This document provides an overview of upper limb anatomy and assessment of common hand injuries seen in the emergency department. It discusses the history, examination, and management of various types of injuries including lacerations, tendon injuries, fractures, nerve injuries, and fingertip amputations. Treatment options such as irrigation, splinting, and immobilization are covered. Anatomical structures like the flexor and extensor compartments are also reviewed.

1. Richard Hay

2.  Overview of upper limb anatomy
 Assessment of upper limb injuries affecting the
hand
 Common injuries seen in ED
◦ Soft tissue
◦ Bones
 Other considerations

3.  Anatomical terminology
◦ Surfaces
◦ Movements
 Flexor and extensor compartments of the forearm
 Flexor and extensor retinaculum
◦ Carpal tunnel
 Hand

8.  History
◦ Hand dominence / ischaemic time / ADT / occupation /
hobbies / conditions affecting peripheral circulation
 Look
 Feel
 Move
◦ Functional assessment of all muscles / tendons
◦ Assessment of neural function
 Sensory and motor
 Anaesthetise and explore wounds only after
completing neurological assessment
◦ Digital blocks
◦ Wrist blocks

9.  Lacerations
◦ Irrigation with either N/S or tap water
 Tendon injuries
◦ Surgical repair if >50% (?75% if no triggering)
 FB
◦ XR / US / CT
 Bite wounds
◦ Good evidence for the use of prophylactic Abx

10.  Nerve injuries
◦ All motor branches
◦ Digital nerves proximal to DIP
 Radial aspect IF / MF
 Ulnar aspect LF
 Both sides of thumb
 Fingertip amputations
◦ Different classification systems

12.  Nail bed injuries
◦ Subungualhaematoma
 Trephination
 If significant pain
 Antibacterial soaking / dressing
◦ When to explore / repair nail bed
 If nail fold disrupted
 If nail plate is dislodged from nail bed
 If nail plate adherent to nail bed then probably does not require
exploration

13.  Management primarily non-operative
◦ Closed reduction and splinting
 <2mm articular congruity
 Accept angulation and rotation that does not interfere with
function or cause significant cosmetic deformity
 Shaft #s
◦ Acceptable angulation varies with MC involved and location
of #
 Greater deformity acceptable in 4th/5th MC
 10° for 2nd/3rd
 20° for 4th
 30° for 5th
 Less angulation if # closer to CMC jts

14.  Neck #s
◦ Acceptable angulation
 10-15° for 2nd/3rd
 45° for 5th
 Immobilisation
◦ Forearm based extending to the PIP dorsally and distal
palmar crease on volar aspect (ie allow motion of IP jts)
 Wrist at 20-30 degrees
 MCP jts at 70-90 degrees
◦ Can buddy strap for rotational control