Evaluation of Hand and Finger Injury

Differential Diagnosis

Most Common

1. Metacarpal Fractures: First Metacarpal and Others

2. Phalynx Fractures

3. Dislocation of PIP: Usually Dorsal but Occassionally Volar

4. Ulnar Collateral Ligament Tear of First MCP (Skier's Thumb)

5. Sprain of PIP Joint

6. Lacerations

7. Infections

8. Subungal Hematoma

Less Common

1. Bennett's Fracture

2. Dislocation of MCP joint

3. Dislocation of DIP joint

4. Radial Collateral Ligament Sprain of First MCP

5. Sprain of DIP Joint

6. Mallet Finger

7. Boutonniere Deformity

8. Stress Fractures

Not To Be Missed

1. Potential Infection (human bite)

2. Avulsion of long flexor tendons

History

• Mechanism of injury

• Cracks or bruising

• Loss of Function

Examination

Always remember to examine the joint above (Elbow)

Inspection

1. Scars or stretch marks

2. Wasting of muscles

3. Obvious Deformity

4. Swelling in region of scaphoid

Palpation

1. Distal Forearm

2. Radial Snuffbox (this is the area surrounded by Extensor Pollicis Longus, Extensor Pollicis Brevis, and Abductor Pollicis Longus)

3. Base of metacarpals

4. Lunate: Palpated as a bony prominance proximal to the capitate sulcus on the dorsal aspect. On the radial side of the lunate lies the scapholunate joint.

5. Head of Ulna

6. Radio-Ulnar Joint

7. Scapholunate Joint

8. Triangular Fibrocartilage

9. Hamate: Hook of Hamate is 1cm distal and radial to the Pisiform.

10. Pisiform: Palpated at the flexor crease of the wrist on the Ulnar side.

Motion

Note that range of movement is measured determined actively first, if there is a deficiency, move on to passive range of motion. Any deficits should be measured with a goniometer. Note should be made of discrepence between active and passive movement.

Active motion of each finger:

1. Flexion

2. Extension

3. Abduction

4. Adduction

Active motions of the Thumb:

1. Flexion

2. Extension

3. Palmar Abduction

4. Palmar Adduction

5. Opposition

Muscles

Measurement of muscle strength using the Oxford (MRC) Scale.

1. Flexion

2. Extension

3. Abduction

4. Adduction

5. Opposition of Thumb

NeuroVascular

1. Check and Grade reflexes (biceps (C5), brachioradialis (C6), and triceps (C7)

2. Check Pulses.

3. Sensation in radial / ulnar / median nerve

4. Strength in radial / ulnar / median nerve

Special Tests for Tendon Integrity

1. Flexor Digitorum Profundus Integrity

2. Flexor Digitorum Superficialis Integrity

3. Extensor Tendon Integrity

Other Special Tests

1. Integrity of Ulnar Collateral Ligament of First MCP

Investigations

1. Plain Films: Should be obtained in all trauma. A pre-reduction and post-reduction film are indicated for dislocations.

Appendix

Hand and Finger Mechanics

Index

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