FIREARM INJURIES -When Things Get Out of Hand

While firearm injuries to the hand and upper extremity represent a small percentage of all firearm traumas, when they happen the injury is often severe.

Frequently the result of mishandling a gun, the damage that both a bullet, the chamber and even the recoil can pose to the small bones and joints of the hand and wrist can be devastating and have a longterm impact.

Scope of Hand & Upper Extremity Problems in Firearm Users Range from Trauma to Repetitive Stress Conditions

From partial limb loss to stress fractures and repetitive stress conditions historically diagnosed in those working in a daily repetitive task, firearm users should recognize the dangers that exist behind the barrel as well.

Trauma – Open Wound

A broadly distributed article on an unfortunate handgun user losing the top half of his ill placed thumb – a result of the powerful vapors escaping from the chamber upon firing – cast a spotlight on the dangers of using certain firearms and the magnitude of damage that can occur to the small bones and intricate network of nerves, tendons and ligaments of the hand.

While this type of injury is uncommon, it is important to know what to do should it happen. Collecting any remains separated from the impacted area could aide a hand surgeon with replantation.  Rinsing the wound with sterile, normal saline and wrapping it if possible is advised just before heading to an emergency center for immediate assistance.

The surgical approach depends on the severity of damage to the tissue and bone. Open wounds like this are always treated with antibiotics, as “skin” is the body’s largest organ and when its protective barrier is compromised in this way and vulnerable to bacteria, antibiotics are used to reduce risk of infection.   If there is damage to the bone, surgery would entail stabilizing the bone.  Then, the tendons are repaired and the blood flow is re-established – with repair of the artery and veins. Potential problems can result from the magnitude of the blast, confounded by the risk of infection.  The expected outcome and long term function of such an injury is often highly variable as it depends on the amount of tissue damage from the accident.  Often times patients are able to regain adequate function despite not having full mobility of the injured extremity during their recovery.

Forceful Impact – Stress Fractures

Sportsmen frequently using what are known as “big-bore” handguns (models with rifle-type cartridges) have increasingly reported problems with their shooting hand – pain, swelling, weakness when shooting – following periods of preparation/practice for an upcoming hunt. This type of pain can stem from damage to the carpal bones of the wrist, as well as the forearm and elbow as a result of the repetitious and harsh recoil impact (much like a worker regularly using a Jackhammer or other such high powered equipment).  In some cases, this can result in a stress fracture.  Stress fractures are most commonly seen in the lower extremity of frequent runners or athletes, but can occasionally occur in the hand and upper extremity when subjected repeatedly to unusual force.

Treatment of stress fractures generally entails rest from the activity and possibly bracing.  Rehabilitative exercises are also effective in strengthening the shooting arm for both overcoming fatigue and reducing risk for more serious damage.

Repetitive Stress Conditions

Conditions like carpal tunnel syndrome and tennis elbow are considered repetitive stress conditions, most often associated with repetitive tasks in work or sports.  They are occasionally seen in the avid sportsman – practicing to perfect their shooting prior to a hunting season or holding the firearm only certain times of the year in a way to which the hand/arm is not accustomed.

These conditions are most often treated nonsurgically with rest and anti inflammatory medication.  Rehabilitation therapy is also frequently used to address these conditions – to restrengthen, stimulate healing and in some cases retrain hand and arm position during tasks identified as triggers. A new procedure known as the Graston Technique® is also an effective therapeutic way to address these types of repetitive stress conditions.  It entails uniquely designed stainless steel instruments and specially trained hand therapists to detect and treat the affected areas of soft tissue irritation.

Long-term Impact

Persistent pain and chronic inflammation can alter the natural mechanics of the affected limb, negatively impacting joints and accelerating joint degeneration – which could eventually result in osteoarthritis if unaddressed.

Reducing Risks

The best way to reduce the risk of firearm or other activity-related hand and upper extremity conditions is to space practices so that adequate time is allowed to rest the “master” hand and arm.  Strengthening exercises will also allow muscles to protect the soft tissue and bones.  Most sports also have protective gear, developed to address some of the most common conditions associated with frequent involvement.  Hunting is no exception, with brakes, grips and shooting gloves designed to reduce the impact of frequent shooting on the hand, wrist and elbow.

When pain is persistent, seeking medical attention will often reduce risk of more serious injury and permit conservative treatment to effectively address the problem and promote a healthier approach to the activities you enjoy.