DEFINITION--Bruising of the skin and underlying tissues of the hand due to a direct blow. Contusions cause bleeding from ruptured small capillaries that allow blood to infiltrate muscles, tendons or other soft tissue. The hand is especially vulnerable to contusions because of its exposure and use in almost all sports.
BODY PARTS INVOLVEDHand tissues, including blood vessels, muscles, tendons, nerves, covering to bones (periosteum) and connective tissue.
SIGNS & SYMPTOMS
Swelling on the back or in the palm of the hand. Swelling may be superficial or deep.
Pain and tenderness over the injury.
Feeling of firmness when pressure is exerted on the injured area.
Discoloration under the skin, beginning with redness and progressing to the characteristic "black and blue" bruise.
Restricted hand motion proportional to the extent of injury.
CAUSESDirect blow to the hand, usually from a blunt object.
RISK INCREASES WITH
Contact sports, especially when the hands are not adequately protected.
Medical history of any bleeding disorder such as hemophilia.
Poor nutrition, including vitamin deficiency.
Use of anticoagulants or aspirin.
HOW TO PREVENTIf possible, wear appropriate protective padding during competition or other athletic activity. If you must compete before a hand contusion heals, use padding, tape or a cast.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care, unless the injury is quite small.
Self-care for minor contusions, and for serious contusions during the rehabilitation phase.
Physical therapy for serious contusions.
Your own observation of symptoms.
Medical history and physical exam by a doctor for all except minor injuries.
X-rays of the hand and wrist to assess total injury to soft tissue and to rule out the possibility of underlying fractures. The total extent of injury may not be apparent for 48 to 72 hours.
Excessive bleeding leading to disability. Infiltrative-type bleeding can (rarely) lead to calcification and impaired function of injured muscles or tendons.
Infection if skin over the contusion is broken.
Infection of the tendon sheaths.
PROBABLE OUTCOMEHealing time varies with the extent of injury, but average healing time for hand contusions is 1 to 3 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
Wrap an elasticized bandage over a felt pad on the injured area. Keep the area compressed for about 72 hours.
After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, heat liniments or ointments, or whirlpool treatments.
Massage gently and often with light lubricating oil to provide comfort and decrease swelling. Stroke from the fingers toward the shoulder.
For minor discomfort, you may use:
Acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe stronger medicine for pain.
ACTIVITYBegin activities slowly and stop exercise as soon as pain begins. Increase activity as healing progresses.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Your doctor may prescribe vitamin and mineral supplements to promote healing.
Begin daily rehabilitation exercises when supportive wrapping is no longer needed.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have a hand contusion that doesn't improve in 1 or 2 days.
Skin is broken and signs of infection (drainage, increasing pain, fever, headache, muscle aches, dizziness or a general ill feeling) occur.