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History
of Hand Injury
Severe
upper extremity injuries are frequently dramatic and attended by emotional
factors. Because of this, it is usually best to obtain a history in a deliberate,
orderly way. If possible, after hearing the story, the examiner should
physically demonstrate the scenario of injury back to the patient to confirm
the examiner's understanding of the details, including the position of
the extremity at the time of injury. If an injury involves machinery unfamiliar
to the examiner, it should be described well enough to be visualized, in
simple mechanical terms. Much of the extent of damage can be predicted
before the examination.
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Were the
fingers in a fist or opened straight when the palm was cut?
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Did the
patient land on their palm with their wrist extended or on the dorsum of
their wrist?
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Was the
patient able to pull their hand out, or was it trapped, requiring extrication?
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Was the
bleeding pulsatile?
Even in
what seems to be an obvious situation, clarification is important, and
one should not assume that all problems with the hand developed as a consequence
of a single reported injury.
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Did the
pain start immediately after the event, or later?
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Did the
numbness begin at the time of injury or later?
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Has the
hand been injured previously? Recently? A long time ago?
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Before
the injury, were there any problem with numbness, weakness or pain? Shoulder
problems? Night time hand numbness?
Attention
to detail from the onset can avoid misguided treatment and false expectations.
Also, in the USA, hand injuries are commonly associated with worker's compensation
and legal proceedings, which may require the surgeon to provide for an
audience minute details of the history years after the fact.
Hand Injury History
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American
Society
for
Surgery
of the
Hand
assh.org
The Best
Resource
For Your
Hands,
Period.
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