Hand Pain after Punching

Examination of Hand Injury Involving the Fifth Metacarpal and Fourth Metacarpal

General Appearance:

• Assess for signs of pain or distress in the patient.
• Observe the patient’s hand for any protective postures.
• Inspect the hand for trauma signs, including:
  • Lacerations
  • Bite marks
  • Swelling
  • Loss of knuckles
  • Pseudoclawing with flexion of DIP and hyperextension of PIP joints.

Palpation:

• Begin palpation from the fingers, examining:
  • Phalanges
  • PIP (Proximal Interphalangeal) and DIP (Distal Interphalangeal) joints.
• Proceed to examine the following areas:
  • Knuckles
  • Metacarpophalangeal (MCP) joint
  • Metacarpals, including:
    • Neck of the metacarpals
    • Shaft of the metacarpals
    • Base of the metacarpals
  • Wrist joint
  • Anatomical snuff box
  • Assess capillary refill time (CRT)
  • Check radial and ulnar pulses.

Examination of Extensor Muscles:

• Evaluate the extensor muscles, including:
  • Extensor digitorum
  • Extensor digiti minimi
  • Extensor carpi ulnaris

Assessment of Movements:

• Extension:
  • Active Movement:
    • Begin with a screening test:
      • Ask the patient to make a fist and then open it.
      • Check for any overlap of the fingertips.
    • Assess individual finger movements:
      • Extend each finger one at a time.
      • Flex the fingers.
      • Abduct the fingers.
      • Adduct the fingers.
    • Evaluate MCP joint:
      • Check for flexion and extension.
    • Examine the wrist:
      • Assess extension, radial deviation, and ulnar deviation.
    • Check elbow joint:
      • Evaluate extension, flexion, pronation, and supination.
  • Passive Movement:
    • Conduct passive movements while ensuring patient comfort:
      • Ask the patient to make a fist and then open it (screening test).
      • Specifically assess extension of each finger.
      • Instruct the patient to place the hand on a desk and extend the index finger, followed by the third, fourth, and fifth fingers, one at a time.

Flexion Movement:

• Assess the flexion movement of the hand and fingers.

Neurological Examination:

• Perform a neurological examination to assess sensory and motor function, including:
  • Sensation in the affected area.
  • Motor strength and coordination.
  • Reflexes if indicated.