Five common causes of hand injuries

The hand is a complex structure made of 27 bones connected by ligaments, muscles, tendons, and nerves. Because the hand is so intricate, hand injuries can cause serious complications. Here are five common hand conditions you should know about.

1. Avocado hand

It might sound like a funny term, but the injury dubbed “avocado hand” is no laughing matter. This injury happens when someone holds half of an avocado in one hand and “stabs” the pit with a knife held in the other hand.

Unfortunately, many people who attempt to move the pit this way either miss their target or use too much force and end up impaling the palm of their hand. This type of knife injury can result in a laceration that requires sutures. It can also cause deeper injuries that involve the muscles, nerves, and tendons that, in some cases, require surgical repair.

Due to the increasing popularity of dishes like avocado toast and guacamole, rates of avocado-related injuries have soared over the past few years. In a 20-year U.S. study, about 50,000 people went to the ER for an “avocado hand” injury. More than 27,000 of these injuries occurred in just the last four years of the study.

A simple tip for preventing “avocado hand” is to use a spoon to scoop out the pit instead of stabbing the pit with a knife. There are also handy tools, like an avocado knife, that can assist you in safely removing an avocado pit. However, if you do injure your hand with a knife, it’s important to seek prompt medical attention to assess the damage and have it correctly repaired.

2. Dequervain’s tenosynovitis

The abductor pollicis longus are two tendons that run along the top side of your thumb and connect to your wrist these tendons run through a lubricated sheath, gliding back and forth whenever you flex or extend your thumb. 

DeQuervain’s Tenosynovitis happens when these tendons and the sheath become inflamed, which results in pain when you move your thumb. This injury is common in people who do repetitive movements with their hands, including gardening and playing golf.

It’s also a common injury in parents of infants because when they pick up their baby, parents typically separate their thumb away from the rest of their hands and put their hands under their child’s armpits.

While DeQuervain’s sometimes resolves with home treatments, including ice packs, rest, and non-steroidal anti-inflammatory drugs (NSAIDs), patients with pain that doesn’t resolve on its own or pain that recurs should seek medical attention. Sometimes patients with DeQuervain’s Tenosynovitis require a splint, stronger oral anti-inflammatory medication, or steroid injections to resolve the problem.

3. Subungual hematoma

A subungual hematoma refers to bleeding or bruising under a nail. It usually happens from blunt force trauma, like hitting your thumb with a hammer or slamming your hand in a car door.

A subungual hematoma causes the space under the fingernail to appear dark purple or black. Patients with a large subungual hematoma often benefit from a procedure called trephination, where a small hole is made in the nail with a hot cautery wire to allow the blood to escape, which relieves the excess pressure.

Trephination is usually most effective if performed within 48 hours of an injury, so it’s a good idea to seek prompt medical care if you sustain this type of injury.

4. Skier’s thumb

While DeQuervain’s Tenosynovitis is a condition that affects the tendons that run along the thumb, a condition called “Skier’s Thumb” affects the ligament that connects the thumb to the hand. The injury happens when the thumb is suddenly bent back with significant force.

“Skier’s Thumb” can happen when a skier falls and their thumb is bent back by their ski poles. It can also happen if someone has a car accident and only had their thumbs wrapped around the steering wheel. Or it can happen to a goalie if a soccer ball bends their thumb back when they try to catch it. 

Patients who sustain this type of hand injury should seek prompt medical attention to confirm the diagnosis and determine the appropriate treatment.

5. Paronychia

A paronychia refers to an infection in the soft tissue along with a fingernail. The word is a combination of the Greek words for “nail” and “around.”

Paronychias cause the skin around the nail to become red, painful, and swollen. In some cases, a collection of pus called an abscess forms in that area.

Paronychias usually occur when bacteria from the surfaces of the skin gain entry into the soft tissue through a small opening like a hangnail or an area of cracked skin. Be mindful when getting your hands dirty doing outside work and other yardwork safety tips.

Small paronychias are often treated with oral antibiotics and warm compresses. Large paronychias often require a procedure called an incision-and-drainage (or, I&D), where the area is injected with an anesthetic, and an incision is made to allow the pus to drain.


Written by Sarah Thebarge, Physician Assistant