Hand Injury Flashcards
Approach to hand lacerations?
TIN AX Tetanus prophylaxis Irrigate with normal saline NPO ABx prophylaxis X rays
Key history questions in hand injury assessment?
- ABC
- AMPLE
- Hand dominance
- Occupation
- Time and place of accident
- Mechanism of injury
- Tetanus status
- Pain Mx
PEx features on observation of hand injury assessment?
Look and draw/photograph
- Position of finger
- Deformity
- Bruising or swelling
- Sweating pattern
- Anatomical structures beneath: blood supply, tendons, nerves, bone and joint
How is vascular status assessed in hand injury?
- Radial and ulnary arteries = Allen’s test (release either artery to assess collateral)
- Digital arteries = capillary refill
Tendons for assessment in hand injury?
FDP and FDS
How is FDP assessed?
Stabilise fingers in extension at PIP and ask pt to flex at DIP
Speed of peripheral nerve regeneration?
1mm/day
What is Tinnel’s sign?
Cutaneous percussion over repaired nerve produces parasthesis and defines level of nerve regeneration.
Why is there no TInnel’s sign until 2weeks post repair?
Wallerian degeneration occurs in the first 2wk
Why does Tinnel’s sign occur?
Parasthesias felt in area of percussion because regrowth of myelin (Schwann cells) is slower than axonal re growth –> percussion on exposed free end on generates paresthesia
Post op management of hand injury with vascular laceration?
- Dress, immobilise and splint hand with finger tips visible
- Monitor colour, capillary refill, skin turgor, fingertip temperature post revascularisation
Where may different tendon repairs be performed?
- Extensor = ED
- Flexor = OT
Mx of nailbed injury?
- Removal nail to examine nailbed under digital block anaesthesia
- Irrigate
- Suture repair of nailbed
- Replace cleaned nail (acts as splint, prevents adhesion formation between nail fold and nailbed)
Organisms causing hand infection?
90% by G+VEs
- S aureus
- S. viridans
- Grp A strep
What is flexor tendon posture referred to as?
Cascade
Describe extensor tendon anatomy
Terminal tendon extends DIP joint, central slip extends PIP
What extends the MP joints of the fingers?
Extensor digitorum communis
How is Median Nerve examined?
- Abductor pollicis brevis
- FDS, FPL, radial FDP, FCR
- Sensation
How is Ulnar Nerve examined?
- Adductor pollicis (Froment’s test)
- Interossei (abduction)
- Ulnar FDP, FCU
- Sensation
How is radial nerve examined?
Long extensors
-sensation
What are the mechanisms of hand injury?
- Cut
- Crush
- Shear
- Puncture
Workup/Mx of paediatric finger tip injury?
Usually crush (e.g. door)
Anatomy: distal phalanx
Ix: XR
Rx: clean wounds, compression, rest (splint in position of function), elevate, ABx, tetanus status, analgesia
Refferal: plastics re nail bed repair, suture finger tip
Workup/management of dorsal laceration injury?
- Mechanism: e.g. circular saw, knife
- Ix: +/- XR (saw/FB/glass)
- Rx: clean wounds, compression, rest i.e. splint in position of function, elevation, ABx, tetanus status, analgesia
- Refer plastics if suspect deeper than skin
Which structures are endangered in dorsal laceration injury?
-Anatomy: extensor tendon, bone, cutaneous, nerves, joint
