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Hand Dislocation Medication

  • Author: Jeff Chan, MD, MS, FACEP; Chief Editor: Sherwin SW Ho, MD  more...
Updated: Feb 29, 2016

Medication Summary

Drugs used for injuries involving the hand include various analgesics. Near-immediate pain relief can be provided when the patient receives an injection of a local anesthetic along the path of the digital nerve (digital, web-space, or palmar block). Of course, the digital block must be preceded by a very thorough neurosensory examination and (when indicated) discussion with the hand specialist.

Oral medications should be prescribed for the patient who is being discharged from the emergency department (ED).



Class Summary

Pain control is essential to quality patient care: It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Analgesic agents are used for pain relief. Acetaminophen is used in patients with mild pain, especially those with a contraindication to NSAID use; narcotics are used in those with moderate to severe pain. Many analgesics have sedating properties that benefit patients who have sustained injuries.

Acetaminophen (Tylenol, Feverall, Aspirin Free Anacin)


Acetaminophen is the drug of choice for mild pain in patients with documented hypersensitivity to aspirin or NSAIDs, those with upper gastrointestinal (GI) disease, or those who are taking oral anticoagulants.

Codeine and acetaminophen (Tylenol With Codeine)


This drug combination is indicated for the treatment of mild to moderate pain.

Hydrocodone bitartrate and acetaminophen (Vicodin ES, Lorcet Plus, Lortab)


This drug combination is indicated for the relief of moderate to severe pain.

Oxycodone and acetaminophen (Percocet, Endocet, Tylox)


This drug combination is indicated for the relief of moderately severe to severe pain. It is the agent of choice for aspirin-hypersensitive patients. Different strengths are available.

Oxycodone and aspirin (Percodan, Endodan)


This drug combination is indicated for the relief of moderately severe to severe pain.


Antianxiety Agents

Class Summary

Patients with painful injuries usually experience significant anxiety. Administration of anxiolytics allows the clinician to achieve the same degree of pain relief with a smaller analgesic dose.

Lorazepam (Ativan)


Lorazepam is a sedative-hypnotic of the benzodiazepine class that has a rapid onset of effect and a relatively long half-life. By increasing the action of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter, it may depress all levels of the central nervous system (CNS), including the limbic system and reticular formations. Lorazepam is excellent for patients who need to be sedated for longer than 24 hours.

Diazepam (Valium, Diastat)


Diazepam depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA. It is considered second-line therapy for seizures.


Local Anesthetics

Class Summary

Local anesthetic agents are used for digital block to facilitate reduction or examination of fingers.

Lidocaine (Anestafoam, Xylocaine, Lidoderm, Topicaine)


Lidocaine is an amide local anesthetic used in 1-2% concentration. The 1% preparation contains 10 mg of lidocaine for each 1 mL of solution; the 2% preparation contains 20 mg of lidocaine for each 1 mL of solution. Lidocaine inhibits depolarization of type C sensory neurons by blocking sodium channels. For a digital block, lidocaine must not be used with epinephrine; 1% lidocaine without epinephrine is the drug of choice.

To improve local anesthetic injection, cool the skin with ethyl chloride before injection. Use smaller-gauge needles (eg, 27 gauge or 30 gauge). Make sure the solution is at body temperature. Infiltrate very slowly to minimize the pain. The time from administration to onset of action is 2-5 minutes, and the effect lasts for 1.5-2 hours.

Buffering the solution helps reduce the pain of local lidocaine injection. Sodium bicarbonate can be added to injectable lidocaine vials (1 part bicarbonate to 9 parts lidocaine) to produce buffered lidocaine. The shelf-life of buffered lidocaine is approximately 1 week at room temperature. All vials should be marked "buffered," labeled with the time and date, and signed by the person who created the buffered mixture.

Contributor Information and Disclosures

Jeff Chan, MD, MS, FACEP Clinical Instructor in Surgery (Emergency Medicine), Stanford University School of Medicine

Jeff Chan, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.


Igor Boyarsky, DO Emergency Room Physician, Kaiser Permanente Southern California

Igor Boyarsky, DO is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Academy of Anti-Aging Medicine, American Osteopathic Association

Disclosure: Nothing to disclose.

Eleby R Washington, III, MD, FACS Associate Professor, Department of Surgery, Division of Orthopedics, Charles R Drew University of Medicine and Science

Eleby R Washington, III, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, International College of Surgeons, National Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.


Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Gerard A Malanga, MD Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Institute of Ultrasound in Medicine, International Spine Intervention Society, and North American Spine Society

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Genzyme Honoraria Speaking and teaching; Prostakan Honoraria Speaking and teaching; Pfizer Consulting fee Speaking and teaching

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

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Carpometacarpal joint dislocation.
Carpometacarpal joint dislocation.
Volar proximal interphalangeal (PIP) joint dislocation.
Dorsal thumb interphalangeal dislocation.
Dorsal thumb interphalangeal dislocation.
Aluminum foam splints.
Hand dislocation. Dorsal aluminum foam splint.
Buddy taping.
Acute dorsal proximal interphalangeal joint fracture-dislocation.
Acute dorsal proximal interphalangeal fracture-dislocation. A concentric reduction could not be maintained in a splint.
Complex second metacarpophalangeal dislocation in a skeletally immature patient (same patient as in the next 2 images). Note the position of the finger and dimpling of skin on volar hand.
Radiograph of the hand of a patient with complex second metacarpophalangeal dislocation (same patient as in the previous and next images).
Intraoperative photo of the second metacarpophalangeal joint (same patient as in the previous 2 images). Note the displaced volar plate between the metacarpal head and the proximal phalanx.
Boutonniere deformity.
Normal lateral band location, dorsal to the axis of rotation of the proximal interphalangeal joint.
After central slip disruption, lateral bands migrate volar to the axis of rotation of the proximal interphalangeal joint.
Lateral view of relevant finger anatomy.
Anteroposterior radiograph displaying a gamekeeper's fracture.
Lateral radiograph displaying a gamekeeper's fracture.
Ruptured ulnar collateral ligament.
Completed UCL repair using suture anchors for fixation (same patient as in the image above).
Radiograph displaying a stress test of a torn ulnar collateral ligament.
Complex unstable fracture of the proximal phalanx.
Displaced fourth and fifth metacarpal fractures, anteroposterior view.
Displaced fourth and fifth metacarpal fractures, lateral view.
Fourth and fifth metacarpal fractures, oblique view.
Fourth and fifth metacarpal fractures after intramedullary pinning, anteroposterior view.
Fourth and fifth metacarpals after intramedullary pinning, lateral view.
Digital block.
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