The Hand Surgery Primer is an educational tool for students interested in evaluating, diagnosing, and treating conditions affecting the human hand. This  free online educational opportunity has been carefully designed for junior residents in Orthopaedics, Plastic Surgery, Family Medicine, Pediatrics, Internal Medicine, and clinicians in other disciplines that encounter, manage, or refer patients with hand complaints. The Primer is also very helpful for medical students, physician assistants (PA), PA students, nurse practitioners, nursing students, physical therapists, occupational therapists, hand therapists, therapy students, and hand surgery educators, among others.

The Hand Surgery Primer is based on 8 mock patients with common hand complaints. Each mock patient’s case study is based on a specific complaint and its differential diagnosis. There are pre-tests, post-tests, and test scoring for each patient. The differential diagnosis for each mock patient is revealed after the pre-test. The Diagnostic Guides explain each of the 26 common hand diagnoses that make up the eight differential diagnoses. After students study the detailed content in the Diagnostic Guides, the exam explanations, and the Diagnostic Study Guide for each work-up tool, they have an opportunity to take a post- test. All tests are graded automatically. The test review includes question feedback with the correct answer, and explanation of the answer, and an active link to appropriate back-up content in the guides.

Each Diagnostic Guide explains the diagnosis, related anatomy, pathological factors, incidence, typical history, presenting symptoms, and classic physical exam findings (Figure 1). Also included is a discussion of potential work-up studies (eg, X-rays), conservative and surgical treatment options, potential complications, and treatment outcomes. Each Diagnostic Guide ends with a review of the key educational points and references, with PMID links where possible.

The Diagnostic Guides are enriched with more than 300 clinical photos, treatment photos, diagrams (Figure 2), videos and an example of positive imaging studies. 

The 78 Physical Exam sections thoroughly explain each exam, test, and sign and provide an historical overview, description of the exam, related pathophysiology, instructions for performing the exam, exam variations, related signs, test sensitivities, definitions of positive and negative results, pearls, and references. The sections are highlighted with more than 250 clinical photos, treatment photos, diagrams and videos.

The 15 Diagnostic Studies section provides in-depth descriptions of each work-up option and reviews how X-ray, electromyography (EMG)/nerve conduction velocity (NCV) studies, laboratory blood tests, magnetic resonance imaging (MRI), and other investigations are used to establish and support the diagnoses. The Work-up Studies sections review background material and history of the procedures, describe the work-up studies, and link back to the diagnoses where these investigations are most useful. Pearls and references are also available. The work-up sections are also supported by diagrams, tables and samples images from X-ray, MRI, and ultrasound studies.

This online teaching tool was built and edited by Dr. Larry Hurst and Dr. Samantha Muhlrad, with help from our team of consultants. This educational Web site has been sponsored by Hand Surgery Resource, LLC and donated to the University at Stony Brook, which hosts the Web site at: http://www.handsurgeryprimer.org.

Our team hopes you will find this free educational resource to be useful, and that you will take some time to use and review it. Our team appreciates your feedback!  Please pass information about the Primer along to your colleagues and team members. On the Web site, you can get your own user name and password using our 3-step sign-up process. This process helps protect the site from hackers.

Thank you for taking time to learn about our exciting new educational project!

Lawrence C. Hurst, MD
Professor and Chairman
Orthopaedics Department
University at Stony Brook
CEO - Hand Surgery Resource, LLC

If there are any problems or question, please email me at: LCHurst100@gmail.com.