Author: Lily Brewster / Editor: Nick Tilbury / Codes: DC5, DC6, DP1, IP2, IP3, MuC6, MuP2, RP6, SLO1, SLO3 / Published: 27/07/2023
A 63-year-old male presents to the Emergency Department (ED) in the early hours of the morning with right-sided elbow and forearm pain. The pain awoke him from sleep but he has not taken any analgesia. He tells you his main concern is that he can’t move his hand.
SOCRATES history is as follows:
- Site – Right elbow and forearm
- Onset – Gradual over the previous 24 hrs
- Character – Throbbing
- Radiation – Down the forearm into the hand
- Associated symptoms/signs – Reduced mobility of the affected arm. Nausea and a reduced appetite
- Timing – Constant
- Exacerbating/alleviating factors – Worse on movement. Nothing makes it better
- Severity – Moderate
On further questioning he reveals he sustained a heat burn in the kitchen one week ago that has nearly heeled but denies any other trauma. There is no history of repetitive strain, infections or systemic upset.
He has rheumatoid arthritis for which he takes methotrexate.
On examination, he looks well and has a NEWS2 Score of 2 (HR 90/min & BP 97/52).
He has a spongey swelling to the olecranon and a firm swelling down the whole of the forearm. There is a healed burn wound site to the second web space that does not look infected. He has reduced wrist movements and is unable to power grip or extend his fingers. He has normal sensation and a good radial pulse.
The patient has an elbow X-Ray1.
Bloods are taken with the following results:
- Lactate: 4
- WCC: 6.31
- Neutrophils: 6.11
- CRP: 125
- D-Dimer: 36933
The remainder of the blood results are normal.