1. Hands
Anne Dobbs
Lead ACP PHB

2. 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

3. 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)

4. 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)

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

6. Normal Anatomy: Bones

7. Normal Anatomy: Tendons

8. Normal Anatomy: Tendons

9. Normal Anatomy: Nerves

10. Normal Anatomy: Nerves

11. Normal Anatomy: Blood Supply

12. Normal Anatomy: Ligaments

13. Hand Examination
History
Look
Feel
Move
Stress NV

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

15. Look Cascade Swelling Bruising Deformity Wounds Redness Discharge
Rings

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

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

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

20. Adjuncts to Assessment
X-ray
Bloods

34. Median nerve

38. 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

43. Gout
septic arthritis
Compartment syndrome
Cellulitis

47. Zones of injury

50. Any Questions?

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