Hand and Wrist Injury

Symptoms

DEFINITION

• Injury to a bone, muscle, joint or ligament of the hand and wrist

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Types of Injuries

• Fractures (broken bones)
• Dislocations (bone out of joint)
• Sprains - Stretches and tears of ligaments
• Strains - Stretches and tears of muscles (pulled muscle)
• Contusion (bruise) - A direct blow or crushing injury

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See More Appropriate Topic (instead of this one) If

• ANIMAL BITE to hand or wrist
• BURN of hand or foot
• PUNCTURE WOUND to hand or wrist
• SKIN INJURY is main concern
• FINGER INJURY is main concern

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FIRST AID Advice for Bleeding: Apply direct pressure to the entire wound with a clean cloth.

FIRST AID Advice for Penetrating Object: If penetrating object still in place, don't remove it (Reason: removal could increase bleeding).

FIRST AID Advice for Shock: Lie down with feet elevated.

FIRST AID Advice for a Sprain or Twisting Injury of Hand or Wrist:

• Apply a cold pack or an ice bag (wrapped in a moist towel) to the area for 20 minutes.
• Wrap area with an elastic bandage.

FIRST AID Advice for Suspected Fracture or Dislocation of Hand or Wrist:

• Immobilize the hand and wrist by placing them on a rigid splint (e.g., small board, magazine folded in half, folded up newspaper).
• Tie several cloth strips around hand/wrist to keep the splint in place.
• Place injured arm in a sling. If no sling is available, victim can support the injured arm with the other non-injured hand.
• Option - Soft Splint: Immobilize the hand and wrist by wrapping them with a soft splint (e.g., a pillow, a rolled-up blanket, a towel). Use tape to keep this splint in place.

Transport of an Amputated Body Part:

• Briefly rinse amputated part with water (to remove any dirt).
• Place amputated part in plastic bag (to protect and keep clean).
• Place plastic bag containing part in a container of ice (to keep cool and preserve tissue).

Should I Call?

WHEN TO CALL YOUR DOCTOR

Call 911 Now (you may need an ambulance) If

• Major bleeding (actively bleeding or spurting) that can't be stopped
• Limb has been partially or completely amputated
• NOTE: For bleeding, see First Aid

Call Your Doctor Now (night or day) If

• You think you have a serious injury
• Injury looks like a dislocated joint (crooked or deformed)
• Severe pain
• High pressure injection injury (e.g., from paint gun, usually work-related)

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

• You think you need to be seen
• Can't use injured hand normally (e.g., make a fist, open fully, hold a glass of water)
• Very large bruise follows a minor injury (wider than 2 inches)
• Several bruises occur without any known injury
• You are over age 54, have osteoporosis, or use steroid medications routinely

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Injury interferes with work or school
• Injury and pain have not improved after 3 days
• Injury is still painful and swollen after 2 weeks

Self Care at Home If

• Minor bruise
• Minor strained (pulled) muscle or sprained (stretched) ligament

Care at Home

HOME CARE ADVICE FOR MINOR INJURIES OF HAND AND WRIST

1. Treatment of Bruise (e.g., direct blow to hand or wrist):
   • Apply a cold pack or an ice pack (wrapped in a moist towel) to the area for 20 minutes each hour for 4 consecutive hours. (20 minutes of cooling followed by 40 minutes of rest for 4 hours in a row).
   • 48 hours after the injury, use local heat for 10 minutes 3 times each day to help reabsorb the blood.
   • Rest the injured part as much as possible for 48 hours.
2. Treatment of Sprains and Strains:
   • FIRST AID - Wrap with a snug elastic bandage. Apply an ice pack (crushed ice in a plastic bag covered with a moist towel) to reduce bleeding, swelling, and pain.
   • Treat with R.I.C.E. (rest, ice, compression, and elevation) for the first 24 to 48 hours.
     • REST the injured part for 24 hours. You may return to normal activity after 24 hours of rest if the activity does not cause pain.
     • Continue to apply crushed ICE packs for 10-20 minutes every hour for the first 4 hours. Then apply ice for 10-20 minutes 4 times a day for the first two days.
     • Apply COMPRESSION by wrapping the injured part with a snug, elastic bandage for 48 hours. If you experience numbness, tingling, or increased pain in the injured part, the bandage may be too tight. Loosen the bandage wrap.
     • Keep injured hand or wrist ELEVATED and at rest for 24 hours. Put your hand and wrist on a pillow positioned above heart level.
3. Pain Medication:
   • For pain relief, take acetaminophen or ibuprofen.
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
4. Expected Course: Pain and swelling usually begin to improve 2 or 3 days after an injury. Swelling is usually gone in 7 days. Pain may take 2 weeks to completely resolve.
5. Call Your Doctor If:
   • Pain becomes severe
   • Pain does not improve after 3 days
   • Pain or swelling lasts more than 2 weeks
   • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Photo Example

 

First Aid - Splint for Wrist Injury

• Immobilize the hand and wrist by placing them on a rigid splint (see drawing).
• Tie several cloth strips around hand/wrist to keep the splint in place. You can use a roll of gauze or tape instead of cloth strips.

Notes:

• You can make a splint from: a wooden board, magazine folded in half, folded-up newspaper, cardboard, or a pillow.
• If you have no splinting materials, then support the injured arm by resting it on a pillow or folded up blanket.
• After putting on the splint, apply a cold pack or an ice pack (wrapped in a towel) to the area.

X-Ray - Wrist Fracture

This 72 year old female tripped and fell injuring her left wrist.

The x-ray shows a fracture through both bones of the forearm (Colles fracture). There is deformity.

Wrist Fracture with Deformity

This 72 year old female tripped and fell injuring her left wrist. The picture shows a deformed left wrist. She went to the emergency department. Treatment included pain medications, reduction (putting the bones back into line), and casting.

First Aid Care Advice for Suspected Fracture or Dislocation:

• Splint: Immobilize the hand and wrist by placing them on a rigid splint (e.g., small board, magazine folded in half, folded up newspaper). Tie several cloth strips around hand/wrist to keep the splint in place.
• Apply a cold pack or an ice pack (wrapped in a towel) to the area.

Bruise from Coumadin

This 74 year old female did not recall hurting her hand. She takes the blood thinner Coumadin.

The picture shows a large amount of bruising (ecchymosis) of the left hand. There is no broken bone (fracture).

First Aid - Bleeding Arm

• Apply direct pressure to the entire wound with a sterile gauze dressing or a clean cloth.

First Aid - R.I.C.E.  

RICE is an acronym for how to take care of a sprain, strain, or bruise. There are four things you should do:

• REST the injured part of your body for 24 hours. Can return to normal activity after 24 hours of rest if the activity does not cause severe pain.
• Continue to apply crushed ICE packs for 10-20 minutes every hour for the first 4 hours. Then apply ice for 10-20 minutes 4 times a day for the first two days.
• Apply COMPRESSION by wrapping the injured part with a snug, elastic bandage for 48 hours. If numbness, tingling, or increased pain occurs in the injured part, the bandage may be too tight. Loosen the bandage wrap.
• Keep the injured part of the body ELEVATED and at rest for 24 hours. For example, for an injured ankle, place that leg up on a pillow and stay off the feet as much as possible.

 

First Aid - Sling - How to Put On

To put on a sling you first need to have a triangular bandage. Many first aid kits have a triangular bandage.

• Find the two ends of the triangle that are farthest apart. These are the ends that you will tie around the neck.
• Lay the arm down the middle of the triangle.
• Take the two ends of the triangle that are farthest apart and tie them behind the neck. (a square knot is best, but any knot will do).

Source: LMS Inc.

Copyright 2000-2009. Self Care Decisions, LLC. Used by Permission.