Carefully inspect any lacerations, keeping in mind that deeper structures may also be damaged. Swelling can be a hallmark of bony injury. Observe carefully for bruising, swelling and lacerations. Reproduced with permission: Brukner P, Khan K. Anatomy of the hand A) Volar aspect B) Dorsal aspect In addition to the general principles common to the assessment of any injury, there are particular issues relevant to examining hand injuries.įigure 1. The anatomy of the hand is complex (Figure 1a, b) and an understanding of all its structures is vital. Many hand injuries also have legal ramifications if sustained during intrapersonal violence or in the workplace. Is this the patient’s dominant hand? What is their occupation, sporting interests, hobbies or other important hand related activities? How crucial is optimal hand function for this person? Occasionally lacerations of the hand can be self inflicted, necessitating psychological assessment and management. Previous injuriesĪ history of any previous hand injury may predispose to further injury and may also mean the ‘normal’ hand for comparison is actually abnormal. A history of dislocation and reduction before presentation is important, as this may not be detected on examination. Blunt trauma causes quite different injuries to penetrating trauma. For example, a bite to the hand conveys a high risk of developing infection a history of a missed tackle (‘grabbing a jumper’) may cause a flexor tendon injury. It is important to establish what forces were applied to the hand during the injury and the direction of these forces, as well as any special features of the injury. The mechanism of injury gives important clues about the structures involved and potential complications.
The aim is not to cover each injury in detail, but to provide a framework so that the general practitioner can confidently assess hand injuries and know which injuries they can manage in their practice and which should be referred to a hand specialist. This article provides a brief guide to the assessment of hand injuries and outlines the general principles of management for any hand injury followed by more specific detail about common injuries and their management. The causes of hand injuries are varied and include sporting accidents, occupational injuries and bites of various types.
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