Presentation
Patient with substance use disorder with painful forearms.
Patient Data
Left: Heterogenous bone trabeculation within the distal humerus associated with joint space narrowing and marginal osteophytes/remodeling. No evidence of fractures. Within the anterior cubital fossa soft tissues there are two linear radiopaque foreign bodies in keeping with the suspected needles.
Right: The distal humerus is expanded and shows diffuse heterogeneous trabeculae. Elbow joint space is preserved, but bone irregularities and marginal osteophytes are noted. Within the anterior cubital fossa soft tissued there is a linear radiopaque foreign body in keeping with a needle.
Case Discussion
A common presence in emergency departments everywhere, substance use disorder patients frequently present with local or spread/embolic infections. This case illustrates broken needles within the soft tissue of both forearms. Bone remodeling and degenerative changes are probably related to previous infections/osteomyelitis.