Finger dislocations

[Apollyon]

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If there's no fracture, do you do a digital block before relocating them? I don't - I just tell them that there will be pain with a digital block while it's being placed, and there will be pain without it - each one is about 15 seconds.

What's your practice (as I assume you don't have ortho residents on-call to come down and put them back in)?

Thanks!

 

[Stitch]

I generally do a finger block, but I'll give a choice to older (more mature) patients.

 

[BADMD]

If there's no fracture, do you do a digital block before relocating them? I don't - I just tell them that there will be pain with a digital block while it's being placed, and there will be pain without it - each one is about 15 seconds.

Depends on the patient. I generally block them. Then again, many of my patients actually ask for sedation and pain meds before the IV insertion.

 

[EctopicFetus]

I block them in case the relocatoin is difficult. i have on occasion done without if the patient wants this. They def do not get an IV lol..

 

[docB]

I block 'em.

 

[leviathan]

FWIW, I dislocated my finger when I was a kid and the doc did a block first. The needle going into my finger hurt like hell, but I don't suppose relocating it without a block would have felt any better.

 

[EvoDevo]

I've found that it's always the ones I don't block who end up having the difficult relocation. I block.

 

[DrMom]

I dislocated my thumb and reduced it myself without a block. Hurt like hell, but so did having it dislocated.

I've had a digital block for a toenail injury. It hurt as well, but I was glad to have it for something that was going to take longer to deal with.

All that said, I almost always block.

 

[WilcoWorld]

As stated above, I block, because I'm never sure who will need multiple attempts.

Also, patients seem more accepting of the pain of a block then the pain of my wrenching on their finger. And when it comes to issues of minor to moderate pain, patient perception plays a huge role.

 

[Arcan57]

I give the option of blocking versus just reducing. They always choose the block.

 

[kungfufishing]

marcaine block. figure it will not only help for the procedure but might provide some persistent relief afterwards if they were going to be sore otherwise.

 

[docB]

marcaine block. figure it will not only help for the procedure but might provide some persistent relief afterwards if they were going to be sore otherwise.

Yeah I use marcaine too. It should last longer.

I use a lot of marcaine. When you're really busy, especially if you're single coverage you wind up running into the room, numbing something up, going off to do other things and then going back for the procedure. The good thing about having to do that is it gives the anesthesia enough time to set up. I think that most of us don't give it enough time. Injecting something and sticking it 20 seconds later is not enough time. 2-3 minutes at least is more reasonable. The marcaine takes longer to work but it usually wind up giving it 10+ minutes anyway. And with marcaine if I get stuck in a code or something and I don't get back for an hour it's no big deal.

 

[RandomAttending]

I try to pop 'em in. If they are easy, this is painless. If there is the least bit of resistance, pain, difficulty, etc. then I block and relocate.

 

[kungfufishing]

Yeah I use marcaine too. It should last longer.

I use a lot of marcaine. When you're really busy, especially if you're single coverage you wind up running into the room, numbing something up, going off to do other things and then going back for the procedure. The good thing about having to do that is it gives the anesthesia enough time to set up. I think that most of us don't give it enough time. Injecting something and sticking it 20 seconds later is not enough time. 2-3 minutes at least is more reasonable. The marcaine takes longer to work but it usually wind up giving it 10+ minutes anyway. And with marcaine if I get stuck in a code or something and I don't get back for an hour it's no big deal.

This is how I practice as well. I almost never use lidocaine.

 

[Janders]

2/3 No block, 1/3 block.... it just depends on the patient.

 

[EctopicFetus]

Funny enough I have had it personally done each way. Honestly it doesnt hurt that bad having it relocated.

The first time i had a ER doc (when i was an undergrad) offer to block it and i was chicken so i did.

The 2nd time we were playing in a resident bballl tourney and we happened to have an ortho attending on our team.. he put it back in for me. 🙂

It was quick and didnt hurt one bit from what I recall but i literally had it reduced within 10 seconds of the dislocation.

 

[dchristismi]

I usually offer to numb it up first, or I could just pop it back in. The two cases I can think of off the top of my head, both said "just do it." Both were very happy with their decisions, and one (a sweet little old lady) gave me a hug and a big kiss on the cheek. (And then I had to go wash off the old-lady lipstick 😀 )

Ay resistance or trouble, and I'd block without hesitation. I guess I've just been lucky.

 

[spyderdoc]

I generally block 'em.

 

[CommunityED]

I offer the block, especially in someone who there might be a back up to go get XRayed

 

[overthebars]

Gets the anxious patients to relax. By the time it wears off they probably only need Motrin.

 

[Jeff698]

I generally block also (with bupivicaine) but have, on occasion, popped 'em back in. I've done this in triage when we have a full house and even on the EMS stretcher. It's always fun to hand them discharge instructions while still on the stretcher. 🙂

Take care,
Jeff

 

[Scrantoncity]

I usually block for finger dislocations, d/w the patient. One advantage of blocking is that you get a better exam, pick up on subtle tendon or ligamentous injuries. If there is a laceration component, I always block so that I don't miss a partial tendon laceration, i.e., eliminate the pain component.

 

[Homunculus]

If there's no fracture, do you do a digital block before relocating them? I don't - I just tell them that there will be pain with a digital block while it's being placed, and there will be pain without it - each one is about 15 seconds.

What's your practice (as I assume you don't have ortho residents on-call to come down and put them back in)?

Thanks!

while deployed in iraq, i would relocate it during my exam. we had some PA's that would (i kid you not) sedate these guys🙂confused:) and then realize later a block would have worked fine. i guess dislocation = sedation or something. anyway, i had good luck with either making it "part of my exam" or telling them it would be painful either way-- kind of like getting a few staples vs the sticks of using lidocaine.

it's not really relevant to the conversation because those guys 1) actually think pain is funny, 2) usually have buddies with them so they try to keep the "macho" thing going, 3) aren't exactly piano players or anything and 4) aren't going to sue you.

--your friendly neighborhood ex battalion "surgeon" (back in clinic now) caveman

 

[EMMD2009]

I dislocated my 5th finger MCP 2 weeks ago playing basketball. It didn't hurt much at all. It felt like a jammed finger; no worse. Fortunately, I was playing with other EM interns and one of them relocated it. Obviously no anesthesia at the YMCA. So there was no pain with the traction until I felt a quick sharp pain, and then I reflexively jerked back just a little bit 2/2 to the pain and that with the traction was enough to pop it back in place. It remains sore today 2 weeks later, but all in all it never hurt much.

Maybe not using blocks would be helpful because then pts could apply counter traction like I did. 🙂

 

[WilcoWorld]

I dislocated my 5th finger MCP 2 weeks ago playing basketball. It didn't hurt much at all. It felt like a jammed finger; no worse. Fortunately, I was playing with other EM interns and one of them relocated it. Obviously no anesthesia at the YMCA. So there was no pain with the traction until I felt a quick sharp pain, and then I reflexively jerked back just a little bit 2/2 to the pain and that with the traction was enough to pop it back in place. It remains sore today 2 weeks later, but all in all it never hurt much.

Maybe not using blocks would be helpful because then pts could apply counter traction like I did. 🙂

Also, a digital block wont anesthetize the MCP, since it's distal to the joint.