A 65-year-old man presents to the clinic for emergency department follow up with a complaint of right forearm pain, bruising, and increased swelling. He reports that 2 weeks ago he slipped and fell in his shower and hit the right arm on the side of the tub. He did not hit his head or lose consciousness. He presented to the emergency department 3 days ago with complaints of continued pain and bruising. X-rays in the emergency department were negative for fracture. He was discharged on ketorolac for pain and swelling. Past medical history includes coronary artery disease hypertension, atrial fibrillation, prediabetes and insomnia. The patient does not drink alcohol or use tobacco. His current medications include lisinopril, trazadone, metoprolol, rivaroxaban, and vitamin D3. Vital signs are within normal limits. Physical examination reveals an irregular rhythm at rate of 78 beats/minute. Pulses are 2+ and symmetric in all extremities. There is moderate swelling of the right medial forearm with frank ecchymosis and a focal area of induration measuring approximately 4cm x 5cm. There is full range of motion of the right elbow and wrist without crepitus, joint pain, or increased pain in the right forearm. Upper extremity Duplex ultrasound shows retrograde flow and compressible veins throughout the right upper extremity.
Which of the following is the most likely cause of this patient’s sudden worsening of symptoms?
- A) Compartment syndrome
- B) Deep vein thrombosis
- C) Hematoma
- D) Occult ulna fracture
- E) Superficial thrombophlebitis
Dr. Ted O'Connell