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 most commonly injured ligaments in the fingers include the central slip of the extensor tendons, the collateral ligaments (radial and ulnar at each finger joint), and the volar plates.
A finger dislocation occurs when the phalanges (finger bones) come out of the proper joint alignment in the finger. Dislocations are most common in the younger population. When a finger dislocates it stretches the ligaments that stabilize and support the joint. Repeated dislocations can result in permanent ligament laxity, which causes chronic reoccurring dislocations. It is important to have a finger injury evaluated by a physician to properly diagnose the dislocation, and check for ligament damage. In some cases an X-Ray or CT scan will be used to evaluate the injury.
- Laxity of the finger ligaments is the most common cause of finger dislocation.
- General ligamentous laxity and arthritis may predispose an individual to dislocation.
- Repetitive strain injuries (RSI) at work, or overuse activities are common in people who participate in sport activities and individuals who have jobs that require performing activities of a repetitive nature, like working on an assembly line.
- Sudden trauma or accident like a fall on an outstretched hand or “jamming” of finger during sports activities.
- Finger pain or tenderness
- Limited motion of involved joint
- Swelling, bruising and possible appearance of deformity or “crookedness” 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
Physicians reduce acute dislocations using several techniques, which may or may not require radiographic examination.
- Age and activity level are factors that guide treatment
- In young athletes (15 to 25 years old,) surgical intervention is considered based on the high risk of recurrence, apprehension, impact on sports participation and quality of life
- Generally arthroscopic repair is used for the younger population
- There is a lower rate of occurrence among 25 to 40 year olds therefore members of this population respond better to conservative interventions
- People 40 years old and over have an even lower rate of recurrence, but do have increased risk of residual disability from nerve or vascular injury
- Conservative treatment whether post surgical or non-surgical is typically recommended
- Typically a period of immobilization supported by a splint for up to six weeks is recommended
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 Dislocation 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.
- 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, ICE, and Splinting of the involved joint
- 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 to stabilize the joint
- 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.