January Case #1: Painful Forearm

25 yo WM presents with increasing right forearm pain and swelling for the past 6 days. He is 5 weeks status post fasciotomy for stab wound to the R forearm and resultant compartment syndrome. Patient denies erythema, fever, chills, or odor/purulence of the incision sites. He does endorse chronic numbness of the right 2nd digit since the injury. The pain is “throbbing.” He is undergoing physical therapy, but has been gradually decreasing compliance with sessions secondary to the increasing pain.
PMHx: Anemia, secondary to blood loss
PSHx: R volar forearm fasciotomy 5 weeks ago
Meds: Percocet, Gabapentin
Allergies: NKDA
FHx: negative
Soc Hx: occasional ETOH, chews tobacco

PE:
Vitals: BP: 132/78, Pulse: 101, RR: 16, Temp: 98.8, Pox: 100%
GEN: A&O x 3, NAD
HEENT: NCAT
CV: RRR, no M/R/G, HR 92 now
RESP: CTA B
ABD: soft, NTND, +BS
EXT: 2+ radial pulses bilaterally, R forearm tight and significantly swollen. Granulation tissue present over fasciotomy sites. No evidence of erythema. No purulence. No axillary lymphadenopathy. Decreased light touch sensation to all fingers on R hand. Wrist held in flexion, with limited extension secondary to pain.

Bedside ultrasound of the right forearm shows:

January Case #1-1 from UF-Jax Emergency Medicine on Vimeo.


January Case #1-2 from UF-Jax Emergency Medicine on Vimeo.






January Case #1-3 from UF-Jax Emergency Medicine on Vimeo.

What’s the Diagnosis?

Thanks to special guest contributer, Dr. Murray Baker, for this case! Excellant job!