Evaluation


How will my hand injury be evaluated?

First aid at the scene of the accident usually consists of dressing any wounds, providing support with a sling and rapid transfer to the emergency room.

In the ER the assessment of a hand injury includes details of the accident, its timing and the patient's past history. Important aspects include whether there is an amputations, a wound or an abrasion; was there a crush injury; was the environment clean or dirty; the position of the hand at the time of injury; any rings on the fingers; any burns; did the patient punch anything or anybody? If fracture or dislocation is suspected an x-ray of the hand, thumb or involved finger will be taken.

There are special views for scaphoid injuries, wrist instability, finger and thumb fractures. In many cases of hand fracture a hand surgeon, usually an orthopaedic surgeon or plastic surgeon will be consulted.

The surgeon's assessment will include going over the history of
the injury and the general medical status of the patient and tobacco, drug and alcohol use.

The examination of the hand is an extremely important part of the assessment. Swelling, tenderness, bruising or bluish discoloration are all important clues to the location and type of injury. Abnormal positioning, especially of a finger, is also a vital indication of fracture and malalignment. When the fingers are flexed all the nails should be parallel and point to the same spot on the base of the thumb.

Loss of movement may be result of a fracture or a tendon injury. The sensory examination may reveal numbness. Loss of movements of the hand may also suggest a nerve injury. The median nerve supplies the muscles that moves the long and index fingers apart and the one which brings the thumb over the palm (called opposition). The ulnar nerve supplies the muscle that moves the little finger outwards.

The surgeon will assess the x-rays and explain the diagnosis. Treatment of the fracture will be discussed with consideration of the fracture, your expectations, your normal activities including work and sports, your general medical status and your preferences.