Hand and Upper Limb Trauma
A Hand and Upper Limb Trauma is a prehensile, multi-fingered appendage, Intricate in design and function. Any injury to the hand and its structures, carries the potential for major handicap. Therefore to avoid this risk, even the smallest hand injuries require proper medical evaluation and treatment.
The hand consists of:
- 27 bones (including the 8 bones of the wrist),
- Skin and Soft tissue ,
- Muscle and tendons,
- Joint cartilage and ligaments,
- arteries and veins,
Common causes of Hand Injury include:
- Sharp injuries (knife)
- Blunt trauma
- Occupation injuries (industrial trauma)
- Road traffic injuries
- Electric burn injuries
- Gunshot injuries
Common Hand injuries can be divided into categories as:
- Lacerations (cuts),
- Bony fractures and dislocations,
- soft tissue injuries and amputations,
- hand infections,
- burns, and
- High-pressure injuries (grease and paint guns).
Hand Injury Symptoms
The symptoms of hand injuries can vary depending on the type of injury, mechanism of injury and severity.
Common symptoms of hand injuries
- Tenderness (pain)
- Decrease range of motion (difficulty moving)
- Pallor (pale or bloodless)
Hand and Upper Limb Trauma Evaluation
Everyone with a hand injury should consider seeking medical advice. The potential for devastating injuries increases greatly when treatment is delayed.
Upon arriving at the emergency or hand clinic, the medical evaluation includes a medical history and physical examination.
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Medical History – Hand and Upper Limb Trauma
- Past medical history (history of diabetes or smoking)
- Hand dominance (patient is right or left-handed?)
- Mechanism of injury (How did the injury occur?)
- Visual inspection
- Sensory nerve examination (feeling)
- Vascular examination (blood supply of hand)
- Muscular and tendon examination (movement and strength)
- Bone examination (broken bones or dislocated joints)
The doctor may order X-rays after the history and physical exam to identify underlying fractures, dislocations or to rule out foreign bodies.
Hand Injury Treatment (Hand and Upper Limb Trauma)
In most cases, serious Hand and Upper Limb Trauma (Hand Injuries) require proper medical attention.
First Aid Treatment
- Apply pressure to the wound to stop bleeding.
- Thoroughly wash dirt and debris from the wound.
- Cover the wound to prevent contamination or injury.
- Immobilize or splint the hand, if possible.
- For amputation retrieve the amputated body part (if possible). Wash the amputated body part, keep it damp, and place the part near ice to cool. Do not place amputated body part in direct contact with ice in order to prevent freezing.
- For Thermal and Chemical burn: Irrigate with lots of water, then cover the injury.
Surgical Management Include (Hand and Upper Limb Trauma)
- Evaluation of the depth of injury and involvement of nerves, arteries, muscles, and tendons
- Local anaesthesia vs general anaesthesia depending upon extend of injury
- Wound preparation – cleansing and irrigation, re-examination
- Wound debridement and removal of dead tissue
- Reduce the dislocated joints
- Bony fixation for fractured bones
- Control of bleeding vessels or vessel repair
- Muscle and tendon repair
- Nerve repair
- Wound repair or closure
- Dressing and splinting if necessary to immobilize the hand
- Pain medication
- Antibiotics for infected wounds
- Tetanus shot if indicated
Hand Injury Follow-up
After primary treatment and wound healing, all hand injuries patients require close follow-up with a hand specialist and a primary care doctor.