Hand Trauma Flashcards
Things to cover in a hand examination
-imaging you would consider
CRT - blood supply
Sensation, motor function
Passive, active movement
-max flexion of MCP = 90
-max flexion of PIP= 100
-max flexion of DIP= 80
Articular stability during mv - compare both sides
Passive lateral stress of MCP, PIP - collaterals
Passive AP stress of volar plate (ligament under PIP)
Xray, CT, MRI, US, bone scan
Nervous innervation of hands
- median
- ulnar
- radial
Testing sensation
Median - lateral 3 1/2 fingers palmar and dorsal tips
Ulnar - medial 1 1/2 fingers palmar and dorsal
Radial - thumb and dorsal side of hand, thenar
2 point discrimination test
- palmar - 0.5cm
- dorsal - 1cm
- palm - 1cm
Ulnar motor function test
Supplies most intrinsic hand muscles forearm flexors FCU and FDP ulnar
Key pinch
Froment’s sign - hold paper between thumb and index
-any thumb flexion => weak ulnar nerve, using median instead
Scissors
Ulnar claw hand - affects 3rd 4th finger
- hyperextension at MCP 3, 4
- flexion at PIP, DIP 3, 4
- hypothenar wasting
- cannot abduct, adduct 3, 4
Median nerve motor innervation
Lateral 2 lumbricals
APB
OB
FDP median half, FPB
Can they make a fist => involves thumb action
Rock
Hand of Benediction - similar to ulnar claw
- hyperextension at MCP 1, 2
- flexion at PIP, DIP 1, 2
- thenar wasting
- cannot abduct, adduct 3, 4
Radial nerve motor innervation
No intrinsic motor
All extrinsic extensor in post forearm
Thumbs up or paper
Radial nerve palsy => wrist drop
How may sharp injuries to the tendons present depending on MOI
Injury whilst finger extended => tendon may be visible
Injury whilst finger flexes => tendon often not visible
Test tendon and explore wound
Testing the flexor tendons
- FDS
- FDP
FDP - DIP of fingers
FDS - hold the fingers you are not testing so you only bend PIP of finger
FPL - DIP of thumb
Mallet finger
- pathophysiology
- types and management
Tear in ext tendon attaching to DP/fracture in DP
- Tendinous - splint for 8wks cont, NEVER flex it
- Bony - k wires/splint
Hand infection
- common organisms
- key questions
- key investigations
- key management
Most common - S Aureus (some MRSA)
Mixed infection
Anaerobes - bites, DM
Mycobacterium marinum - fish tanks, work with fish and water
Predisposing factors - DM, IVDU, alcohol, IC?
Occupational exposure to bacteria
MC&S - pus, discharge (ABx after culture taken)
WCC
CRP, ESR trend
Xrays - foreign materials
USS/CT/MRI
Incise and drain abscesses
Debride necrotic tissue - leave open so discharge can drain
Splint - reduce pain
Pyogenic flexor tenosynovitis
- presentation
- management
Kanavel’s cardinal signs
- tender sausage finger
- pain on passive ext
- finger in flexion
SURGICAL EMERGENCY
- excise, wash, drain, keep open => repeat 24hrs later
- continuous ward irrigation
- ABx
Human bites
- MOI => pathophysiology
- presentation
Bite into clenched fist => can cut into ext tendon/joint, introduce mouth bacteria into wound => can cause septic arthritis
Urgent surgical debridement
- extend wound, wash and debride => keep open and reassess 24hrs later
- empirical ABx => specific ABx
Felon
- MOI => pathophysiology
- presentation
- management
Penetration of pads of fingertips/paronychia => infection enters
- swelling red, intense pain
- abscess (poor blood supply of finger tips)
Incise, wash, drain, keep open and reasses 24hrs later
Paronychia
- MOI => pathophysiology
- presentation
- management
Penetration/nail biting => signs of infection of nail bed
-S aureus
Abscess => excise, wash, drain
Skiers thumbs
- MOI => pathophysiology
- management
Fall onto ski => thumb ulnar collateral ligament damage => increased laxity
Non operative => immobilisation
Operative => surgical repair
