Clinical Pathways
Clinical Pathways
Acute Hand Injuries - Urgent Care
Acute Hand Injuries - Urgent Care

Acute Hand Injuries - Urgent Care

Tags
EB Urgent Care
Published
February 1, 2023
Author(s)
Keith A. Pochick, MD, FACEP

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Action

Patient presents with an acute hand injury.

Decision

Which type of hand injury?

Background

In hand trauma, a focused history risk-stratifies the differential diagnosis and possible complications (eg, retained foreign body, joint violation, tendon injury, infection, tetanus, rabies, and compartment syndrome). Particular emphasis is placed on rapid identification of limb-threatening and high-morbidity injuries. (See Table 2.) Information that may change the patient’s ultimate disposition or alter management should be sought, such as in cases of a suicide attempt or suspicion of child abuse. If the patient is unable to offer a reliable history (eg, as with a child or cognitively impaired patient), attempts should be made to obtain information from alternative sources such as parents or caregivers.10^{10}

A detailed description of the mechanism of injury and the symptoms should be sought, including asking whether the injury was from blunt force, penetrating force, FOOSH, closed fist, or high-pressure injection, or a combination of these. The patient or witness should also be asked about the time of onset, pain, location, range of motion, functional impairment, exacerbating/relieving factors, weakness, numbness, tingling, and discoloration.10^{10} In certain situations (such as amputation), additional data are critical, including the method of storage of the body part and ischemic time. Knowledge of patient hand dominance, occupation, and hobbies are significant in surgical decision making in specific patient populations (eg, for a professional musician).

The patient's medical history should include baseline functional status, disability, immunosuppression (eg, diabetes mellitus, asplenia, peripheral vascular disease), rheumatologic disease (eg, rheumatoid arthritis), bleeding disorders, current medications, allergies, smoking, and past surgical history.10^{10}

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References
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Full Acute Hand Injuries Pathway
Full Acute Hand Injuries Pathway
Metacarpal Fractures
Metacarpal Fractures
Finger Fractures
Finger Fractures
Open Fractures
Open Fractures
Dislocations/Ligament Injuries
Dislocations/Ligament Injuries
Tendon Injuries
Tendon Injuries
Lacerations and Miscellaneous Injuries
Lacerations and Miscellaneous Injuries

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