A previously healthy, left hand dominant, 7 year-old male boxer presented with left hand pain after falling off a jungle gym the previous day. The patient could not recall how he injured his hand other than “it got stuck” in the bars as he lost his balance. The fall was not witnessed but a nearby parent stated that there was an immediate cry. The patient denied striking his head or losing consciousness. The patient was initially seen in the ED and was referred to our clinic the following day.

PMH was unremarkable.

Physical exam revealed swelling surrounding the base of the 1st digit including the thenar eminence as well as diffuse ecchymosis. Gross sensation and two-point discrimination were intact and capillary refill was < 2 seconds. Pain was produced with ulnar and radial deviation at the PIP. The patient was diffusely tender proximal to the IP although flexion and extension of the IP were intact. There was no snuff box tenderness but axial loading produced pain at the MP of the affected extremity.

Initial Differential Diagnosis Based on the History and Physical: