Orthopedics Book


Hand Injury

Aka: Hand Injury, Hand Trauma
  1. See Also
    1. Hand Anatomy
    2. Wrist Anatomy
    3. Fall on Outstretched Hand
    4. Rheumatologic Conditions affecting the Hand
    5. Overuse Syndromes of the Hand and Wrist
    6. Hand Fracture
    7. Hand Infection
    8. Finger Laceration
    9. Finger Tip Injury
  2. 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
  3. 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)
  4. Exam: Specific Findings
    1. Interphalangeal Dislocation
      1. Dorsal PIP Dislocation
      2. Lateral PIP Dislocation
      3. Volar PIP Dislocation
      4. DIP Dislocation
      5. IP Joint Dislocation at Thumb
      6. Metacarpal-Phalangeal Dislocation
    2. Fractures
      1. See Scaphoid Fracture
      2. See Metacarpal Fracture
      3. Loss of 4th or 5th MCP knuckle prominence
        1. Boxer's Fracture
      4. Phalangeal Fractures
        1. Distal Phalanx Fracture
        2. Middle Phalanx Fracture
        3. Proximal Phalanx Fracture
    3. Tendon Avulsions and Injuries
      1. Flexed DIP
        1. DIP Extensor Tendon Avulsion (Drop Finger, Mallet Finger, Baseball Finger)
      2. Hyperextended DIP (especially ring finger)
        1. DIP Flexor Tendon Avulsion (Jersey Finger)
      3. Swollen PIP with dorsal tenderness
        1. Extensor Tendon Injury at the PIP Joint (PIP Central Slip Dislocation)
        2. Complication: Boutonniere Deformity
      4. Swollen PIP with volar tenderness
        1. Flexor Surface Injury at the PIP Joint (PIP Joint Volar Plate Injury)
        2. Complication: Extension deformity
      5. Game Keeper's Thumb
        1. Thumb Ulnar Collateral Ligament Rupture
  5. References
    1. Hori (2015) Crit Dec Emerg Med 29(3): 2-7

Hand Injuries (C0018571)

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
Polish Urazy ręki, Urazy rąk
Hungarian Kézsérülés k.m.n.
Norwegian Håndskader, Skader, hand, Handskader, Skader, hånd
Derived from the NIH UMLS (Unified Medical Language System)

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