Hand Injury

Question 1

What examination aspects should be considered in the context of a hand injury?

Answer 1

• Mechanism of injury and hand dominance, occupation
• Examination in the position in which the hand was injured
• Check
  
  • Blood supply
  • Tendons
  • Nerves
  • Bones and joints

Question 2

How can the blood supply to the hand be assessed in the context of a hand injury?

Answer 2

• Capillary refill
• Colour
• Temperature
• Allen’s test (arches)

Question 3

If the flexor tendons of the hand are all intact, what position will the fingers assume?

Answer 3

A cascade

Question 4

What sensation and movements can be used to assess radial nerve function?

Answer 4

• Anatomical snuffbox
• Wrist drop

Question 5

What sensation and movements can be used to assess median nerve function?

Answer 5

• Middle finger tip
• Thumb abduction

Question 6

What sensation and movements can be used to assess ulnar nerve function?

Answer 6

• Little finger sensation
• Froment’s sign - hold paper between thumb and forefinger. Pinching denotes ulnar lesion

Question 7

In a hand injury, how might one assess the function of the flexor tendons?

Answer 7

• Assess FDP by actively and passively flexing the DIP joint
• Assess FDS by immobilising the other fingers and actively and passively flexing the PIP joint

Question 8

In a hand injury, how might one assess the function of the extensor tendons?

Answer 8

• If the terminal ED is abnormal (e.g. mallet injury), there may be a passive bend in the DIP joint. Assess by immobilising the middle phalanx
• Assess central ED slip by immobilising the proximal phalanx. Boutonniere (swan-neck) deformity may be present
• Assess proximal ED communis by forming a fist and extending only MCP
• Assess EPL by getting patient to lift their thumb off the table with a flat hand