What should I do for a painful and swollen hematoma on my right thumb?

Management of Painful and Swollen Thumb Hematoma

Apply ice to the hematoma for a minimum of 10 minutes and maintain manual compression with a pressure dressing to control swelling and pain. 1

Immediate First-Line Treatment

• Apply ice directly to the hematoma site for at least 10 minutes to reduce swelling and limit further bleeding into the tissue 1
• Apply firm manual compression followed by a pressure dressing to prevent hematoma expansion and control any ongoing bleeding 1
• Elevate the thumb above heart level to reduce venous pressure and minimize continued bleeding 1

Critical Assessment Required

You must closely assess the thumb for signs of vascular compromise or compartment syndrome, as hematomas can cause tissue necrosis through increased pressure or ischemic changes even without elevated compartment pressure 2, 3:

• Check for absent or diminished pulses distal to the hematoma (radial pulse at wrist, capillary refill in thumb tip) 2
• Assess for pallor, coolness, or color changes in the thumb 2
• Test for neurological deficits including numbness, tingling, or inability to move the thumb 2
• Evaluate for progressive or severe pain that seems disproportionate to the injury, which may indicate compartment syndrome 2

Pain Management

• Use over-the-counter NSAIDs like ibuprofen for pain control once you confirm there is no active bleeding 4
• Take ibuprofen at the lowest effective dose for the shortest time needed, typically 200-400mg every 6-8 hours as needed 4
• Avoid NSAIDs if you have a history of stomach ulcers, bleeding disorders, kidney problems, or are taking anticoagulants 4

When to Seek Immediate Medical Attention

Seek emergency care immediately if any of the following develop 2, 3:

• The hematoma continues to expand despite compression and ice
• You develop numbness, tingling, or inability to move the thumb
• The thumb becomes pale, cold, or dusky in color
• Pain becomes severe or progressively worsens
• You cannot feel pulses in your wrist or thumb
• The overlying skin develops blisters, becomes tense and shiny, or shows signs of tissue death

Follow-Up Care

• If the hematoma is large (greater than 2-3 cm) or causing significant functional impairment, you should be evaluated by a healthcare provider within 24-48 hours 3
• Large hematomas may require operative evacuation under local anesthesia to prevent skin necrosis from tissue pressure and ischemic changes 3
• Continue ice application intermittently (15-20 minutes every 2-3 hours) for the first 48-72 hours 1

Common Pitfalls to Avoid

• Do not apply heat to the hematoma in the acute phase (first 48-72 hours), as this will increase bleeding and swelling 1
• Do not attempt to drain the hematoma yourself with needles or other instruments, as this risks infection and further injury 3
• Do not ignore progressive symptoms, as delayed recognition of compartment syndrome or vascular compromise can lead to permanent tissue damage and loss of thumb function 2, 3
• Do not assume the injury is minor if pain and swelling persist beyond 3-5 days despite conservative treatment 3