ATHLETIC EDGE
Sports Medicine
Sports Injury Prevention & Rehabilitation
 540 BRYANT ST, PALO ALTO, CA 94301
(650) 815-6552

Voted Best Sports Therapy Clinic in the San Francisco Bay Area 2010-2016!

Dislocated Finger

(Also known as Finger Dislocation)
 
What is a dislocated finger?
A dislocated finger is a relatively common, traumatic sporting injury characterized by tearing of the connective tissue surrounding one of the finger joints with subsequent displacement of the bones forming the joint so they are no longer situated next to each other.
Each of the four fingers (excluding the thumb) comprises of three small bones known as phalanges. These small bones join to each other at the IP joints (interphalangeal Joints) and to the bones of the palm (metacarpals) at the MCP joints (metacarpophalangeal joints) thereby forming three joints for each finger. Each of these joints comprises of strong connective tissue wrapping around the bony ends and cartilage which lies between the joint surfaces, cushioning the impact of one bone on another during activity.
During certain movements of the fingers, stretching forces are placed on the finger joints. If these forces are excessive due to too much repetition or high force, injury to the joints may occur. This typically involves damage or tearing to the connective tissue surrounding the joint. When the forces involved are too great and beyond what the connective tissue and supporting muscles can withstand, one or more small bones of the fingers may displace or 'pop out' of their normal position. When this occurs, the condition is known as a dislocated finger and may affect one or more IP or MCP joints. Damage to other structures such as tendons and bones (fractures) may also occur as a result of a finger dislocation.

Causes of a dislocated finger
Dislocated fingers are relatively common in ball sports involving catching, such as basketball, volleyball, cricket or football, and typically occur due to a specific incident that forcibly bends the finger in the wrong direction (such as a hyperextension force or a sideways force). A direct blow to the point of the finger may also cause a dislocation. A dislocated finger may also occur in contact sports due to a collision with another player or in martial arts.

Signs and symptoms of a dislocated finger
Patients with a dislocated finger often experience a sudden onset of intense finger pain during the acute incident or causative activity. This is typically associated with an obvious bump or deformity in the finger owing to the displacement of the finger bones. An audible 'pop' or tearing sound may have occurred at the time of injury.
Pain may be felt on the front, back or sides of the affected finger joint. Occasionally pain may also be referred further along the finger or into the hand on the affected side. Swelling may occur instantly or may progressively develop over a number of hours. Patients may also sometimes experience pins and needles or numbness in the affected fingers.
Once the dislocated finger has been 'relocated', the patient may experience pain and stiffness that may increase with specific activities or with rest (particularly in the morning). Symptoms may be exacerbated with activities that involve the use of the hand and fingers such as opening jars or doors, writing, typing, picking up heavy objects, general gripping activity, cooking, household activities or placing weight through the affected hand and fingers. It is also common for patients to experience pain on firmly touching the affected region, and a feeling of weakness or 'instability' such that the finger may easily 'pop out' again. Bruising may also occur following injury, however may take a number of days to develop.

Diagnosis of a dislocated finger
A thorough subjective and objective examination from a physician is usually sufficient to diagnose a dislocated finger. X-rays should be taken to rule out fractures and assist with diagnosis. All finger dislocations should be X-rayed before reduction to exclude a fracture and after reduction to confirm relocation. Investigations such as an MRI or CT scan may sometimes be used to assist with diagnosis.

Treatment for a dislocated finger

Before commencing treatment for a dislocated finger, patients with this condition should have X-rays to determine if there are any fractures associated with the dislocation. This is particularly important in the case of traumatic finger dislocation where large forces are involved and should ideally occur before attempting to 'relocate' the bones back into their original position. Following X-ray an experienced sports medicine professional can assist with safely 'relocating' the bones. This should not be attempted alone, as long term damage may occur to other structures around the finger such as nerves, bones, ligaments and cartilage if the finger relocation is performed incorrectly. If a fracture is detected on X-ray, or if the condition is severe, surgical intervention may be indicated.
Following relocation of the finger, most patients heal well with appropriate physical therapy treatment. The success rate of treatment is largely dictated by patient compliance. Treatment usually entails an initial period of immobilization in a splint for a number of weeks to allow the damaged connective tissue to heal and form a 'scar'. During this period of immobilization, gentle exercises to maintain movement and strength may be allowed as guided by the treating physical therapist.
Following this, patients should perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. The treating physical therapist can advise which exercises are most appropriate and when they should be commenced. Particular emphasis needs to be placed on strengthening the finger and hand muscles to improve stability of the affected joint.
Patients with a dislocated finger usually benefit from following RICE. RICE is beneficial in the initial phase of the injury (first 72 hours) or when inflammatory signs are present (i.e. morning pain or pain with rest). This should primarily involve resting from aggravating activities, regular icing, and elevating the affected arm (above the level of the heart). Heat, alcohol and massage should also be avoided in the initial 72 hour period following injury or when inflammatory signs are present. Anti-inflammatory medication may also benefit those with a dislocated finger by reducing the pain and swelling associated with inflammation.
In the final stages of rehabilitation for a finger dislocation, a gradual return to activity is indicated as guided by a physical therapist provided there is no increase in symptoms. This often involves the use of protective taping, particularly upon resumption of ball sports or contact sports.

Prognosis of a dislocated finger

Many patients with a dislocated finger heal well with appropriate physical therapy and return to normal function. This may take weeks to months to achieve an optimal outcome. However, due to the severity of injury and severe connective tissue damage associated with this condition, some patients may experience long term effects such as ongoing pain, stiffness, swelling or instability of the affected finger.
Some patients with this condition may also require surgery. This is particularly common in cases of recurrent finger dislocation, or in cases with associated fractures or tendon damage. This is usually followed by an extensive rehabilitation program lasting many months.
Patients with a dislocated finger who also have damage to other structures such as cartilage, bone or nerves are likely to have a significantly extended rehabilitation period to gain optimum function.

Physical therapy for a dislocated finger
Physical therapy for a dislocated finger can hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • anti-inflammatory advice
  • joint immobilization
  • joint mobilization
  • finger taping
  • finger bracing or splinting
  • ice or heat treatment
  • exercises to improve flexibility and strength
  • education
  • activity modification advice
  • a gradual return to activity program

Other intervention for a dislocated finger

Despite appropriate physical therapy management, some patients with a dislocated finger do not improve adequately and require other intervention. When this occurs the treating physical therapist or doctor can advise on the best course of management. This may involve hand therapy, pharmaceutical intervention, corticosteroid injection, further investigation such as an X-ray, CT scan or MRI, or a review by a specialist who can advise on any procedures that may be appropriate to improve the condition. Some patients with certain types of finger dislocations, those with severe injuries or those with associated fractures may require surgical intervention to ensure an optimal outcome.