Endgames Spot Diagnosis

A painful hand after a fall

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h3388 (Published 03 July 2015) Cite this as: BMJ 2015;351:h3388
  1. Adam Monsell, senior house officer, trauma and orthopaedics1,
  2. Vipin Asopa, consultant surgeon, trauma and orthopaedics1
  1. 1North Middlesex University Hospital, Orthopaedics, London N18 1QX, UK
  1. Correspondence to: A Monsell adam.monsell{at}nhs.net

A 33 year old man presented to his local emergency department after having fallen on to clenched knuckles from standing height. On examination he had a swollen painful right hand. A plain lateral radiograph was taken of the hand. What is the diagnosis?



Carpometacarpal dislocation.


Carpometacarpal dislocations other than those affecting the thumb are relatively common and can be easily missed.1 This may be a source of litigation.


Fig 2 Lateral radiograph of the hand showing carpometacarpal dislocation (arrow)

A step deformity of the dorsum of the hand (as noted in fig 2) is noticed immediately after injury. However, this may become obscured by the development of swelling. A true lateral radiograph of the hand is essential when this injury is suspected.


Cite this as: BMJ 2015;351:h3388


  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: none.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

  • Patient consent obtained.


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