A bruise of the hand is a closed injury to its soft tissues. Injury to the wrist from impact or from falling is most common. No damage to bones or skin occurs. According to ICD-10, the pathology code is S60.2.
Differences between bruise and fracture
In case of injury, the functionality of the hand is preserved. The fracture is supported by:
- Inspection data:
- a significant reduction in the range of possible movements: the inability to take something, make rotational movements, bend or unbend the hand, lean on the injured arm;
- unnatural mobility and / or deformation of the hand;
- sensation of crepitus on movement.
- X-ray examination results.
The reasons
In etiology, the leading role is played by:
- falls (from a bicycle or when playing volleyball);
- punches (when practicing karate);
- Road accident;
- clamping hands (in the doorway);
- sporting events (boxers' fight, a typical injury is a bruise of the wrist).
Classification
At the place of trauma, bruises are distinguished:
- industrial (when struck by heavy tools);
- household;
- sports.
By localization, bruises are distinguished:
- wrists;
- fingers of the hand;
- palms;
- wrist joint.
In terms of severity, bruises are:
- lungs (slight redness of the skin at the site of injury is determined);
- medium (subcutaneous hemorrhages are visualized, soft tissues swell);
- severe (severe edema and extensive hematomas).
The severity of bruises correlates with the severity of pain. For severe bruises, causalgia is characteristic - pain of high intensity, radiating to the forearm and shoulder. The range of motion in causalgia may be limited.
Symptoms
Common signs of this type of injury include:
- pain in the hand, often radiating to the forearm or fingers (with severe injuries);
- subcutaneous hemorrhages (appear after 2-3 hours) and hematomas;
- soreness when performing movements (it can be difficult to clench your fingers into a fist);
- swelling;
- a feeling of numbness, accompanied by a decrease in various types of sensitivity;
- hyperemia (redness) of the skin.
With hemorrhages in the subcutaneous fat, the phenomenon of "blooming bruises" is characteristic, in which the cherry color turns blue-green after four to five days, and then yellow (due to the metabolism of the iron-containing blood piment).
With severe bruising, hematomas localized on the dorsal surface of the hand, in some cases, reach significant sizes. The skin at the site of localization may turn blue. Sometimes the skin exfoliates, forming blisters with hemorrhagic contents.
Severe pain syndrome can provoke a sharp decrease in blood pressure, the development of syncope or traumatic shock.
First aid and how to bandage the joint
If a bruise is suspected, immediate (maximum within 15 minutes) application of a cold compress to the damaged area is indicated.
Ice packed in a plastic bag and wrapped in a cloth is best.
Next, the site of the injury is washed with cold water, after which a bandage is applied, then until the moment of contacting a traumatologist to verify the diagnosis, the hand must be kept in an elevated position.
To reduce edema, internal bleeding and immobilization of the hand, it is bandaged. Possible dressing options:
- mitten;
- on the hand and wrist (without gripping the fingers);
- on the hand and finger;
- on the hand and fingers like a glove.
When applying a bandage, remember that at least two joints must be immobilized. The use of Cramer's bus or improvised means is allowed. In this case, the tire components should not come into contact with the skin to avoid irritation. To do this, they must first be wrapped with a bandage.
With severe bruising, the time of wearing a fixing bandage can be 14 days.
How to develop a hand
On the third day after injury, in order to avoid wasting of the hand muscles, it is recommended to start performing the following exercises:
- put your hand on the table and drum your fingers on its surface;
- fold your palms, swinging them like a metronome;
- put your palm on the table, pressing your fingers to the surface (the exercise is to try to lift them up);
- gently squeeze the expander or ball with the fingers of the injured hand;
- take two balls in the palm of your hand and rotate them in your hand clockwise and counterclockwise. Ideally, they shouldn't collide.
In no case should you make sudden movements or perform exercises overcoming pain.
It is advisable to prescribe massage or self-massage of the hand, which involves light massaging of the injured hand from the distal phalanges of the fingers to the proximal parts of the hand.
A severe bruise of the hand is also treated with acupuncture sessions.
What can be done at home in different cases
If a fracture is excluded, treatment can be carried out on an outpatient basis under the supervision of the attending physician.
In the first 24 hours after trauma (the sooner the better), dry cold should be applied to the damaged area for no more than 10 minutes every 2 hours. Anesthetic ointments may be applied topically. After 72 to 96 hours, heat can be applied to speed up the resolution of the bruise.
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Warming can be done using:
- pouches of heated salt (dry heat);
- paraffin applications;
- warm baths.
For severe pain, NSAIDs (Ketotifen, Diclofenac sodium, Ibuprofen) are prescribed orally, and NSAID-based ointments (Fastum gel) are applied locally, which are applied 1-3 times a day.
Narcotic analgesics (Promedol, Omnopon) are used to relieve pronounced pain syndrome by prescription and under the supervision of a physician.
With pronounced edema, vitamin C, Rutin, Ascorutin, Quercetin, Troxevasin, Actovegin, Eskuzan, Pentoxifylline are used to strengthen the walls of the capillaries and improve microcirculation.
Physiotherapy methods can be prescribed from the third day after injury and include:
- UHF currents;
- low frequency magnetic field action;
- UFO;
- laser therapy.
In the presence of signs of compression of the branches of the ulnar or median nerves (branches of the radial nerve are rarely compressed in case of hand injury), blockade with the use of anesthetics (Novocaine, Trimecaine) can be used to anesthetize the innervated areas. For the same purpose, electro- or phonophoresis with anesthetics and Bernard's currents are used. Sometimes they resort to surgery.
In order to stimulate regeneration in the presence of damaged tissues, anabolic agents are prescribed (substances that enhance protein synthesis):
- non-steroidal (methyluracil);
- steroid (Methandrostenolone, Phenobolin).
Under the influence of anabolic steroids, soft tissues heal much faster. For the same purpose, the following can be applied locally:
- biogenic stimulants based on aloe, rosehip, fir and sea buckthorn oils;
- ointments containing Actovegin and Solcoseryl;
- compresses based on a solution of Dimexide, Novocaine and ethanol.
To stimulate the speedy resorption of hematomas under the supervision of a hirudotherapist, leeches can be used.
Folk remedies for therapy
3-4 days after the injury, the following will help reduce pain:
- Warm baths of sea salt (40 g of salt must be dissolved in 1 liter of water; lower your hand for 30 minutes).
- Camphor oil or alcohol tincture of wild rosemary - can be used topically 1-2 times a day.
- Ointment based on honey and aloe - aloe pulp and honey are taken in equal amounts.
- Local application of goose fat.
- Egg yolk ointment - raw yolk and 5 g of edible salt are mixed, after which the mixture is applied to the skin 3-4 times a day.
- Bandage with Badyaga - freshwater sponge powder diluted in water in a ratio of one to two. The composition is applied to the site of damage. The dressing is changed twice a day.
- Compresses based on:
- Vegetable oil, food vinegar (9%) and water - the ingredients are taken in equal volumes (in the first days, a cold compress is used, starting from 3-4 days - a warm one).
- Alcoholic horseradish tincture (ratio with ethanol 1: 1) - the recommended application time is about 30 minutes.
- Crumpled cabbage leaf - the procedure is performed in the evening before bedtime.
- Raw Potato Slices - Compress also overnight.
Recovery time
Usually, the rehabilitation period is 9 to 15 days. Depending on the severity of the injury, it can vary from 1 to 6 weeks.
Possible complications
The consequences of damage to the soft tissues of the hand are determined by the amount of damage, concomitant diseases, and the adequacy of the medical care provided.
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At the time of injury, damage to the branches of the median (changes in sensitivity from the palmar surface of 1-3 fingers and half of the ring finger) or ulnar nerves (respectively, from the side of the little finger and half of the ring finger) is possible. With a bruised joint of the hand, internal hemorrhage is possible, accompanied by hemarthrosis. Compression of the nerve trunks in the anatomical canals can lead to the manifestation of tunnel syndrome and carpal tunnel syndrome (neuritis of the median nerve).
With crushing of soft tissues (extensive destruction of tissues with the loss of their viability), their aseptic necrosis is possible, accompanied by the development of inflammation. Crushing is always dangerous with the possibility of a secondary infection.
Typical complications of bruising with prolonged inactivity are muscle wasting of the hand, osteoporosis, arthrosis and contractures (fibrotic changes in tendons, joints and soft tissues). Contractures are accompanied by deformation of the hand and fingers, which excludes the performance of physiological functions by the hand. Common types of contractures are:
- preacher's hand;
- clawed paw;
- monkey brush.
