Let me be direct about the myth first: the ability to move a finger does not rule out a fracture. I see broken fingers with preserved range of motion regularly. The confusion comes from the fact that a mild fracture with intact tendons and ligaments can still allow the finger to bend and straighten — painfully, but mechanically. What movement tells you is whether the tendons are working, not whether the bone is intact. These are two different questions, and conflating them leads to delayed treatment and avoidable complications.

A jammed finger is typically a ligament or soft tissue injury at one of the finger joints, most often the PIP — the middle knuckle. These are common in sports, extremely common in ball sports, and the majority of them are genuinely no big deal. Buddy taping, ice, and early gentle movement is the right approach for a straightforward sprain, and most people are functionally back to normal within a few weeks. The injury I don't want you to miss is a volar plate injury — the strong ligament on the palm side of the PIP joint — which, if left untreated in a certain position, can lead to a swan-neck deformity that is much harder to correct later than to prevent early.

The drooping fingertip — what we call a mallet finger — deserves special mention because it is time-sensitive. If the extensor tendon that holds the fingertip up has been disrupted, continuous splinting in extension for six to eight weeks is the treatment. Miss that window and the deformity becomes fixed. If your fingertip droops and you cannot actively straighten it after a finger injury, that is a same-day evaluation.

Carpal tunnel syndrome is one of the most common conditions I treat, and it is also one of the most commonly self-diagnosed — usually incorrectly. The hand going numb at night gets labeled carpal tunnel, the wrist aching after typing gets labeled carpal tunnel, the fingers feeling stiff in the morning gets labeled carpal tunnel. Some of those are accurate. Many are not. What I want to give you today is a single clinical test that is more sensitive and more specific than any other physical exam maneuver for carpal tunnel — one that you can perform at home before you ever come see me.

The test is called Durkan's compression test, and the technique is straightforward. Place your opposite thumb directly over the center of your wrist crease — the soft hollow in the middle where your wrist bends. Apply firm, steady pressure there and hold it for thirty seconds. If you develop tingling or numbness in your thumb, index finger, or middle finger during those thirty seconds, that is a positive test. Those three fingers are the distribution of the median nerve, the nerve compressed in carpal tunnel syndrome. Symptoms in your ring and little finger point elsewhere — toward the ulnar nerve, which we covered in Issue 1.

A positive Durkan's test is not a diagnosis. It is a strong clinical signal that warrants a proper evaluation, which typically includes nerve conduction studies to confirm the diagnosis and assess severity before any treatment decisions are made. What it does give you is something valuable: an informed reason to seek that evaluation rather than continuing to wonder whether your nighttime hand numbness is something or nothing. In my experience, people who understand their own symptoms come to appointments better prepared, ask better questions, and make better decisions about treatment. That is the entire point of this column.

Last week I introduced this column by saying that the injuries I treat most often are predictable failures — not freak accidents. This week I want to make that concrete with the category I see most consistently overlooked: footwear. I am not talking about athletic performance. I am talking about the basic mechanical interface between a person and whatever surface they are standing on, and how often that interface is chosen based on appearance, habit, or price rather than any meaningful assessment of the environment.

Consider what I actually see in the operating room as a consequence of footwear failures. Wrist fractures from falls on wet dock surfaces — the same FOOSH mechanism we discussed last week — where the deck was slippery and the footwear had no grip pattern suited to wet conditions. Hand lacerations from fishing deck falls. Ankle fractures from river crossings in footwear with smooth soles. The upper extremity bears the brunt of fall trauma because we throw our hands out instinctively to protect ourselves, which means every fall prevention conversation is also a hand and wrist injury prevention conversation. That is not abstract. That is my patient panel.

The Alaska trip puts this in sharp focus for me because the environments we will move through — wet boat decks, river approaches for fly fishing, glacier terrain, rain-slicked boardwalks — each present a distinct traction and stability challenge. There is no single footwear solution that addresses all of them, which is itself a planning consideration. What I am thinking through for our family is not which brand to buy, but which properties matter in each environment: sole compound and lug pattern for wet rock, ankle support versus mobility trade-offs for uneven terrain, and the specific question of how sole performance degrades when it is wet versus dry. These are engineering questions before they are product questions. I will keep working through them here over the coming weeks as the departure date gets closer.