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

Images: Related links to external sites (from Bing)

Related Studies

Ontology: 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