OrthoMinute_01

What would you think if I told you that taking care of finger injuries is simpler than we make it? People get their fingers in all sorts of wrong places: lawn mowers, wood chippers, snow blowers and don't forget those firework injuries!! But we won't get into those gruesome details in this post. ;-)

When a patient presents with a "JAMMED FINGER" it's hard to know where to start or what to look for. All we see is a swollen finger, typically the PIP (proximal interphalangeal) joint is involved, and there's pain. Pain when we palpate, pain when they move it. So we place them in a splint and refer them to Orthopedics or Hand Surgery.

Start by thinking about the anatomy: the bones, joint capsule, collateral ligaments (radial and ulnar), extensor tendon, flexor tendons (remember there are two), and last but not least the digital nerves (radial and ulnar). 

Often a "jammed finger" just involves a sprain or stretch to these structures, but other times there's more going on. How will we know since we don't have X-ray vision? GET X-RAYS! Not 3 views of the whole hand, but dedicated finger radiographs that show you AP, Oblique, and True Lateral views of the injured finger.

You will gain valuable information from x-rays, even if you don't always look at the x-rays and often wait for the radiology report to come back, start a new routine: have the patient return to the exam room after getting x-rays and do not dismiss them until you have looked them - you will be amazed how quickly you learn what to look for!

The last thing we want is a patient to leave our office on a Friday after the x-rays without knowing the result which could lead to the provider forgetting to call the patient because the radiology report took so long to result, so the patient calls the office only to find out the provider has left for the day. The patient is frustrated and the next day goes to their chiropractor only to find out on Monday that Orthopedics is calling them to schedule an appointment because there's a fracture that should be evaluated and managed. (This may or may not be based on a true story ;-)

If you already do this (look over the x-rays before discharging the patient), Bravo! THIS IS HOW WE PROVIDE THE BEST POSSIBLE PATIENT CARE.

For some more highlights on the "JAMMED FINGER" take a look at The OrthoMinute_Volume 1.

And as always, I am here to help! You have a hand/wrist question and would like to talk, you can reach me here.