In each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of dermatologic conditions that real urgent care patients have presented with.

If you would like to submit a case for consideration, please e-mail the relevant materials and presenting information to [email protected]

The patient is a 4 1/2 -year-old girl who presents with local pain and swelling in the fifth digit of her left hand. The parents report that she experienced a fall.

On examination, you note local swelling as the base on the thumb. The patient confirms this is the site of her pain, as well.

View the image taken (Figure 1) and consider what your diagnosis and next steps would be.

Resolution of the case is described on the next page.

Clinical Challenge: June, 2010

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services
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