The hands are a magnificent piece of work. Its intricate design and functional form follow the hand. However, any injury to the underlying structures of the hand can overlap with other injuries/conditions. Even the smallest hand injuries require a proper medical examination. The objective is a quick and accurate initial evaluation along with treatment. Early treatment is done quickly to minimize short and long-term effects.

Anatomy

The hand consists of 27 bones that, include 8 bones in the wrist. If the associated structures:

• Nerves
• Arteries
• Veins
• Muscles
• Tendons
• Ligaments
• Joint cartilage
• Fingernails
• Get injured or damaged in some way; there is increased potential for various injuries.

Causes

The most common cause of injury/s is blunt trauma, followed by injury from a sharp object. Hand injuries are divided into categories:

• Lacerations/cuts
• High-pressure injection injuries – nail guns, staple guns
• Fractures
• Dislocations
• Soft tissue injuries
• Burns
• Infections
• Amputations

Other hand injuries include:

• Finger injuries
• Wrist injuries
• Broken hand
• Nail injuries
• Finger infection

Symptoms

Symptoms vary depending on the type of injury, how the injury occurred/mechanism, the depth, severity, and location. Common symptoms:

Lacerations

• Tenderness
• Pain
• Bleeding
• Numbness
• Decreased range of motion
• Difficulty moving
• Weakness
• Pale appearance

Fractures and Dislocations

• Swelling
• Discoloration
• Tenderness
• Deformity
• Reduced range of motion
• Numbness
• Weakness
• Bleeding

Soft Tissue Injuries and Amputations

• Swelling
• Discoloration
• Tenderness
• Deformity with or without tissue loss/bone loss
• Bleeding
• Weakness
• Numbness

Infection

• Tenderness
• Swelling
• Warmth/Heat around the area
• Redness
• Deformity
• Reduced range of motion
• Fever is rare in hand infections

Burns

• Redness
• Tenderness
• Blistering
• Complete numbness
• Discoloration
• Loss of tissue
• The texture of the skin change
• Areas of tissue blackened
• Deformity

High-pressure Injection Injury

• Pain
• Swelling
• Bleeding
• Skin discoloration
• Muscle, tendon, and ligament tears
• Cracked/Broken bones

Medical Care

Anyone with a hand injury is recommended to call a doctor or seek medical attention. When medical attention is delayed, the possibility of worsening or creating further injuries increases. Even the smallest cut or what looks like a minor injury could require advanced treatment to prevent infection or loss of function. Any cut or laceration that requires stitches to repair should also have a medical evaluation to ensure the hands’ musculoskeletal system is functioning properly. Injuries causing the following symptoms require emergency medical attention at an emergency clinic.

• Severe bleeding
• Severe pain
• Numbness
• Loss of motion
• Loss of strength
• Deformity
• Signs of infection – tenderness, warmth/heat, redness, swelling, pus, or fever
• Exposure of structures – tendons, bones, joints, arteries, veins, or nerves

Diagnosis

A medical examination can include a medical history and physical examination.

Medical History

• Past medical history
• Does the patient have diabetes or arthritis?
• Is the patient right or left-handed?
• Occupation
• Extracurricular activities and hobbies
• How does the patient use their hands?
• How did the injury occur, mechanism of injury?
• Does the patient smoke?

Physical Exam

• Visual inspection look at the injury
• Sensory nerve exam feeling
• Vascular exam circulation of blood supply
• Muscular and tendon exam movement and strength
• Bone exam broken bones or dislocated joints

Tests

A doctor will order X-rays after the history and physical exam if necessary. Certain injuries will require imaging to identify fractures/dislocations or to rule out foreign bodies. Many types of injuries can lead to compartment syndrome. Compartment syndrome is a condition in which there is swelling and increased pressure within a limited space or a compartment that presses on and compromises blood vessels, nerves, and/or tendons that run through that particular area. Once the immediate injury is addressed, a personalized treatment plan can be developed .to rehabilitate the hand/s to optimal function quickly

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Body Composition

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Artificial Sweeteners And Muscle Gain

Artificial sweeteners don’t individuals that are trying to build lean body mass. The body needs carbs after a workout to replenish the depleted glycogen stores. Many commercially prepared protein supplements are made with artificial sweeteners that don’t provide an adequate source of carbohydrates. If an individual consumes only protein made with sugar substitutes after a workout, they are missing essential components of post-workout recovery. A study found that supplementing with carbohydrates before and during strength training can increase performance, compared to participants that were taking the artificial sweeteners saccharin and aspartame. To properly refuel after a workout, remove the artificially sweetened protein powders and replace them with a snack packed with protein and high-quality carbohydrates. These include:

• Greek yogurt
• Fruit with nuts or nut butter
• Hummus with whole-grain crackers
• Tuna
• Hard-boiled eggs

References

Banting, Joshua, and Tony Meriano. “Hand Injuries.” Journal of special operations medicine: a peer-reviewed journal for SOF medical professionals vol. 17,4 (2017): 93-96.

Fuhrer, Reto, et al. “Tipps und Tricks in der Behandlung offener Handverletzungen in der Notfallpraxis” [Treatment of acute injuries of the hand]. Therapeutische Umschau. Revue therapeutique vol. 77,5 (2020): 199-206. doi:10.1024/0040-5930/a001177

Harrison, BP, and M W Hilliard. “Emergency department evaluation and treatment of hand injuries.” Emergency medicine clinics of North America vol. 17,4 (1999): 793-822, v. doi:10.1016/s0733-8627(05)70098-5

MedscapeReference.com. High-Pressure Hand Injury.

MedscapeReference.com. Soft Tissue Hand Injury Differential Diagnoses.

Siotos, C et al. “Hand injuries in low- and middle-income countries: a systematic review of existing literature and call for greater attention.” Public health vol. 162 (2018): 135-146. doi:10.1016/j.puhe.2018.05.016

WebMD.com. Finger, Hand, and Wrist Injuries.