40-year-old woman presents to the emergency department with left hand pain after a fall on to an outstretched hand just one hour earlier. Her pain is located on the radial side of her wrist. She is right hand dominant and has no medical or surgical history. She occasionally drinks alcohol but does not use tobacco products or any illicit drugs. She works as an office secretary. Physical examination reveals no bruising or swelling, but she does have tenderness located on the dorsal surface of her radial wrist just proximal to the carpal metacarpal joint of her left thumb. She also endorses pain with axial loading of her left thumb. She has full range of motion in her wrist and fingers with sensation fully intact and 2+ radial pulses bilaterally. X-rays of her left hand, wrist and forearm are all negative for any acute pathology.
Which of the following next steps in evaluation is most likely to reveal the diagnosis?
- A) CT scan of the left hand and wrist
- B) Fluoroscopic imaging of the left hand and wrist
- C) MRI of the left hand and wrist
- D) Open reduction internal fixation of the left wrist
- E) Repeat x-rays in 24 hours