Hand injuries are common problems resulting from a wide variety of injurious agents. Many of these injuries occur as a result of the occupation of the patient. The patients have pressing concerns about their livelihood and recreational activities. The primary care physician must make initial decisions about  the severity of the injury and the optimal treatment.

It is important to obtain an accurate history of the injury since the pattern of injury may have more to do with the ultimate prognosis after a hand injury than any other factor. The injury may have occurred due to lacerations, amputation, avulsion, crush, burn, or injection injuries. In the case of roller injuries, it is important to know what normally passes through the rollers, whether there was an automatic release mechanism, how quickly the rollers were stopped once the hand was caught, and whether there is an associated burn. If the injury is due to a punch press, then it is important to note what the machine normally produces. If the injury is due to a saw, the width of  the saw, the set (or the deflection of the saw's teeth from a straight line) , and the material that was being cut are important. In the case of lacerations, the length of the blade, the depth of penetration, and the type of end on the knife are important. In the case of gun shots, the caliber of the bullet, the muzzle velocity, and the range of injury is useful. In the case of falls, the height from which the person fell and how they landed is important. The duration from the time of injury to the time of assessment is important.

Author: Dr. SF Morris