Stab wound to left forearm

Authors:

Joseph J. Kaplan, MD
Sarah A. Schwen, MD

Affiliations:

Joint Military Medical Centers of San Antonio
Emergency Medicine Residency, San Antonio, TX (JJK, SAS)

Chief Complaint:

Stab wound to the left forearm

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History of Present Illness:

A 22 year old left hand dominant male presents to the emergency department (ED) complaining of a stab wound to the left forearm. The injury resulted from a knife fight approximately one hour prior to presentation. The patient complains of progressive forearm swelling and pain with left hand movement. The pain and swelling started 30 minutes after the injury occurred. The patient is otherwise healthy. There is no family history of bleeding disorders. Social history includes smoking and occasional alcohol use. The patient consumed three beers prior to his injury.

Physical Examination:

The patient is alert but in mild discomfort holding his left wrist and fingers in moderate flexion. The vital signs are normal. The physical examination is normal except for left forearm. There is a 20 mm by 1 mm bleeding stab wound on the ulnar aspect of the volar forearm 5 cm proximal to the wrist (figure 1). There is moderate swelling of the volar aspect of the distal forearm. Diffuse tenderness is present with palpation of the left forearm. The patient experiences severe pain with passive extension of the fingers and wrist and refuses to actively extend his wrist or fingers. He is unable to flex his fingers further but has normal strength of his interosseous, thenar, and hypothenar muscle groups. The radial pulse is palpable and the ulnar pulse is detectable only with Doppler. Capillary refill is less than two seconds for all digits and two point discrimination is less than 5 mm on both the radial and ulnar aspects of each digit. The examination of the hand, elbow, upper arm, and shoulder are normal.

Radiographs:

Radiographs of left forearm are normal.

The patient course, diagnosis and discussion

Disclaimer: This article represents the views of the author and is not to be interpreted as official, or representing the US Army, US Air Force, or the Department of Defense.

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