Background & Etiology
The bones in the hand align precisely to provide a full range of motion and dexterity. When one of the bones is injured, it can force the entire hand out of alignment. There are five bones in the palm of the hand, called the metacarpals; and 14 bones in the fingers, called the phalanges.
A fracture is defined as a partial or complete crack in a bone. Fractures can be minor with little or no displacement of the bone, or more severe with complete displacement of the two ends of the bone that requires surgery to realign. There are closed fractures that do not break the skin, and open fractures that do break the skin.
The most common finger fracture is to the metacarpal of the little or “pinky” finger. In the event that an individual suspects they may have sustained a finger fracture, a radiographic evaluation (X-Ray) or a comparison between the angle of the fingers on the un-injured hand may be helpful in identifying which bone is injured.
- Direct trauma, like slamming a finger in a car door
- A fall on an outstretched hand (FOOSH)
- Athletic injuries
- Work behaviors (for instance, work with power tools)
- Crush Injuries of the hand
Fractures are acute injuries (occur suddenly) therefore symptoms can often be noticed immediately following injury.
- Sudden, sharp pain in the finger or hand
- Swelling and tenderness at the site of injury
- Visible deformity of the bones in the finger
- Inability to move the finger without pain
The most common course of treatment for a finger fracture is realignment (referred to as reducing the fracture) and splinting or casting to immobilize the joint, and give the bones time to heal. In some cases the physician will splint the injured finger together with the neighboring un-injured finger to provide more stability to the injured bone.
For more severe fractures, surgery may be needed to realign the bones properly. Pins, screws, or wires may be used to hold the finger bones properly in place. How much movement should be restricted following the fracture will depend on the severity of the break.
Once cleared by the physician, a hand therapy program should be initiated to reverse the effects of immobilization and restore finger motion. In more involved fractures recovery can take more time. Formal therapy and compliance with an extensive home program is the mainstay to restoring function of the hand.
Hand therapy interventions
Post finger fracture immobilization can have detrimental effects that can be improved through hand therapy including:
- Joint articular cartilage softening
- Shortening and atrophy of musculotendinous units
- Decreased circulation
- Loss of active and passive motion
- Weakness of the hand
Goals for hand therapy post-finger fracture immobilization are optimal loading and restoration of normal tissue relationships to improve motion, strength and ability to perform functional activities of daily living.
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, passive/active/active assisted stretching of finger and joint mobilization by a hand therapist to modulate pain and reduce any soft tissue or tendon irritation and restore normal joint mechanics and range of motion.
- Therapeutic Exercises (TE) including exercises to improve strength and performance of the finger and surrounding muscles.
- Neuromuscular Reeducation (NMR) to restore stability, begin retraining the hand, improve joint stability and improve movement technique, functional use and mechanics (for example: grasping and fine motor manipulation), in use of the involved upper extremity in daily activities.
- Modalities that can include the use of ultrasound, paraffin, electrical stimulation, ice, cold and laser to decrease pain, improve mobility and reduce inflammation of the fingers and surrounding muscles and tendons.
- Home program development should include strengthening, stretching and stabilization exercises as well as instructions to help the person perform daily tasks and advance to the next functional level.
Most fractures can be diagnosed with X-Ray studies and when necessary a CAT scan. The use of pain medications, immobilization, rest and ice are the first line of treatment. Surgical intervention may be required in more severe fractures or those that affect the integrity of the hand.
Rate of recovery and the prognosis from a finger fracture will depend on a number of factors:
- Severity – Minor fractures do well with immobilization and hand therapy, while fractures that are more severe and require surgery or effect joint integrity take longer to recover. Patients may have residual motion and strength deficits.
- Age- Younger individuals recover faster and are less likely to have residual deficits. Younger individuals heal quicker, have better circulation, are stronger and usually their pre-injury tissue integrity is better.
- Prior activity level plays an important role in post-injury recovery. Those who exercise regularly are stronger and more flexible, and generally have an easier and more complete recovery.
- Compliance- Patients that are committed to their rehabilitation program and are compliant with their home program are more successful in returning to full function.