APPROACH TO HAND / WRIST INJURIES

Question 1

DDx

Answer 1

Mallet Finger
Phalanx Fracture
IP Dislocation
Boxer’s Fracture
Bennett’s Fracture
Ski-Pole (Gamekeeper’s) Thumb
Triquetral Flake Fracture
Hamate Fracture
Lunate/Peri-lunate Dislocation
Scapho-lunate Dissociation
Scaphoid Fracture
Colle’s Fracture
Barton’s Fracture
Smith’s Fracture
Distal Radio-Ulnar Joint

Question 2

Hand / Wrist Physical Exam

Answer 2

Inspect: Circumferentially – check for “open”
Compare to opposite side

Neurovascular exam: Check Motor and Sensory distribution of the radial, median, ulnar, interosseus nerves

Exam joints above and below
Thoroughly feel the entire bone to r/o multiple injuries Point of maximal tenderness

ROM:
Check for rotation of phalanges
Joint or limb prior to the XRAY

Question 3

Hand / Wrist Peripheral Motor Nerve Testing

Answer 3

‘Thumbs-Up’ - Radial Nerve
‘Power to the People’ - Median Nerve
‘Peace’ - Ulner Nerve
‘A-OK’ - Anterior Interosseus Nerve

Question 4

Hand / Wrist Peripheral Sensory Nerve Testing

Answer 4

Anatomical Snuff Box - Radial Nerve
Distal Phalanges, 2nd Digit - Median Nerve
Distal Phalanges, 5th Digit - Ulnar Nerve