Little Fingers – Big Trouble: 3 Common Hand Injuries

Last week, we talked about 3 common leg and foot injuries that we often see in urgent care; this week, let’s address the upper extremity shall we? Specifically, hand injuries that are bound to happen because we use our hands for nearly everything we do. So, let’s jump into the three most common hand injuries I see in urgent care: how to prevent, recognize, and treat them.

Broken Finger

Children are naturally more active and less careful when it comes to their small digits, resulting in potential broken fingers. These appendages are small and fragile enough for even a minor hit or fall to lead to fracture. The symptoms of a broken finger in children can include pain, swelling, bruising, and difficulty moving the injured finger. In some cases, the finger may also appear crooked or deformed. If the injury is significant, there may be an open wound or bleeding from the finger.

Treatment for a broken finger in children depends on the severity of the injury. In mild cases, the finger may be immobilized simply by “buddy taping” it to the adjacent digit or supporting it with a splint for a few weeks to allow it to heal. In more severe cases, surgery may be necessary to realign the bones and stabilize the finger. It is important to seek medical attention for a suspected broken finger that looks like there is a disruption in the alignment because prompt treatment can help to prevent permanent damage or arthritis.

The best way to prevent a broken finger in children involves teaching and modeling safe play and sports practices. It is also a good idea to prove protective gloves and guards for activities like rollerblading, bicycling, and ball sports. Children should also be taught to report any pain or discomfort to a trusted adult and not try to “tough it out.”

Paronychia

Paronychia is a common infection that affects the skin around the fingernail or toenail, caused by bacteria that commonly lives on our skin such as Staphylococcus aureus or Streptococcus pyogenes. It can occur when there is damage to the skin around the nail, sometimes occurring due to biting the nails or cutting the cuticles too deeply. It can also be caused by moisture from sucking on fingers or wearing wet gloves, socks, or shoes.

Common symptoms of this bacterial infection are pain, redness, swelling, and warmth around the nail. Pus or drainage is also possible, and, in severe cases, the nail may become discolored or deformed. To treat paronychia, keep the affected area clean and dry. Soaking the finger in warm water several times a day can help to relieve symptoms and promote healing. When there is an accumulation of cloudy fluid around the nail, it needs to be drained, typically by lancing the pocket of infectious fluid and expressing it out. Once that procedure has been performed, antibiotics may not be necessary.

Preventing paronychia in children involves encouraging good hygiene practices such as frequent handwashing and discouraging nail-biting or sucking. Keeping hands and feet dry and avoiding prolonged exposure to moisture can also help to prevent the development of paronychia.

Nailbed Injury

Another common nail-related concern is the nailbed injury, affecting the soft tissue underneath the nail, which is important for nail growth and function. Much like fractures, this injury is more likely in children because of how active and careless they tend to be during play. Little fingers find smaller openings, and curious minds explore narrow crevices that could pose pinching and trapping risks.

Depending on the way they’re acquired, nailbed injuries can present with pain, swelling, bleeding, and deformity of the nail. If it’s really bad, the nail may also become detached from the nailbed and eventually fall off. Sometimes, an accumulation of blood may appear under the nail that looks like a black/purple colored spot. It’s usually painful and is called a subungual hematoma. The pain is due to the pressure of the extra fluid accumulating under the nail and is relieved by puncturing the nail with a special heat cauterizing tool that helps drain the fluid.

To treat milder cases of nailbed injury, the nail may be trimmed and the injured area cleaned and bandaged. In more severe cases, the nail may need to be removed to allow for proper healing of the nailbed.

It is important to seek medical attention for nailbed injuries in children to prevent complications such as infection, scarring, or deformity of the nail. In some cases, the nail may not grow back normally, or the nail may grow back with an abnormal shape or texture.

As always, supervision, proper protective equipment, and self-aware hygiene habits are all keys to preventing and catching small injuries, such as those affecting hands. Even though they might seem minor, they can sometimes develop into more serious issues later on, such as arthritis or infection. This is why it’s important to teach kids to come to us anytime they get hurt, in order to assess the situation and to potentially seek professional medical intervention. I’d rather have lots of folks come visit me and have it be a “false alarm” rather than not come in and miss something significant. Keep this in mind; applies to more than just finger injuries.