Subcutaneous emphysema in the hand can result from infectious and non-infectious aetiologies. Adequate history, physical examination, laboratory studies and imaging are needed to delineate the cause, to prevent debilitating consequences and to avoid unnecessary procedures and interventions. In this case report, an 18-year-old man sustained a trauma to the dorsum of the hand after a fist fight, without any penetrating objects, that resulted in instantaneous non-infectious subcutaneous emphysema which resolved with conservative management. A literature review of cases of non-infectious subcutaneous emphysema is presented here with an overview of the mechanism of injury, as well as the course and management. Certain criteria are also outlined to help differentiate between infectious and non-infectious emphysema, which include laboratory studies, imaging, timing and clinical symptoms.