Skip to main content

Health condition · Clinically reviewed

Hand injuries, from a cut fingertip to a crush amputation.

The hand is a fine, layered structure. Getting the right diagnosis in the first 24 hours, and the right hand-therapy plan after, decides how well it works for the rest of your life.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK-registered clinician before publication.

  • 02

    Sourced from guidance

    Checked against BOAST, BSSH, NICE and peer-reviewed hand-surgery sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice, including microsurgical repair, replantation criteria and structured hand therapy.

Key facts

Hand injuries at a glance.

The essentials in plain English: what counts as a hand injury, why it is common, and why time and technique both matter.

  • What it covers

    Every injury to bone, tendon, ligament, nerve, vessel or skin of the hand and wrist, from a paper cut to a crush amputation.

  • How common

    Hand injuries account for roughly 5 to 10 percent of all emergency department attendances in the UK.

  • Why it matters

    The hand is a fine, layered structure. A small missed injury (a partial tendon, a Stener lesion) can leave lasting loss of function.

  • Time matters

    Tendon, nerve and vascular repair, flexor tenosynovitis, high-pressure injection and open fracture all have narrow surgical windows.

  • Repair is a team

    Hand surgery, plastic surgery, orthopaedics, hand therapy and physiotherapy work as an MDT under BSSH standards.

  • Recovery is active

    Splinting and structured hand therapy sit alongside surgery. Motion, oedema control and scar work drive the final result.

Why this guide matters

Small structures, narrow windows.

Hand injuries look local but affect everything: work, driving, sport, sleep and self-care. The three points below shape every decision on this page.

  • Time-critical repair

    Tendon, nerve and vascular repair, flexor tenosynovitis, open fracture and high-pressure injection each have narrow surgical windows.

  • A specialist team, not a single doctor

    Hand surgery, plastic surgery, hand therapy, physio and occupational therapy work as an MDT under BOAST and BSSH standards.

  • Therapy is half the operation

    Splinting, oedema control, scar work and graded motion drive the final result. Skipping therapy undoes even a perfect repair.

How the diagnosis is made

From the injury to a clear plan.

The steps a UK emergency department, hand surgeon or hand therapist will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    History and mechanism

    Sharp, crush, avulsion, bite, injection, burn or cold. Timing, contamination, occupation, hand dominance and tetanus status all shape the plan.

  2. 02

    Assessing

    Structured hand examination

    Look, feel, move: skin loss, deformity, capillary refill, Allen test, sensation in each digital nerve territory, individual tendon function.

  3. 03

    Assessing

    Special tests

    Grind for thumb CMC, Watson and scaphoid shift for scapholunate, valgus stress for thumb UCL (Stener), Kanavel signs for flexor tenosynovitis, Tinel over nerves.

  4. 04

    Confirming

    Plain X-ray, dedicated views

    PA, lateral and oblique of the hand or wrist, with scaphoid views if tenderness in the anatomical snuffbox. Foreign body views if metal or glass is suspected.

  5. 05

    Confirming

    Ultrasound and MRI

    Ultrasound for tendon, nerve, foreign body and vascular assessment. MRI for occult fracture, ligament (SLIL, TFCC) and complex soft-tissue injury.

  6. 06

    Planning

    Specialist hand review

    Open fracture, tendon or nerve injury, vascular compromise, deep bite, high-pressure injection or Stener lesion goes urgently to a hand surgeon.

  7. 07

    Planning

    Plan the pathway

    Emergency theatre, urgent elective repair, splinting with hand therapy, or watchful review. Each injury has a defined BOAST or BSSH pathway.

Typical timeline: a full assessment and treatment plan on the same day for urgent injuries.

Injury types

The main patterns of hand injury.

From fractures and tendon divisions to bites, burns, frostbite (see /conditions/frostbite/), high-pressure injection and complex regional pain syndrome (see /conditions/crps-complex-regional-pain-syndrome/).

  • Fractures

    Metacarpal, phalangeal, carpal (especially scaphoid) and distal radius. See our full guide at /conditions/hand-fractures/.

  • Tendon injuries

    Flexor tendons in Zones I to V and extensor tendons in Zones I to VIII, including mallet finger, boutonniere and sagittal band rupture.

  • Ligament injuries

    Thumb UCL (skier’s thumb, Stener lesion), volar plate injuries at the PIP joint and TFCC tears on the ulnar side of the wrist.

  • Nerve injuries

    Digital, median, ulnar and radial nerve division or contusion. Numbness, weakness or a positive Tinel sign needs a specialist opinion.

  • Vascular injuries

    Digital artery, radial and ulnar artery (including Guyon canal) and hypothenar hammer syndrome from repetitive palm impact.

  • Soft-tissue and skin loss

    Lacerations, degloving, crush and amputation. Coverage often needs a plastic or hand surgeon, sometimes with a flap.

  • Hand infections

    Paronychia, felon, herpetic whitlow, flexor tenosynovitis (Kanavel signs) and bite wounds (dog, cat, human) with MRSA or Eikenella risk.

  • Red flag - high-pressure injection

    Grease, paint or solvent injected under pressure looks deceptively benign but needs urgent surgical exploration by a hand specialist.

Treatment

How hand injuries are treated in the UK.

Emergency care first, then targeted surgery for bone, tendon, nerve or vessel, with structured hand therapy running through the recovery.

  • Emergency stabilisation

    ABC, control of bleeding, neurovascular check, splinting and tetanus. Open injuries get antibiotics and urgent hand-surgery review.

  • Splinting and immobilisation

    A tailored splint (mallet, thumb spica, boxer, ulnar gutter) rests the injury in a functional position and starts the therapy plan.

  • Wound care and antibiotics

    Copious irrigation, foreign-body removal and targeted antibiotics for bites, deep contamination and clinical infection.

  • Percutaneous fixation

    K-wires or screws for displaced metacarpal, phalangeal or scaphoid fractures where closed reduction cannot hold alignment.

  • Open reduction and plating

    Plates and screws for unstable fractures of the metacarpals, phalanges and distal radius. See /treatments/distal-radius-orif-plate/.

  • Tendon and ligament repair

    Microsurgical primary repair of flexor and extensor tendons and the thumb UCL, followed by an early-motion hand-therapy programme.

  • Nerve and vessel repair

    Microsurgical repair or grafting of digital and forearm nerves and arteries, ideally within hours of injury for the best result.

  • Replantation and reconstruction

    For amputations and near-amputations, urgent microsurgical replantation may be possible. See /treatments/microsurgical-replantation/.

  • Structured hand therapy

    Splint fabrication, oedema control, scar work, graded motion and strengthening. See /conditions/hand-and-wrist-manual-therapies/.

  • Injection for late problems

    A targeted corticosteroid injection can settle post-injury stiffness or tenosynovitis in selected patients. See /treatments/cortisone-injection-large-joint/.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards for hand and upper-limb trauma, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

If you have injured your hand, be seen. A hand surgeon or emergency clinician can examine and image your hand and tell you which parts of this page apply to you.

  • BOAST (British Orthopaedic Association Standard for Trauma). Open fractures, hand injuries and pyogenic flexor tenosynovitis.

  • British Society for Surgery of the Hand (BSSH). Guidelines and patient information on hand trauma, tendon repair and replantation.

  • NICE. Fractures (complex): assessment and management (NG37) and fractures (non-complex): assessment and management (NG38).

  • Royal College of Surgeons and Royal College of Emergency Medicine. Standards for wound care, tetanus prophylaxis and bite injuries.

Red flags

When a hand injury needs urgent care.

Most cuts and sprains settle. These are the patterns that will not, and where a specialist hand-surgery opinion should be same day.

  • Open fracture

    Bone exposed through the skin, or a wound overlying a fracture. Needs early antibiotics, tetanus and urgent orthopaedic or hand-surgery review under BOAST.

  • Neurovascular compromise

    A pale, cold, pulseless or numb digit is a surgical emergency. Time to revascularisation drives whether the digit survives.

  • Compartment syndrome

    Disproportionate pain, tense swelling and pain on passive stretch. Needs urgent measurement and, if confirmed, emergency fasciotomy.

  • High-pressure injection injury

    Grease, paint or solvent injected through a small puncture wound. Requires urgent surgical exploration despite a benign-looking entry point.

  • Pyogenic flexor tenosynovitis

    Fusiform swelling, flexed posture, pain on passive extension and tenderness along the sheath (Kanavel signs). Urgent theatre and antibiotics.

  • Deep bite wounds

    Dog, cat and human bites carry a real risk of deep infection (including MRSA and Eikenella). Need irrigation, antibiotics and often a hand-surgery opinion.

  • Stener lesion

    A complete thumb UCL rupture where the adductor aponeurosis is trapped between the ends. Will not heal without surgery.

  • Loss of tendon function

    Inability to flex or extend a specific joint after a laceration or closed injury points to a divided or ruptured tendon needing repair.

  • Amputation or near-amputation

    Preserve the amputated part cool but not frozen (wrapped in damp gauze, in a bag on ice) and get to a replantation centre urgently.

Recovery

Getting your hand back to work.

Four things that make the biggest difference day to day: guided motion, disciplined splinting, structured hand therapy and a low threshold for review if something changes.

A quiet reminder

Recovery is a plan, not a wait.

The best outcomes come from steady, guided rehab with a specialist hand therapist, not from resting until it feels right.

  1. 01 Move

    Motion is medicine

    Guided early motion, within the limits of the splint and repair, prevents stiffness and adhesions that are hard to undo later.

  2. 02 Splint

    Wear your splint as prescribed

    A splint is doing precise work. Taking it off early can undo a repair and add weeks or months to your recovery.

  3. 03 Therapy

    Hand therapy is not optional

    A specialist hand therapist tailors your splint, exercises, oedema and scar work. Missed sessions show in the final result.

  4. 04 Escalate

    Trust changes in sensation

    New numbness, coldness, colour change or spreading pain after an injury is a reason to go back, not to wait.

Frequently asked

Everything we get asked about hand injuries.

Quick answers on emergencies, Stener lesions, tendon repair, bites and realistic timelines.

  • How do I know if my hand injury is serious?

    Any open wound over a joint or tendon, a deformed digit, loss of feeling or movement, a pale or cold finger, a deep bite, a high-pressure injection or severe swelling with disproportionate pain is serious. All of these need same-day assessment, ideally in an emergency department with access to a hand surgeon.

  • When is a hand injury a surgical emergency?

    Open fractures, neurovascular compromise, compartment syndrome, high-pressure injection injuries, pyogenic flexor tenosynovitis (Kanavel signs), amputations and complete tendon or nerve division are all surgical emergencies. Under BOAST and BSSH standards these need theatre in hours, not days.

  • What is a Stener lesion and why does it matter?

    A Stener lesion is a complete rupture of the thumb ulnar collateral ligament in which the adductor aponeurosis has flipped between the torn ligament ends. Because the ligament can no longer touch its footprint, it will not heal without surgery. That is why every suspected skier’s thumb needs a careful specialist assessment.

  • Can a divided tendon or nerve be repaired later?

    Ideally tendons and nerves are repaired within days. Delayed repair is possible but harder: tendons retract, nerves scar and outcomes drop. If you think you have divided a tendon or nerve, ask for a hand-surgery review as soon as possible rather than waiting to see if it settles.

  • Do animal and human bites really need antibiotics?

    Yes. Cat, dog and human bites to the hand carry a high infection risk from Pasteurella, Eikenella and other organisms, and can quickly involve the joint or tendon sheath. Standard care is thorough irrigation, wound review, tetanus cover and prophylactic antibiotics (usually co-amoxiclav), with a low threshold for hand-surgery review.

  • How long will it take to get my hand back to normal?

    It depends on which structures are hurt. A simple metacarpal fracture may settle in 4 to 6 weeks. A flexor tendon repair takes 3 to 6 months of structured hand therapy before full loading. Nerve regeneration is measured in months to years. Realistic timelines and steady therapy get the best long-term result.

Related content

Keep reading.

Pulse Healthcare concierge

Send us your enquiry

A concierge service for UK private healthcare. We match you with the best vetted clinics and consultants in our network - they then contact you directly.

So we can match you to the right clinician close to you.

We reply to every enquiry within 24 hours (Mon–Fri). Confidential - your details are never shared outside our vetted consultant network.