Finger and hand lacerations
It's not necessary to see a hand surgeon or a specialist surgeon for a truly simple finger or hand laceration. But if you've cut yourself in the kitchen or the shed how do you know whether your laceration is simple or if something deeper might be injured? Should you see a doctor? Should your doctor refer you to a specialist?
It can be difficult to answer these questions, because a partial injury to a tendon usually won't stop you moving your finger, and you can completely sever one (or sometimes even both) of the two arteries in your finger without any clear signs. However, these injuries can affect your long term function - for instance a tendon that is partially may rupture, and injured arteries can lead to later cold intolerance. If you or your GP or emergency doctor have any concerns about what injury might lie beneath the skin it is best to see a specialist. If you need your hands - and most people do - it's always better to have your injury properly explored and treated than to leave things to luck or chance.
- tingling in the tip or on one side of the finger - this may indicate nerve injury, especially if it persists more than 24 hours
- a different sensation between the skin of the injured finger and the skin of the adjacent uninjured finger - this may indicate nerve injury, especially if it persists more than 24 hours
- a ragged, deep or dirty wound, especially one that was caused by an animal or human bite
- increasing redness, pain and swelling around the wound - this suggests infection
- a finger that doesn't straighten or bend where it used to straighten or bend - this may indicate a complete tendon injury
- fallen on glass or a sharp object - usually when the injury occurs in this way the injury goes down to the bone. The same applies to injuries that occur when a ceramic cup or bowl breaks in your grasp.
- a medical condition that puts you at increased risk of complications, such as diabetes, immunosuppression or conditions that affect the blood flow to your hand
- a suspicion that something is inside the wound, such as a splinter or piece of glass
- concerns or a feeling that something is just not right
What will my GP or emergency department do?
For most hand injuries an X-ray is performed to check for bone damage, severe tendon damage or foreign matter in the wound. If your tetanus immunisation is not up to date your GP or emergency department will be able to correct this.
Washing out the wound thoroughly reduces the risk of infection. This is often done after local anaesthetic is injected to make the area numb. Your doctor may suture the wound (stitches) or leave it open. A simple dressing will be applied - preferably a non-stick one, so that it can be removed in the future without hurting you. For clean injuries (like cut from a clean knife) antibiotics are not required, but they should be given for bite injuries and when there is a broken bone with a cut. A plaster splint is often made to immobilise your finger or hand; this reduces pain and swelling by keeping your injury still. Most people have minimal pain when their injury is immobilised, so pain medications like paracetamol or ibuprofen are usually sufficient. You will be given instructions to keep your hand elevated at or above the level of your heart, which is often easier with a sling.
Your doctor will make an assessment of the likelihood of infection or deeper injury to the structures in the fingers. If there is any doubt you will be referred to a specialist surgeon for treatment.
I was told that it was "nothing", but my hand is still swollen and sore. Should I see a specialist?
Often fingers and hands remain swollen for much longer than you may expect after a simple injury, even if there is no infection. Early treatment and specialist advice regarding dressings, mobilisation, swelling control and elevation can get you back to best earlier. If you are having problems or concerns it's entirely reasonable to seek medical attention - your hands are important, so see your GP and ask if you should visit Melbourne Hand Surgery.