How hands, wrists and elbows are injured

Throwing a hand out as you fall is a protective reflex, but it sends the whole weight of the body through the palm. A fall on an outstretched hand is the classic cause of both a wrist fracture and a scaphoid fracture, and the same force can travel up the forearm and injure the elbow.

In a car, hands gripping the steering wheel absorb the impact, which can sprain the thumb or break the wrist; a deploying airbag can strike the forearms, and in a side impact the elbow hits the door or console. At work, hands get caught in machinery, crushed under loads or cut. Forceful or repetitive gripping at work is also one of the settings in which nerve compression at the wrist is evaluated. The orthopedic physician looks for:

• Finger and thumb sprains, dislocations and fractures — see hand and finger injury
• A break at the end of the forearm bone (distal radius) or in the scaphoid
• Elbow fracture, dislocation, ligament or tendon injury — see elbow injury
• Nerve compression — carpal tunnel syndrome at the wrist, ulnar nerve irritation at the elbow

Why a sore wrist after a fall is not just a sprain until proven otherwise

The scaphoid is a small bone on the thumb side of the wrist. A scaphoid fracture can feel like a mild sprain: some swelling, tenderness in the hollow at the base of the thumb, and pain that settles enough to ignore. That is exactly how it gets missed. Its blood supply is fragile, so a scaphoid fracture left untreated can fail to heal and lead to arthritis in the wrist, and an early X-ray can look normal. For those reasons, tenderness over the scaphoid after a fall is treated as a possible fracture — protected in a splint, with repeat imaging or an MRI — until the diagnosis is clear.

What the orthopedic hand and elbow exam checks

Small structures in the hand do large jobs, so the examination is detailed:

• Alignment: whether a finger rotates or crosses its neighbour when you make a fist, a sign of fracture
• Tendons: whether each finger bends and straightens under its own power; a drooping fingertip can mean a torn extensor tendon
• Ligaments: stability of the thumb, the small wrist bones and the elbow
• Nerves: sensation in the median, ulnar and radial nerve territories, and pinch and grip strength
• Circulation: colour, warmth and capillary refill in each finger
• Neck: hand numbness can start in the neck, so the cervical spine is screened too

Grip and pinch are measured, and range of motion testing records wrist and elbow movement, so later visits are compared against objective figures.

Imaging and nerve testing

Digital X-ray is available on site at select offices, with dedicated scaphoid views when the wrist is tender on the thumb side. When the X-ray is normal but suspicion stays high, or a ligament or tendon injury is suspected, the physician orders MRI or CT through diagnostic imaging. When a scan helps and when it does not is covered in do I need an MRI after a car accident.

Numb fingers, a weak hand or symptoms that follow a nerve pattern are assessed with EMG nerve testing. It helps tell carpal tunnel compression at the wrist apart from ulnar nerve irritation at the elbow or a pinched nerve in the neck, which are treated differently.

What a non-surgical hand, wrist and elbow plan coordinates

• Splinting or bracing to protect a fracture, sprain or tendon, with the physician reviewing the need for it at every visit
• Physical therapy for stiffness, grip strength and fine motor control
• Injection treatments where the diagnosis supports them, such as tendon inflammation or nerve compression
• Pain management review when pain is limiting therapy
• Written work restrictions naming the hand involved and what gripping, keyboard work, tool use or lifting is appropriate, revised as the injury changes

The length of care varies with the injury. A bone that has knitted is not the same thing as permission to grip hard, lift or return to heavy hand work; your physician makes those decisions after examining you. Treatment stops when your goals are met rather than on a set schedule.

When a surgical opinion is needed

Displaced or unstable fractures, some scaphoid fractures, a torn tendon that can no longer pull, an unstable elbow, and nerve compression with muscle wasting or constant numbness are among the findings that lead to a referral for a surgical opinion. Injury Recovery MD does not perform surgery. Which hand or elbow surgeon you see is up to you. We supply the imaging and examination findings the surgeon needs, and afterwards your operating surgeon sets the rehabilitation protocol and milestones; intake can tell you where that rehabilitation is available. For nerve compression at the wrist, our page on carpal tunnel release describes the operation.

No-Fault and workers’ compensation billing

A hand or wrist hurt in a motor vehicle accident is billed directly to New York No-Fault — see our No-Fault doctor page. The No-Fault application is due within 30 days of the accident; our guide to the No-Fault 30-day deadline explains why that date matters.

Crush injuries, cuts and other hand, wrist and elbow injuries from work go through workers’ compensation; the workers’ compensation orthopedic doctor page explains the process. It is $0 out of pocket for covered patients, and you choose your own treating provider. Under workers’ comp, that choice is among providers authorized by the New York Workers’ Compensation Board, and Injury Recovery MD is one.

Where to be seen for a hand, wrist or elbow injury

IRMD orthopedic physicians see these injuries at all 7 offices — Medford, Islandia, East Islip, Mineola, Bohemia, Smithtown and Stony Brook; find the nearest on the locations page. Call (631) 560-8357; same-day and next-day appointments are often available. For the full range of crash injuries, see car accident orthopedic care; the orthopedic care hub links other joints, including the shoulder and the knee. A fall on an outstretched hand can hurt the shoulder too, so mention any shoulder pain at your visit.

Where to see an orthopedic physician

• Medford3243 NY-112, Bldg 1, Suite 4, Medford, NY 11763Suffolk County
• Islandia1717 Veterans Memorial Hwy, Suite 100, Islandia, NY 11749Suffolk County
• East Islip11 Carleton Ave, East Islip, NY 11730Suffolk County
• Mineola300 Old Country Rd, Suite 321, Mineola, NY 11501Nassau County
• Bohemia1690 Washington Ave, Bohemia, NY 11716Suffolk County
• Smithtown732 Smithtown Bypass, Suite 200, Smithtown, NY 11787Suffolk County
• Stony Brook2500 Nesconset Hwy, Building 10A, Stony Brook, NY 11790Suffolk County

Orthopedic physicians see patients at every Injury Recovery MD office. Intake books the office and time that suit you. Call (631) 560-8357 — answered 24/7.

Frequently asked questions

My wrist hurt after I fell but it feels better now. Do I still need an X-ray?

Yes. Wrist pain after a fall onto an outstretched hand should be examined and X-rayed even when it eases. A scaphoid fracture, a break in a small bone at the base of the thumb, can feel like a mild sprain and is missed precisely because the pain settles. Left untreated, it can fail to heal. A hand that is cold, pale or numb, or a visibly deformed wrist, needs the emergency department now.

Can a car accident injure my hand or wrist?

Yes. Gripping the steering wheel at impact can sprain the thumb or break the wrist, a deploying airbag can strike the forearms, and the elbow can hit the door in a side impact. An orthopedic exam checks alignment, tendons, ligaments, nerves and circulation, and an X-ray shows bone injury. A tense, swollen forearm with pain out of proportion to the injury needs the emergency department now.

Is numbness in my fingers after an injury carpal tunnel syndrome?

It might be, but numb fingers can also come from the ulnar nerve at the elbow or a pinched nerve in the neck. An orthopedic physician maps which fingers are affected, tests strength and sensation, and may order EMG nerve testing to locate the problem. Numbness together with a cold, pale or discoloured hand after an injury is an emergency and needs the emergency department now.

Does Injury Recovery MD operate on hands or elbows?

No. Hand, wrist and elbow care at IRMD is non-surgical: examination, X-ray, MRI or CT when indicated, EMG, splinting or bracing, physical therapy, injections and pain management. When a surgical opinion is needed you are referred and you pick the surgeon. IRMD provides the imaging and exam findings for that consultation and can deliver rehabilitation afterwards, following the protocol set by your operating surgeon.

Are hand and wrist injuries from work covered by workers’ comp in New York?

Workers’ compensation covers medically necessary care for injuries that arise from work, including hand, wrist and elbow injuries, and IRMD bills the carrier directly. Hand injuries from a car accident are billed to No-Fault instead. Either way it is $0 out of pocket for covered patients. Report a work injury to your employer promptly, and remember that you choose your own treating provider. Under workers’ comp, that choice is among providers authorized by the New York Workers’ Compensation Board, and Injury Recovery MD is one.

Where on Long Island can I see an orthopedic doctor for a hand or elbow injury?

Hand, wrist and elbow injuries are seen by IRMD orthopedic physicians at Medford, Islandia, East Islip, Mineola, Bohemia, Smithtown and Stony Brook. Appointments are on (631) 560-8357, and same-day or next-day slots are often available.