Swollen Knuckle: Causes, Symptoms, and Treatment Options

Swelling of the bones in the back of the hand?

Hello, doctor.
Four days ago, I struck the back of my right hand (near the wrist joint where the ring finger and little finger tendons are located) against a wall corner while swinging.
The soft tissue has since reduced in swelling, but there is now a raised hard lump at the impact site.
Currently, I still experience abnormal strength and pain in my ring and little fingers (I suspect the injury has not fully healed).
After researching online, I believe it may be periostitis (or periosteal proliferation) resulting from the impact.
I would like to ask the doctor to assess whether these symptoms align with that condition, how to treat it, and if there could be any long-term consequences.
Thank you for your guidance.

Xian, 30~39 year old female. Ask Date: 2016/05/07

Dr. Shi Guozheng reply Orthopedics

A bump on the back of the hand after hitting a wall corner is likely a result of a hematoma, but it could also indicate a fracture.
Before treatment, it is essential to confirm the diagnosis.
Generally, there are no long-term complications, but it is advisable to consult a physician for evaluation.

Reply Date: 2016/05/07

More Info

Swollen knuckles can be a common issue following trauma, such as the incident you described where you struck your hand against a wall. The symptoms you're experiencing, including the hard lump at the site of impact, pain, and difficulty applying force with your ring and little fingers, suggest that you may be dealing with a soft tissue injury, possibly involving the periosteum (the connective tissue surrounding the bone) or even a fracture that may not have been evident initially.

Causes:
1. Soft Tissue Injury: The impact could have caused damage to the ligaments, tendons, or muscles around the knuckle. This can lead to swelling and the formation of a hard lump as the body responds to the injury.

2. Bone Injury: While you may not have experienced immediate severe pain or swelling, it's possible that a small fracture or bone bruise occurred, which can sometimes take time to manifest symptoms.

3. Periostitis: This is an inflammation of the periosteum, which can occur after trauma. It can cause localized pain and swelling, and the hard lump you feel could be a result of this inflammation.

Symptoms:
- Pain at the site of injury, especially when applying pressure or using the affected fingers.

- Swelling and tenderness around the knuckle.

- A hard lump may indicate a localized response to injury, such as a hematoma or inflammation.

Treatment Options:
1. Rest: Avoid using the affected hand as much as possible to allow for healing.

2. Ice Therapy: Applying ice to the swollen area for 15-20 minutes every hour can help reduce swelling and numb the pain.

3. Compression: Using a compression bandage can help minimize swelling. Ensure it’s not too tight to avoid cutting off circulation.

4. Elevation: Keeping your hand elevated above heart level can help reduce swelling.

5. Over-the-Counter Pain Relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and reduce inflammation. However, consult with a healthcare provider if you have any contraindications to these medications.

6. Physical Therapy: Once the initial pain and swelling subside, gentle stretching and strengthening exercises may be beneficial to restore function and prevent stiffness.

7. Medical Evaluation: If symptoms persist or worsen, it is crucial to seek medical attention. An X-ray or MRI may be necessary to rule out fractures or other serious injuries.

Potential Complications:
- Chronic Pain: If the injury is not properly managed, it could lead to long-term pain or discomfort in the affected area.

- Reduced Range of Motion: Scar tissue formation or joint stiffness could limit the movement of your fingers.

- Arthritis: In some cases, trauma to a joint can increase the risk of developing arthritis in that joint later in life.

In conclusion, while it sounds like you are experiencing a typical response to a soft tissue injury, it is important to monitor your symptoms closely. If the pain persists or if you notice any changes in the appearance of your hand, such as increased swelling, redness, or warmth, it would be advisable to consult a healthcare professional for a thorough evaluation and appropriate imaging studies. Early intervention can help prevent complications and ensure a better recovery.

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