Hand Injury: Symptoms, Types and Treatment

First aid for a hand injury

1. Stop bleeding: press firmly with a clean cloth and raise the hand above heart level.
2. Remove rings and watches right away, before swelling makes this impossible.
3. Rest, ice and elevate: wrap ice in a cloth and apply for 15 to 20 minutes every 2 to 3 hours for the first 48 hours. Keep the hand raised on pillows.
4. Splint: support an obviously injured finger or hand in a comfortable position with a padded rolled magazine or a sling. Do not try to straighten a deformed finger.
5. Clean minor cuts under running water and cover with a sterile dressing.

Symptoms of a hand injury

• pain at a specific point, especially pain directly over a bone
• swelling and bruising, which can spread across the back of the hand
• deformity, such as a finger pointing the wrong way or a knuckle that looks sunken
• scissoring: fingers crossing over each other when you make a fist, a sign of a rotated fracture
• numbness or tingling, suggesting nerve damage
• a finger that cannot bend, straighten or grip normally, suggesting tendon injury
• a pale or cold finger, suggesting blood vessel damage

A swollen hand after a wrist injury is common. But pain in the snuffbox (the hollow at the base of the thumb) after a fall on the outstretched hand suggests a scaphoid fracture, which is easily missed on first X-ray.

Types of hand injury

Open finger injuries

An open finger injury is one where the skin is broken over a fracture, or a cut reaches tendon, nerve or bone. If bone shows through the skin, it is an open fracture and needs ER care for washout, antibiotics and repair. Bones in open injuries can still heal well, but infection is the main risk, so do not delay treatment. Nail bed injuries often need repair to help the nail grow back normally.

How doctors diagnose hand injuries

The doctor checks:

• where it hurts and how it happened (a punch, a fall, a cut, a crush)
• whether each finger can bend and straighten at each joint against resistance
• sensation on both sides of each fingertip, and two-point discrimination for nerve injury
• blood flow (color, warmth, capillary refill)
• finger alignment when you make a fist

X-rays from at least two angles show most fractures and dislocations. Ultrasound or MRI can show tendon and ligament injuries. A CT scan helps with complex wrist and joint fractures.

Treatment

• Buddy taping: taping an injured finger to its neighbor supports stable fractures and sprains.
• Splints and casts: most hand fractures heal in 3 to 6 weeks in a splint. Mallet finger needs a splint worn continuously for 6 to 8 weeks.
• Reduction: realigning a dislocated joint or displaced fracture, usually after local anesthetic.
• Surgery: with pins, plates or screws for unstable or rotated fractures, and for repairs of tendons, nerves and arteries. Cut flexor tendons are usually repaired within days.
• Wound care: washing out, stitches, a tetanus booster if needed, and antibiotics for bites or contaminated wounds.
• Pain relief: over-the-counter pain relievers such as ibuprofen or acetaminophen (paracetamol), following the label dose.
• Hand therapy: guided exercises to restore movement. Stiffness is the most common long-term problem after hand injury.

Complications

• stiffness and loss of grip strength
• malunion (a bone healing out of line), causing crossing fingers
• infection, especially after bites and open injuries
• nerve damage with lasting numbness
• complex regional pain syndrome, with burning pain, swelling and color changes out of proportion to the injury
• arthritis in a damaged joint years later

Frequently asked questions

What are the symptoms of a broken hand?

Pain over a bone, swelling, bruising on the back of the hand, difficulty making a fist and sometimes a sunken knuckle or fingers that cross when you curl them. You may still be able to move the hand, so movement does not rule out a fracture. An X-ray confirms it.

How do I know if a hand injury is serious?

Get urgent care for deformity, a finger that cannot bend or straighten, numbness, a pale or cold finger, heavy bleeding, a bite that broke the skin, or bone showing. Severe swelling or pain that worsens over hours also needs prompt review.

Why is my hand swollen after a wrist injury?

Swelling spreads into the hand because the back of the hand has loose tissue and fluid collects there with gravity. It can come from a sprain, but persistent pain at the base of the thumb or over the wrist bones needs an X-ray to check for a scaphoid or wrist fracture.

Can an open finger injury heal with bone showing?

An open fracture can heal, but it needs emergency care for cleaning, antibiotics and often surgery to fix the bone and close the wound. Without that, the risk of bone infection is high. Cover it with a clean damp dressing and go to the ER.

How long does a hand injury take to heal?

Minor sprains improve in 1 to 2 weeks. Most fractures heal in 3 to 6 weeks, but stiffness and grip strength can take 2 to 3 months to recover. Tendon repairs need about 12 weeks of protected rehabilitation.

Should I see a doctor for a jammed finger?

Yes if the finger is deformed, cannot bend or straighten fully, the fingertip droops, or pain and swelling persist beyond a few days. A jammed finger can hide a small fracture or tendon injury that heals poorly without a splint.