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Suspected dorsal hand extensor tendon laceration — MSRA MCQ

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HardSoft Tissue InjurySuspected dorsal hand extensor tendon lacerationMSRA

A 38-year-old right-hand-dominant violinist attends a GP-led urgent treatment centre 3 hours after a wine glass shattered while he was gripping it. He sustained a 1.5 cm oblique laceration on the dorsum of the right hand, 1 cm proximal to the fourth metacarpophalangeal joint. His fingers were flexed around the glass at the time of injury. The wound is clean and continues to ooze slightly after irrigation. Its base cannot be visualised. He has full active extension of all fingers, including the ring finger, and normal finger flexion. Sensation, capillary refill and radial pulse are normal. Hand radiographs show no fracture or radiopaque foreign body. Tetanus immunisation is complete. There was no bite injury. What is the most appropriate management now?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Irrigate the wound, apply a non-adherent dressing and protective extension splint, and arrange same-day hand surgical assessment

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · B = shown as D

This is a suspected extensor tendon laceration in the dorsal hand. The mechanism and wound position are important: because the hand was clenched at injury, the tendon may have been displaced relative to the skin wound. A normal radiograph excludes a radiopaque foreign body or fracture but does not assess tendon integrity. Full active extension does not safely exclude a complete extensor tendon injury. Interconnections between extensor tendons (juncturae tendinum) can permit apparent extension despite division of an individual tendon. The wound base is not visible, so tendon injury cannot be excluded by local inspection. UK hand-injury guidance advises that a cut extensor tendon requires repair and splintage; suspected open tendon injuries therefore require urgent specialist assessment. A and C are unsafe because primary closure and delayed review risk postponing definitive exploration and repair. D may be appropriate for selected closed or confirmed partial tendon injuries managed non-operatively, but not for an open injury in which tendon division remains possible. E does not address the principal structural concern; there is no bite or contamination history to make antibiotic treatment the key management decision.

Reference: HAND INJURIES (December 2024) — https://www.rightdecisions.scot.nhs.uk/media/jujp5l25/hand-injuries-dec-24.pdf The diagnostic accuracy of clinical examination in hand lacerations (2007) — https://pubmed.ncbi.nlm.nih.gov/17448974/