AdultPediatric
Cannot miss / life threats
Cannot miss / life threats
Diagnostic flow — check first
Diagnostic flow — check first
- Any laceration over MCP from punch → fight bite → IV abx + hand surgery.
- Kanavel signs → flexor tenosynovitis → emergent OR.
- Tiny puncture from grease/paint gun → high-pressure injection → emergent OR.
- Vesicles on finger pulp → herpetic whitlow → do NOT I&D.
Differential diagnosis — checklist
0/16
Check off each diagnosis as you consider it. Tap the name for unique exam, lab/imaging clues, first-line confirmatory test, and management.
Infection0/6
Trauma / overuse0/6
Vascular / nerve / occupational0/4
Initial ED workup
Bedside0/5
- Inspect for deformity, rotation, lacerations, foreign body, FB entry sites
- Assess tendon function (FDP, FDS, EDC) finger by finger
- Two-point discrimination on radial + ulnar aspects of each digit
- Allen test; capillary refill of each digit
- Tetanus status
Labs0/2
- CBC, CRP if infection
- Aspiration if joint involvement
Imaging0/3
- Hand / finger XR (PA, oblique, lateral)
- US for abscess or FB
- CTA for digital ischemia
Initial management0/4
- Splint, elevate, ice, analgesia
- Irrigate / explore lacerations under tourniquet (with consent)
- Antibiotics + hand surgery for fight bites, flexor tenosynovitis, high-pressure injection
- Update tetanus
Pearls / pitfalls
Pearls
- Always document tendon function and 2-point discrimination before nerve block.
- Rotational deformity of any finger = ortho reduction; fingers should all point to scaphoid when flexed.
- Mallet/jersey finger XRs are easy to overlook — examine active DIP flexion/extension.