Hand Hematoma

ExitCare ImageA hematoma is an area of pooled blood outside the blood vessels. This often occurs in a small space on the back of the hand. It results from a direct hit (trauma) to the area. Hematomas just beneath the skin are called bruises. When blood vessels are hurt, they cause bleeding in the surrounding space, which results in a "black and blue" look.

SYMPTOMS

  • Swelling over the injury site.

  • Pain and tenderness over the affected area.

  • Fluid-like feeling, often firm, bump or area of swelling (fluctuance).

  • Redness that goes through several color changes before it heals completely. (Redness to black and blue or purple, then green-yellow, then yellow.)

CAUSES

Hand hematomas in sports are often caused by a direct blow to the hand. This often comes from a blunt object, such as another player, the player's equipment (helmet), or the playing surface (hockey sideboard or artificial turf). Bleeding into the tissue causes the surrounding tissue to be pushed away.

RISK INCREASES WITH:

  • Contact or collision sports (i.e. football, hockey, lacrosse, rugby).

  • Not protecting exposed areas during contact or collision sports.

  • Bleeding disorder or use of anticoagulants (blood thinners), aspirin, or non-steroidal anti-inflammatory medicines (aspirin, ibuprofen).

PREVENTION

  • Wear proper protective equipment and ensure correct fit (i.e. hand pads for contact sports).

  • Limit the use of blood thinners, aspirin, and ibuprofen.

  • Wear tape, pads, a splint, or a cast to prevent re-injury, if play is resumed before healing is complete.

PROGNOSIS

Hand hematomas often subside in 2 to 8 weeks. Healing is quicker, if the blood is withdrawn by a needle (aspiration).

RELATED COMPLICATIONS

  • Too much bleeding, leading to longer impairment.

  • Infection (uncommon).

  • Hand stiffness.

  • Delayed healing, especially if activity is resumed too soon.

  • Recurring injury.

  • Calcium deposits in the blood left in the hematoma, if blood has not been fully removed or absorbed.

TREATMENT

Treatment first consists of ice, medicine, and pressure, to reduce pain and inflammation. Heat, massage, nonsteroidal anti-inflammatory medicines, and intense physical therapy are often delayed for at least 48 hours. For severe hematomas, you may be referred to a physical therapist or athletic trainer for further evaluation and treatment. Sometimes, withdrawal of the hematoma by a needle is performed, to speed up healing. Needle withdrawal should be preformed by a medically trained person. For return to play, pad the hand to reduce the likelihood of re-injury. Do not massage the hand while it is healing. This may trigger bleeding again.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Stronger pain relievers may be prescribed. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used prior to performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • The skin is broken and you have signs of infection (drainage of fluids, increasing pain, fever).

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)