Nothing To Thumb Your Nose At
Finger injuries in athletics are very common. Most of these injuries are small however, some can be major. It is very important, especially in the skeletally immature athlete, to not miss a potentially debilitating injury.
General management of finger injuries should begin with a detailed history of the injury. An Athletic Trainer will be the front line medical professional with athletes and many times will treat the injury immediately after it has occurred. If the injury is sub-acute (seen well after the accident) the history is extremely important. The history should include mechanism of injury, previous injury, whether the joint was dislocated (out of place) and if so, how it was reduced.
Any finger injury that is sustained by a young adolescent (12 - 16) should be seen by a physician and have x-rays performed. These skeletally immature athletes are very susceptible to developing debilitating joint arthritis later in adulthood.
The anatomy of the fingers is depicted in this picture. The joints of the finger are comprised of the two bones, ligaments, and tendons. The dynamic interaction of these structures maintains the stability of the finger joints.
The most common joint injured the proximal-interphalangeal (PIP) joint (the middle joint of the finger). The most common mechanism of injury is hyperextension. The joint is straightened too far. Other common mechanisms of injury are torsion and axial loading. The distal interphalangeal (DIP) (joint near the finger nail) is injured less often due to the small size of the distal phalanx (finger bone). Its small size means that it would take a major force moment to injure this joint.
A hyperextension mechanism to any joint of the finger, either to the PIP or DIP, can result in a sprain of the volar or palmar plate. The volar plate is a very thick ligament that prevents hyperextension injuries. If the force is sufficient enough, the joint may be dislocated. The most common dislocation of the PIP results in dorsal (upward) displacement of the middle phalanx.
A simple hyperextension may result in a small avulsion (chip) fracture of the volar plate. This x-ray demonstrates this injury. This injury is most often treated with immobilization at 20º to 30º of flexion for 2 to 4 weeks. In contrast, a hyperextension that results in dislocation can produce a much larger fragment. The fragment in this x-ray needs surgical treatment to repair the fragment.
Finger joint stability is also provided by the collateral ligaments. (Refer to finger anatomy.) The collateral ligaments provide stability side-to-side. These ligaments are often injured in athletics. The stability of the joint needs to be assessed with the appropriate joint stress tests. Depending upon the amount of joint laxity, treatment will be determined.
Treatment for collateral ligament injuries ranges from buddy taping (taping one finger to another next to it) to splinting with a finger immobilizer. If splinting is deemed appropriate, the finger will usually be immobilized in 30º of flexion for 10 to 14 days. After that time, buddy taping is used until complete healing has occurred.
Young teenage or pre-teens should be x-rayed to rule out a collateral ligament avulsion fracture. In an adult, the ligament will most often be sprained. A child however, is more likely to have the ligament avulsed from the bone. If this is the case, stressing the ligament before x-rays can result in displacement of the ligament-bone fragment. This injury may result in surgical fixation of the avulsed fragment to ensure proper healing. This x-ray demonstrates this type of injury.
A less common injury to the finger may result in a boutonnière deformity. This injury is the result of an axial load on the tip of the finger. The load results in the deformity shown in this picture. This injury is characterized by incomplete extension of the PIP and hyperextension of the DIP. The fibers of the central slip of the finger extensor tendon rupture. The lateral bands of the same tendon move palmar, flexing the DIP. This injury may result in surgical intervention to repair the damage. Most often, the injury is not severe enough for surgery and splinting for 12 weeks is appropriate.
A mallet finger is the result of a forceful flexion of the DIP. The force of the blow may have enough force to cause an avulsion of the extensor tendon from the DIP. This results in the inability to fully extend the last joint of the finger. This injury is shown in this x-ray.
This injury must be treated with a splint that keeps the finger in full or hyperextension. The splint must be kept on for 24 hours per day. Removal of the splint for even 5 minutes can stop the healing process and necessitate surgical repair of the finger.
A far less romantic injury is a “jammed finger.” This results from a axial load to the finger. The joint surfaces of each bone “jam” together, causing a joint surface injury. This often results in swelling and loss of motion that lasts for over 6 weeks. There is usually no signs of trauma on x-ray and the joint will not exhibit instability.
This type of injury should be treated with RICES (Rest, Ice, Compression, Elevation, and Support). The finger should be supported by buddy taping to the next finger. Ice and compression should be used to help control swelling. Since the finger is at the end of the hand, swelling is difficult to control. Therefore, the hand should be elevated as often as possible to control the swelling.
With proper management, finger injuries will not result in a life-long debilitating problem.
©2000 - 2009 David Edell
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Last Update for AthleticAdvisor.com: 10/24/2009 12:09:35 AM