Provider Prepared’s Weekly Pearl of Wound Wisdom #19 Thumbs up!

A 27 year old female presents to the Emergency Department for management of a laceration to her left hand. While cutting an avocado, she accidentally cut her left hand using the knife to remove the pit. The laceration is at the base of the thumb, extending into deep tissue.

Proper examination of hand wounds requires an understanding of hand anatomy and function. During assessment of the wound, function and sensation of the digits must be evaluated. The thumb requires special attention for proper examination. The thumb is made up of two phalanges, in comparison to the other digits which have three. The thumb has more movement capabilities than the other fingers. At the carpometacarpal joint the thumb can flex, extend, abduct, adduct, oppose, and retropulse. The metocarpophalangeal joint allows the thumb to flex, extend, abduct, and adduct. The interphalangeal joint provides for flexion and extension.
Bassett, RE et al. Finger and thumb anatomy. UpToDate, July 2016.

Evaluation to ensure all these thumb movements are intact must be part of thumb wound evaluation.

This patient has all movements of her left them intact with good strength, sensation is intact as well. On exploration of the wound there is no evidence of any deep structure injury. The laceration was closed with a single layer repair without complication. A thumb spica splint was then placed to immobilize the thumb, promoting less tension on the wound.

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Provider Prepared
Nathan Whittaker, MD