57 yo female with a history of hypertension, osteoarthritis, and asthma with chronic steroid use, presenting with multiple complaints, including chronic right shoulder pain that has been worsening the past week. The pain is constant and worse with any ROM of the right shoulder. Physical exam, including Spurling's Test, is otherwise unremarkable. On further discussion, the patient has had a remote hip replacement for avascular necrosis, and no recent traumas.
Wrists are the most commonly injured upper extremity joint, and 8.8% of injuries are missed, with 2% being clinically important. With 27 bones and 34 muscles, there is a significant possibility of missing a fracture. A high index of suspicion is required to prevent missing a significant injury.