Caring for Pediatric Hand Injuries
With fall sports and activities in full swing, it’s a critical time of the year to remind children of all ages about the importance of hand safety on and off the field.
Pediatric hand injuries are a common reason for physician consultation. The most common and potentially problematic pediatric sports-related hand injuries include fingertip injuries, phalangeal fractures, tendon and ligament injuries, fractures, and dislocations.
Injuries to the hand are frequent in the pediatric population because children are so active. They are a top reason for visits to urgent care clinics and emergency departments. Hand fractures account for about 15% of all pediatric fractures and 2.3% of pediatric emergency visits. Although some of the most common hand and wrist injuries heal quickly with rest and at-home treatment, other injuries are more serious and can take weeks to heal.
Studies have confirmed what many student athletes and their parents have learned the hard way: hand injuries and playing sports can go “hand-in-hand.” Field sports, like football, lacrosse, soccer, and field hockey, that require open field running and where athletes have the chance of being tackled, lead to the most hand and wrist injuries. Falling on an outstretched hand can cause wrist injuries. Court sports like tennis and basketball also have a great risk of injury to a child’s hands and wrists.
Strains and sprains are common with load-bearing activities like gymnastics, cheerleading and weightlifting. They can also cause tendinitis, an inflammation or irritation of a tendon, which can occur with repeated motion.
When to see a doctor for a hand injury
Open wounds, visible bones or bones that should be lined up but aren't, are obvious signs your child needs immediate medical attention. Other serious hand and wrist injuries aren't always as obvious, however.
If swelling that doesn't improve within one to two days, pain that gets worse with movement, or a finger that hangs down or can't be moved are signs that it's time to see a hand specialist. To prevent a potential worsening of a condition, get an evaluation sooner rather than later. Even if you think something isn't a big deal, a hand specialist can evaluate it to make sure. You can know moving forward that you haven't put your child's hand at risk.
Thankfully, most hand injuries children and adolescents have don't require surgery and can be treated with rest, ice and immobilizing the injury with a splint or cast. Every injury is different, but the average healing times for common hand injuries are:
Fractures: Fingers need about 6 weeks to heal, a wrist up to 8 weeks. If surgery is needed, recovery takes longer.
Dislocations: Depending on the severity, a finger may be buddy taped (taping the injured finger to a healthy one) for 2-3 weeks, or splinted for 2-3 weeks, followed by buddy taping for 2-3 weeks.
Tendon ruptures: These take the longest to heal, requiring 3-4 weeks in a cast, followed by 6-8 weeks of rehabilitation.
Tendinitis: The area should improve within a couple of weeks with rest and ice. Steroid injections may be an option for chronic cases.
It's better to err on the side of protecting an injury more rather than less – a cast versus a splint or sitting out versus continuing to play – if there's a risk the injury may worsen or not heal properly. The best chance of recovery and regaining normal use is if an injury heals properly the first time. Otherwise, it could get much more complicated if it does not get the proper time to heal.
How to prevent hand injuries
Playing and training smart are the best ways to avoid being sidelined with a hand injury. Make the most of protective gear. Use those shoulder pads to break a fall rather than an outstretched arm. Wear gloves and/or wrist wraps to protect the hands against falls and lacerations.
Using the proper technique during training is important, too. Wrists bent all the way back, bearing too much weight in weight training, for instance, can cause sprains and strains. Make sure your child gets guidance in the right mechanics of his or her sport.
Appropriate assessment, initial management, and, if necessary, timely referral of pediatric patients with hand injuries are paramount given the importance of the hand in function and child development. While some principles from managing adult hand injuries might apply, children often require special considerations.