From the Guidelines
The next step for a patient involved in a motor vehicle collision (MVC) with left hand swelling, no erythema, no fluctuance, afebrile, normal white blood cell (WBC) count, and a computed tomography (CT) scan of the hand negative for fracture (fx) but showing soft tissue swelling, with mildly elevated C-reactive protein (CRP) and sedimentation rate (sed rate) is to consider further imaging to evaluate the extent of soft tissue injury.
Possible Imaging Options
- MRI of the hand without IV contrast: This is a suitable option for evaluating soft tissue injuries, including tendon and ligament trauma, as well as detecting inflammation and areas of necrosis 1.
- Ultrasound (US) of the hand: This can be used to detect soft tissue fluid collections, foreign bodies, and joint effusions, and is particularly useful in young children or when radiation is a concern 1.
- CT of the hand without IV contrast: This can be used to evaluate the extent of soft tissue swelling and detect foreign bodies, but is generally less sensitive than MRI for detecting inflammation and soft tissue injuries 1.
Clinical Considerations
- The patient's mildly elevated CRP and sed rate suggest an inflammatory response, which should be further evaluated with imaging 1.
- The absence of erythema, fluctuance, and fever makes a soft tissue infection less likely, but further imaging is still necessary to rule out other potential injuries 1.
- The patient's normal WBC count suggests that an infectious process is less likely, but does not rule out the possibility of a soft tissue injury 1.
From the Research
Patient Assessment and Next Steps
The patient presents with left hand swelling, no erythema, no fluctuance, afebrile, normal white blood cell (WBC) count, and a computed tomography (CT) scan of the hand negative for fracture (fx) but showing soft tissue swelling, with mildly elevated C-reactive protein (CRP) and sedimentation rate (sed rate).
- The patient's symptoms and test results suggest a possible inflammatory response, as indicated by the elevated CRP and sed rate 2.
- The absence of erythema, fluctuance, and fever, along with a normal WBC count, suggests that the patient may not have an acute infection.
- The CT scan results showing soft tissue swelling without fracture are consistent with a possible traumatic injury, such as a sprain or strain, resulting from the motor vehicle collision (MVC) 3.
- The patient's age and other factors, such as fragility, may affect the accuracy of injury severity prediction algorithms, potentially leading to overtriage or undertriage 4.
Considerations for Further Evaluation and Management
- The patient's mildly elevated CRP and sed rate may indicate an ongoing inflammatory response, which should be monitored and addressed accordingly 2.
- Further evaluation and management of the patient's condition may involve additional imaging studies, such as an MRI, to assess the extent of soft tissue injury.
- The patient may benefit from a rehabilitation program, including physical therapy and pain management, to address any persistent symptoms or functional impairments resulting from the MVC 3.
- It is essential to consider the patient's overall health status, medical history, and potential comorbidities when developing a treatment plan.