Background & Etiology
Ligaments are fibrous bands of connective tissue made of collagen, which join bone to bone. They provide stability and limit excessive motion of the joint. In the fingers there are several ligaments that can be stretched or torn, causing a sprain. In addition, there are different degrees of instability that can occur in the fingers, like dislocation.
The ligaments in the fingers include the central slip of the extensor tendons, collateral ligaments (radial and ulnar at each joint), and the volar plates. There are three grades of finger sprain:
- Grade 1 – The mildest form of sprain where the ligament is stretched, not torn.
- Grade 2 – The ligament is partially torn
- Grade 3 – The ligament is completely torn. The most serious type of sprain, this condition may require surgery
It is important to have a finger injury evaluated by a physician to properly diagnose the grade of a finger sprain. In some cases an X-Ray or CT scan will be used to evaluate the injury.
Finger sprains are a common injury, often caused by a fall on an outstretched hand (FOOSH) or “jamming” finger during forceful activities. Typically these are the result of athletic or recreational activities where an individual uses their hands to protect themselves.
- Finger pain or tenderness
- Swelling or bruising at the finger
- Pain when moving or using the finger in daily activities
- A “popping” or “tearing” feeling in the finger
- Warmth or redness of the skin on the injured finger
If an individual suspects they have a finger sprain, the initial treatment should consist of avoiding the positions and activities that produce the pain. A course of conservative treatment is usually recommended that includes rest and immobilization, ice, physical therapy and non-steroidal medications to reduce inflammation. If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy. In severe cases surgical intervention may be needed to repair the torn ligament.
Hand Therapy Interventions
Hand Therapists are occupational therapists or physical therapists who through advanced study and experience, specialize in treating individuals with conditions affecting the hands and upper extremity. A hand specialist may also have advanced certification as a Certified Hand Therapist (CHT). A qualified hand therapist is educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of Finger Sprain include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage and joint mobilization by a hand therapist to regain mobility and range of motion of the finger and ligament.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion, function and strengthen the fingers.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the upper extremity, and improve movement technique and mechanics in daily use of the involved upper extremity.
- Splinting for stabilizing or mobilizing the involved joint as needed.
- Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the finger and ligament
- Home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.
Procedures that your physician may recommend and perform in addition to physical therapy that include:
- REST and ICE
- The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
- Steroidal injections to reduce inflammation
- Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
- Splinting and immobilization of the effected finger
- Surgery to correct underlying pathology or the cause of the sprain
Most people recover full function following a course of conservative care that includes hand therapy, to strengthen and stabilize the fingers. Those with more involved conditions like ligament tears and chronic dislocations will require surgery and intensive hand therapy afterward to restore full function.