II. History

  1. Background
    1. Hand dominance
    2. Occupation and hobbies
  2. Mechanism
    1. Fall on Outstretched Hand
    2. High Pressure Injection Wound
    3. Boxer's Fracture
    4. Fight Bite
    5. Jammed Finger
  3. Past medical history
    1. Last tetanus Immunization
    2. Prior Hand Injuries
    3. Medications and Allergies

III. Exam: General

  1. See Hand Exam
  2. See Wrist Injury and Wrist Exam
  3. Hand Position of Function
    1. OrthoHandPositionOfFunction.jpg
    2. Inability to perform is a red flag
    3. Observe for isolated finger flexion (extensor Tendon Injury)
      1. OrthoHandExtensorTendonInjury.jpg
    4. Observe for isolated finger extension (flexor Tendon Injury)
      1. OrthoHandFlexorTendonInjury.jpg
  4. Flex fingers against palm
    1. OrthoHandPositionFistToScaphoid.jpg
    2. Finger tips should align to Scaphoid
  5. Skin changes
    1. Capillary Refill should be <2 seconds
    2. Anhidrosis, blanching, hyperemia of involved finger
  6. Tendon evaluation
    1. Extend DIP joint of affected finger only
    2. Flex PIP joint of affected finger only
    3. Flex DIP joint of affected finger only
  7. Neurologic Exam
    1. Sensory: Two Point Discrimination: <6 mm is normal
      1. Ulnar Nerve
      2. Median Nerve distribution
        1. NeuroMedianNerve.jpg
      3. Radial Nerve distribution
        1. NeuroRadialNerve.jpg
    2. Motor Exam (against resistance)
      1. Finger abduction (Ulnar Nerve)
      2. Oppose thumb to index finger (Median Nerve)
      3. Wrist extension (Radial Nerve)

V. References

  1. Hori (2015) Crit Dec Emerg Med 29(3): 2-7

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