Hands Anne Dobbs Lead ACP PHB

Objectives Understand the anatomy of a normal hand Understand the assessment of a patient presenting with a hand problem Understand some common hand presentations to urgent and emergency care Understand treatments of common hand presentations

The Hand Hand injuries are common – they account for: 20% of patients attending emergency departments 30% of work related injuries 25% of all days lost from work Approximately 30% of all partial disabilities (Collier, McNab 2001)

The Hand The aim of treatment is full and rapid restoration of hand function. High quality primary assessment and treatment is vital to the final functional outcome of all hand injuries. (STH, 2009)

Hand Injury Litigation Ring et al 2015 17 years of data showed 1354 claims for wrist and scaphoid fractures Ring et al (2015)

Normal Anatomy: Bones

Normal Anatomy: Tendons

Normal Anatomy: Tendons

Normal Anatomy: Nerves

Normal Anatomy: Nerves

Normal Anatomy: Blood Supply

Normal Anatomy: Ligaments

Hand Examination History Look Feel Move Stress NV

History Age Hand Dominance Occupation Hobbies Previous injuries or surgery PMH / DH Allergies What When Where How Tetanus

Look Cascade Swelling Bruising Deformity Wounds Redness Discharge Rings

Feel Joint above & below Each bone and joint Scaphoid Pain Heat Swelling Effusion Crepitus Ligaments

Assess tendon function Move Assess tendon function FDS FDP Extensors Central Slip Thumb

Neurovascular Radial Nerve Ulna Nerve Median Nerve Digital Nerves Skin Colour Temperature Capillary Refill Radial Artery Ulna Artery Allens Test

Adjuncts to Assessment X-ray Bloods

Median nerve

Patients with pyogenic flexor tenosynovitis present with the four cardinal signs as described by Kanavel: (1) uniform, symmetric digit swelling; (2) at rest, digit is held in partial flexion; (3) excessive tenderness along the entire course of the flexor tendon sheath; and (4) pain along the tendon sheath with passive digit extension.25 Pain with passive extension has been reported as the most clinically reproducible of these four signs.24,26

Gout septic arthritis Compartment syndrome Cellulitis

Zones of injury

Any Questions?

In Summary Normal anatomy Explored how to examine a hand Looked at some of the frequent presentations to emergency & urgent care