Physical Examination

The diagnosis of an extremity laceration is straightforward, but damage to underlying structures must be excluded. Prior to administering anesthesia, the wound should be grossly inspected and the extremity assessed for injury to underlying tendons, nerves, and blood vessels. Pulses and capillary refill distal to the wound should be present and symmetrical when compared to the contralateral extremity. Distal peripheral nerve sensation should be tested separately for light touch ( Fig

40-1 and Fig.. 40-2). Two-point discrimination at 5 mm should be assessed on both sides of each involved finger to evaluate individual digital nerves. Motor function may be assessed more easily after the wound is anesthetized, since the patient's effort will be less affected by pain. After administering a local or regional anesthetic, examine the wound for depth and size. The involved extremity or joint should be placed through its complete range of motion, both actively and passively. 3 Motor nerve function should be treated individually (lable ^O-S). Particular attention to underlying structures in the position of injury is essential, since this is where damage is most likely to be seen. Each tendon function should be tested separately ( Fig..40:3 and Iablei40-4). A partially lacerated tendon will still function, and the injury may be overlooked if visual inspection is not performed. Care should be taken to avoid excessive countertraction during physical examination because this could completely disrupt a partial tendon laceration.

FIG. 40-1. Sensory innervation to the hand.

FIG. 40-1. Sensory innervation to the hand.

FIG. 40-2. Sensory innervation to the foot.

FIG. 40-2. Sensory innervation to the foot.

TABLE 40-3 Motor Function of Peripheral Nerves

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