eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Hand Injury, Soft Tissue: Differential Diagnoses & Workup

Author: Andrea B Lese, MD, Staff Physician, Section of Emergency Medicine, Yale-New Haven Hospital
Coauthor(s): Kenneth R Chuang, MD, Attending Physician, Emergency Department, Long Beach Memorial Medical Center and Miller Children's Hospital; Wyatt Decker, MD, Chair and Program Director, Department of Emergency Medicine, Mayo Clinic
Contributor Information and Disclosures

Updated: Sep 29, 2008

Differential Diagnoses

Dislocations, Hand
Fractures, Hand
Hand Infections
Hand Injury, High Pressure

Workup

Imaging Studies

  • Plain-film radiographs of the hand or wrist should be obtained when a patient presents with a soft tissue injury suggestive of fracture or an occult foreign body. Of particular concern are lacerations from glass.
    • Radiography is indicated in dislocation of a DIP joint to rule out fracture.
    • In dislocation of an MCP joint, posterior-anterior view shows marked widening of the joint. Sesamoid bones seen inside the joint space on radiographs are diagnostic of complex MCP joint dislocation.
  • Ultrasonography has a growing role in locating foreign bodies and in evaluating soft tissues (see Media file 9). It can be used to detect ruptured tendons and ulnar collateral ligament injuries to the thumb. One can also assess the dynamic function of tendons noninvasively using ultrasonography. One prospective study found that high-resolution ultrasound (5-13 Mhz) is often superior to clinical diagnosis of many disorders, including ganglion cysts, tendinopathies, and retained foreign bodies.2 However, it is less accurate with diagnosis of solid lesions.2,3
This image shows an ultrasound of the flexor tend...

This image shows an ultrasound of the flexor tendon of a finger with the structures labeled. It was performed using a water bath with the water as the conduction agent. (Image courtesy of Dr. Christopher Moore and Dr. Michael Osborne.)

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This image shows an ultrasound of the flexor tend...

This image shows an ultrasound of the flexor tendon of a finger with the structures labeled. It was performed using a water bath with the water as the conduction agent. (Image courtesy of Dr. Christopher Moore and Dr. Michael Osborne.)


  • MRI has been shown to be highly sensitive in detecting ruptured tendons. However, it does not have a role in emergent management of hand wounds.

More on Hand Injury, Soft Tissue

Overview: Hand Injury, Soft Tissue
Differential Diagnoses & Workup: Hand Injury, Soft Tissue
Treatment & Medication: Hand Injury, Soft Tissue
Follow-up: Hand Injury, Soft Tissue
Multimedia: Hand Injury, Soft Tissue
References
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References

  1. Dias JJ, Garcia-Elias M. Hand injury costs. Injury. Nov 2006;37(11):1071-7. [Medline].

  2. Allen GM, Drakonaki EE, Tan ML, et al. High-resolution ultrasound in the diagnosis of upper limb disorders: a tertiary referral centre experience. Ann Plast Surg. Sep 2008;61(3):259-64. [Medline].

  3. Teefey SA, Middleton WD, Patel V, et al. The accuracy of high-resolution ultrasound for evaluating focal lesions of the hand and wrist. J Hand Surg [Am]. May 2004;29(3):393-9. [Medline].

  4. Patel J, Couli R, Harris PA, et al. Hand lacerations. An audit of clinical examination. J Hand Surg [Br]. Aug 1998;23(4):482-4. [Medline].

  5. Antosia RE, Lyn L. The hand. In: Emergency Medicine: Concepts and Clinical Practice. 4th ed. 1998:625-68.

  6. Chick LR, Lister GD. Emergency management of thermal, electrical, and chemical burns. Occupational Hand and Upper Extremity Injuries and Diseases. 1991.

  7. Chuinard RG, Friermood TG, Lipscomb PR. The 'suicide' wrist: epidemiologic study of the injury. Orthopaedics. 1979;2:499-502.

  8. Cooney WP 3rd, Dobyns JH, Linscheid RL. Complications of Colles' fractures. J Bone Joint Surg Am. 1980;62(4):613-9. [Medline].

  9. Cowen NJ, Loftus JM. Distraction augmentation manoplasty technique for lengthening digits of hands. Orthopedic Rev. 1978;7:45-53.

  10. Damert HG, Altmann S, Schneider W. [The potential of high-resolution sonography in the follow-up of surgically treated flexor tendons]. Handchir Mikrochir Plast Chir. Apr 2006;38(2):109-12. [Medline].

  11. Greenspan A. Orthopedic Radiology: A Practical Approach. 1992:2.

  12. Hergan K, Mittler C, Oser W. Pitfalls in sonography of the Gamekeeper's thumb. Eur Radiol. 1997;7(1):65-9. [Medline].

  13. Idler RS, et al. The Hand: Examination and Diagnosis. American Society for Surgery of the Hand; 1990:3.

  14. Koslowsky TC, Mader K, Gausepohl T, et al. Ultrasonographic stress test of the metacarpophalangeal joint of the thumb. Clin Orthop Relat Res. Oct 2004;115-9. [Medline].

  15. Kuschner SH, Ebramzadeh E, Johnson D, et al. Tinel's sign and Phalen's test in carpal tunnel syndrome. Orthopedics. Nov 1992;15(11):1297-302. [Medline].

  16. Lister G. The Hand: Diagnosis and Indications. 1993;3.

  17. Louis DS. Barton's and Smith's fractures. Hand Clin. Aug 1988;4(3):399-402. [Medline].

  18. Mehara AK, Rastogi S, Bhan S, et al. Classification and treatment of volar Barton fractures. Injury. 1993;24(1):55-9. [Medline].

  19. Moore KL. Clinically Oriented Anatomy. 1992;III:591-607.

  20. O'Brien ET. Fractures and dislocations of the wrist region. In: Fractures in Children. 1991:3.

  21. Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist--anatomy and function. J Hand Surg [Am]. Mar 1981;6(2):153-62. [Medline].

  22. Salisbury RE. Soft tissue injuries of the hand. Hand Clin. Feb 1986;2(1):25-32. [Medline].

  23. Schnur DP, DeLone FX, McClellan RM, et al. Ultrasound: a powerful tool in the diagnosis of ulnar collateral ligament injuries of the thumb. Ann Plast Surg. Jul 2002;49(1):19-22; discussion 22-3. [Medline].

  24. Simon RR, Slobodkin D. Injuries to the wrist and hand. In: Emergency Medicine: A Comprehensive Study Guide. Vol 4. 1996:1217-35.

  25. Skandalakis JE, Colborn GL, Skandalakis PN, et al. The carpal tunnel syndrome: Part I. Am Surg. Jan 1992;58(1):72-6. [Medline].

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Further Reading

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Keywords

soft tissue hand injury, soft-tissue hand injury, nerve injury, sprain, dislocation, finger dislocation, hand injury treatment, penetrating hand injury, crush injury hand, ligament injury, tendon injury, hand injuries, gamekeeper's thumb, skier's thumb, boutonniere deformity, mallet finger

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Contributor Information and Disclosures

Author

Andrea B Lese, MD, Staff Physician, Section of Emergency Medicine, Yale-New Haven Hospital
Andrea B Lese, MD is a member of the following medical societies: Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Kenneth R Chuang, MD, Attending Physician, Emergency Department, Long Beach Memorial Medical Center and Miller Children's Hospital
Disclosure: Nothing to disclose.

Wyatt Decker, MD, Chair and Program Director, Department of Emergency Medicine, Mayo Clinic
Wyatt Decker, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Dan Danzl, MD, Chair, Department of Emergency Medicine, Professor, University of Louisville Hospital
Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital, Manhattan
Eric Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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