Ultrasound-Guided Forearm Nerve Block For Examination And Repair Of Hand Injury Sustained From Motorbike Racing

HISTORY: 33-year-old male with no past medical history who sustained a right-hand injury during a motorbike racing accident at approximately 40 miles per hour. The patient lost control of his motorbike, was expelled from the motorbike, and he himself flipped over multiple times, sustaining injuries to bilateral knees and right hand. The patient was able to ambulate after the accident but had difficulty moving his right hand and fingers. PHYSICAL EXAMINATION: Examination revealed a moderately deep muscular laceration running across the palmar aspect of his right hand with decreased range of motion in his finger and wrist. Sensation was diffusely intact to light touch distal to injury, and the hand appeared well perfused with a normal radial pulse. DIFFERENTIAL DIAGNOSIS: Hand Laceration, Hand Fracture, Tendon Laceration, Hand Sprain. TEST AND RESULTS: Right Hand X-Ray: Fifth metacarpal and hamate non-displaced fracture, associated with soft tissue injury. Ultrasound: Right arm’s ulnar and median nerve identified. After the nerve block, anesthetic was seen encircling the nerves. FINAL WORKING DIAGNOSIS: Right hand laceration, Fifth metacarpal and hamate fracture. TREATMENT AND OUTCOMES: The patient was originally planned for an extensive washout and probing of the injury in the OR due to concerns of tendon rupture and inability to properly evaluate, clean and repair the injury at bedside due to the discomfort associated with the procedure. However, after an ultrasound-guided nerve block of the ulnar and median nerve, the patient was able to tolerate washout and injury assessment at bedside without complications. Once his pain was relieved, the patient obtained full range of motion in his fingers. Injury probing did not reveal any tendon or bone exposure. His initial decreased range of motion was then attributed to pain. The laceration was copiously irrigated and sutured with approximately 30 stitches. The fractures were treated with an ulnar gutter splint. The patient was discharged with antibiotics and followed up with orthopedic surgery as an outpatient. Injuries crossing multiple dermatomal and peripheral nerve distributions are commonplace in sports and treatment can involve nerve blocks at bedside.