Making Super Bowl Guacamole? Be Careful To Avoid The Pits Of An Avocado Hand Injury

Originally published on February 3, 2020 10:34 am

Is it your turn to make the guacamole at the Super Bowl party this year?

If so, be careful. You don't want to join the thousands of people who've ended up in an emergency room for avocado-related injuries.

"These injuries are exceedingly common," says Dr. Matt Aizpuru of the Mayo Clinic.

Aizpuru is the co-author of a 2019 study published in The American Journal of Emergency Medicine that found that as avocado consumption has gone up in America, so too have avocado-related knife injuries.

Aizpuru and his colleagues looked at emergency room data and found that between 1998 and 2017 an estimated 50,413 people paid a visit to the emergency room for an avocado-related knife mishap. Aizpuru says that in 1998 there were around 650 such injuries. By 2017, there were nearly 6,000, close to a 10-fold increase.

The most common demographic injured were women aged 23-29, according to the study, and injuries were most common on the left — and likely nondominant — hands of patients.

"When you're trying to free the pit up, it's just too easy to slip the knife off and catch yourself on the hand," he says.

He would know. While in medical school at Emory University, Aizpuru sliced his left thumb cutting an avocado for his own guacamole. The accident inspired him to study how common this injury is.

"I thought, if this is happening to me, it's surely happening to other people who are cutting avocados way more often than I do," he says.

A trend emerged when Aizpuru and his colleagues looked at that dataset alongside the U.S. Department of Agriculture's data on avocado consumption.

"We theorized that avocado-related injuries aren't happening more frequently or less frequently — just that people are eating more avocados," he says.

Since completing the study, Aizpuru takes extra precaution. Whenever he cuts an avocado now, he protects his left hand by covering it with a heavy dish rag. He also recommends the plastic cutting alternatives out there.

Assuming people are eating more guacamole this Super Bowl Sunday, Maria Raven, chief of emergency medicine at the University of California, San Francisco, expects a rise in visits. She says patients come in for the injury about once a week.

That may sound like a lot, but according to a separate study published in the January issue of the American Journal of Health Behavior, avocado mishaps account for only 2% of all knife-related injuries.

Only in rare cases do these types of injuries require surgery, Raven says.

Ryan Endress, a hand surgeon with the University of Kansas Health System, wishes his patients were more careful.

"It's best to just avoid holding whatever item you're cutting, and if you are going to hold what you're cutting, always cut away from yourself," he says.

Wilmer Carcamo, the executive chef of Rosa Mexicano, a restaurant in Washington, suggests a different approach.

Carcamo says he has never cut himself handling avocados, even though his technique involves whacking the pit with a knife. The restaurant, which prides itself on its guacamole, goes through about 2,000 avocados a week.

He says kitchen staffers are trained to follow the same method:

  • Once the knife sticks to the pit, wiggle the knife in a right-left motion to loosen up the pit — just enough so it slips easily out of the fruit
  • With the knife still attached, knock the pit against a disposal container
  • Use a spoon to scoop out that buttery, green good stuff

But Carcamo does have some crucial "don'ts" to impart on those making guacamole: Don't mask the avocado's natural flavor.

"No garlic. No limes."

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Our next story might make some of you very squeamish, especially if you've suffered from avocado hand.

TAMARA KEITH, BYLINE: I'm an early adopter on avocado hand.

FOLKENFLIK: That's NPR's Tamara Keith. She injured herself 10 years ago.

KETIH: I have a scar the size of a paring knife on my right hand just, you know, about an inch below my index finger.

FOLKENFLIK: And here's Tam's story. She was making breakfast. She thought, hey, how about some avocado? So fruit in one hand, knife in the other, she went for the pit. And then...

KETIH: It glanced off the pit and just stabbed into my hand. Blood went flying. It was just, like, on the walls. It was on the ceiling.

FOLKENFLIK: We did warn you. Tam ended up with stitches and a partially numb index finger. Now, we tell you this because it's Super Bowl Sunday - a big day for food, a bigger day for guacamole.

MATT AIZPURU: I was thinking about how easy it is to cut yourself cutting an avocado.

FOLKENFLIK: Dr. Matt Aizpuru of the Mayo Clinic - he's also a victim. He sliced his thumb. It happened when he was at Emory University, and it led him to study how common this injury really is. When he and his colleagues looked at data from the National Electronic Injury Surveillance System...

AIZPURU: We saw in 1998, there were just 647, whereas in 2017, there were nearly 6,000.

FOLKENFLIK: Six hundred and forty-seven to nearly 6,000 over a 19-year period, which, to be fair, makes sense, given the rise of avocado consumption in the U.S. And the main group hurting themselves - white women between the ages of 23 to 39.

MARIA RAVEN: I have treated a number of avocado injuries.

FOLKENFLIK: That's Maria Raven, chief of emergency medicine at the University of California, San Francisco. She's ready for today.

RAVEN: Assuming that people are making a lot of guacamole, we could anticipate seeing more avocado injuries in the emergency department.

FOLKENFLIK: And when Dr. Raven makes guac...

RAVEN: So I am completely guilty of doing this where I try to stab a knife into the avocado pit.

FOLKENFLIK: Is any of this making you feel better - one NPR correspondent, two doctors, all making the same painful mistake? Let's go 1,800 miles east to Kansas City.

RYAN ENDRESS: The first-ever case I treated as an attending surgeon was an avocado-related flexor tendon and digital nerve injury - my very first case.

FOLKENFLIK: That's Ryan Endress, an actual hand surgeon with the University of Kansas health system. He is not a victim. He's very careful in his own kitchen. He really wishes his patients were more careful, too.

ENDRESS: It's best to just avoid holding whatever item you're cutting. And if you are going to hold what you're cutting, always cut away from yourself.

FOLKENFLIK: Let's hear from an expert at handling avocados.

WILMER CARCAMO: Cut avocados very easy for Rosa Mexicano (laughter).

FOLKENFLIK: Wilmer Carcamo is executive chef of Rosa Mexicano here in Washington, D.C. They go through about 2,000 avocados a week. Chef Carcamo has never cut himself, even though his technique does involve hitting the pit with a knife.

CARCAMO: And we stick the knife on the seed, and then we just move it to the right side and left side.

FOLKENFLIK: That motion loosens up the pit just enough so it slips right out of the fruit...

CARCAMO: Kind of like this, OK?

FOLKENFLIK: ...When he knocks it against a clean container. Then he uses a spoon to scoop out that buttery green good stuff. No cuts, no pain, no avocado hand for him or for you if you use this method. But Chef Carcamo says there's one other crucial thing you should avoid when making guac for your Super Bowl party.

CARCAMO: No garlic, no limes.

FOLKENFLIK: That's his recipe, anyway, for a real winner, no matter if you're rooting for the 49ers or the Chiefs. Transcript provided by NPR, Copyright NPR.