What to do if I get a hard bump on a burned finger?

Hard Bump on Burned Finger: Management and Evaluation

A hard bump developing on a burned finger requires immediate evaluation by a burn specialist or emergency department, as this may indicate deep tissue injury, compartment syndrome, or hypertrophic scar formation—all of which can lead to permanent functional disability if not promptly addressed. 1

Immediate Assessment Required

Determine if this is an emergency:

• Blue, purple, or pale finger = compartment syndrome requiring emergency escharotomy 1, 2
• Increasing pain, numbness, or inability to move the finger = vascular compromise requiring immediate surgical intervention 3
• Any hand burn with blanched skin falling off = deep partial-thickness or full-thickness burn requiring burn center admission 1

Initial Management While Arranging Specialist Evaluation

Pain Control

• Take over-the-counter acetaminophen or NSAIDs (ibuprofen) for pain 3
• Burn pain is often severe and difficult to control; do not hesitate to seek medical care if pain is not adequately managed 3

Wound Protection

• Loosely cover the burn with a clean, non-adherent dressing 3
• For small superficial burns being managed at home temporarily, apply petrolatum-based ointment (with or without antibiotic like polymyxin) and a clean non-adherent dressing 3
• Do not break any blisters—leave them intact as this reduces infection risk and improves healing 3, 1

Monitor for Warning Signs

• Increased pain, redness extending beyond burn margins, swelling, or pus = infection requiring immediate medical attention 1
• Swelling that causes jewelry or rings to become tight = remove all jewelry immediately before swelling worsens and causes vascular compromise 3

Why Specialist Evaluation is Mandatory

All hand burns involving partial-thickness or full-thickness depth require specialized care beyond first aid to prevent permanent functional disability. 1 The American Burn Association specifically recommends that hand burns be evaluated by a burn specialist because:

• Hand burns frequently require surgical intervention to prevent permanent loss of function 3, 1
• Specialized burn centers improve survival and functional outcomes through concentrated expertise in burn care techniques 1
• Direct admission to a burn center (rather than sequential transfers) reduces complications and improves long-term hand function 1, 2
• Undertriage (failure to refer appropriately) increases morbidity and mortality 3, 1

What the Hard Bump Might Represent

The hard bump could indicate several conditions requiring different treatments:

Hypertrophic scar formation: Burn scars can develop quickly—even one week of inadequate treatment can lead to digital malpositioning and distortion that becomes difficult to correct 4

Deep tissue injury: Electrical or thermal burns can cause internal damage not visible on the skin surface, with thermal burns present at entry and exit points along the internal pathway 3, 2

Compartment syndrome: Circumferential burns can cause acute limb ischemia with neurological disorders requiring emergency escharotomy 2

Critical Pitfalls to Avoid

• Do not delay specialist referral—even a week of neglect in a burned hand can lead to permanent deformity 4
• Do not apply butter, oil, or other home remedies 1
• Do not use systemic antibiotics prophylactically—reserve for clinically evident infections 3, 1
• Do not underestimate injury severity based on visible skin damage alone—internal damage may be extensive 2, 5

How to Access Specialist Care

• Contact a burn specialist immediately to determine if burn center admission is needed 3, 1
• If immediate specialist access is unavailable, use telemedicine consultation to guide initial management and determine transfer urgency 3, 1
• Go to the emergency department if you observe any warning signs listed above 3

The bottom line: A hard bump on a burned finger is not a normal part of healing and requires professional evaluation to prevent permanent loss of hand function. 1, 4