Ep 178 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. In this first part of our two-part series on hand injuries Dr. Matt Distefano and Dr. Arun Sayal guide us through the principles and pitfalls of assessment and management of hand injuries and answer questions such as: what is the differential diagnosis of a globally swollen hand? What is the intrinsic minus hand position? When should we suspect compartment syndrome of the hand? How should we best locate retracted lacerated tendons of the hand? What are the best ways to control bleeding of a finger tip amputation? What are the best analgesic choices? How large of a skin avulsion hand injury should we let heal by secondary intention rather than recommend a flap/skin graft? and many more...

Podcast production, sound design & editing by Anton Helman, voice editing by Braedon Paul

Written Summary and blog post by Kate Dillon & Ian Beamish, edited by Anton Helman January, 2023

Cite this podcast as: Helman, A. Sayal, A. Distefano, M. Episode 178 Hand Injuries - Pitfalls in Assessment and Management. Emergency Medicine Cases. January, 2023. https://emergencymedicinecases.com/hand-injuries-assessment-management. Accessed May 30, 2024

Résumés EM CasesPrinciples of assessment and management of hand injuries

3 key points to keep in mind when approaching hand injuries:

* Explore every wound – missing a foreign body or the violation of a joint space can drastically alter the course of disease

* Splint judiciously, properly, occasionally, and briefly – a poor splint leads to poor outcomes

* Appreciate the anatomic density of the hand in regards to trauma, infection and potential for compartment syndrome

Essential hand anatomy overview video: https://www.youtube.com/watch?v=zyl6eoU-3Rg

Mnemonic for carpal bones: So Long To Pinky, Here Comes The Thumb

* S: scaphoid

* L: lunate

* T: triquetrum

* P: pisiform

* H: hamate

* C: capitate

* T: trapezoid

* T: trapezium

Clinical assessment of hand injuries: history taking

Hand dominance and vocation/recreation

Mechanism of injury

* High-impact blunt trauma, crush injury, high-pressure injection injuries increase the risk of compartment syndrome

* Deep volar and all dorsal laceration injuries are at high risk for tendon damage, infection, joint space violation and retained foreign bodies

Clinical Pearl: The mechanism of injury should not only guide your physical exam, but immediately generate a list of possible complications. Retained foreign body, joint space violation, tendon injury, bacterial infection, tetanus, rabies, high pressure injection injury complications, and compartment syndrome need to be front of mind.

Comorbidities

* Diabetes, vascular disease, smokers are at increased risk for poor wound healing and may require early follow-up to prevent chronic pathology

* Patients on anticoagulants/antiplatelet agents are at risk of bleeds into deep space compartments

Clinical assessment of hand injuries: physical exam

https://vimeo.com/796113105

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