Of all types of injuries sustained at work, hand injuries are the most common. Workers’ hands are used for everything from handling packages in commercial settings to using cutting and drilling equipment. No tool is more valuable and versatile than the human hand. According to the US Bureau of Labor Statistics, hand injuries are the most common injuries sustained while on the job. In some fields like construction, hospitality, and carpentry, workers have a higher risk of hand and finger injuries than in other industries. Understanding the risks and how hand injuries occur is essential in preventing them.
Overuse Syndrome
Overuse syndrome is caused by repetitive motion, and it is associated with inflammation of the tendon. Tendonitis is often called an overuse syndrome and is associated with pain, stiffness, and muscle weakness. Work-related reasons for developing an overuse syndrome could be:
- Employing tools that do not work well
- Long work hours with repetitive tasks and no breaks
- Use of poor body mechanics
The most common structure involved in hand overuse is the tendon. It is a cord-like substance that connects muscle to bone. Each tendon in the hand is encased in a protective sheath. The tendon glides within the smooth inner portion of this sheath like a train passing inside the tunnel. Some jobs, like typing, sorting, and lifting, require repetitive wrist movements, leading to tendon irritation. This can cause inflammation and swelling of the surrounding tissues, decreasing the room for the tendon to glide, thus hindering its movement.
The most common conditions caused by overuse are:
- DE Quervain syndrome: affecting the tendon of the thumb
- Carpal tunnel syndrome: irritation of the nerve at the wrist often caused by repetitive wrist movements
Lacerations
Lacerations vary in severity and may lead to traumatic tendon injuries. Along with punctures, lacerations are the most common work-related injuries to the hand and fingers. The risk of laceration is significantly higher when the tools do not work as expected or are used incorrectly. This injury, like all others, often happens when the worker gets distracted. Depending on what structures are damaged, lacerations will vary in seriousness. A minor cut may simply require stopping the bleeding and keeping the wound clean. In more serious cases, the muscle, tendon, or nerve are involved. In those cases, a surgical procedure performed by a specialist is required. As the patient enters recovery, they are referred to a hand therapist. Hand therapists are specialists in this kind of rehabilitation, and will guide the healing process.
Common conditions associated with tendon injuries that are treated by hand therapists include:
- Flexor tendon repair
- Extensor tendon repair
- Mallet Finger – inability to straighten the tip of the finger
- Jersey finger -inability to flex the tip of the finger
Work-Related Fractures of the Hand and Fingers
The risk of fracture is present at any work setting. The most common fractures of the hand include:
- Distal radius
- Metacarpal
- Phalangeal
- Scaphoid
One example of frequent type of fracture is a fall on the outstretched hand. A distal radius break is a common fracture of the wrist when falling directly on the palm of the hand. There is also a small bone in the base of the thumb called scaphoid that can be also fractured in a fall. Scaphoid fractures are often undetected because they do not show up on the X-rays until two weeks after the injury.
Metacarpals run from the base of your wrist to the fingers. The fall on the closed fist can produce a fracture of the ring and pinky metacarpals. Each finger contains three separate bones (the thumb has two) called phalanges. Phalangeal fractures are more likely to result from an object falling on the fingers.
Role of the Ligaments
Ligaments are fibrous tissues that hold the bones of the joint together. If a ligament is damaged, the joint becomes unstable. It leads to pain, weakness, and loss of strength. Any traumatic event that forces the hand or fingers into an unnatural position may cause an injury to the ligament. The seriousness of the injury depends on the amount and angle of force; it can vary from a mild sprain to a complete tear. Treatment for ligament injuries involves rest and using a splint. If the ligament is completely torn, then a surgical repair of the ligament is performed.
Because the thumb is the most moveable part of the hand, it is most susceptible to ligament tears. An object that is held by the thumb and then suddenly pulled away, or a fall on the thumb is likely to cause a ligament tear. Any strong force that bends the thumb sideways beyond its limits can damage the ligaments.
Crush Injuries to the Hand and Fingers
Crush injuries often involve the tip of the fingers. Commonly, these are pinch compression types. Unfortunately, crush injuries to the fingertips take a long time to heal. These injuries are very painful because they affect part of the finger that has many sensory endings, nailbeds, and soft pads.
Crush injury at work may happen in many ways:
- Heavy objects falling on the tip of the hand
- Fingers getting caught between moving parts of the machinery
- Injury with a hammer
- Jammed against a closing door
Prevention and Precautions in the Workplace
Taking necessary precautions and following proper safety guidelines is the best way to prevent hand and finger injuries at work. A worker taking control of their immediate environment is essential in ensuring their safety. This can include:
- Making sure there are no loose sleeves that can be pulled into the moving part of the machine
- Personal protective equipment (PPE) is used when necessary
- Wearing gloves in some jobs to eliminate the risk of punctures and lacerations
- Paying attention to the routine daily task and not becoming complacent
- Recognizing and planning for any situation when fingers or hands can be severed, compressed, or caught
- Checking the equipment and reading the manufacturers’ warning signs
- Preparing the hand tools before work and making sure they are in the proper working order
Hand Therapists are Here to Help
We always hope that hand injuries can be avoid at work, but they still happen frequently. Physical and Occupational Therapists at Ivy Rehab specialize in treatment of all conditions of the hand. Whether it is a complex surgical reconstruction, a custom-made splint, or a routine sprain, the injured worker can expect the highest standard of care at Ivy Rehab. Our clinicians work closely with referring physicians and the rehab team in ensuring a comprehensive approach. Click here to find a location near you.
Article By: Boris Gilzon, PT, DPT, OCS, CHT
Boris Gilzon began his career 34 years ago. Boris loves working with the hand injured population and believes in the importance of improving their daily function. He currently specializes in Hand Injuries. Boris enjoys working with post-surgical and trauma cases to reach their full functional potential.
