When assessing hand injuries,
gathering
a
range
of
information
enables
the
healthcare
provider
to
competently
assess
the
situation and build a picture for
treatment and rehabilitation
planning.
Initial Assessment
After a hand injury, the
healthcare provider should
undertake a comprehensive
assessment of the patient. The
patient should be asked to
describe the mechanism of
injury, i.e. how the accident
happened, and their symptoms,
e.g. tenderness, pain, weakness,
decreased range of movement,
etc.
Any medical history, no matter
how trivial, may be of use in
providing care, e.g. previous
trauma to the hand; current
medical
history,
e.g.
medications, allergies, etc.;
hand dominance; occupation;
extracurricular activities, e.g.
hobbies/sports;
smoking
history; social history, e.g.
family situation, violence,
etc.; use of alcohol and
recreational drugs; mental
health including presence of
confusion or dementia.
The ability to undertake
normal daily activities is
affected by hand injuries, so
check if there are any mobility
issues, such as use of a
March 2018 L.O.G.I.C
walking frame or stick; whether
there are any support people at
home; whether provision of or
increase in home assistance is
required. ACC are responsible
for providing home support
after
an
accident,
so
appropriate referral may be
required.
Physical Examination
When undertaking an initial
hand examination, always
compare the injured hand with
the un-injured unless both are
injured,
which
gets
complicated, and your best
knowledge of anatomy and
physiology will be required.
First, a visual examination:
check for colour, discolouration,
swelling and lacerations. Then,
sensory nerve comparison:
touch different parts of the
hands checking for changes or
loss of sensation.
Check
vascularity: any blanching,
coldness, etc. Muscular and
tendon exam: looking for motor
nerve damage resulting in loss
of movement. Bone exam: look
for obvious deformities or
misalignment of the digits.
The
primary
healthcare
provider will conclude with
management of pain and
referral
to
appropriate
secondary care, e.g. radiology,
ED, physiotherapy, etc, as
appropriate.
In The Bone Shop
Assessment of the hand injury is
repeated in the Bone Shop and
includes tests for sensation, to
check if the hand is ne