Browse categories and answer follow-up questions to refine your symptom profile.
History
Presenting context
Injury context
Time since injury
Location at time of injury
Dominant hand
Occupation and sport requirements
Mechanism and wound characteristics
Mechanism details
Sharp object
Glass
Knife
Saw
Crush
Avulsion
High pressure injection
Bite
Human
Animal
Fight bite
Contamination exposure
Soil
Fresh water
Salt water
Functional deficit history
Function changes
Inability to actively flex a finger
Inability to actively extend a finger
Weakness with flexion
Weakness with extension
Mechanical catching
Loss of grip strength
Neurovascular symptoms
Neurovascular symptoms
Numbness
Tingling
Cold digit
Color change
Persistent bleeding
Onset
Onset
Sudden at injury
Worsening after injury
Provocation/Palliation
Provocation and palliation
Worse with finger motion
Worse with wrist motion
Worse with passive stretch
Better with elevation
Quality
Quality
Sharp
Throbbing
Burning
Electric
Region/Radiation
Region and radiation
Finger
Palm
Dorsum hand
Wrist
Radiation proximally
Severity
Severity
Pain score 0 to 10
Functional limitation
Timing
Timing
Constant
Intermittent with motion
Night pain
Prior care and timing
Prior care
Field irrigation
Prior closure attempt
Prior antibiotics
Time from injury to closure consideration
Immunization and infectious risks
Immunization and infectious risks
Tetanus vaccination date
Rabies risk if animal bite
Blood exposure risk assessment
Alarm Features
Hemorrhage and shock
Hemorrhage risk
Pulsatile bleeding
Expanding hematoma
Soaking dressings despite pressure
Systolic blood pressure under 90 mmHg
Heart rate over 120 beats per minute
Limb ischemia
Ischemia features
Pale digit
Mottled digit
Cool digit
Capillary refill over 2 seconds
Absent Doppler signal
Compartment syndrome and crush risk
Compartment syndrome concern
Pain out of proportion
Pain with passive stretch
Tense compartments
Progressive paresthesia
Open fracture and joint violation
Deep structure violation
Bone exposed
Joint capsule concern
Limited motion due to pain and instability
Infection and rapidly progressive soft tissue disease
Severe infection risk
Fever
Rapidly spreading erythema
Crepitus
Skin necrosis
Flexor tenosynovitis red flags
Flexor tendon sheath infection concern
Fusiform swelling
Finger held in flexion
Tenderness along flexor sheath
Pain with passive extension
Immediate escalation triggers
Escalation triggers
Any ischemia feature with open wound
Suspected arterial laceration
Suspected complete tendon laceration
Suspected joint violation
Fight bite over MCP joint
Medications
Current and recent medications
Medication profile
Anticoagulants
Antiplatelets
NSAIDs
Chronic opioids
Steroids
Biologics
Diabetes medications
Bleeding risk modifiers
Bleeding risk modifiers
Warfarin
DOAC
Aspirin
Clopidogrel
Antibiotic considerations
Antibiotic related risks
Allergy history
Prior MRSA colonization
Recent antibiotics within 90 days
Analgesia and sedation interactions
Interaction risks
Benzodiazepines
Alcohol use with sedatives
QT prolonging medications if planning antiemetics
Diet
Intake and hydration
Intake status
Last oral intake time
NPO status if procedural sedation possible
Alcohol and substances
Substance exposures
Alcohol today
Cannabis today
Stimulant exposure
Wound relevant exposures
Exposure modifiers
Poor nutrition concern
Recent vomiting limiting intake
Review of Systems
Constitutional and infection
Constitutional symptoms
Fever
Chills
Malaise
Hand and upper extremity
Upper extremity symptoms
Increasing swelling
Increasing pain
Redness tracking proximally
Drainage
Neurologic
Neurologic symptoms
Numbness
Weakness
Radiating pain
Cardiopulmonary for procedural risk
Cardiopulmonary symptoms
Chest pain
Dyspnea
Collateral History and Family History
Collateral sources
Collateral
Witness account
EMS report
Photo of object and scene
Family history
Family risks
Bleeding disorder history
Connective tissue disorder history
Household and exposure context
Exposure context
Sick contacts if febrile
Animal vaccination status if bite
Risk Factors
Patient factors affecting healing
Healing risk factors
Diabetes mellitus (E11.9)
Peripheral arterial disease (I73.9)
Smoking
Chronic kidney disease (N18.9)
Immunosuppression
Infection risk by wound type
Wound infection risks
Bite wound
Fight bite
Gross contamination
Delayed presentation over 12 hours
Occupational and functional risk
Functional risk
Manual labor
Need for fine motor precision
Bleeding and thrombosis risks
Hemostasis modifiers
Anticoagulation use
Platelet dysfunction concern
Differential Diagnosis
Life threatening and limb threatening
Life threatening or limb threatening
Arterial laceration
Pulsatile bleeding
Ischemia features
Compartment syndrome (T79.A)
Pain with passive stretch
Tense compartments
Necrotizing soft tissue infection (M72.6)
Rapid progression
Pain out of proportion
Flexor tenosynovitis (M65.9)
Kanavel features present
Fever or systemic symptoms
Common
Common
Simple laceration
No deep structure involvement
Normal tendon function
Partial tendon laceration
Pain with active motion
Weakness with isolated testing
Digital nerve laceration
Two point discrimination abnormal
Sensory loss in nerve distribution
Retained foreign body (Z18.9)
Glass mechanism
Persistent focal pain
Less common and mimics
Less common
Open fracture (S62.9)
Bony tenderness
Deformity
Joint capsule violation
Laceration over joint
Pain with joint range
Central slip injury
PIP extension weakness
Elson test abnormal
Volar plate injury
PIP pain after hyperextension
Instability on exam
Past Medical History
Conditions impacting management
Relevant conditions
Diabetes mellitus (E11.9)
Peripheral arterial disease (I73.9)
Prior tendon injury or repair
Prior hand infection
Prior surgeries and procedures
Prior procedures
Prior hand surgery
Prior vascular repair
Baseline function
Baseline status
Baseline range of motion limits
Baseline neuropathy symptoms
Physical Exam
Vitals and general
General
Fever pattern
Hemodynamic stability
Distress level
Wound inspection
Wound characteristics
Location by digit and surface
Length and configuration
Depth estimate
Contamination
Tissue loss
Nail bed involvement
Hemostasis and vascular exam
Vascular status
Capillary refill each digit
Temperature comparison
Radial pulse
Ulnar pulse
Doppler signal distal to wound
Allen test result
Neurologic exam
Sensation and motor
Two point discrimination
Light touch by digital nerve territories
Thumb opposition
Finger abduction and adduction
Tendon exam flexor
Flexor tendon function
FDP isolated testing
DIP flexion with PIP held extended
Compare to contralateral side
FDS isolated testing
PIP flexion with other digits held extended
Compare to contralateral side
Tendon exam extensor
Extensor tendon function
MCP extension against resistance
PIP extension
DIP extension
Elson test for central slip
Joint and bone assessment
Bone and joint
Point tenderness over phalanges and metacarpals
Rotational alignment with finger flexion
Passive range of motion limits
Infection focused exam
Infection signs
Erythema extent
Warmth
Purulence
Lymphangitic streaking
Pitfalls and subtle findings
Pitfalls
Tendon laceration with preserved motion
Partial tendon laceration with pain only
Nerve injury masked by local anesthesia
Lab Studies
Core labs when indicated
Labs for complications
CBC if systemic infection concern
CRP if deep infection concern
BMP if IV antibiotics planned
Bleeding and anticoagulation context
Coagulation context
INR if warfarin use
Platelets if bleeding concern
Point of care and special populations
Point of care
Glucose if diabetes or altered status
Pregnancy test when relevant before imaging or meds
Limitations
Limitations
Normal labs do not exclude tendon injury
Normal labs do not exclude early deep space infection
Imaging
Scoring Systems
Clinical criteria tools
Kanavel features for flexor tenosynovitis
High pressure injection injury triage as limb threatening
MRI
MRI use cases
Occult tendon discontinuity when exam limited
Deep space infection extent when unclear
Contraindications
Non MRI compatible device
Metallic foreign body in eye risk
CT
CT use cases
Occult fracture when radiographs equivocal
Radiopaque foreign body localization if complex
Contrast cautions
Prior severe contrast reaction
Severe chronic kidney disease
Ultrasound
Ultrasound and POCUS
Tendon continuity assessment
Dynamic exam with active motion
Foreign body detection
Pitfalls
Small superficial foreign bodies can be missed
Operator dependent accuracy
Special Tests
Bedside tendon and ligament tests
Tendon and ligament tests
FDP isolation test
FDS isolation test
Elson test for central slip injury
Mallet finger assessment
Neurovascular bedside tests
Neurovascular tests
Two point discrimination threshold documentation
Allen test
Doppler evaluation of digital arteries
Deep structure violation tests
Deep structure tests
Saline load test for suspected joint penetration local protocol dependent
Exploration under adequate anesthesia and tourniquet control
ECG
Indications in this presentation
ECG indications
Age over 40 with sedation planned
Known cardiac disease with sedation planned
Abnormalities impacting sedation choice
Sedation relevant patterns
Significant bradycardia
Tachyarrhythmia
Ischemic changes
Assessment
Problem representation
Injury summary
Hand laceration with tendon injury concern (S61.4)
Location and suspected tendon zone
Severity and risk stratification
Severity stratification
Complete tendon laceration suspected
Partial tendon laceration suspected
Neurovascular injury suspected
Contaminated wound or bite wound
Complications to exclude
Must exclude
Joint violation
Open fracture
Retained foreign body
Flexor tenosynovitis if infectious features
Key supporting features
Supporting features
Mechanism consistent with deep injury
Exam showing isolated tendon weakness
Sensory deficit consistent with digital nerve injury
Plan
First 5 minutes
Immediate stabilization
Direct pressure for bleeding
Tourniquet use if uncontrolled bleeding and brief duration
IV access if ongoing bleeding or need for sedation
Analgesia early
Wound anesthesia and exploration
Exploration strategy
Digital nerve block with local anesthetic
Avoid epinephrine in poorly perfused digit
Irrigation volume based on contamination
Visualization through full range of motion
Tendon injury management
Tendon injury pathway
Suspected complete tendon laceration
Hand surgery consult in ED
Splint immobilization position based on tendon group
Suspected partial tendon laceration
Avoid bedside tendon repair if uncertain depth
Urgent hand surgery follow up within 24 to 72 hours
Neurovascular injury management
Neurovascular pathway
Digital nerve laceration suspected
Early hand surgery referral
Sensory mapping documentation pre anesthesia when possible
Arterial injury suspected
Immediate hand surgery consult
Warmth and elevation while awaiting definitive care
Imaging and testing sequence
Diagnostic sequencing
Radiographs if foreign body concern
Ultrasound if tendon continuity unclear
Antibiotics and tetanus
Antibiotic strategy
Clean simple laceration without deep injury
No antibiotics routine
Consider if high risk host
Bite wound or gross contamination
Amoxicillin clavulanate PO 875 mg twice daily
Duration 3 to 5 days prophylaxis local protocol dependent
Penicillin allergy option local protocol dependent
Doxycycline PO 100 mg twice daily
Add metronidazole PO 500 mg twice daily if anaerobe coverage needed
Tetanus prophylaxis
Unknown or incomplete vaccination and dirty wound
Tdap
Tetanus immune globulin per local protocol
Up to date vaccination
Booster timing based on wound type
Closure and immobilization
Closure considerations
Delayed primary closure if heavily contaminated
Avoid tight closure if swelling expected
Splinting
Suspected flexor tendon injury
Dorsal blocking splint
Wrist flexion and MCP flexion position per hand surgery protocol
Suspected extensor tendon injury
Extension splinting across involved joint
Maintain joint alignment
Reassessment loop
Reassessment
Neurovascular recheck after anesthesia and after splint
Pain reassessment within 30 to 60 minutes
Bleeding reassessment after closure and dressing
Disposition
Admit and OR pathway
Admission or urgent OR
Arterial injury requiring repair
Open fracture
Joint violation requiring washout
Flexor tenosynovitis concern
High pressure injection injury
Observation pathway
Observation
Uncertain tendon injury with high functional risk
Pain control requiring parenteral meds
Discharge criteria
Discharge criteria
Hemostasis achieved
Normal perfusion
No concern for complete tendon laceration requiring immediate repair
Reliable follow up within 24 to 72 hours
Splint and dressing tolerated
Follow up timing
Follow up
Hand surgery within 24 to 72 hours for tendon or nerve concern
Wound check in 2 days if high risk wound
Suture removal timing by location
Hand and fingers often 10 to 14 days local protocol dependent
Palm often 14 days local protocol dependent
Discharge Instructions
Copy discharge instructions
Summary
You have a cut on your hand that may involve deeper structures like tendons that move the finger
Your hand has been cleaned and dressed and may be splinted to protect healing
Wound care
Keep the dressing clean and dry for 24 hours
After 24 hours gentle soap and water around the wound
No soaking in a bath pool or hot tub until healed
Splint care
Keep the splint on at all times unless told otherwise
Do not test finger strength against resistance
Medications
Take pain medicine as directed
If antibiotics were prescribed take all doses as directed
Follow up
Hand specialist follow up within ___ days
Wound check within ___ days if instructed
Return to ED now for
Finger becomes cold pale or blue
New numbness or worsening numbness
Increasing pain not controlled with medication
Increasing swelling redness warmth or pus
Fever
Bleeding that does not stop with 10 minutes of firm pressure
References
Guidelines and core sources
Key references
CDC Tetanus prophylaxis guidance 2024
IDSA Skin and soft tissue infections guideline 2014
American Society for Surgery of the Hand acute hand injury resources 2023
British Society for Surgery of the Hand standards for hand trauma care 2020
AAOS management of open fractures and antibiotic prophylaxis resources 2022
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.