) are unremarkable.