Demystifying the Hand Exam

The human hand is a fascinatingly intricate arrangement of pulleys, tendons, muscles, and nerves that work together in a complex system to perform daily tasks. It is often difficult to visualize the various paths that the tendons and muscles take. It can also make a thorough hand exam difficult to perform with proficiency. This post will review the clinically relevant anatomy of the hand, and apply it to both a screening exam and detailed exam with maneuvers used in the diagnosis of common hand injuries.

 Episode 29: Hand Emergencies

Dr. Andrew Arcand & Dr. Laura Tate discuss the key clinical pearls and pitfalls in the recognition and management of many apparently benign hand emergencies that have serious morbidity, including high pressure injection injury, flexor tenosynovitis, gamekeeper’s thumb (or skier’s thumb), fight bites, hook of the hammate fractures and many more important hand emergencies.

 Four hand injuries not to miss: avoiding pitfalls in the emergency department

The clinical and radiological findings in some hand injuries can be subtle and easily misinterpreted, leading to irreversible changes and profound functional loss. The importance of early and accurate diagnosis is clear.

 Hand Injuries – Finger Tip Injuries, Jersey Finger, PIP Dislocations, Metacarpal Fractures, Thumb Injuries, Tendon Lacerations

Some injuries are easy to diagnose but we often fall short when managing them in the ED, while others are hard to recognize and frequently go undiagnosed.

 Hand Injuries – Pitfalls in Assessment and Management

The hand is anatomically complex. Having an anatomical-based approach to the assessment of patients who present to the Emergency Department is important to preserve quality of life following a hand injury. Hand injuries are the second most common injury leading to days without work. It is no surprise then that open finger injuries land in the top 10 most common diagnoses that end up in court.

 Handy Knowledge: subtle and high-risk hand injuries

Authors: Ryan Mason, MD and Alex St. John, MD (University of Washington, Division of Emergency Medicine) // Edited by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Chief Resident at SAUSHEC, USAF) Hand injuries can inflict a high degree of morbidity in the form of pain and loss of the ability to work or perform activities of daily living. Due to the hand’s highly specialized and complicated anatomic structure, many of these injuries can be subtle. Indeed, an entire sub-specialty of surgery exists to care for the hand. Our job as emergency physicians is to identify these elusive injuries for further specialist management in order to avoid their devastating consequences.

 Minor Hand Injuries

Mallet, Boxer's, Bennett's and Rolando's...

FOOSH: The Most Common Hand Injuries Seen in the ER

FOOSH is an acronym for fall on an outstretched hand. This really describes the mechanism of injury. The injury can involve anything that includes the hand, wrist, elbow or shoulder. One common type of Foosh injury is the Colle’s fracture of the wrist.. This type of injury involves a break of the radius bone in the distal forearm.

Can't Miss Hand and Wrist Fractures in the ED

Three less common injuries are reviewed here. If found, these injuries can alter the management and disposition of the patient. Each of these injuries should be carefully assessed for on physical exam and imaging.

CRACKCast E050 – Orthopedics – Hand Injuries

Hand Injuries. Hand injuries constitute 5-10 percent of all emergency room visits, and this high yield chapter will dive into the essential anatomy, examination, and management pearls for managing a whole host of hand injuries.

EM Cases: Hand Emergencies

Suspect a “fight bite” when there is a laceration over an MCP joint. 10% of “fight bites” develop septic arthritis;these injuries need prophylactic antibiotics. For metacarpal fractures, assess for rotation & compare to contralateral hand:

Evidence-Based Management Of Acute Hand Injuries In The Emergency Department

Although injuries of the hand are infrequently life-threatening, they are common in the emergency department and are associated with significant patient morbidity and medicolegal risk for physicians.

Extensor tendon injuries of the hand: Emergency Department management

Test each extensor joint through active range of motion against resistance. If there is any uncertainty, compare it to the other hand. The key to diagnosing an extensor tendon injury is to maintain a high index of suspicion. Do not forget to test the distal joint to identify a subtle mallet finger injury.

Hand and Wrist Injuries: Part I. Nonemergent Evaluation

The most commonly fractured bone of the wrist is the scaphoid, and the most common ligamentous instability involves the scaphoid and lunate.

Hand Surgeon Dr. Scott Lifchez Shares Thoughts on Emergency Care

What is the short list of those things that really need your level of expertise that can’t be handled by the general orthopedist or the general plastic surgeon? The obvious lead one would be digital amputations.

High-Pressure Injection Injury to the Hand – A Case Report

High-pressure injection injuries to the hand can be surgical emergencies. The injected material and subsequent edema increase the risk for infection, ischemia, compartment syndrome, and limb loss.

How to Treat Open Injuries to Flexor Compartment of Fingers and Hands

Open injuries to the flexor compartment of the fingers and hand pose specific challenges to the EP both in terms of diagnosis and management. Unlike the extensor tendons, which are relatively close to the skin surface, the flexor tendons are buried deep in the palmar hand and surrounded by layers of muscle, fascia, nerves and arteries.

Tips and Tricks on Assessing a Pediatric Hand Injury

While most childhood fractures are caused by accidental trauma, it is important to always have this in the back of your head. Be on the lookout for red flags and inconsistencies in history including unwitnessed injury, or recurring fractures. Look for presence of other injuries and bruising and /or fractures at various stages of healing.