Evaluation of Hand Injuries in the Emergency Department
The standard of care in emergency medicine for a patient with a hand laceration includes an evaluation for possible tendon damage, as this is a common and serious consequence of this sort of injury. This evaluation has three primary components. The review of systems must include an inquiry regarding weakness or decreased motion. The physical exam must focus on evaluating tendon function, which should be assessed against resistance if motion against resistance is intact. The wound must be thoroughly inspected for visible evidence of tendon damage and this exam should include inspection of any visible tendons with the hand in position of injury. So doing will expose the part of tendon which may have been injured. A thorough exam will reveal almost all instances of significant tendon injury. The one main exception is that there may be partial injuries. The natural history of partial injuries is that they may heal or go on to complete tendon disruption.
Evaluation of hand injuries in the Emergency Department medical expert witness specialties include emergency medicine, pediatric emergency medicine, hand surgery, and radiology.