Elevation, in the context of first aid, involves raising the affected hand and forearm to manage immediate symptoms. This technique is a component of standard care for many minor injuries and aims to reduce discomfort and prevent complications. The primary goal is to limit the accumulation of excess fluid in the injured tissues, which contributes significantly to swelling.
The Physiological Reason for Elevation
Raising the injured hand works by leveraging the force of gravity to alter the dynamics of fluid circulation. Following an injury, small blood vessels near the site become more permeable, allowing fluid, proteins, and white blood cells to leak into the surrounding tissues, a process known as edema. This leakage causes noticeable swelling and pressure.
The key to reducing this fluid accumulation is to position the hand above the level of the heart. When the limb is positioned higher than the heart, the hydrostatic pressure within the capillaries decreases significantly. Lower pressure in the small blood vessels minimizes the amount of fluid that leaks out into the interstitial space, which is the area between your cells.
Gravity simultaneously aids the lymphatic system and the veins in draining the accumulated excess fluid back toward the central circulation. This enhanced drainage reduces the overall volume of fluid at the injury site, thereby minimizing swelling. Less swelling translates to less pressure on nearby nerve endings, often leading to reduced pain and discomfort.
Proper Technique for Hand Elevation
Effective elevation requires the hand to be consistently positioned higher than the heart, which means the elbow must also be supported at a level above the heart. When sitting or resting, this position is best achieved by propping the entire forearm and hand on a stack of two or three pillows. It is important to ensure the hand is not allowed to dangle or rest over the edge of the support, which can restrict blood flow at the wrist or elbow.
For nighttime elevation, the same principle applies, requiring the hand to be supported on pillows situated next to the body so that the limb is elevated above the chest. If the hand is in a sling for comfort or support, the sling must be adjusted so the fingertips rest near the opposite shoulder, ensuring the hand is truly higher than the elbow, rather than dangling below it. When moving around, holding the hand up against the opposite shoulder is an effective way to maintain the necessary height.
Maintaining continuous, comfortable support for the hand, wrist, and elbow is important to prevent muscle strain. Avoid wearing any rings or tight bracelets, as swelling can rapidly increase and restrict circulation. Regularly check that the skin color remains pink and the fingers do not feel cold or tingly, which could signal restricted blood flow.
Situations Requiring Hand Elevation
Elevation is a standard component of first aid for many minor soft tissue injuries to the hand and wrist. These include common occurrences like minor sprains, strains, and contusions, such as a jammed finger or a bruise from blunt trauma. For these injuries, elevation helps to limit the formation of a hematoma (deep bruise) and minimizes localized swelling that could stiffen the hand.
Following a minor cut or abrasion, once any bleeding has been controlled with direct pressure, elevating the hand can further help to slow blood flow to the area. This reduction in blood flow can help the clotting process and keep swelling to a minimum. Elevation is also recommended for localized reactions to insect stings, such as from a bee or wasp.
For insect stings, elevation assists in draining the inflammatory fluids the body releases in response to the venom. This helps manage the fluid buildup and reduces discomfort caused by the localized inflammatory reaction.
Safety Limits and When to Call a Doctor
While elevation is an effective first aid measure, it cannot treat all hand injuries, and certain signs warrant immediate medical evaluation. You should seek medical attention if the hand or fingers show signs of severe deformity, suggesting a possible fracture or dislocation. Persistent or worsening pain that is not relieved by over-the-counter medication is a warning sign.
Any numbness, tingling, or an inability to move the fingers should be immediately evaluated, as these symptoms can indicate nerve damage or a tendon injury. Similarly, if the fingers turn pale, white, or blue, or feel cold, this suggests a compromise to the blood supply, which is a medical emergency. Swelling that continues to increase despite consistent elevation, or swelling accompanied by spreading redness, warmth, or pus, may indicate a severe infection.
If a fracture is suspected, it is important to immobilize the hand and wrist first before attempting to elevate it. Elevation should not be used as a substitute for professional medical care when faced with a serious injury. An assessment of the injury is necessary to determine if the issue is minor enough for home care or requires a doctor’s intervention.