How To Know If Your Knuckle Is Broken or Bruised

After a knuckle injury, it’s important to understand whether it’s broken or bruised so you know how to treat it effectively. Common causes of knuckle injuries include impacts during sports such as boxing or golf, punching a hard surface, or even accidental falls. In this article, our team at The Hand and Wrist Institute will explore the differences between a broken or bruised knuckle, including symptoms, treatment options, and when to seek professional care.

Symptoms of a Broken Knuckle

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A broken knuckle is a more intense injury and involves more severe symptoms than a bruised knuckle. These include:

• Severe pain: Intense, persistent pain that doesn’t go away with rest or pain medication often suggests a fracture. This pain is usually sharp and exacerbated by movement.
• Swelling: Significant swelling around the injured knuckle may spread to adjacent fingers or parts of the hand.
• Bruising: While both injuries will bruise, the bruising associated with a fracture is typically more extensive and may appear rapidly after the injury.
• Deformity: An abnormal shape or angle in the finger if the bone is out of place.
• Difficulty moving the finger:  You may also experience a sensation of the bones grating against each other (crepitus).
• Tenderness: Intense tenderness around the knuckle, especially when you apply pressure, can indicate a fracture.

Symptoms of a Bruised Knuckle

A bruised knuckle, while uncomfortable, typically presents with less severe symptoms. These include:

• Mild to moderate pain: Duller and more tolerable than the sharp, intense pain of a fracture, this pain often subsides with rest and medications.
• Discoloration: The area may appear blue, purple, or yellowish as the bruise heals, but this is usually localized and doesn’t spread extensively.
• Mild to moderate swelling: Swelling occurs around the injured knuckle but is generally less pronounced and limited to the immediate area of impact.
• Maintained mobility: Although it may be uncomfortable to move your knuckle, you can usually still move the finger.
• Tenderness: The bruised area is tender to the touch.

Diagnostic Methods

Diagnosing a broken or bruised knuckle ensures effective treatment and recovery. At The Hand and Wrist Institute, we use various diagnostic methods:

• Physical examination: We will examine the injured knuckle for visible signs of deformity, swelling, bruising, and any open wounds. The doctor will gently feel the knuckle and surrounding areas to identify tenderness, warmth, and irregularities in bone structure.
• Range of motion test: Assessing the finger’s ability to move helps determine if there are limitations or pain associated with movement, which can indicate a fracture.
• X-rays: X-rays are the primary imaging technique for confirming a fracture or dislocation. We will take X-rays from different angles to get a clear view of the injury.
• Other imaging techniques: If X-rays are inconclusive or if we need a more detailed view, a CT scan can provide cross-sectional images of the bone and soft tissues. MRIs are less common for knuckle injuries but can help assess soft tissue damage, such as ligament or tendon injuries, that might accompany a fracture or severe bruise.

Seeking professional medical advice is essential. Misdiagnosing a fracture as a bruise can result in ineffective treatment, causing chronic pain, reduced mobility, or a permanent deformity. A professional diagnosis ensures you receive the correct treatment for your condition.

Treatment Options

Here are some of the treatment options for bruised and broken knuckles.

Immediate First Aid

Whether you have a bruised or broken knuckle, initial first aid measures can help manage pain and reduce swelling. Apply ice to the injured knuckle for 15 to 20 minutes every hour during the first 48 hours to reduce swelling and numb the area. Keep the injured hand still and avoid using the affected finger to prevent further injury and pain.

Treatment for Bruised Knuckles

As a bruised knuckle is less severe, you can treat it with more conservative methods. Get plenty of rest, and avoid activities that could aggravate the injury to give the affected tissues time to heal. You can take over-the-counter pain relief medications such as ibuprofen (Advil) or acetaminophen (Tylenol) to manage pain and reduce inflammation. Wrapping the injured knuckle with an elastic bandage (snug, but not tight) can help control swelling. Keep the hand elevated above the level of your heart to reduce swelling by promoting fluid drainage away from the injury site.

Treatment for Broken Knuckles

A health care professional will assess the injury to confirm the fracture. We may apply a splint to less severe fractures to immobilize the knuckle and allow the bones to heal correctly. For more serious fractures, a cast may be necessary to ensure complete immobilization and proper alignment of the bones while they heal. For misaligned bones, we may suggest a procedure called reduction. This involves manipulating the bones back into place. We can do this manually (closed reduction) or surgically (open reduction).

Surgery

If your fracture is severe and alignment through closed reduction is not possible or if you have other injuries, you may require surgery. Types of surgery include:

• Internal fixation: Using pins, screws, or plates to hold the bones in place.
• External fixation: Using an external device to stabilize the bones while they heal.

After immobilization, physical therapy may be necessary to restore strength, flexibility, and function to the hand. These exercises will help you regain your full range of motion and prevent stiffness. You may require prescription pain medications in the initial stages post-injury or post-surgery to manage severe pain.

Recovery and Rehabilitation

Recovering from a broken or bruised knuckle involves careful management and following the treatment plan to ensure a smooth recovery. For bruised knuckles, which typically heal within a few days, the focus is on rest, icing to reduce swelling, and pain management with over-the-counter medications.

Broken knuckles may require more extensive treatment, such as splinting, casting, or surgery, depending on the severity. Healing times vary but generally range from four to six weeks. Rehabilitation, including physical therapy, is key to restoring strength, flexibility, and function to your hand.

Take the Next Step With Hand and Wrist Institute

Whether you’re dealing with a broken or bruised knuckle, seek prompt and appropriate medical care for an accurate diagnosis and successful recovery. Bruised knuckles typically heal quickly with few long-term effects, while broken knuckles may require more intensive interventions such as splinting, casting, or surgery and a longer recovery period. If you’ve damaged your knuckle, visit the Hand and Wrist Institute for expert diagnosis and treatment today.

Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.