Question

A female patient comes to the clinic following a recent fall. She states that she tripped over her dog and reached out to break the fall. Her wrist has been hurting her for the past two days so she decided to have it checked. The nurse practitioner notes that the pain is on axial loading of the thumb. The nurse practitioner orders an x-ray, which revealed no fracture of the hand or wrist. The NP suggests a splint and ice. Two weeks later the patients revisits the clinic because the pain has not improved. What is the next course of action?

a. Order a repeat x-ray
b. Order physical therapy
c. Prescribe the patient a stronger NSAID
d. Continue with splinting and ice

Answer 1

The best next step after a patient's wrist pain persists despite initial treatment is to order a repeat x-ray to rule out a missed fracture, such as a scaphoid fracture which might not appear immediately on x-rays. If no fracture is evident, referral to physical therapy should be considered to facilitate recovery.

Step-by-step explanation:

After a patient presents with continuing wrist pain following a fall, with initial x-rays showing no fractures, the next course of action would be multifaceted. Since the initial conservative treatment has not led to improvement, it is reasonable to consider further diagnostic measures to ensure no fractures were missed, as a scaphoid fracture can sometimes only be seen on x-rays after some time due to initial swelling. Hence, option a, ordering a repeat x-ray to check for any fractures that may have been missed the first time, would be a prudent step. If the repeat x-ray also shows no fractures, then option b, referring the patient for physical therapy, might be recommended to aid in recovery through supervised exercises and therapies.

In cases where tendinitis is suspected or diagnosed, a splint and NSAIDs are common initial treatments. If these do not lead to improvement, escalating care with physical therapy is appropriate to ensure progress and prevent worsening of the condition. Prescribing stronger NSAIDs or continuing with only splinting and ice without re-evaluation or additional diagnostic follow-up, such as an MRI if indicated, could lead to further delays in healing and potential complications.