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Hand andor Wrist Injuries How to easily test nerve function
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Hand and/or wrist injuries are very common problems presenting to the Emergency Department. A thorough evaluation of these complaints can be limb-saving in these patients. • medskl.com is a global, free open access medical education (FOAMEd) project covering the fundamentals of clinical medicine with animations, lectures and concise summaries. medskl.com is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations for use in the classroom and for physician CME. • Orthopedics – Hand and/or Wrist Injuries: What you need to know • Whiteboard Animation Transcript • with Ida Li, MD and Abbas Husain, MD • https://medskl.com/module/index/hand-... • Hand injuries are commonly seen in the ED and proper evaluation and treatment of these complaints can be limb-saving. Injuries often involve the tendons, nerves, bones, blood vessels, and skin of the hand. • When obtaining a history from the patient, it’s important to note the patient’s age, hand dominance, occupation, tetanus status, the mechanism and the time course of the injury. These factors are important in risk-stratifying the patient. For instance, an injury which occurred due to a dog bite places the patient for high risk of pasteurella multocida infection or likewise eikenella corrodens infection from a human bite. In open fractures, the time elapsed since injury is important to know in order to minimize injury from vascular loss and for wound management. • When examining the hand, it’s important to assess the patient in steps: • 1. Appearance • Check for: • Finger position, with respect to scissoring or flexing at rest. • Gross deformity, such as an open fracture or dislocation. • Bruising or swelling. • 2. Vascular Status • Check by assessing: • Radial and ulnar pulses. • Capillary refill (should be less than 2-3 seconds). • 3. Sensation Motor Function • For motor function, check the following: • First, the median nerve, also known as the “Tea-drinking” Nerve. • Test by checking the “OK” Sign: Ask the patient to touch the tip of the index finger to the tip of the thumb. • Second, the ulnar nerve, looking at intrinsic muscle function. • Test by asking the patient to hold a piece of paper between adducted fingers, as you try to pull it away. • Finally, the radial nerve, looking at extensor muscle function. • Test by asking the patient to give a “thumbs up” and to twist their wrist. • For sensory function, check the patient’s sensation in the distribution of the median, ulnar, and radial nerves.
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