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Download the article PDF: Clinical Image Challenges October 2026
A 68-year-old woman presents to urgent care with her husband after tripping on a rug at home the previous day and falling onto her left hand. She has experienced persistent pain and swelling in the hand since the fall. Ibuprofen provided modest pain relief. Physical examination reveals normal vital signs with focal edema and tenderness over the dorsal surface of the 4th and 5th metacarpals. Decreased range of motion and knuckle contour at the 5th metacarpophalangeal (MCP) joint are noted, and ecchymosis is seen to the palmar surface on the 5th metacarpal area. Sensation is intact to the 4th and 5th digits, interphalangeal joints are mobile, and capillary refill is brisk.
View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
