Soft Tissue Hand Injury Workup

  • Author: Andrea B Lese, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Nov 28, 2011
 

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 the image below). 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.[5] However, it is less accurate with diagnosis of solid lesions.[5, 6] This image shows an ultrasound of the flexor tendoThis 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.
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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  Vice President and Chief Executive Officer, Mayo Clinic Campus, Arizona

Wyatt Decker, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Dan Danzl, MD  Chair, Professor, Department of Emergency Medicine, 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L 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.

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  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

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

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Kahill Glenn, MD, to the development and writing of this article.

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Metacarpophalangeal joints of the digits
Volar tendons at the wrist. These can be used as landmarks for injections.
Sagittal section of extensor compartments
Superficial volar sensation of the hand
Superficial dorsal sensation of the hand
Boutonnière deformity due to closed central tendon rupture
Boutonnière deformity
Mallet finger due to loss of central extensor tendon to the distal phalanx
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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