We use our hands all the time. That’s why hand injuries happen so often. While some injuries are not always avoidable, understanding the types and causes can help prevent them in the future.

Types of Hand injuries

Severed fingertips

The most common hand injuries we see are of the fingertips. They are severed by table saws and circular saws, caught in doors and treadmills, squashed at work, mangled in lawn mowers and snow blowers, stepped on during sports, infected when hangnails are nibbled, and when they are scraped on garage floors or pierced by dirty fishhooks.

Most of these injuries can be managed in the Emergency Department. Occasionally, admission to the hospital is needed for intravenous antibiotics or care in the operating room. But recovery can take several months, depending on the injury. Time away from work may be needed. Revision operations may also be necessary at a later date.

Finger and hand fractures

Finger and hand fractures are the next most common injury. Ten percent of patients who come to the Emergency Department have a hand fracture. They can be caused by falls or fights or may be associated with other large traumas. The “boxer’s fracture” of the small finger is incredibly common and occurs when someone hits a wall or other immovable surface, such as a door or furniture. About 10 percent of men between the ages of 16 and 29 years will get a boxer’s fracture; and it has been estimated that up to 70% of them will have another trauma-related injury in the future.

The majority of these can be managed by numbing the area and performing a simple procedure, or by splinting the hand for four to six weeks. Rarely does this type of break require surgery.

Wrist fractures

Fractures of the wrist and the forearm bone where it connects to the wrist (distal radius) are generally caused by a fall onto an outstretched hand. Hands are not well-padded and don’t do well when your entire body weight lands on them. Some broken bones in the wrist, like the scaphoid bone, may not initially be seen on an X-ray. But if there is pain at the base of the thumb that doesn’t improve within a week or two, a second X-ray should be ordered to check for a fracture. A cast may be appropriate for most, but some fractures may need surgery to allow for the best healing. Scaphoid fractures can take up to four months to heal, and a computed tomography (CT) scan may be needed to confirm healing. If not, other treatments may be considered.

Bigger wrist injuries that occur when you fall onto the wrist from a height or during a motor vehicle collision may result in broken or dislocated wrist bones. These are serious injuries which may need several operations and which may cause lifelong stiffness and weakness. Healing enough to return to work may take several months. Distal radius fractures are breaks of the far end of the arm bone at the level of the wrist. They are commonly seen in women who fall onto their hand. Women’s bones get weaker around the time of menopause, and this puts them at greater risk for distal radius fractures. Fractures may need to be repositioned in the Emergency Department, but surgery may be needed if the bone is badly displaced, cannot be returned to a good position, or is broken in several locations and is unlikely to stay in a good position.

Tendon injuries

Tendons are structures that connect your muscles to bone. Flexor tendons connect the muscles in your forearms to the bones in your fingers. Injuries to flexor tendons in the fingers are also common. These occur when a person is using a knife incorrectly (say, trying to cut a bagel or piece of fruit while holding it in their palm), when not focusing on a task and getting cut by a sharp piece of metal or a broken piece of glass, or during a fight when defending themselves.

These injuries may also involve nerves and blood vessels. Flexor tendon cuts are diagnosed by looking at the hand and seeing if the fingers are in their normal position while resting and by asking the patient to gently move the injured part. Flexor tendon injuries are very serious: for a reasonable outcome, they should be diagnosed and repaired within 10 to 14 days. If there are several injured fingers or if the blood vessels are also cut, surgery may be more urgently needed. Recovery from a flexor tendon injury can take from eight to 12 weeks and requires the assistance of a skilled hand therapist. If a nerve in the finger has also been cut, feeling may never be normal.

Preventing hand injuries

Prevention of injuries is the goal. Here are some tips to prevent some of the most common injuries we see:

  • Use a guard on the saw or a Saw Stop.
  • Avoid distractions when using sharp tools.
  • Do not look away from your hands when using sharp tools.
  • Do not drink or use medications that make you sleepy while woodworking, doing home maintenance, playing sports, or driving.
  • Stop doing work with sharp instruments or tools when you are sleepy.
  • If you have a dog, make sure they are trained so they don’t pull you off of your feet.
  • Be careful and focus while walking on uneven, icy, or wet surfaces.
  • If you are falling, do not try to break your fall with your hand(s).
  • When angry, pause and walk away rather than hitting anything or anyone.
  • Don’t try to unclog a lawn mower or snow blower with your hand, even if the machine has been turned off.
  • When cooking and baking, cut away from yourself.
  • If you cut or scrape yourself and it isn’t severe enough to go to the Urgent Care or Emergency Department, wash your hands vigorously with soap and water and apply antibiotic ointment and a bandage.
  • Keep your tetanus immunization up to date.

Remember, If you have had an injury to your hand or arm and things don’t appear to be improving after one or two weeks, consider seeing a hand surgeon for an exam to make sure that a more serious injury isn’t present.  Call your doctor if you experience any of the following:

  • numbness
  • swelling
  • color changes
  • pain
  • drainage
  • unusual position
  • continued inability to move
  • difficulty or pain with motion 

For more information on hand, wrist and elbow surgery with our experts, please visit our website.

Loree Kalliainen, MD

Dr. Loree Kalliainen is a plastic surgeon with Lifespan Physician Group.