Mechanism of injury (sharp, blunt, or avulsion)

The position of the hand at the time of injury (flexed vs. extended position)

Numbness or tingling (question whether patient had local anesthetic injected)

Significant bleeding at time of injury

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  Suggests arterial and digital nerve injury

Time elapsed since injury (e.g., 2 days vs. 2 months)

Right hand dominant versus left hand dominant

Any additional or associated injuries

Occupation and hobbies

Prior injuries or associated medical problems especially to hands

Comorbidities and social history (drug/alcohol abuse)

Resting cascade of the hand: Interphalangeal joints should maintain flexion with arc increasing as examination moves ulnarly

Tenodesis (especially important to check with child/obtunded patient)

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  Passive wrist extension results in flexion of the fingers

  
  
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  Lack of flexion of the lacerated finger demonstrates discontinuity of flexor tendons

Level of laceration and likely zone of injury (e.g., laceration over center of middle phalanx, likely zone 1 and flexor digitorum profundus [FDP] only repair)

Separately assess active flexor action for all fingers

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  Flexor digitorum superficialis (FDS): The examiner maintains other digits in extension while attempting flexion of injured finger to isolate the FDS

  
  
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  FDP: The examiner maintains the PIP in extension while attempting flexion of the DIP

  
  
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  Flexor pollicis longus (FPL): In the setting of an injured thumb/palm, the examiner maintains the metacarpophalangeal joint (MCP) in extension while attempting flexion of the interphalangeal joint (IP)

Sensibility: Radial and digital nerve injuries

Perfusion of the digit: Absence of perfusion would prompt emergent intervention

Standard three-view X-rays (anteroposterior, lateral, and oblique) of the hand should be obtained to assess for fracture or foreign bodies