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Acute joint injuries of the hand.

The joints of the hand are stabilized by articular contours, tough ligamentous structures, and dynamically by a system of flexor and extensor tendons. Disruption of a joint seriously reduces the ability of the hand to function properly. The history and especially a detailed description of the mechanism of injury is invaluable information for the diagnosis and for the ability to anticipate complications. Radiographic evaluation is required for virtually all potential injuries. Multiple views and especially a true lateral view of the digit, when appropriate, are usually sufficient. The clinical examination includes the evaluation of (1) deformity, (2) swelling, (3) tendon and neurovascular status, (4) tests for stability, and (5) active and gentle passive range of motion. The most important aspect of treatment is the ability to distinguish between injuries that require surgery and those that can be splinted and referred for follow-up. In general a near full range of active motion indicates joint congruity, and the injury can be treated by splinting and referral to a hand surgeon.