MANUAL MINORS
Hand injuries can affect multiple structures, including bones, tendons, ligaments, and nerves. There are specific clinical signs that can help identify the type and severity of the injury. Early detection of these signs is essential for accurate diagnosis and appropriate treatment, preventing long-term complications.
Diagnosis
Clinical Sign | Description |
|---|---|
Mallet finger | Inability to extend the distal interphalangeal joint (DIP) of the finger, usually caused by rupture of the extensor tendon at the distal phalanx. |
Boutonnière deformity | Flexion of the proximal interphalangeal joint (PIP) with hyperextension of the distal interphalangeal joint (DIP), caused by extensor tendon injury. |
Trigger finger (stenosing tenosynovitis) | Finger locking or "snapping" during flexion or extension, with pain at the base of the finger, caused by tendon entrapment in its sheath. |
Tinel’s sign | Tingling or pain when tapping over the carpal tunnel, indicating irritation of the median nerve, common in carpal tunnel syndrome. |
Phalen’s test | Pain or paresthesia in the median nerve distribution (thumb, index, and middle fingers) when the wrist is flexed for 60 seconds. |
Dinner fork deformity | Visible wrist deformity following a Colles' fracture (distal radius fracture with dorsal displacement). |
Inability to flex fingers | Suggests injury to the flexor tendons, often following deep laceration. |
Weakness of pinch | Difficulty pinching with the thumb and index finger, associated with median nerve injury or flexor pollicis longus tendon damage. |
Interosseous muscle atrophy | Loss of muscle mass on the dorsum of the hand, particularly between the metacarpals, indicating chronic ulnar nerve injury. |
Differential Diagnosis
Injury | Distinctive Features |
|---|---|
Extensor tendon rupture | Mallet finger, with inability to extend the distal joint after a blow or injury to the fingertip. |
Flexor tendon rupture | Inability to flex the joints of the affected finger, typically following a deep laceration. |
Phalangeal or metacarpal fracture | Localized pain, visible deformity, and limited movement of the finger or hand, confirmed by X-ray. |
Joint dislocation | Joint deformity with severe pain, mechanical blockage, and loss of mobility, usually from direct trauma. |
Carpal tunnel syndrome | Pain, tingling, and weakness in the thumb, index, and middle fingers, with positive Tinel's and Phalen's signs. |
Emergency Management
Emergency management of hand injuries includes initial immobilisation of the affected limb, administration of analgesics and anti-inflammatories, and referral for diagnostic imaging (X-rays, ultrasound) if fractures or tendon injuries are suspected. Injuries involving nerves or tendons, as well as displaced fractures, require immediate evaluation for possible surgical intervention.
Definitive Treatment
Definitive treatment depends on the type of injury. Fractures may require reduction and immobilisation or surgical intervention. Tendon injuries, such as mallet finger or flexor ruptures, often require surgical repair. Conservative management of minor injuries may involve temporary immobilisation, physical therapy, and, in some cases, corticosteroid injections to relieve inflammation in cases of tenosynovitis or carpal tunnel syndrome. Rehabilitation is essential for restoring hand mobility and function.
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