NEVITT Hand and Wrist presentation 0812

Studies

X-ray

Diagnosis Plan

Ice Elevate Splint Refer to hand specialist

History

Punching injury Tenderness, deformity X-ray

Physical Exam

Pain, Numbness, Fever, Cosmetic X-rays, MRI/CT, Electrodiagnostic studies Medications, Splints, Injections, Therapy DM, blood thinners?
Treatment
Nail biting, finger sucking, manicuring, hail nails Tenderness, erythema, nail discoloration, purulence

Physical Exam


Studies

Labs Cultures

Diagnosis Plan

Sensation
Motor Range of motion

X-rays


CT scan

Arthritis, fractures, dislocation Fracture, deformity Occult fracture or mass

MRI
Байду номын сангаас

Electrodiagnostic tests

Admit, IV abx (S. aureus) Consult/refer to hand specialist for urgent drainage

History

Closed fist injury during altercation Small wound over MCP joint Extensor tendon injury Joint capsule penetration

Numbness/tingling Neck pain

Sprains Dislocations Fractures Lacerations/Wounds Infections Nerve Compression Tendinitis Masses

Ligament stretch or tear
Physical Exam


Studies

X-ray, CT, MRI

Diagnosis Plan

Splint Refer to hand specialist

History

Fall onto outstretched hand Gross deformity Tenderness Swelling Loss of motion

History

Crush Tender, swollen, subungual hematoma X-ray

Physical Exam


Studies


Diagnosis Plan

Splint, ice, elevate

History

Jammed finger catching a ball Unable to extend finger tip

Physical Exam


Studies

X-ray

Diagnosis Plan

Splint- DO NOT REMOVE Refer to hand specialist

History

Caught finger on jersey of running player Unable to flex fingertip

History

Hyperextension injury Laxity of MCP joint

Physical Exam


Studies

X-ray MRI

Diagnosis Plan

Splint Refer to hand specialist

History

Fall onto hand Tenderness, swelling, limited painful motion

1% lidocaine No epinephrine

History

Physical Exam
Trauma

Studies

Tenderness, swelling, deformity, limited motion Xray
Diagnosis Plan

Splint, ice, elevate, pain meds, refer to hand specialist
History

Penetrating trauma Uniform swelling Flexed position Tender along sheath Pain with extension

Physical Exam


Studies

Labs

Diagnosis Plan

Physical Exam


Studies

Labs Xray Cultures

Diagnosis Plan

S. aureus
Elevation, splint, soaks, antibiotics Surgical incision and debridement


Physical Exam


Studies

Xray
Culture
Fracture, tooth Polymicrobial S. aureus, Strep, Eikenella

Plan

corrodens
Soaks, oral abx, close observation Refer to hand specialist for surgical debridement and IV abx

History

Fall or jam Tenderness Swelling Bruising Limited motion

Physical Exam


Studies

X-ray

Diagnosis Plan

Rest Ice NSAIDs Buddy tape Splint?

Physical Exam


Studies


Diagnosis Plan

Irrigate Antibiotics Stitch? Splint Refer to hand specialist

Nail plate/bed Bone/tuft Soft tissue

Physical Exam


Studies

X-ray

Diagnosis Plan

Splint Refer to hand specialist

History

Trauma Tender, swollen, deformed, limited motion

Physical Exam
Matthew Nevitt, MD

History Physical Exam Studies Diagnosis Plan

Hand dominance Occupation Acute vs. chronic Trauma Symptoms Testing

S. aureus Strep species Pseudomonas
Warm soaks Antibiotics Incision and drainage Nail removal

History

Finger sticks, splinters, punctures Throbbing pain, erythema, swelling

Trauma Pain Deformity Tenderness Limited motion

Physical Exam


Studies

X-ray

Diagnosis Plan

Digital block/reduce Splint/buddy tape Refer to hand specialist

History


Physical Exam

Scratch, burn, or other skin break Hyperememia, edema, tenderness Labs

Studies


Diagnosis Plan

Immobilization Elevation Antibiotics

History


Physical Exam

Dog or cat

Studies

Crush or puncture wounds Xray

Diagnosis Plan

Antibiotics
Surgical debridement
Pasteurella multocida

History

Physical Exam Studies

No trauma
Red, hot, swollen, tender Labs

Diagnosis Plan

Steroids Splint F/U within 48 hrs Refer to hand specialist


Studies


Diagnosis Plan

Splint Refer to hand specialist


Most common carpal bone fracture Men > women 2nd -3rd decade

History



Fall onto a hyperextended and radially deviated wrist Deep dull pain and swelling Snuffbox tenderness

Physical Exam


Studies

X-ray MRI

Diagnosis Plan

Rest Ice NSAIDs Splint Therapy


More severe ligament injury Bones are mal-aligned

History
Medical History

Inspection


Palpation
Deformity Contracture Wounds Redness Drainage Focal tenderness Provocative nerve tests Distribution
Group A beta hemolytic Strep S. aureus

Most common Perionychium

Envelops the nail plate Eponychium, lateral nail folds, hyponychium

History


History

Crush, cut Nail plate avulsed, subungual hematoma, laceration X-ray – fracture

Physical Exam


Studies


Diagnosis Plan

Antibiotics Wound care/soaks Splint Refer to hand specialist

Physical Exam


Studies

Xray

Diagnosis Plan

Ice Elevate Splint Refer to hand specialist

History

Cut on broken glass, knife, saw Wound Inability to straighten or bend finger X-ray