A 30yo lady was playing volleyball when her hand got injured with the ball. The right hand is not swollen and there is tenderness under the root of the thumb. XR is normal. What is the most appropriate next management?
a. Arm sling for 1 wk
b. Raise hand for 2d
c. Repeat XR
d. Full arm cast
Ans. The key is C. Repeat XR. [Likely diagnosis is scaphoid fracture where X-ray may not show the fracture right away. In such case put her hand in a below elbow cast and repeat X-ray in a week or two to see if the fracture become visible. Usually it becomes visible as a healing fracture line].