1	Examination of the Hand L C Bainbridge
2	Presentation How they walk through the door position of the arm sling assistance
3	History Not an exhaustive treatise Systematic Do not forget the rest of the body!!! What happened to your hand does it have rollers what are they surfaced with are they hot what is the separation
4	History 2 Punch press injuries shape and area what does it make how thick is the gap
5	History 3 Saw Injuries What is the set what were you cutting Knife injuries sharp or dull blade did it come down on your hand or slice across it what position was your hand in
6	History 4 Penetrating injuries What was it what sort of end does it have what direction did it go in show me how it happened Firearm range and calibre Falls height, force
7	History 5 Time of injury general health, current medication, known allergies Social history
8	Examination Surface Anatomy get to know where the tissues are in the hand Methodical examination, Build yourself a system that covers all structures. Compare with contralateral side or yourself Never use pointed objects, you are trying to assess nerve integrity not a full neuro exam! Compare sensation between the two sides of the digit or the two hands.
9	Examination 2 Cover each body part Skin vessels nerves tendons bones ligaments
10	Examination 3 Skin note nature of injury sharp / blunt serrated contused devitalised blistered leathery calluses loss
11	Examination 4 Vessels assess viability skin color - poor skin temp - reasonable skin return - best bleeding pulsatile major or minor
12	Examination 5 Nerves At this stage you have not done anything painful Therefore DO NOT USE A NEEDLE!!!! Compare touch with adjacent: finger hand cortical comparison is best test of altered sensation
13	Examination 6 Tendons Motor nerves very difficult to examine at the hand level in the trauma patient.
14	Examination 7 Wrist tenodesis test: Drunks and children parents turn the childs hand over flexors and extensors again compare with opposite side
15	Examination 8 Flexors FDS isolated PIP flexion FDP isolated DIP flexion Remember little finger FDS is absent or joined to FDS IV in 25% at least of patients FPL Thenar muscles
16	Examination 9 Extensors More subtle - junctura looking for a discontinuity in the arc of fingers Extensor indicis and digiti minimi Wrist extensors Thumb
17	Examination 10 Bones In closed injuries will come first looking for angulation rotation local tenderness In open injuries driven by type of injury In crush injuries examine before tendons, vessels and nerves
18	Examination 11 Ligaments and Joints Dislocation Subluxation Swelling Test ligaments for local tenderness pain on stress Volar plate