Kevin D Plancher

History and Clinical Presentation

A 20-year-old right hand dominant male laborer caught his left hand in a circular saw with the "guard" off. He has a laceration to his left index finger and can't feel the tip of his finger, and has an open bleeding wound.

Physical Examination

On physical examination, the patient has an acute open laceration involving the radial side of the right index finger. A careful motor examination was performed. The functioning level of specific muscles is determined to assist with identifying peripheral nerve injuries. A two-point sensory discrimination test (Fig. 20—1), as determined by the Weber two-point discrimination test, using a dull pointed eye caliper applied in the longitudinal axis of the digit without blanching the skin, and a two-point discrimination (2-PD) (both moving and static), Semmes-Weinstein monofilaments, and vibrometer tests were used to assess the status of the nerves. Denervated skin responds differently to stimuli; when the injured hand is placed in water, innervated skin wrinkles and denervated skin does not. This test can be helpful in determining the affected peripheral nerves in the hand in unconscious patients.

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