Evidence-Based Management of Acute Hand Injuries in Urgent Care (Trauma CME)

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Delivery Method:	Online
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Publication Date: February 2023 (Volume 2, Number 2)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 02/01/2026.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits, subject to your state and institutional requirements.

Editor-in-Chief and Urgent Care Update Author

Peer Reviewers

Charting & Coding Author

Abstract

Hand injuries are common presentations in urgent care and are associated with significant patient morbidity and medicolegal risk for clinicians. Care of patients with acute hand injuries begins with a focused history and physical examination. In most clinical scenarios, a diagnosis is achieved clinically or with plain radiographs. While the care of most patients with hand injuries is straightforward, urgent care clinicians must rapidly identify limb-threatening injuries, obtain critical clinical information, navigate diagnostic uncertainty, and facilitate specialist consultation and referral when required. This review discusses the clinical evaluation and management of high-morbidity hand injuries in the urgent care setting.

Case Presentations

A 32-year-old man with a laceration of his left palm arrives at your urgent care center...

• The injury occurred 1 hour prior to arrival when he was using a flat-head screwdriver to open a can of paint.
• He complains of pain and swelling at the wound site and inability to flex his fifth digit.
• The patient is a right-hand dominant construction worker with a history of hypertension; his last tetanus shot was 12 years ago.
• There is a 2-cm laceration of the palmar surface of the hand at the base of the fifth digit. He is unable to flex the fifth digit at the proximal interphalangeal joint or distal interphalangeal joint.
• You order 3-view hand radiographs, update his Tdap vaccine, and prepare for local anesthesia, irrigation, and wound exploration. You suspect this patient has a flexor tendon injury…

A 22-year-old man presents with an injury to his right hand sustained the previous night...

• He admits to drinking “a bit too much” and states that he punched a wall in anger at a local bar.
• The patient’s right hand is swollen over the fourth and fifth metacarpophalangeal (MCP) joints and there is a 5-mm puncture wound over the fourth MCP joint.
• You confirm in the EMR that his tetanus vaccination status is up to date.
• The patient says he needs “a stitch or two and maybe some antibiotics.” You wonder if there's more to the story...

A 65-year-old woman arrives after falling backwards on uneven ground outdoors...

• The patient reports that she attempted to break the fall with her right hand and says, “maybe my thumb hit the ground first before the rest of my hand, because it really hurts here,” as she points to the base of the thumb.
• There is tenderness and mild swelling at the first MCP joint, with restricted range of motion due to pain
• You don’t appreciate any deformity, and as you’re ordering radiographs you wonder how best to treat this patient if the x-rays are negative...

Accreditation:

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