Emergency Department Management of Patients With Hand and Wrist Emergencies

Publication Date: July 2024 (Volume 27, Number 7)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 07/01/2028.

Authors

Courtney L. Schmidt, MD

Orthopaedic Associates of Michigan, Hand & Upper Extremity Surgery, Grand Rapids, MI

Ryan W. Horn, MD

Department of Orthopaedic Surgery, Division of Hand & Upper Extremity Surgery, University of Alabama at Birmingham, Birmingham, AL

Andrew D. Bloom, MD, FACEP

Assistant Professor, Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL

Rachel E. Aliotta, MD

Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL

Peer Reviewers

Jeffrey P. Feden, MD, FACEP, FAMSSM

Professor, Clinician Educator, Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI

Mark Silverberg, MD, FACEP, MMB

Clinical Professor of Emergency Medicine, Wilderness Medicine Division Director, Department of Emergency Medicine, Kings County Hospital/SUNY Downstate, Brooklyn, NY

Abstract

Injuries of the hand and wrist are commonly encountered in the emergency department. Though they are rarely life-threatening, there is potential for significant patient pain, morbidity, and long-term functional loss if they are not treated appropriately. A thorough and focused examination and plain radiographs are sufficient to diagnose most hand injuries, with outpatient referral to a hand specialist when indicated. Clinicians must be able to identify the life- or limb-threatening hand injuries that can present, both in treating and facilitating urgent hand consultation. This review provides a best-practice update on the evaluation and treatment of common hand and wrist emergencies.

Case Presentations

CASE 1

A 20-year-old man presents to the ED with right wrist pain after getting tackled in a college football game…

His vital signs are all normal, but he seems to be in some pain. He says he is right-hand dominant.
Upon examination, the patient’s wrist is tender and swollen but neurovascularly intact. You order x-rays of the right wrist, including a scaphoid view.
He is asking whether he can play football again next week…

CASE 2

A 30-year-old man who works with industrial paint presents with left index finger and hand pain after an accident at work with a paint gun…

You note that the patient has a small wound over the volar index finger. He is right-hand dominant.
His vital signs are normal, but he is in extreme pain. Despite the wound appearing to be very small, he is having difficulty moving the finger.
Considering the mechanism of injury, you obtain a 3-view x-ray of the hand to determine next steps...

CASE 3

A 40-year-old man arrives by air with a blood-soaked bandage wrapped around his left hand…

He says he suffered a table saw injury to the left index finger proximal phalanx approximately 90 minutes ago. The finger is completely amputated. The finger is present in the room, wrapped in saline-soaked gauze, on ice.
The patient says he has a history of hypertension and a 1-pack-per-day smoking habit. He is right-hand dominant.
You obtain a 3-view x-ray study of the hand and the amputated part and initiate a consult with the hand service. While awaiting consultation, you consider the indications and contraindications for replantation...

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Product Reviews

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Cynthia Savage, MD - 10/10/2025