ABSTRACT
The border digits are injured most often, with most injuries occurring to the distal phalanx, metacarpal, followed by proximal then middle phalanges. The thumb produces the same movements; however, it has been internally rotated by 90, so care should be taken in describing these movements. The thumb is assessed with the hand supinated to a neutral position, resting on its ulnar border; the same process is followed as for the other digits. Assessment of movement starts with simple screening: If interphalangeal joint (IPJ) flexion is limited, the most common cause is either post-traumatic scarring of the extensor tendons or secondary contracture of the involved IPJ capsule or intrinsic hand muscle resulting in excessive tension on the extensor tendons. Systematic palpation of bones and joints should be undertaken, assessing the range of movement and stability in each and focusing on areas of tenderness, swelling or deformity. Volar dislocations almost always damage the volar plate, collateral ligaments and central slip.
