Review Question - QID 213819

A 27-year-old woman presents to the emergency department after falling while rollerblading. The patient states that she tripped over a stick, fell onto both hands, and has numbness and tingling in her fingers. Notably, she had these symptoms about 1 week prior; however, she states they are currently worse. The patient works at a coffee shop, is sexually active, and uses a vaping pen. Review of systems is notable for a recent weight gain of 25 pounds, nausea, and increased food sensitivity that triggers headaches and nausea. She also states she has had increased emotionally lability lately and feels very down at times, though she denies any thoughts of self harm. Her temperature is 97.5°F (36.4°C), blood pressure is 122/82 mmHg, pulse is 85/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for a normal cardiopulmonary exam and an obese body habitus. Numbness is noted in the index/middle finger and thumb of both hands. Laboratory values are ordered as seen below.

Hemoglobin: 14 g/dL
Hematocrit: 41%
Leukocyte count: 6,780/mm^3 with normal differential
Platelet count: 166,800/mm^3

Serum:
Na+: 139 mEq/L
Cl-: 100 mEq/L
K+: 4.3 mEq/L
HCO3-: 24 mEq/L
BUN: 20 mg/dL
Glucose: 129 mg/dL
Creatinine: 1.1 mg/dL
hCG: 10,400 mIU/mL
Ca2+: 10.2 mg/dL

A radiograph of the wrist is performed as seen in Figure A. Which of the following is the most likely etiology of this patient’s symptoms?