Hand Injury Treatment
Initial priorities are outlined below
- Stop bleeding (direct pressure)
- Relieve pain (digital/wrist block)
- Assess injury (and splint)
- Path of Recovery
- Pain relief
- Protection Physiotherapy
A digital, or wrist block is the best way of relieving pain (Lignocaine 2%, without adrenaline, in doses not exceeding 5mg/kg, any nerve injury must have been assessed and documented prior to the nerve block).
Splinting the injured part is a simple (sadly often forgotten) way of providing effective and rapid pain relief. Splint as it lies or in the ‘safe’ position, (the wrist in about 30º extension, metacarpophalangeal joints 70–90º flexed, and the interphalangeal joints fully extended. The thumb, if included, is held parallel to the index finger). In this position the collateral ligaments are at their longest.
The coach can correct faulty technique and advise the medical team on the demands of the sport. But the patient is primarily responsible for their own recovery. Only the patient can do and carry out the given advice.
Pain relief, protection and physiotherapy are the three ‘Ps’ on the path to recovery.
Pain relief. Use ice, crepe and elevation (to reduce pain and swelling). Analgesics are used. Ice, heat, laser and TENS will also reduce pain.
Steroids (betamethasone *‘Celestone’* or methylprednisolone *‘Depomedrol’* have no place in acute injury. Useful in chronic inflammatory conditions (only two or three injections be given in one area). Complications with prolonged use included skin atrophy, fat necroses, infection and tendon rupture.
Athletes (under pressure to get back into competition) may request a ‘pain killing injection’. The injection of local anaesthetic is not indicated. If the hand is too painful to stand up to a the demand of competition it is not ‘ready for them’.
Protection. Continue splinting from acute phase of injury if necessary to stabilize and protect. (Allows protected movement (buddy taping’ to a healthy digit is easy and useful), apply tape so as not to interfere with joint movement, be careful when buddying an injured small finger to the right ring finger as a deforming rotatory forces may be applied to the injured digit). Dynamic splinting is best and often used in combination with static splints (at night). (S-Thumb will protect thumb or wrist).
Surgery may be necessary to get stability and protection.
Physiotherapy. Early active movement should begin as soon as possible. When pain settles, stability is established, and movement returns, stretching and strengthening are started. Any impediment to movement should be removed. (Pain, instability and oedema).
Oedema is lessened by movement, elevation, ice, and pressure from elastic bandages (Coban or similar) or tailor made gloves. Massage, laser, and intermittent positive pressure (Masman pump) will help.