A 32-year-old IV drug user with wrist swelling and full range of motion has a photograph of the wrist; which is the most appropriate management?

• A. Incision and Drainage
• B. Arthrocentesis
• C. Antibiotics alone
• D. Immobilization

Answer: (A)

This question tests recognizing a soft-tissue abscess that needs drainage rather than a joint problem. In an IV drug user with wrist swelling, a discrete, fluctuant, localized collection points to a purulent abscess in the soft tissues. The priority management is to perform incision and drainage to evacuate the pus, relieve pressure, and allow antibiotics to work more effectively. Antibiotics alone won’t resolve an established abscess because the purulent material is poorly penetrated by drugs. Arthrocentesis is used when septic arthritis is suspected (joint involvement with infection), and immobilization doesn’t treat infection. After drainage, antibiotics are typically given to cover skin flora, especially Staphylococcus aureus, and cultures can guide further therapy.