Cigarettes and Hand Conditions

Smoking cigarettes and other substances can delay healing and worsen medical conditions in the hands. This is likely related to chemicals absorbed by the body from smoking. Nicotine, which is found in cigarettes, cigars, pipes, and e-cigarettes, causes blood vessels to become smaller.

When blood vessels narrow, there is less blood available to carry oxygen around the body. Reduced blood flow and oxygen supply affect the small blood vessels at the fingertips most, but larger blood vessels that bring oxygen to bone, nerves, tendons, and muscles can also be affected. Nicotine may cause permanent damage to the hands.

Reduced Blood Flow

Scientific studies show that smokers have decreased blood flow in the skin of the fingers compared with non-smokers. Smokers also have increased vascular resistance, meaning the blood vessels are tighter. This may be related to increased adrenaline-like chemicals in the body.

Patients with scleroderma who smoke have a higher chance of finger vascular problems. These problems can require surgery and, in some cases, finger amputation. One study suggests that finger skin blood flow can improve within seven days of stopping smoking.

Poor Wound Healing

Skin wound healing is slower in fingers exposed to cigarette smoke and nicotine. Smokers are more likely to have wounds that do not heal and wound infections. Even former smokers are more likely to have wound problems.

Patients who have smoked during the past year have increased complications from surgery. Smokers are also more likely to return to the hospital or need additional surgery to heal fully. A scientific review found that multiple phases of wound healing are negatively affected by smoking. Some improvement in the inflammatory phase may occur within four weeks after stopping smoking, but other phases may take longer to recover.

Infection

Smokers are more likely to develop an infection compared with non-smokers.

Poor Bone Healing

Fractures, or broken bones, have more trouble healing in smokers. Healing may take longer, and some fractures may never heal, which is called non-union. Unhealed fractures can require multiple surgeries with plates and screws. Longer healing time can increase pain, stiffness, and time away from work or hobbies.

Worsened Nerve Problems

Nerve symptoms such as tingling, numbness, and pain can be worse in smokers, especially in patients with other conditions such as diabetes. Smokers often report more severe symptoms before carpal tunnel surgery and are more likely to have continued nerve pain symptoms after surgery.

Birth Differences

A child born to a pregnant mother who smokes is more likely to have congenital hand differences, including extra fingers, fused fingers, or a missing finger. The more the mother smokes, the more likely this is to occur.

Dupuytren’s Contracture

Dupuytren’s contracture is a condition where fingers may become contracted in a bent position due to thick bands that form in the palm and around the joints of the hand. Dupuytren’s contracture is more common in smokers.

Hand Pain

Unexplained hand pain is reported to be higher and last longer in smokers compared with non-smokers. Some disabling conditions, such as complex regional pain syndrome, may also be more likely in smokers.

Testing and Quitting

In some situations, a surgeon may ask a patient to take a test to confirm that they have stopped smoking before surgery. After tobacco exposure, nicotine is converted by the body into cotinine, which stays in the body longer than nicotine and can be measured.

Quitting smoking can be very difficult, but reducing or stopping smoking gives patients some control over preventing complications. Speak with your physician about resources that can help you quit smoking.

This mobile-friendly version is adapted from patient education content originally provided by the American Society for Surgery of the Hand.