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Avocado hand injuries
Avocados are a staple of the Australian kitchen. They are also a recognised cause of serious hand injuries. “Avocado hand” describes a knife wound to the hand sustained while preparing an avocado, most often while trying to remove the pit.
Most of these injuries happen at home, to people who are not expecting them, and the wound can look far less serious than it is.
What is it?
An avocado hand injury is a cut to the hand or fingers caused by a kitchen knife during avocado preparation. The usual mechanism is stabbing the point of the knife into the pit. The blade glances off the hard, smooth stone and continues into the hand that is holding the fruit. Less often, a very sharp knife passes straight through the pit and into the palm beyond it.
Sometimes no important structures are damaged. Sometimes the knife divides a nerve, an artery or a tendon. It is possible to have a partial tendon injury and still move the hand normally, so a wound that seems minor can still need assessment.
At a glance
What is it?
A knife wound to the hand sustained while preparing an avocado, usually while removing the pit
Common symptoms
A cut to the palm or fingers, bleeding, numbness, weakness, or trouble bending or straightening a finger
Who it affects
Home cooks of any age. In the US emergency department study reported by the Sydney Morning Herald, 80 per cent of those injured were female
Is it serious?
Often minor, but a knife can divide a nerve, artery or tendon. These injuries can cause lasting loss of movement or sensation
Treatment options
Wound cleaning and closure alone, or surgical repair of a divided nerve, artery or tendon
First step
Assessment of the wound and of hand movement and sensation. Deep, numb or bleeding wounds should be seen promptly
Symptoms and how it presents
The wound itself is usually on the palm side of the non-dominant hand, at the base of the fingers or in the middle of the palm. It may be short and look unremarkable.
Features that suggest a deeper injury include:
- Numbness, pins and needles, or altered feeling in part of a finger
- Inability to bend or straighten a finger fully, or reduced strength
- Bleeding that is brisk or difficult to stop
- A wound that is deep, gaping, or was made by a long or very sharp blade
Normal movement does not rule out a tendon injury. A tendon that is partly cut can still work, but it may rupture completely later, which is why assessment is recommended.
Causes and risk factors
- Stabbing the point of a knife into the pit, so the blade can glance off the stone and continue into the hand
- Holding the halved avocado in the palm of the other hand while driving the knife towards it
- Using a very sharp knife, which can pass through the pit and into the hand beyond
- Rising consumption. Australians ate around 30,000 tonnes of avocado in 1998 and almost 90,000 tonnes in 2018, according to Avocados Australia figures reported by the Sydney Morning Herald
The safest way to remove the pit is with a spoon. Cutting the avocado into quarters rather than halves also makes the pit easy to lift out. If you do use a knife, keep the fruit on a board or bench rather than in your hand.
How is it diagnosed?
Diagnosis is clinical. Assessment covers the position and depth of the wound, sensation in each part of each finger, the movement and strength of every tendon that crosses the wound, and the blood supply to the finger.
The structures at risk depend on exactly where the blade entered, so the examination is targeted rather than general. Imaging is not usually required, although an X-ray may be taken if a fragment of blade could be retained in the wound.
Treatment options
Treatment depends on what the knife has divided.
- Skin only. The wound is cleaned and closed. Healing is usually straightforward.
- Partial tendon injury. Movement may be normal, but a partly divided tendon can rupture later. Management depends on how much of the tendon is involved and is discussed at assessment.
- Complete tendon division. Surgical repair is required to restore movement, followed by a period of splinting and hand therapy.
- Nerve division. Surgical repair is required if feeling is to recover. Sensation returns slowly and recovery is not always complete.
- Artery division. Bleeding is controlled and the artery is repaired or tied off, depending on the blood supply to the finger.
Wounds left untreated can heal on the surface while a divided tendon or nerve remains unrepaired underneath, which makes later reconstruction harder.
When to see a hand surgeon
Seek review promptly at an urgent care clinic, hospital emergency department or your GP if any of the following apply after an avocado injury:
- Any numbness or altered feeling in a finger
- Any difficulty bending or straightening a finger
- Bleeding that does not settle with firm pressure
- A deep or gaping wound, or one you cannot see the bottom of
- A finger that looks pale, blue or unusually cold
If the hand is bleeding heavily or a finger has lost its blood supply, attend a hospital emergency department rather than waiting for an appointment with a GP or hand surgeon.
For less urgent injuries, see getting an earlier or emergency appointment.
What to expect at your appointment
Dr Tomlinson will examine the wound and test the movement, strength and sensation of the hand, then explain what has clearly been injured and what the options are. If an exploration or surgical repair is needed, the timing, setting and anaesthetic options are discussed at that visit.
See also preparing for your appointment.
Dr Tomlinson in the media
Dr Tomlinson has spoken publicly about avocado hand injuries and safe preparation technique.
- ABC Radio Darwin, Mornings with Adam Steer, 16 May 2017. A four minute interview on how severe these injuries can be, prompted by British surgeons calling for safety labelling on avocados. Listen on ABC Listen.
- The Sydney Morning Herald, Good Food, 3 August 2019. “Smashed avos and sliced arteries: the secret cost of our avocado obsession” by Paul Sakkal, reporting a US study of more than 50,000 emergency department presentations for avocado related hand injuries in the twenty years to 2017. Describing the usual mechanism, Dr Tomlinson said: “The knife then glances off the pip and goes into their hand.” Read the article.
Watch: removing an avocado pit safely
Frequently asked questions
What is the safest way to remove an avocado pit?
Use a spoon. Halve the avocado, then slide a dessert spoon under the pit and lever it out. No blade goes anywhere near your hand.
If you prefer a knife, cut the avocado into quarters rather than halves. The pit lifts out easily and you are not holding the fruit against your palm. Whatever method you use, keep the avocado on a board or bench, not in your hand.
I cut my hand on an avocado knife. Do I need to be seen?
If there is any numbness, any loss of movement, brisk bleeding, or the wound is deep, yes. Those findings suggest the knife has reached a nerve, artery or tendon.
If the cut is shallow, feeling and movement are entirely normal, and the bleeding stopped quickly with pressure, it may only need simple wound care. If you are unsure, it is reasonable to have it checked rather than wait.
The cut is small and I can still move my finger. Could something still be damaged?
Yes. A tendon that is only partly cut can still move the finger normally, so full movement does not prove the tendon is intact. The concern is that a partly divided tendon carries a real risk of rupturing completely later, sometimes weeks afterwards and during ordinary activity.
This is the main reason review by a doctor is recommended even when the hand seems to be working.
How quickly do tendon and nerve injuries need to be repaired?
Sooner is better. Repairs are technically easier and outcomes are generally better when a divided tendon or nerve is repaired early rather than after the ends have retracted and scarred. A flexor tendon is ideally repaired within 72 hours of the injury.
An injury that has cut the blood supply to a finger is urgent and should be assessed at a hospital emergency department immediately.
Will I need surgery?
Only if a structure beneath the skin has been divided. Many avocado injuries involve skin alone and need nothing more than cleaning and closure.
Where a tendon, nerve or artery has been cut, surgical repair is how movement, feeling or blood supply is restored. What is involved depends on which structure is affected and where in the hand it sits, and will be explained to you at your assessment.
Where would my surgery be done?
How much time will I need away from work?
This depends on what your job involves and what was injured. If your work is desk-based or administrative, you may be able to return relatively soon, often with some temporary modifications. If your work is physical, involving heavy lifting, manual labour or being on tools, you will usually need longer. A repaired tendon or nerve requires a protected period during which the hand cannot be used normally.
Dr Tomlinson will give you advice tailored to your job at your consultation, and we are happy to provide a letter for your employer outlining recommended modifications.
When will I be able to drive again?
Multiple things affect this: which hand was treated, whether you are wearing a bandage or splint, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You also need to be safely in control of the vehicle for insurance purposes. You should be able to grip the steering wheel strongly with both hands and take evasive action in an emergency before you get behind the wheel.
Will I need to see a hand therapist afterwards?
If a tendon or nerve has been repaired, hand therapy is an important part of recovery and Dr Tomlinson will give you a referral. Therapy guides how and when the hand is moved so that the repair is protected while stiffness is kept to a minimum.
For a skin-only wound it is generally not needed, but you are welcome to see a hand therapist if you would find it helpful. Dr Tomlinson can arrange a referral either way.
How common are avocado hand injuries?
More common than most people expect, and probably under-reported because people are embarrassed to say how it happened.
A United States study published in the American Journal of Emergency Medicine, reported by the Sydney Morning Herald in 2019, found more than 50,000 emergency department presentations for avocado related hand injuries in the twenty years to 2017, with almost 30,000 of those in the final five years. In New Zealand, around 100 compensation claims a year were lodged for avocado injuries between 2013 and 2015.
Australian health authorities do not collect statistics on the specific activities that lead to hand injuries, so there is no equivalent national figure here.