Health Library Finger, Hand, and Wrist InjuriesFrom Healthwise

At one time or another, everyone has had a minor injury to a finger, hand, or wrist that caused pain or swelling. Most of the time our body movements do not cause problems, but it's not surprising that symptoms develop from everyday wear and tear, overuse, or an injury.

Finger, hand, or wrist injuries most commonly occur during:

• Sports or recreational activities.
• Work-related tasks.
• Work or projects around the home, especially if using machinery such as lawn mowers, snow blowers, or hand tools.
• Accidental falls.
• Fistfights.

The risk of finger, hand, or wrist injury is higher in contact sports, such as wrestling, football, or soccer, and in high-speed sports, such as biking, in-line skating, skiing, snowboarding, and skateboarding. Sports that require weight-bearing on the hands and arms, such as gymnastics, can increase the risk for injury. Sports that use hand equipment such as ski poles, hockey or lacrosse sticks, or racquets also increase the risk of injury.

In children, most finger, hand, or wrist injuries occur during sports or play or from accidental falls. Any injury occurring at the end of a long bone near a joint may injure the growth plate (physis) and needs to be evaluated.

Older adults are at higher risk for injuries and fractures because they lose muscle mass and bone strength (osteopenia) as they age. They also have more problems with vision and balance, which increases their risk of accidental injury.

Most minor injuries will heal on their own, and home treatment is usually all that is needed to relieve symptoms and promote healing.

Sudden (acute) injury

An acute injury may occur from a direct blow, a penetrating injury, a fall, or from twisting, jerking, jamming, or bending a limb abnormally. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

• Bruises. After a wrist or hand injury, bruising may extend to the fingers from the effects of gravity. See an illustration of a bruise (contusion).
• Injuries to ligaments. See an illustration of a torn thumb ligament as in skier's thumb.
• Injuries to tendons, such as mallet finger.
• Injuries to joints (sprains).
• Pulled muscles (strains).
• Broken bones (fractures), such as a wrist fracture.
• Dislocations.
• Crushing injury, which can lead to compartment syndrome.

Overuse injuries

Overuse injuries occur when too much stress is placed on a joint or other tissue, often by "overdoing" an activity or repeating the same activity. Overuse injuries include the following:

• Carpal tunnel syndrome is caused by pressure on a nerve ( median nerve) in the wrist. The symptoms include tingling, numbness, weakness, or pain of the fingers and hand. See an illustration of carpal tunnel syndrome.
• Tendon pain is actually a symptom of tendinosis, a series of very small tears (microtears) in the tissue in or around the tendon. In addition to pain and tenderness, common symptoms of tendon injury include decreased strength and movement in the affected area.
• De Quervain's disease can occur in the hand and wrist when tendons and the tendon covering (sheath) on the thumb side of the wrist swell and become inflamed. See an illustration of de Quervain's disease.

Treatment

Treatment for a finger, hand, or wrist injury may include first aid measures; medication; "buddy-taping" for support; application of a brace, splint, or cast, physical therapy; and in some cases, surgery. Treatment depends on:

• The location, type, and severity of the injury.
• How long ago the injury occurred.
• Your age, health condition, and activities (such as work, sports, or hobbies).

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.

• Signs of shock occur:
  • In children.
  • In adults and older children.
• Severe bleeding does not slow during the first 15 minutes of steady, direct pressure.
• Any part of your hand is partially or completely amputated. Begin first aid measures.
• Pieces of bone are visible in a wound, or a bone is sticking through the skin. Note: Do not try to push the bone back into the skin. Cover the area with a clean bandage.
• Injection of a substance under high pressure into the hand, such as paint from a high-pressure paint sprayer or a nail from a powered nail gun
• Severe pain with pale, white, blue, or cold fingers or hand

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Bleeding: Go to the topic Cuts or Scrapes.
• Puncture wound or injection of a foreign body under high pressure: Go to the topic Puncture Wounds.
• A finger, hand, or wrist problem not related to an injury: Go to the topic Finger, Hand, and Wrist Problems, Noninjury.
• Injury from cold exposure: Go to the topic Cold Temperature Exposure.
• A burn to a finger, hand, or wrist: Go to the topic Burns.
• A bite to a finger, hand, or wrist: Go to the topic Animal and Human Bites.
• A fingernail problem or blood under a nail: Go to the topic Nail Problems and Injuries.

	Yes	Is your finger, hand, or wrist twisted, bent out of shape, or out of its normal position?
When to See a Doctor See significance of a finger, hand, or wrist that looks twisted, bent, or out of its normal position if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Take the following first aid steps while transporting the injured person for medical evaluation of a broken bone or dislocation: Use a splint to limit movement. Keep the wrist or hand elevated, if possible. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Does your finger, hand, or wrist look twisted, bent out of shape, or out of its normal position? Yes Do you have a blood-filled blister, scrape, or cut skin at the site of a suspected broken bone or dislocation? Call your health professional today if you answer "Yes" to the following question. Yes Did your finger, hand, or wrist pop, move, or get pulled out of its normal position, then return to its normal position? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Does your finger continue to look misshapen from an injury that occurred more than 2 weeks ago? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have pain or tenderness in your finger, hand, or wrist?
When to See a Doctor See significance of pain or tenderness if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have severe pain? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have pain with swelling or bruising that began within 30 minutes of an injury? Yes Is a young child protecting an injured hand or wrist carefully or unwilling or unable to use it? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Do you have moderate pain that is getting worse or has not gotten better after 24 hours of home treatment? Yes Does normal use of your finger, hand, or wrist cause pain after 24 hours of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Do you have mild pain that has not gotten better after 1 week of home treatment? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are your fingers or hands pale, white, blue, or cold?
When to See a Doctor See significance of pale, white, blue, or cold fingers or hands if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Has a finger or hand turned pale, white, blue, or cold after an injury? Yes After having a brace, cast, or splint applied, have your fingers or hand turned pale, white, blue, or cold? Note: See first aid for a cast or splint that may be too tight. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have numbness or tingling in an injured finger, hand, or wrist?
When to See a Doctor See significance of numbness or tingling if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have new numbness or tingling and the skin on the injured hand is more pale, white, blue, or cold than the uninjured hand? Yes Do you have new numbness or tingling and you are unable to move your finger or hand normally (not because a splint is in the way or because of pain)? Call your health professional today if you answer "Yes" to any of the following questions. Yes Have you had steady numbness or tingling for 1 hour or longer? Yes Has numbness or tingling become worse? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had numbness or tingling that comes and goes for 24 hours or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you unable to move your fingers, hand, or wrist normally?
When to See a Doctor See significance of inability to move normally if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Are you unable to move an injured finger, hand, or wrist? Yes After having a brace, cast, or splint applied, are you unable to move your fingers or hand normally (not because the splint is in the way)? Call your health professional today if you answer "Yes" to any of the following questions. Yes Are you unable to make a complete fist? Yes Are you unable to straighten all your fingers? Yes Are you unable to bend or straighten your wrist? Yes Are you unable to grasp an object? Yes Is a young child unwilling or unable to use a finger, hand, or wrist, or protecting a hand carefully? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Are you unable to move your hand or wrist normally or do you have decreased strength after 48 hours of home treatment? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Is your finger, hand, or wrist swollen after an injury?
When to See a Doctor See significance of swelling if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have swelling and the skin below the swollen area is cold or pale? Call your health professional today if you answer "Yes" to the following question. Yes Did a lot of swelling develop within 30 minutes of an injury? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you have moderate swelling after 48 hours of home treatment? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Did you feel or hear a snap, pop, or grating in your finger, hand, or wrist?
When to See a Doctor See significance of a snap, pop or grating if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Did you feel or hear a snap, pop, or grating, and a lot of swelling developed within 30 minutes after the injury? Yes Did you feel or hear a snap, pop, or grating, and your finger, hand, or wrist looks twisted, bent, or out of its normal position? Yes Did you feel or hear a snap, pop, or grating, and you are unable to move your hand or wrist normally? Call your health professional today if you answer "Yes" to any of the following questions. Yes Did you feel or hear a snap, pop, or grating, but you do not have other changes? Yes Does your finger, hand, or wrist feel unstable when you try to use it? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you unable to free a trapped finger or hand from an object such as a toy, bottle, or jar?
When to See a Doctor See significance of inability to free a trapped finger or hand if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have severe pain? Yes Is your trapped finger or hand pale, white, blue, or cold when compared to the other hand? Yes Do you have numbness or tingling in your finger or hand? Call your health professional today if you answer "Yes" to the following question. Yes Are you unable to free a trapped finger or hand from an object using home treatment measures? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have signs of infection in your finger, hand, or wrist?
When to See a Doctor See significance of signs of infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have peripheral arterial disease? Yes Do you have a disease that causes problems with your immune system? Yes Do you have red streaks extending from the injured area? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have increased pain, swelling, redness, or warmth around the injured area? Yes Is your finger, hand, or wrist increasingly tender to the touch? Yes Do you have any drainage of pus? Yes Do you know or think you have a fever? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) around the area for 24 hours or longer? Yes Have you had a swollen gland (lymph node) in the neck, armpit, or the bend of the elbow for 24 hours or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Is an object, such as a nail, embedded in your finger or hand?
When to See a Doctor See significance of an object in your finger or hand if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Are you unable to remove an object, such as a sliver, needle, or nail, that is in or near a joint? Call your health professional today if you answer "Yes" to the following question. Yes Are you unable to remove an object, such as a sliver, needle, or nail, that is not in or near a joint? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your injury may have been caused by abuse?
When to See a Doctor See significance of abuse if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have an injury because someone hurt you? Yes Was your injury intentionally caused by another person? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have bruising of your finger, hand, or wrist?
When to See a Doctor See significance of bruising if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Did a large, painful, swollen bruise develop within 30 minutes of an injury? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Are you concerned about how easily you bruise? Yes Have bruises from an injury lasted longer than 2 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you know or think you need a tetanus shot?
When to See a Doctor See significance of getting a tetanus shot if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need a tetanus shot, call your doctor to arrange for the shot as soon as possible. Your need for a tetanus shot depends on the seriousness of your wound and your tetanus shot history. Your doctor may be able to tell you over the telephone if you need a tetanus shot. Call your health professional today if you answer "Yes" to any of the following questions. Yes Were you cut by something clean and your last tetanus shot was longer than 10 years ago? Note: Something is clean if it does not have dirt, soil, spit, or feces on it. Examples include a broken water glass, a kitchen knife, or sewing scissors. Yes Were you cut by something dirty and your last tetanus shot was longer than 5 years ago? Note: Something is dirty if it has dirt, soil, spit, or feces on it. Examples include a garden tool, a dirty nail, or a piece of glass that has been buried in the dirt. Yes Are you not sure if you were cut by something clean or dirty and your last tetanus shot was longer than 5 years ago? Yes Are you not sure when you had your last tetanus shot? Yes Did you not get the first series of tetanus shots? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

First aid for a suspected broken bone

• If a bone is sticking out of the skin, do not try to push it back into the skin. Cover the area with a clean bandage.
• Control bleeding.
• Remove all bracelets or rings. It may be difficult to remove the jewelry once swelling occurs, which in turn can cause other serious problems, such as nerve compression or restricted blood flow. See an illustration of removing a ring that is stuck.
• Free a trapped finger or hand from an object, such as a pipe, toy, or jar.
• Splint the injured area without trying to straighten the injured limb. Loosen the wrap around the splint if signs develop that indicate the wrap is too tight, such as numbness, tingling, increased pain, swelling, or cool skin below the wrap. A problem called compartment syndrome can develop.

Home treatment for a sore or sprained finger

• Use rest, ice, compression, and elevation (RICE) for pain and swelling.
• If you do not have diabetes or peripheral arterial disease, your sore or sprained finger can be " buddy-taped" to your uninjured finger next to it. Protect the skin by putting some soft padding, such as felt or foam, between your fingers before you tape them together. Your injured finger may need to be buddy-taped for 2 to 4 weeks to heal. If your injured finger hurts more after buddy taping it, remove the tape.
• Stop, change, or take a break from activities that cause your symptoms.

Home treatment for a minor hand or wrist injury

Home treatment may help relieve pain, swelling, and stiffness.

• Remove all rings, bracelets, or any other jewelry that goes around a finger or wrist. It will be more difficult to remove the jewelry later if swelling increases.
• Use rest, ice, compression, and elevation (RICE) for pain and swelling.
• Do not use your injured hand or wrist for the first 24 hours after an injury, if possible. An elastic bandage, such as an Ace wrap, can help decrease swelling. The wrap will also remind you to rest the injured hand or wrist. A wrist splint can help support an injured wrist. Talk to your health professional if you think you need to use a splint or bandage for more than 2 or 3 days.
• Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain.
• For the first 48 hours after an injury, avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages.
• After 48 to 72 hours, if swelling is gone, apply heat and begin gentle exercise with the aid of moist heat to help restore and maintain flexibility. Some experts recommend alternating between heat and cold treatments.
• Treat blisters.

Cast and splint care

If a cast or splint is applied, it is important to keep it dry and to try to move your extremity as normally as possible to help maintain muscle strength and tone. Your health professional will give you instructions on how to care for your cast or splint.

Do not smoke or use other tobacco products. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Tobacco Use.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment.

• Signs of infection develop.
• Numbness, tingling, or cool, pale skin develops.
• Symptoms do not improve with home treatment.
• Symptoms become more severe or frequent.

The following tips may prevent finger, hand, and wrist injuries.

• Do exercises that strengthen your hand and arm muscles.
• Stop, change, or take a break from activities that cause your symptoms.
• Reduce the speed and force of repetitive movements in activities such as hammering, typing, knitting, quilting, sweeping, raking, racquet sports, or rowing.
• Change positions when holding objects, such as a book or playing cards, for any length of time.
• Use your whole hand to grasp an object. Gripping with only your thumb and index finger can stress your wrist.
• Consider wearing gloves that support the wrist and have vibration-absorbing padding when working with tools that vibrate.
• Use safety measures, such as gloves, and follow instructions for the proper use of hand and power tools.
• Use caution when using knives in preparing food or craft activities. Supervise a child using knives or sharp scissors in craft activities.
• Wear protective gear, such as wrist guards, in sports activities.
• Review your work posture and body mechanics.
  • Organize your work so that you can change your position occasionally while maintaining a comfortable posture.
  • Position your work so you do not have to turn excessively to either side.
  • Keep your shoulders relaxed when your arms are hanging by your sides.
  • When using a keyboard, keep your forearms parallel to the floor or slightly lowered and keep your fingers lower than your wrists. Allow your arms and hands to move freely. Take frequent breaks to stretch your fingers, hands, wrist, shoulders, and neck. If you use a wrist pad during breaks from typing, it's best to rest your palm or the heel of your hand on the support, rather than your wrist.

Reduce falls

• Take steps to prevent falls and injuries in adults, such as removing any obstacles from your walking path.
• Take steps to prevent falls and injuries in babies and toddlers, such as not leaving your baby unattended in any infant seat or "sitting" toy.

General prevention tips

• Wear your seat belt in a motor vehicle.
• Don't carry objects that are too heavy.
• Use a step stool. Do not stand on chairs or other unsteady objects.
• Wear protective gear during sports or recreational activities, such as roller-skating or soccer. Supportive splints, such as wrist guards, may reduce your risk for injury.
• Warm up well and stretch before any activity. Stretch after exercise to keep hot muscles from shortening and cramping.
• Use the correct techniques (movements) or positions during activities so that you do not strain your muscles.
• Avoid overusing your hand and wrist doing repeated movements that can injure your bursa or tendon. In daily routines or hobbies, examine activities in which you make repeated arm movements.
• Consider taking lessons to learn the proper techniques for sports. Have a trainer or person who is familiar with sports equipment check your equipment to see if it is well-suited for your level of ability, body size, and body strength.
• If you feel that certain activities at your workplace are causing pain or soreness from overuse, talk to your human resources department for information on alternative ways of doing your job or to discuss equipment modifications or other job assignments.

Keep your bones strong

• Eat a nutritious diet with enough calcium and vitamin D, which helps your body absorb calcium. Calcium is found in dairy products, such as milk, cheese, and yogurt; dark green, leafy vegetables, such as broccoli; and other foods.
• Exercise and stay active. It is best to do weight-bearing exercise (walking, jogging, stair climbing, dancing, or lifting weights) for 45 to 60 minutes at least 4 days a week. Weight-bearing exercises stimulate new bone growth by working the muscles and bones against gravity. Exercises that are not weight-bearing, such as swimming, are good for your general health but do not stimulate new bone growth. Talk to your health professional about an exercise program that is right for you. Begin slowly, especially if you have been inactive. For more information, see the topic Fitness.
• Avoid drinking more than 1 alcoholic drink per day. People who drink more than this may be at higher risk for weakening bones (osteoporosis). Alcohol use also increases your risk of falling and breaking a bone.
• Do not smoke or use other tobacco products. Smoking puts you at a much higher risk of developing osteoporosis. It also interferes with blood supply and healing. For more information, see the topic Quitting Tobacco Use.

Possible abuse

Injuries such as bruises, burns, fractures, cuts, or punctures may be a sign of abuse. Suspect possible abuse when an injury cannot be explained or does not match the explanation, repeated injuries occur, or the explanations for the cause of the injury change. You may be able to prevent further abuse by reporting it and seeking help.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• What are your main symptoms?
• How long have you had your symptoms?
• How and when did an injury occur? How was it treated?
• Have you had any injuries in the past to the same area?
  • Was your injury evaluated by a health professional? What was the diagnosis?
  • How was your injury treated?
  • Do you have any continuing problems because of the previous injury?
• What activities, related to sports, work, or your lifestyle, make your symptoms better or worse?
• Do you think that activities related to your job or hobbies caused your symptoms?
• What home treatment measures have you tried? Did they help? Be sure to include any nonprescription medicines you have taken. Did they help?
• Do you have any health risks?

• Animal and Human Bites
• Burns
• Cold Temperature Exposure
• Cuts
• Finger, Hand, and Wrist Problems, Noninjury
• Nail Problems and Injuries
• Puncture Wounds
• Quitting Tobacco Use
• Scrapes

Author:	Susan Van Houten, RN, BSN, MBA	Last Updated: January 12, 2007
Medical Review:	Martin Gabica, MD - Family Medicine William M. Green, MD - Emergency Medicine Adam Husney, MD - Family Medicine H. Michael O'Connor, MD - Emergency Medicine
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