Ann was digging hard at large roots in the garden when she encountered a piece of glass that cut through the palm of her hand. Jack was rinsing an opened tuna can, preparing it for recycling, when he cut the top of his hand on the jagged rim.

Whether it’s dirty work or cleaning up, your hands are on the front line of nearly everything you do–digging, scraping, testing, poking, scrubbing. As a result, they’re at high risk of injury, and doctors know that hand injuries must be treated promptly and effectively.
A complex structure of bones, muscles, ligaments and nerves, the human hand is designed to perform a variety of tasks–from hammering a nail to opening a jar to threading a needle. Injury to even a small part can alter the overall function of the hand, sometimes permanently. About 75 percent of industrial accidents resulting in a partial or complete disability involve one or both hands.

Minor injuries to the hand are common, and the majority can be treated at home–usually with ice, cold water and a reasonable period of rest followed by a quick return to action. For example:

You jam a couple of fingers playing softball. To ease the pain and reduce the swelling, massage an ice cube over the injured areas as soon as possible and repeat frequently over the next few days. The general rule is to get back to active use of the fingers as soon as pain allows. Motion speeds healing by improving circulation and reducing swelling and stiffness.

You burn the top of your hand reaching in the oven to take out a loaf of bread. Hold your hand under cold running water for several minutes or immerse it in a basin of ice water. Home remedies such as smearing butter or grease on the burn will only make things worse.
You slam the car door on your finger, and your fingernail turns blue-black and feels extremely painful. In addition to the pain of the bruised finger, you have the pressure of blood building up and being trapped under the nail. If you act quickly, before the blood clots, you can relieve some of the pressure by burning a small hole in the nail with the heated tip of a paper clip.

You fall off your bike and scrape the skin off your hands. It’s important to clean the wound thoroughly and flush out dirt and debris with tap water. For a wound that has been properly cleaned soon after the injury, antibiotic ointment is seldom necessary, and the wound will heal faster if it’s left open and exposed to air. For extensive or deep abrasions, however, you may want a protective dressing.

Don’t Let It Get Out of Hand
No matter how benign the wound may seem, however, it’s important to keep an eye on it and remember that a little injury can quickly grow into something more serious.

When Jack cut his finger on the tuna can, he grabbed a paper towel to wipe off the blood, then slapped on a band-aid. He was making lunch and didn’t take the time to worry about the cut. When he took off the band-aid a day or two later, a puffy red area had formed that was sore to the touch, so he called his doctor who urged him to come in immediately.

There are numerous closed spaces within the hand–very near the surface of the skin–that are vulnerable to infection. If an abscess forms, it may require surgical drainage in order to heal properly. Although Jack’s problem never reached that point, he was wise to seek medical attention promptly. Fortunately, his tetanus shots were already up-to-date.

One study of infections under the skin surface found a six percent rate of complications. This figure went up to 25 percent when the infection involved a joint and 38 percent when it involved a tendon sheath. Tendons are located just underneath the surface of the skin so there’s always the possibility of tendon damage from even a small cut.

The complication rate from hand infections is high among diabetics, AIDS patients and persons who are HIV positive. For such individuals, a hand infection may be reason for hospitalization.

Mostly because of impaired circulation and uncontrolled blood sugar, diabetic patients can develop infections even after minor blunt trauma such as a fall or a blow to the hand. Without prompt attention, consequences can be severe, including gangrene and amputation.

Requiring a Doctor’s Care
Particularly worrisome are bite wounds (especially human bites), injuries that penetrate deeply into the hand and those suffered in a barnyard or other area where the risk of infection is high.

Such wounds require a doctor’s attention for thorough cleaning and possible antibiotic treatment. In some cases, the doctor may surgically incise a puncture or bite injury so it can drain freely and then be treated as an open wound.
Foreign bodies such as needles, nail gun projectiles, fragments of glass or splinters can create problems if they become embedded. Unless they can be retrieved easily, you can compound the damage by poking and probing; it’s usually better to let a doctor remove the object.

Severe strains, dislocations and torn or strained ligaments nearly always require medical attention, including splinting, at least for a brief period.

A hand stepped on in football or soccer or crushed by a machine often results in broken bones. But even if a crush injury doesn’t break the skin or fracture a bone, prompt treatment is necessary to reduce swelling and the risk of damage to nerves and tendons. If the skin is broken, the risk of infection is high.

About 16 million Americans each year suffer hand injuries serious enough to require emergency care. Rarely life threatening, these injuries are painful, potentially disabling and costly to treat. For industrial accidents, the Bureau of Labor Statistics estimates an average of $6,300 for each hand injury claim.

Most injuries could be prevented simply by taking the time to think before you thrust your hand into action and by wearing hand protection. Safety-minded employers know the importance of requiring proper, high-quality gloves appropriate to the task. The glove should be tough enough to protect against possible hazards, and it should fit properly. Gloves that are too large or unwieldy may actually cause an accident.
Individuals working around the home need a similar level of consciousness. If the glove fits, wear it.

REFERENCES:
Paul W. Brown, “Pointers for Managing Common Hand Injuries,” The Journal of Musculoskeletal Medicine, December, 1999.
Mark A. Brandenburg, Linda Hawkins and Gary Quick, “Hand Injuries, Part 1: Initial Evaluation and Wound Care,” Consultant, December, 1999.
Peter R. Carter, Charles Hamlin, Dennis T. Uehara, “Early Care for Hand Emergencies,” Patient Care, July 15, 1990.
Candace Goforth, “A Guide to Better Hand Protection,” Occupational Hazards, August, 1996.
Geoffrey V. Gill, Olufunsho O. Famulyiwa, Michael Rolfe and Lennox K. Archibald, “Tropical Diabetic Hand Syndrome,” The Lancet, January 10, 1998.
John A. McAuliffe, “Hand Infections: A Pictorial Guide to Management,” The Journal of Musculoskeletal Medicine, May, 1999.
“Raise Your Hand for Safety,” Safety Now, June, 2002.