APPROACH TO HAND INJURIES

Question 1

HPI

Answer 1

Location
Age (of wound)
Mechanism: shear, blunt, crush
Contamination
Foreign Body Sensation
Foreign Body Type

Question 2

Associated Symptoms

Answer 2

r/o
Life threatening Injuries
Limb Threatening Injuries
Neurovascular compromise
Loss of function

Question 3

PMHx: Risk Assessment

Answer 3

Extreme of Age
Hand dominance
Diabetes
Chr Renal Failure
Obesity
Malnutrition
Immunosuppression

Question 4

Allergies

Answer 4

Latex
Anesthetic

Question 5

Immunization

Answer 5

Tetanus Status

Question 6

Social Hx

Answer 6

Occupation

Question 7

Elements of physical exam

Answer 7

Inspection
Palpation
Motor testing
Sensory Testing
Tendon Assessment
Vascular Assessment
Compartment Syndrome Testing

Question 8

Elements of the motor test

Answer 8

make a fist
straighten fingers
radial, ulnar, median nerve testing

Question 9

Motor testing of the radial nerve

Answer 9

Dorsiflexion of the wrist
Thumbs up sign

Question 10

Motor testing median nerve

Answer 10

Thumb interphalangeal joint flexion “Okay sign”

Question 11

Motor Testing ulnar nerve

Answer 11

Abduction / Adduction of digits

Question 12

Sensory assessment distal to the mid palm

Answer 12

Static 2 point discrimination
Normal < 6 mm apart
Inspect for loss of sweating ability and papillary ridges
Ten Test - rate affected area compared to unaffected area, rate on scale of 10
Test in radial, ulnar, median distributions

Question 13

Sensory testing radial nerve

Answer 13

First dorsal web space

Question 14

Sensory testing Median nerve

Answer 14

Volar tip of index finger

Question 15

Sensory testing ulnar nerve

Answer 15

Volar tip of little finger

Question 16

Tendon assessment

Answer 16

Extensor digitorum
Flexor digitorum profundus
Flexor digitorum superficialis

Question 17

How to test Flexor digitorum superficialis

Answer 17

Hold all other digits in extension
Flex the proximal interphalangeal joint AGAINST RESISTANCE

Question 18

How to test Flexor digitorum profundus

Answer 18

Hold proximal IP joint against resistance
Flex the distal interphalangeal joint AGAINST RESISTANCE

Question 19

How to test Extensor digitorum

Answer 19

Sequentially flex the MCP, PIP and DIP
Have patient extend the digit against gravity and AGAINT RESISTANCE

Question 20

Signs of partial tendon involvement

Answer 20

Weak, limited or painful movement

Question 21

Best Vascular Assessment

Answer 21

Allen’s Test

Question 22

Allen’s Test suspicious for significant vascular injury

Answer 22

Refill time > 3 seconds

Question 23

XRAY views

Answer 23

AP
Oblique
Lateral

Question 24

XRAY Indications

Answer 24

Bony injuries
Foreign Bodies
Joint penetration

Question 25

Indications for prophylactic antibiotics

Answer 25

Complicated hand lacerations Mammalian bite wounds Injuries > 12 hrs old Contaminated wounds Exposed bone Concurrent medical problems affecting wound healing (DM, Renal disease, peripheral vascular disease, immunocompromise)

Question 26

Definition of complicated hand laceration

Answer 26

Human or animal bite Burn Fracture through bone or joint Tendons, bones, large vessels or nerves Severe tissue damage or maceration

Question 27

List the Special Tests

Answer 27

Snuffbox Tenderness Grind Test Finkelstein's Test Tinel's Sign Phalen's Maneuver Durkan's Compression Test

Question 28

Snuffbox Tenderness

Answer 28

Tenderness with deep palpation between tendons of EPL and EPB just distal to the radial styloid Scaphoid fracture

Question 29

Grind Test

Answer 29

Axial compression and rotation of the MCP joing of thumb Degenerative arthritis

Question 30

Finkelstein's Test

Answer 30

Grasp thumb and deviate ulnarly Tenosynovitis of the EPB and ABL (de Quervain's disease)

Question 31

Tinel's Sign

Answer 31

Paresthesias after tapping over the course of the median nerve Carpal Tunel Syndrome

Question 32

Phalen's Maneuver

Answer 32

Flexion of the bilateral wrists for 1 minute. Paresthesias in the hand. Carpal Tunel Syndrome.

Question 33

Durkan's Compression Test

Answer 33

Direct median nerve compression at transverse carpal ligament. Paresthesias. Carpal Tunel.

Question 34

Flexor Pollicis Longus (FPL) Test

Answer 34

Bend tip of the thumb

Question 35

Flexor Digitorum Profundus (FDP) Test

Answer 35

Stabilize the PIP joint, isolate the DIP Flex tip of the finger

Question 36

Flexor Digitorum Superficialis (FDS) Test

Answer 36

Isolate Affected Digit Block other digits Flex the PIP

Question 37

Abductor pollicis longus (APL) and extensor pollicis brevis (EPB) Test

Answer 37

Abduct thumb out to the radial side The examiner palpates the taut tendons over the radial side of the wrist

Question 38

Extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB)

Answer 38

Make a fist, Extend wrist back The examiner then palpates the tendons over dorsoradial aspect of wrist

Question 39

Extensor pollicis longus (EPL) Test

Answer 39

Placing hand flat on the table Lift only the thumb off the table

Question 40

Extensor digitorum communis (EDC) test

Answer 40

Straighten fingers

Question 41

Extensor carpi ulnaris (ECU) test

Answer 41

instructing patient, “Pull your hand up and out to the side” examiner palpates the tendon over the ulnar side of the wrist.

Question 42

Adductor pollicis (AdP) test

Answer 42

forcibly grasp a piece of paper between the thumb and radial side of the index P1 Froment’s sign = compensatory flexion at the IP joint

Question 43

Interosseous muscles test

Answer 43

applying resistance to the index and small finger and instructing patient, “Spread your fingers apart”

Question 44

Best sign of healing

Answer 44

No pain