Contusion (Bruise) of Hand

An injury to the hand may cause bruises (contusions). Contusions are caused by bleeding from small blood vessels (capillaries) that allow blood to leak out into the muscles, tendons, and surrounding soft tissue. This is followed by swelling and pain (inflammation). Contusions of the hand are common because of the use of hands in daily and recreational activities. Signs of a hand injury include pain, swelling, and a color change. Initially the skin may turn blue to purple in color. As the bruise ages, the color turns yellow and orange. Swelling may decrease the movement of the fingers. Contusions are seen more commonly with:

  • Contact sports (especially in football, wrestling, and basketball).

  • Use of medications that thin the blood (anticoagulants).

  • Use of aspirin and nonsteroidal anti-inflammatory agents that decrease the ability of the blood to clot.

  • Vitamin deficiencies.

  • Aging.

DIAGNOSIS

Diagnosis of hand injuries can be made by your own observation. If problems continue, a caregiver may be required for further evaluation and treatment. X-rays may be required to make sure there are no broken bones (fractures). Continued problems may require physical therapy for treatment.

RISKS AND COMPLICATIONS

  • Extensive bleeding and tissue inflammation. This can lead to disability and arthritis-type problems later on if the hand does not heal properly.

  • Infection of the hand if there are breaks in the skin. This is especially true if the hand injury came from someone's teeth, such as would occur with punching someone in the mouth. This can lead to an infection of the tendons and the membranes surrounding the tendons (sheaths). This infection can have severe complications including a loss of function (a "frozen" hand).

  • Rupture of the tendons requiring a surgical repair. Failure to repair the tendons can result in loss of function of the hand or fingers.

HOME CARE INSTRUCTIONS

  • Apply ice to the injury for 15 to 20 minutes, 3 to 4 times per day. Put the ice in a plastic bag and place a towel between the bag of ice and your skin.

  • An elastic bandage may be used initially for support and to minimize swelling. Do not wrap the hand too tightly. Do not sleep with the elastic bandage on.

  • Gentle massage from the fingertips towards the elbow will help keep the swelling down. Gently open and close your fist while doing this to maintain range of motion. Do this only after the first few days, when there is no or minimal pain.

  • Keep your hand above the level of the heart when swelling and pain are present. This will allow the fluid to drain out of the hand, decreasing the amount of swelling. This will improve healing time.

  • Try to avoid use of the injured hand (except for gentle range of motion) while the hand is hurting. Do not resume use until instructed by your caregiver. Then begin use gradually, do not increase use to the point of pain. If pain does develop, decrease use and continue the above measures, gradually increasing activities that do not cause discomfort until you achieve normal use.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

  • Follow up with your caregiver as directed. Follow-up care may include orthopedic referrals, physical therapy, and rehabilitation. Any delay in obtaining necessary care could result in delayed healing, or temporary or permanent disability.

REHABILITATION

  • Begin daily rehabilitation exercises when an elastic bandage is no longer needed and you are either pain free or only have minimal pain.

  • Use ice massage for 10 minutes before and after workouts. Put ice in a plastic bag and place a towel between the bag of ice and your skin. Massage the injured area with the ice pack.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your pain and swelling increase, or pain is uncontrolled with medications.

  • You have loss of feeling in your hand, or your hand turns cold or blue.

  • An oral temperature above 102° F (38.9° C) develops, not controlled by medication.

  • Your hand becomes warm to the touch, or you have increased pain with even slight movement of your fingers.

  • Your hand does not begin to improve in 1 or 2 days.

  • The skin is broken and signs of infection occur (fluid draining from the contusion, increasing pain, fever, headache, muscle aches, dizziness, or a general ill feeling).

  • You develop new, unexplained problems, or an increase of the symptoms that brought you to your caregiver.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.