by Brent A. Smith, M.D.
CHIEF COMPLAINT:
Right hand laceration, swelling and pain.
HISTORY OF PRESENT ILLNESS:
A 19 year-old right-hand dominant male presents to the emergency department with right hand laceration, swelling and pain. He states he stumbled and cut his hand on some furniture at home 12 hours ago. He appears angry and has the smell of alcohol on his breath. In the last 6 hours he has noted increased pain, swelling and redness adjacent to a dorsal laceration near the fourth metacarpophalangeal joint. He denies fever, chills or other systemic symptoms. His past medical history is unremarkable and immunizations are current.
PHYSICAL EXAMINATION:
The patient is alert and in no distress. He smells of alcohol but is not overtly intoxicated. Vital signs are temperature 37.2øC (oral), pulse 88 beats/min, blood pressure 130/80 torr, and respirations 16/min. A general physical examination is unremarkable except for the right hand.
An approximately 2 cm stellate laceration is present over the fourth metacarpophalangeal (MCP) joint. Mild swelling, erythema and tenderness are present around the wound and proximal to it on the dorsum of the hand (figure 1). He complains of pain with both passive and active range of motion of the fourth digit which is most pronounced at the fourth MCP joint area. There is pain with axial loading at the fourth MCP joint. No palmar or finger tenderness, swelling or erythema is found. The neurovascular examination of the hand and digits is normal. There is no lymphangitis or adenopathy of the affected upper extremity.
LABORATORY AND RADIOGRAPHY:
A complete blood count is normal. Plain radiographs of the affected hand and finger are normal with the exception of soft tissue swelling in the area of the fourth MCP joint.
From Academic Emergency Medicine 2(1):68-69 1995 January
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