Dislocated finger is the term given to a traumatic injury most commonly in sports, which involves rupture of connective tissue covering either of finger joints with displacement of bones that form the joint disturbing the alignment of the finger joint.
All the four fingers except the thumb particularly consists of three little bones called phalanges. The phalanges stick together at the interphalangeal joints and to the metacarpals at metacarpophalangeal joint(1) developing three joints for every single finger. These joints individually consist of connective tissues covering around the ends of bone and cartilage that lie between the surfaces of the joints reducing the force of bones on each other while performing regular activities.
Compression or stretching forces get placed on joints of fingers when certain movements are performed. Excessive forces such as overuse or heavy force leads to the joint injury, which may result in damaging the cartilage or tearing of the connective tissues covering the joints. If these forces are too high and beyond the tolerance power of supporting muscles or connective tissues, then the phalanges of fingers may come out of their actual position or may get displaced. This finger displacement is known as a dislocated finger.
Types of Dislocated Finger
- All the four fingers excluding thumb particularly consist of three little bones called phalanges. The phalanges stick together at the interphalangeal joints and to the metacarpals at the metacarpophalangeal joints developing three joints for every single finger. Finger dislocation can occur at any of these interphalangeal or metacarpophalangeal joints based on the mechanism of injury.
- Distal interphalangeal joints are the joints present closest to the fingernails. Dislocation of these joints is caused due to trauma and often results in an open wound at the injury site.
- Proximal interphalangeal joints(2) are the joints present in the middle portion of the fingers. Dislocation of any of these interphalangeal joints is also termed as coach’s finger or jammed finger. This type of injury is most common in athletes, especially those playing ball sports such as football, basketball and baseball. The most common mechanism of injury is the fingers being bent backward while trying to catch a ball or block a shot. These types of joint dislocations can also occur from athlete’s fingers getting twisted or bent when colliding with an opponent.
- Metacarpophalangeal joints are the joints present in the knuckles at the beginning of the fingers. These joints join the fingers to the palm of the hand. Metacarpophalangeal joint dislocations are less common when compared to the other two types of dislocations mentioned above as these joints are very stable. Metacarpophalangeal dislocations usually occur in either the little or the index finger.
Causes of Dislocated Finger
- This condition is usually common in contact sports like cricket, football, basketball etc.
- This may take place due to a particular incident through, which the finger is bent forcibly the wrong way like sideways force or a hyperextension force.
- A dislocated finger can also be caused by a direct blow at the finger joint.
- Contact sports could also be a reason for finger dislocation as they involve collision of players with each other.
- Catching a finger in a jersey or any other piece of sports equipment is also a mechanism of sports injury leading to finger dislocation. If the pulling force is stronger than the tolerance limits of the ligaments and the joint, this could lead to finger dislocation.
- Finger dislocation can also take place by falling on outstretched hands.
Signs and Symptoms of Dislocated Finger
- Instant onset of pain in finger at time of injury.
- Deformity or bump in finger due to displacement of its bones.
- A tearing or a pop is heard at time of injury.
- Feeling of pain at the back, sides and front of the injured finger is also noted.
- Referred pain along fingers and into hands on the affected side.
- Bruising or swelling around the affected joint.
- Numbness, needles and pins in the injured finger could also be experienced in some cases.
- Exacerbation of the symptoms on performing activities involving fingers like general gripping, typing, opening jars, cooking, household chores, or picking heavy objects with affected hand.
- Pain is experienced with firm palpation of the injured area.
- Instability or weakness is also felt as if the finger may easily come out of its place again.
Treatment for Dislocated Finger
- Generally, conservative route suffices for dislocated finger where there is no significant displacement or rotational deformity. Conservative care involves closed reduction under local anesthesia followed by casting or splinting of the finger. Some digital motion may be allowed while casting for improved results depending upon the severity of the fracture. Fracture may require about six to ten weeks for complete recovery, which involves a period of immobilization for about three to four weeks followed by protective splinting for about six weeks.
- Surgery may be recommended in some severe cases where there are multiple fractures or open wound. Two factors play a major role in determining if surgery is warranted.
- Length: If the digit gets shortened or decreases in length due to fracture, surgery is recommended to restore the digit to its normal size.
- Rotation: In cases where the digit gets rotated due to the fracture, surgery is recommended to correct the deformity and restore the digit to its normal position.
- Metal implants such as plates, wires, and screws are needed to fix the broken fragments of bone depending upon the nature and type of the fracture.
- Some of the high level athletes may go for open reduction and internal fixation in an effort to return to sports earlier.
- Surgery brings with it risks of infection, bleeding, injury neurovascularly, as well as failure of hardware.
- RICE protocol for affected finger is to be followed. Antiinflammatory(3) medications are used to help with pain, swelling, and inflammation.
Physical Therapy for Dislocated Finger
This is important for finger dislocation to hasten up the healing process and to get optimum results. It also reduces the chances of having this injury again.
Physical Therapy May Include:
- Mobilization of joints.
- Soft tissue massages.
- Using heat and ice.
- Exercises for improvement of strength and making the joints flexible.
- Activity modifications.
- Good planning for returning to activities.
Exercises for Dislocated Finger
- Hand Open and Close: The exercise consists of making a tight fist by curling fingers and thumb. Then, we need to make the fingers straight again slowly as much as possible until there is pain-free motion felt. This need to be repeated 10 times with exacerbating the symptoms.
- Finger Adduction to Abduction: The exercise consists of making the fingers straight and joining them together. After this, then we need to stretch them as far as possible until there is a painless stretch. This again is required to be repeated 10 times without exacerbating symptoms.
- Tennis Ball Squeeze: In this exercise, a spongy object like a ball is held in the hand squeezed hardly without aggravating the pain for about five seconds and then released. This need to be repeated about 10 times without aggravation of symptoms.
Investigations of Dislocated Finger
Usually, a detailed history and physical assessment is done for diagnosis of finger dislocation and identify and other affected areas. Other tests can be:
- X-ray, which is a common test.
- CT scan.