How to Treat a Finger Injury from a Hammer Strike

Check for Swelling. Regardless of how hard the blow was, your finger will swell. This is the most common reaction to such an injury. The swelling should subside within a few days if the impact wasn’t too severe. If the only symptom is swelling, you can apply an ice pack to the injured finger to help reduce the swelling and pain.

• You can also take over-the-counter painkillers.
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB) or naproxen sodium (Aleve) can also help relieve pain and swelling. Follow the dosage instructions on the packaging.
• You don’t need to see a doctor unless the swelling doesn’t decrease, the pain intensifies, or there is numbness, or if your finger cannot bend or straighten.

Handle a broken bone situation. If your finger is severely swollen and painful, it's possible you've fractured your finger, especially if you experienced a strong impact. If your finger looks deformed and is extremely sensitive to touch, it might be broken. This condition may also include visible skin bleeding or a crushed nail.

• Seek medical attention if you suspect a fracture. You will need an X-ray, and a doctor might need to splint your finger or offer other forms of treatment. Do not splint the finger unless directed by a doctor.

Clean the wound. If your finger is bleeding after being hit, it's important to clean the wound to assess the damage. Rinse your finger under warm water if bleeding occurs. Make sure the water flows downwards and not back into the wound. Then, use gauze to clean the wound with Betadine or another antiseptic solution.

• Apply pressure to the wound for a few minutes to slow the bleeding, allowing you to assess the depth of the injury and determine if you need a doctor.
• Call emergency services immediately if the bleeding is excessive or spurting.

Assess the tear. Once you've cleaned the wound, check your finger for any cuts or tears in the skin. The wound might still bleed slightly during inspection, which is normal. Tears often appear as splits or small patches of skin coming off the finger. Any significant tissue damage or exposed bleeding meat must be checked by a doctor. Sutures may be needed for tears greater than 1.2 cm. However, the skin may not stay intact if it's severely damaged.

• Many doctors still stitch the damaged skin above the exposed tissue to protect the growing new skin. The outer layer will be removed once the new skin forms.
• Shallow tears may stop bleeding on their own, especially if the impact was not too severe. If this happens, wash the wound, apply antibiotic ointment, and cover with gauze.

Check for tendon damage. The hand and fingers are a complex system of muscles, tendons, and nerves, so it's crucial to check for signs of tendon injury. Tendons connect muscles to bones. There are two types of tendons in the hand: flexor tendons in the palm that help bend the fingers and extensor tendons on the back of the hand that straighten the fingers. Cuts and bruises can damage or even sever these tendons.

• You will not be able to bend your finger if a tendon is torn or cut.
• Injuries to the palm or near the finger joint creases could damage tendons underneath.
• You might also experience numbness if nerves are damaged.
• A soft palm may indicate tendon damage.
• You may need surgical intervention if any of these signs are present, as treating hand and finger injuries can be complex.

Examine the nail. Your nail is likely to suffer significant damage if struck by a hammer. Carefully observe the nail and assess the injury. You won’t need to see a doctor if you only notice a small blood spot under the nail. Just apply an ice pack and take over-the-counter pain relief if you're in pain. However, you should seek medical care if the pain lasts for days, the blood under the nail covers more than 25% of the nail's surface, or if the blood is putting pressure on the nail. You might have a subungual hematoma.

• If part of your nail is torn off or broken, and the nail bed is deeply injured, you will need medical attention as the wound might require sutures. Without treatment, the injury could prevent proper nail growth, causing deformities or infections.
• Seek medical attention immediately if part or all of the nail is lost. This is a serious condition and requires attention. The nail may need to be removed or stitched until a new healthy nail grows back, a process that can take up to six months.

Visit a doctor. You should seek medical attention if you have a large blood clot beneath the nail, covering more than 25% of the nail area. A blood clot under the nail means that small blood vessels beneath the nail have ruptured. A doctor may suggest draining the blood by either making a small hole or cutting the nail. You can perform this procedure yourself if done quickly. If you experience significant pain, push the skin around your fingertip inward to gently insert a sterile needle. This is less painful than the initial injury and easier to do than pricking the nail's base. Drain several times until the fluid comes out. This prevents the nail from turning black due to dried blood underneath.

• If the blood beneath the nail occupies less than 25% of the nail, you don't need to do anything. The blood will move upward as the nail grows. The extent of the blackened nail depends on how hard the nail was struck.
• If the blood clot covers more than 50% of the nail, the doctor may order an X-ray.
• It's recommended to see a doctor for treating blood clots under the nail within 24-48 hours.

Blood extraction at a clinic. The safest method to extract blood from under the nail is by having a doctor perform the procedure using a cauterizing tool. The doctor will use an electrocautery device to create a small hole through the nail. When the cautery tool touches the blood clot beneath the nail, the tip of the tool automatically cools down to avoid burning the finger.

• Once the hole is made, blood will leak out of the nail until the pressure is relieved. The doctor will bandage your finger and send you home.
• A doctor may use a size 18 needle as an alternative, but cauterization is more commonly used.
• This procedure is painless because nails do not have nerve endings.
• This method helps reduce the pressure beneath the nail, meaning there's less chance of needing to remove the nail.

Treating blood clot under the nail at home. A doctor may allow you to drain the blood clot under the nail at home. Prepare a paperclip, a lighter, and clean your hands thoroughly before performing the procedure. Straighten the paperclip and heat the end with the lighter for 10-15 seconds until it becomes red-hot. Then, place the heated end of the paperclip at a 90-degree angle over the blood clot area. Gently press down and slowly twist it so the paperclip punctures the nail. Once done, blood will flow out of the nail. Use cloth or gauze to clean up the blood.

• If the first attempt doesn't penetrate the nail, reheat the paperclip and try again, pressing a little harder.
• Do not press too hard, as you might puncture the nail bed.
• You can take pain relievers before doing this if your finger hurts a lot.
• Ask a friend or family member for help if you cannot perform this procedure yourself.

Clean the nail. Once the blood has drained, you need to clean the nail again with betadine or another disinfecting solution. Wrap the finger with gauze, adding a cotton ball at the fingertip to form a cushion and protect it from irritation or impact. Secure it at the base of the finger with medical tape.

• You can also bandage it in an eight-shaped pattern, from the finger down to the base of the hand. This will help keep the bandage in place.

Change the bandage. Regardless of how your finger is injured, you should replace the bandage once a day. However, you should replace it earlier if it becomes soiled before 24 hours. When removing the bandage, wash your finger with a disinfecting solution and reapply the bandage exactly as it was before.

• If your finger required stitches, check with your doctor before washing it. Follow the doctor’s instructions for caring for the stitches. You may need to keep it dry and avoid any kind of washing solution.

Watch for signs of infection if present. Every time you remove the bandage, carefully inspect the wound for any signs of infection. Look for pus, discharge, redness, or warmth, especially if these signs appear on your hand or arm. Be cautious if you begin to develop a fever, as it might indicate complications like cellulitis, paronychia (infection around the nail), or other hand infections.

Continue follow-up visits to your doctor. A few weeks after your injury, it’s important to see your doctor again. If you had stitches or drainage from under your nail, your doctor will schedule a follow-up. However, always seek medical attention for serious injuries like these.

• Be sure to contact your doctor if you experience any new symptoms, such as suspected infection, dirt trapped in the wound that can’t be removed, increasing pain, or uncontrolled bleeding from the wound.
• You should also reach out to your doctor if you experience symptoms of nerve damage, including numbness, tingling, or the development of a “neuroma,” a nerve scar that can cause pain and electric-shock-like sensations when touched.