Melbourne Hand Surgery 

Coronavirus update: We will be closed on Wednesday 8 April, but will reopen at 8:30am on Thursday 9 April. 

Melbourne Hand Surgery has mechanisms to protect our patients and staff while we continue to provide healthcare services. All consultations are now conducted via telehealth (phone or videoconference), except where we have previously confirmed the requirement for an in-person physical examination or wound care management.  Only emergency surgery is being conducted in hospitals for the foreseeable future, in keeping with Government directives. 

Due to the change in circumstances we will be closed on Fridays until further notice. If our practice is unable to physically open for business at any point in the coming weeks or months we will communicate this to existing scheduled patients via email and SMS (please do not attempt to reply other than with Y or N to an SMS, as the automated system does not facilitate this). Incoming telephone calls and receipt of voicemail messages may be temporarily affected by such a change. We will use this website banner to update you on changes to our practice and the availability of non-urgent procedures and surgery in the weeks and months ahead. Thank you for your understanding as our entire community works through these unprecedented and rapidly evolving times together (last updated: 4 April 2020).

Finger and hand lacerations

It's not necessary to see a hand surgeon or a specialist surgeoncooking cutting eggplant for a truly simple finger or hand laceration. But if you've cut yourself in the kitchen or the shed how do you know whether your laceration is simple or if something deeper might be injured? Should you see a doctor? Should your doctor refer you to a specialist?

It can be difficult to answer these questions, because a partial injury to a tendon usually won't stop you moving your finger, and you can completely sever one (or sometimes even both) of the two arteries in your finger without any clear signs. However, these injuries can affect your long term function - for instance a tendon that is partially may rupture, and injured arteries can lead to later cold intolerance. If you or your GP or emergency doctor have any concerns about what injury might lie beneath the skin it is best to see a specialist. If you need your hands - and most people do - it's always better to have your injury properly explored and treated than to leave things to luck or chance.

Bleeding fingerYou definitely should see a doctor, and ideally seek referral to a specialist, if you have:

  • tingling in the tip or on one side of the finger - this may indicate nerve injury, especially if it persists more than 24 hours
  • a different sensation between the skin of the injured finger and the skin of the adjacent uninjured finger - this may indicate nerve injury, especially if it persists more than 24 hours
  • a ragged, deep or dirty wound, especially one that was caused by an animal or human bite 
  • increasing redness, pain and swelling around the wound - this suggests infection
  • a finger that doesn't straighten or bend where it used to straighten or bend - this may indicate a complete tendon injury
  • fallen on glass or a sharp object - usually when the injury occurs in this way the injury goes down to the bone. The same applies to injuries that occur when a ceramic cup or bowl breaks in your grasp.
  • a medical condition that puts you at increased risk of complications, such as diabetes, immunosuppression or conditions that affect the blood flow to your hand
  • a suspicion that something is inside the wound, such as a splinter or piece of glass
  • concerns or a feeling that something is just not right

What will my GP or emergency department do?

firstaidstation 186x200For most hand injuries an X-ray is performed to check for bone damage, severe tendon damage or foreign matter in the wound. If your tetanus immunisation is not up to date your GP or emergency department will be able to correct this.

Washing out the wound thoroughly reduces the risk of infection. This is often done after local anaesthetic is injected to make the area numb. Your doctor may suture the wound (stitches) or leave it open. A simple dressing will be applied - preferably a non-stick one, so that it can be removed in the future without hurting you. For clean injuries (like cut from a clean knife) antibiotics are not required, but they should be given for bite injuries and when there is a broken bone with a cut. A plaster splint is often made to immobilise your finger or hand; this reduces pain and swelling by keeping your injury still. Most people have minimal pain when their injury is immobilised, so pain medications like paracetamol or ibuprofen are usually sufficient. You will be given instructions to keep your hand elevated at or above the level of your heart, which is often easier with a sling.

Your doctor will make an assessment of the likelihood of infection or deeper injury to the structures in the fingers. If there is any doubt you will be referred to a specialist surgeon for treatment.

I was told that it was "nothing", but my hand is still swollen and sore. Should I see a specialist?

happy man on phone striped shirtOften fingers and hands remain swollen for much longer than you may expect after a simple injury, even if there is no infection. Early treatment and specialist advice regarding dressings, mobilisation, swelling control and elevation can get you back to best earlier. If you are having problems or concerns it's entirely reasonable to seek medical attention - your hands are important, so see your GP and ask if you should visit Melbourne Hand Surgery.

FRACS

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