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of the Hand What are Joint Injuries of the Hand? The hand is a complex part of the body with many interrelated parts, including the joint at the wrist and three joints each in the thumb and fingers. Sprains and dislocations of finger joints are quite common. With a sprain, the supporting soft tissue surrounding the bones of the joint is partially torn. In the finger joints, this soft tissue is known as the collateral ligament and the volar plate. These structures are often torn completely when a joint is dislocated. The middle joint of the fingers is known as the proximal interphalangeal (PIP) joint, and it is sprained and dislocated most frequently. The other finger joints, the distal interphalangeal (DIP) joint at the tip of the finger, and the metacarpophalangeal (MP) joint at the base of the finger, are involved in these injuries much less often. Sometimes joint injuries produce a break in the skin (an open wound), but very often they do not. Dislocations of the PIP joint usually result in obvious deformation. Dislocation injuries seldom occur in isolation. In many cases there will be associated bone fractures or damage to surrounding muscles, ligaments, and nerves. There may be damage to the membrane lining the joint. Causes of Joint Injuries of the Hand? Joint injuries are the result of trauma. An accident occurs in which the finger is hit or bent forcibly, pulling the joint out of alignment. The PIP joint at the middle of the finger and the MP joint at the base of thumb can be dislocated if pulled forcibly. Any sport involving the strenuous use of the hands can result in a dislocation or sprain. While many of these injuries are the result of accidents that cannot be prevented, it is wise to wear the protective gloves or padding recommended for use in your particular sport. Symptoms of Joint Injuries of the Hand? If you sprain or dislocate a joint of the hand, you will be unable to move the joint in the normal way. It will appear swollen and possibly misshapen. The area around the injury will be painful. If you have dislocated a finger or thumb you may be tempted to try to reduce the dislocation on your own, perhaps with the help of a well-meaning friend. The reduction of a dislocated joint, should always be done by a physician, or a trainer under the physician’s supervision. Treatment of Joint Injuries of the Hand? If one of the joints of your hand has been sprained or dislocated, ice the injury and seek medical treatment immediately. Icing relieves pain and helps slow the flow of blood to the injured area, therefore reducing swelling. Do not attempt to put a dislocated bone back into its socket, as this can result in further damage to surrounding tissue or nerves. If possible, splint the finger or thumb in the position found immediately after the injury. You will be asked to supply information about the circumstances of the injury, and about previous or ongoing conditions of the arm, wrist, shoulder, and hand. Your doctor will take x-rays to evaluate the injury and examine the hand for neurovascular damage. X-rays also reveal any associated fractures. Your physician will palpate the sides of the finger, noticing tenderness and swelling. He or she will test the joint for stability. If these observational tests indicate pain but no basic instability in the joint, the collateral ligament has been sprained but not dislocated. Digital block anesthesia is used when reducing dislocations, making the procedure less uncomfortable. Your doctor will apply gentle pressure and traction to the finger, stabilizing the joint in relation to the rest of the hand. After reduction, he or she will move the finger through a range of motion. Once the joint appears to be correctly realigned, it is usually “buddy-splinted” to an adjacent finger for about two weeks. If soft tissue is interposed in the wound, a surgical procedure may be needed to reduce the joint. Sometimes the joint has full range of motion after reduction but slips back out of alignment during the last 20 degrees of extension. This problem requires a special kind of splint, one that prevents the finger from fully extending during a period of about three weeks. After three weeks the finger is fully extended and then buddy-splinted to a neighbor for an additional three weeks. Dislocations of the DIP joint at the tip of the finger are often open wounds, frequently associated with a tear of the extensor tendon. Your doctor will use digital block anesthesia and apply traction to reduce the dislocation. A special aluminum splint is applied over both the DIP and PIP joints, to be worn for one to two weeks. If the fingertip droops after the reduction, making it impossible to extend the DIP joint, the extensor tendon has been ruptured. This results in a condition known as mallet finger, and it requires specific treatment. Dislocations of the MP joint of the thumb are fairly common. These can be relatively complex injuries, involving the entrapment of the metacarpal head, the end of the thumb attached to the trapezium, one of the eight small bones of the wrist. The metacarpal head may be caught between a flexor tendon and a lumbrical tendon. Sometimes the palmar plate, another muscular tissue, is interposed between these bones. These situations are best corrected with open reduction, a surgical procedure allowing for the correct repositioning of tissue and bone. An experienced hand surgeon should do this procedure, which is commonly performed on an outpatient basis, using local anesthetic. Proper treatment of joint injuries to the hands helps prevent the development of persistent conditions such as instability, chronic joint stiffness, or an inability to flex and extend the finger or thumb in a normal way. If a dislocation has been improperly reduced, arthritis may eventually develop in the joint. Inadequate reduction leads to the damage of protective cartilage over the bony surfaces of the joint. Complete recovery from any injury depends on many factors, including your general state of health. Follow-up visits are important for tracking the healing process. As the joint recovers, your doctor or other medical professional can show you how to gently exercise the injured area to regain strength and motion. He or she will probably recommend using ice and/or heat to help relieve discomfort. Whirlpool treatments and the application of heat increase the flow of blood and nutrients to the injury. Ice massage before and after exercising the hand is also beneficial. The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician. © 2000 DynoMed.com, LLC, Indianapolis, IN |