MANUAL MINORS
Contusive hand injuries are closed wounds caused by direct trauma, such as blows, falls, or crush injuries. These wounds usually do not involve open cuts in the skin but can damage internal structures such as muscles, tendons, nerves, blood vessels, and even bones.
Contusions can vary in severity, from mild bruising to severe crush injuries that compromise hand function. These injuries may be accompanied by pain, swelling, bruising (ecchymosis), and in more severe cases, tissue ischemia or necrosis.
Diagnosis
The diagnosis of a contusive hand injury is based on the trauma history and physical examination. It is essential to assess the affected area for signs of swelling, bruising, deformities, tenderness, and functional limitation. Active and passive mobility of the fingers and wrist should be evaluated, as well as distal sensitivity and blood perfusion.
Depending on the severity of the trauma, imaging studies such as X-rays may be performed to rule out hidden fractures or bone injuries, while ultrasound can be used to assess the integrity of tendons, nerves, and blood vessels. In severe contusions or crush injuries, a CT scan may be useful for a more detailed evaluation of internal damage.
Differential Diagnosis
Condition | Main Clinical Characteristics | Key Differentiation |
|---|---|---|
Simple haematoma | Swelling and bruising without significant functional loss | Absence of deformity or tendon/bone injury |
Hidden fracture | Intense pain, possible deformity | Confirmed by X-ray |
Tendon injury | Difficulty or inability to move fingers | Deficit in active extension or flexion |
Nerve injury | Loss of sensation in specific areas | Paresthesia or anaesthesia distal to the injury |
Severe crush injury | Severe pain, massive swelling, possible tissue necrosis | History of crush trauma and extensive involvement |
Emergency Management
Initial management of a contusive hand injury focuses on controlling pain, reducing swelling, and assessing the severity of the injury. The affected hand should be immobilised to prevent further damage. Applying ice locally helps reduce inflammation and pain but should be done intermittently (20 minutes per hour) to avoid cold-related damage. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually sufficient to manage pain in most cases.
If deeper damage (fractures, tendon or nerve injuries) is suspected, a thorough examination and imaging studies should be conducted. In cases of crush injuries or vascular compromise, the patient should be immediately referred to a specialist to avoid complications such as compartment syndrome, which may require urgent surgical intervention.
Definitive Treatment
The definitive treatment of contusive hand injuries depends on the severity of the injury. In mild cases, conservative management with temporary immobilisation, hand elevation, and pain relief is sufficient. However, in more severe injuries, such as severe crush injuries, surgical debridement may be necessary to remove necrotic tissue, or surgical intervention may be required to repair fractures or tendon injuries.
Rehabilitation is essential in post-traumatic management, even in mild contusions, to prevent joint stiffness and restore full hand function. Physiotherapy should focus on mobility, strength, and fine coordination, depending on the injury treated.
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