Hand wounds

Question 1

History

Answer 1

1. Right or left handed
2. Occupation
3. Social situation
4. Look for fight bite – Wound on dorsum of the hand over the index, middle, ring or little finger MC heads of having sustain a human fight bite

Question 2

Name the bones of the hand

Answer 2

Question 3

Median nerve injury signs

Answer 3

• Decreased sensation in the palm over radial 3 ½ digits
• unable to abduct thumb against resistance

Question 4

Ulnar nerve injury signs

Answer 4

• Decreased sensation palmar and dorsal 1 ½ fingers, little finger flexed (non-functioning lumbrical)
• Unable to cross index and middle fingers
• Decreased abduction/ adduction

Question 5

Radial nerve injury signs

Answer 5

• Decreased sensation dorsum first web space
• no motor branches in hand, but proximal injury results in inability to extend wrist

Question 6

Digital nerve injury signs

Answer 6

Decreased sensation along radial or ulnar half of digit distally: note that some sensation is usually preserved, even with significant nerve injuries

Question 7

Superficial flexor injury signs

Answer 7

• Hold other fingers straight (immobilizing all deep flexors), the unable to flex PIP (unreliable for index finger)
• 10% of individuals do not have a flexor superficial tendon to the little finger

Question 8

Deep flexor injury signs

Answer 8

Unable to flex at DIP

Question 9

Extensor injury signs

Answer 9

• Complete division prevents extension (at DIPJ causes mallet deformity)
• Central slip division cause boutonniere deformity
• In recent trauma, hold PIPJ at 90o over table edge and try to extend versus resistance DIPJ hyperextends in central slip division (elsons test)

Question 10

Deformity

Answer 10

• Small amount of rotational deformity of a digit (typically associate with a spiral/ oblique MC or finger fracture) can have a dramatic effect on long term hand function
• Check carefully to ensure there is no abnormal overlapping of finger tups in the palm on making a fist