History:
77 year-old man presents to the ED with pain to his right hand following an accident on his motor scooter 4 days prior to arrival. He states he swerved into a field to avoid being struck by another motorist, lost control of his scooter, and as he laid the bike down his right hand was crushed by the scooter. He was wearing a helmet and sustained no other injuries.
Exam:
Afebrile, vitals signs stable.
Examination of the right hand reveals a mildly edematous hand (diffusely along the dorsal surface of the metacarpals) with no point tenderness of the metacarpals or the carpal bones. No scaphoid tenderness. Skin examination is warm and dry, capillary refill is <2s. The 1st & 3rd-5th digits are nontender and have full ROM at the IP joints and the MCP joints. The 2nd digit is diffusely edematous with the IP joints held in partial flexion. There is tenderness along the volar aspect of the finger and the PIP joint is unable to be actively extended whatsoever. The DIP joint is able to be actively extended approximately 5-10 degrees. The skin of the 2nd digit has two small abrasions on the dorsal surface of the middle phalanx and the distal phalanx, and a small puncture wound on the volar surface of the base of the middle phalanx. The 2nd digit is diffusely tender to palpation. No purulence from the wounds, no induration, no fluctuance. Continue reading