LOGIC March 2018 Vol 17 Vol 1 - Page 38

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