II. History
- Background
- Hand dominance
- Occupation and hobbies
- Mechanism
- Past medical history
- Last tetanus Immunization
- Prior Hand Injuries
- Medications and Allergies
III. Exam: General
- See Hand Exam
- See Wrist Injury and Wrist Exam
-
Hand Position of Function
-
- Inability to perform is a red flag
- Observe for isolated finger flexion (extensor Tendon Injury)
- Observe for isolated finger extension (flexor Tendon Injury)
-
- Flex fingers against palm
- Finger tips should align to Scaphoid
- Skin changes
- Capillary Refill should be <2 seconds
- Anhidrosis, blanching, hyperemia of involved finger
- Tendon evaluation
- Extend DIP joint of affected finger only
- Flex PIP joint of affected finger only
- Flex DIP joint of affected finger only
-
Neurologic Exam
- Sensory: Two Point Discrimination: <6 mm is normal
- Ulnar Nerve
- Median Nerve distribution
- Radial Nerve distribution
-
Motor Exam (against resistance)
- Finger abduction (Ulnar Nerve)
- Oppose thumb to index finger (Median Nerve)
- Wrist extension (Radial Nerve)
- Sensory: Two Point Discrimination: <6 mm is normal
IV. Exam: Specific Findings
- Interphalangeal Dislocation
-
Fractures
- See Scaphoid Fracture
- See Metacarpal Fracture
- Loss of 4th or 5th MCP knuckle prominence
- Phalangeal Fractures
- Tendon Avulsions and Injuries
- Flexed DIP
- Hyperextended DIP (especially ring finger)
- Swollen PIP with dorsal tenderness
- Swollen PIP with volar tenderness
- Flexor Surface Injury at the PIP Joint (PIP Joint Volar Plate Injury)
- Complication: Extension deformity
- Game Keeper's Thumb
V. References
- Hori (2015) Crit Dec Emerg Med 29(3): 2-7
Images: Related links to external sites (from Bing)
Related Studies
Definition (MSH) | General or unspecified injuries to the hand. |
Concepts | Injury or Poisoning (T037) |
MSH | D006230 |
SnomedCT | 212430001, 309772005, 125599006 |
English | Hand Injuries, Injuries, Hand, Injury, Hand, INJ HAND, HAND INJ, Unspecified injury of hand, injury of hand (diagnosis), injury of hand, hand injury, Injury to hand NOS, wound of hand (physical finding), wound of hand, Hand Injuries [Disease/Finding], Injury;hand, hand injuries, Unspecified injury of hand (disorder), Hand injury, Injury of hand (disorder), Injury of hand, hand; injury, hand; wound, injury; hand, wound; hand, Hand Injury |
Dutch | letsel aan hand NAO, hand; letsel, hand; wond, letsel; hand, wond; hand, Handletsel, Handletsels, Letsel, hand-, Letsels, hand- |
French | Lésion de la main SAI, Blessures de la main, Traumatismes de la main, Lésions traumatiques de la main |
German | Verletzung der Hand NNB, Handverletzungen, Verletzungen, Hand- |
Italian | Traumatismo della mano NAS, Lesioni della mano |
Portuguese | Lesão traumática da mão NE, Lesões da Mão, Traumatismos da Mão |
Spanish | Lesión traumática de mano NEOM, lesión de la mano, no especificada, lesión de la mano, no especificada (trastorno), Unspecified injury of hand, Lesiones de la Mano, injuria de la mano, lesión traumática de la mano (trastorno), lesión traumática de la mano, Traumatismos de la Mano |
Japanese | 手の損傷NOS, テノソンショウNOS, 外傷-手部, 手外傷, 手の外傷, 手の損傷, 外傷-手, 手部外傷 |
Swedish | Handskador |
Czech | ruka - poranění, Poranění ruky NOS |
Finnish | Käsivammat |
Russian | KISTI TRAVMY, КИСТИ ТРАВМЫ |
Croatian | ŠAKA, OZLJEDE |
Polish | Urazy ręki, Urazy rąk |
Hungarian | Kézsérülés k.m.n. |
Norwegian | Håndskader, Skader, hand, Handskader, Skader, hånd |