Patient in my rehab facility presents with reddened and itch | Figure 1

Patient in my rehab facility presents with reddened and itchy palms (without any sort of lesion here) plus swelling and itching of his right wrist (flat, raised bumps on the wrist, hard to see here). He has been putting lotrimin on it for several days and it was relieving the itching, but the redness has spread and it continues to itch. I think it might be your run-of-the-mill fungal infection, but would this also explain the swelling?

Similar cases

above is (poor quality) radiographs of a 28 yr M who complains of wrist pain and hand swelling after falling backwards and catching himself with said hand, playing soccer. Injury occurred about 24 hours before ED presentation. Exam reveals marked marked soft tissue swelling to dorsal hand and wrist. Pt reports paresthesias to digits 2 and 3 but sensational to light touch., and brisk cap refill. Whole wrist is tender, poorly localized.... What is the injury here, and what is the management?

58 yrs female slipped and fall on concrete ground on out stretched hand and obtained swelling in Left wrist.

I need some help here. 23 yo truck driver. No medical history. Injured RIGHT wrist OTJ about 7 weeks ago. Felt pop and had pain/swelling. 3 days later, woke up with LEFT wrist pain/swelling. Never injured left wrist. Right wrist pain quickly resolved after Steroid pack. Saw ortho who attempted to asp left wrist twice without success. Both times, got intra-artic steroids. Ortho got the films on the left as well as a ESR of 87 and CRP of 6.2 😳 and ortho thought maybe CRPS. Ref to me. Pt now has circumferential left wrist swelling with a radial nerve palsy. Able to wiggle fingers but complete wrist drop and intrinsics deficit. Severe pain and mild warmth at wrist but no pain, swelling, color/sensory changes distally. ROS totally negative. No fam hx of autoimmune. The X-rays on the right were take NINE DAYS after the ones on the left. Severe erosive changes in the carpals. Esr now 101. Please give me your thoughts!! I work in Rheumatology but have never seen an inflammatory arthritis cause this dramatic of change in such a short time!

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