“An otherwise well 42-year-old lady presents having fallen over in town three days previously whilst carrying heavy shopping.”

She is complaining of pain around her right thumb and wrist. She initially used NSAIDs and ice as treatment but the thumb remains painful and bruised and she is struggling to drive or grip.

On initial inspection she has a swollen left thumb with bruising to the thenar eminence.

Her wrist is not swollen, bruised or deformed.

Wrist has full range of movement with pain on extreme flexion. No bony tenderness. There is some mild discomfort on palpation of the anatomical snuff box.

She is exquisitely tender over the base of the first metacarpal. She has less than 5 degrees of movement in flexion, extension, abduction, adduction and opposition of the thumb. You think you can feel some bony crepitus.

You give her paracetamol and ibuprofen and send her round for x-rays of her thumb.