Broken or Sprained Hand? How to Tell (Fingers, Knuckles)

A punch into a wall in a moment of anger, a basketball hitting a fingertip, a car door closing on a hand, or a fall you try to catch with your palm: hand injuries are among the most common things we see in urgent care. The hand and wrist have 27 small bones and dozens of ligaments, so telling a break from a sprain by looking alone is hard, even for doctors. This guide covers the signs that point to a fracture, the common finger and thumb injuries, what to do in the first few minutes, and when you need the ER.

How to tell if your hand is broken or sprained

The NHS says a broken finger or thumb is usually painful, swollen, bruised and hard to move, and that you'll probably need an X-ray. These signs make a break more likely than a sprain:

• Obvious deformity: a bent finger, a lump on the back of the hand, or a knuckle that looks sunken or flattened compared with the other hand.
• When you slowly make a fist, one finger twists, crosses over its neighbour or points in a different direction from the rest.
• Severe swelling and bruising that comes up within hours.
• Sharp pain when you press one spot of the bone with a fingertip, rather than general soreness around a joint.
• Being unable to hold a cup, grip, or pinch between thumb and finger.
• A snap or crack at the time of injury, or numbness in a finger.

Being able to move your fingers doesn't rule out a break; plenty of people wiggle their fingers with a fractured hand. Because the signs overlap, the only way to be sure is an X-ray. Our guide to a broken bone or a sprain covers the general rules for any limb, and if the pain is in your wrist rather than your hand, see broken wrist or sprained wrist.

Sprain, fracture or dislocation?

Boxer's fracture: did you break your hand punching a wall?

Punching with a closed fist drives the force into the neck of the bone just below the little-finger knuckle, which is where it breaks. The American Academy of Orthopaedic Surgeons (AAOS) says the knuckle may look sunken afterwards and the finger may twist when you make a fist. Pain and swelling along the outer edge of the back of the hand after a punch deserve an X-ray the same day. Be especially careful if the skin over a knuckle was cut by someone's teeth: that small wound can carry bacteria into the joint and needs assessment the same day, even if it looks minor.

Broken or jammed finger? And skier's thumb

A ball hitting the tip of a finger usually sprains one of its joints: swelling, pain and stiffness, but the finger stays straight. A fingertip that droops and won't straighten on its own, or a finger that looks rotated or bent, needs checking the same day. Skier's thumb (also called gamekeeper's thumb) is a tear of the ligament on the inner side of the base of the thumb when it's forced backwards, and it makes holding a key or opening a jar painful and weak. Get it examined within a few days, because an unstable thumb can stay weak if it isn't treated.

When does a hand injury need the ER?

Call 911 for

• Part of a finger or fingertip cut or torn off. Wrap it in clean gauze or tissue, seal it in a plastic bag, and keep the bag on ice without the ice touching the part directly.
• Bleeding that won't stop after 10 minutes of firm, direct pressure.
• A machinery or severe crush injury with other injuries, fainting, or pale, sweaty skin.

Go to the ER now

• Bone showing through the skin, or a wound over a possible break.
• Fingers that are cold, white, blue or numb after the injury.
• A finger pointing at an odd angle or obviously out of place.
• A crush injury, such as a hand trapped in a heavy door or machine.
• A cut over a knuckle from someone's teeth (a "fight bite"), or an animal bite to the hand.

Urgent care or a doctor the same day

• Pain, swelling and bruising in the hand or a finger, with difficulty moving or gripping.
• Pain over a knuckle after punching something hard.
• A finger that twists or crosses its neighbour when you make a fist.
• A fingertip that droops and won't straighten by itself.
• Pain and weakness at the base of the thumb after it was bent backwards.

Usually fine at home

• Mild pain and swelling, with the hand a normal shape and still able to grip and be used.
• No sharp pain when you press one spot of the bone.
• Clear improvement within two to three days. If it isn't improving, come to urgent care.

What should you do right after a hand injury?

• Take rings off now from the injured hand, before swelling builds; a stuck ring can cut off blood flow to the finger.
• Wrapped ice: an ice pack or bag of frozen vegetables wrapped in a towel for 15 to 20 minutes every 2 to 3 hours. Never put ice straight on the skin.
• Raise the hand above the level of your heart on a pillow to reduce swelling.
• Keep it still. Don't try to straighten a bent finger or push a dislocated joint back yourself. Taping a finger to its neighbour (buddy strapping) helps some injuries, but only do it if a doctor or nurse advises it.
• Wounds: cover any cut with a clean dressing. For when a cut needs closing, see does my cut need stitches?, and for animal bites see dog and cat bites and tetanus.
• Pain relief: paracetamol can ease pain on the way in; ask a pharmacist if you're not sure what suits you.

How long does a broken hand take to heal?

At urgent care at Emergency Plus, open 24/7 with no appointment, the doctor examines your hand and may request an X-ray on site, then decides on treatment: a splint, buddy strapping or a cast, or referral to a hand specialist if the break is displaced or rotated. According to the NHS, a broken finger or thumb usually heals within 6 to 8 weeks, and full strength can take 3 to 4 months to return. MedlinePlus says a splint for a broken hand bone is often worn for about 3 weeks, with return to work or sport usually around 8 to 12 weeks.

Physiotherapy after the cast comes off

Stiffness and a weak grip are common after weeks in a splint or cast. Physiotherapy helps you get back the bend and stretch of your fingers, grip strength and the fine control you need for writing, your phone and work. The physiotherapy clinic at Emergency Plus runs 9:00–20:00 daily with no referral (it isn't open 24 hours). For what to expect, see physiotherapy after surgery in Amman.

Sources

• NHS — Broken finger or thumb
• MedlinePlus — Hand fracture: aftercare
• AAOS OrthoInfo — Hand fractures
• AAOS OrthoInfo — Finger fractures
• NHS — Animal and human bites