Interphalangeal Dislocation Clinical Presentation
- Author: Grace M Young, MD; Chief Editor: Rick Kulkarni, MD more...
History
History usually reveals a traumatic athletic injury or entrapment of the finger between objects. Typically, the finger was jammed or bent backwards during basketball, football, or other sports activity. The patient often experiences diffuse pain, swelling, and tingling.
Determine the following aspects of the patient's history:
- Which is the dominant hand of the patient and which hand is injured?
- What is the patient's occupation?
- Where did injury occur (eg, job, assault)?
- How much time has passed since the initial injury?
Physical
An accurate and detailed examination often requires digital block anesthesia. The clinician should test and document each of the following:[6, 7]
- Gross deformity, diffuse edema, ecchymosis, and tenderness of the involved digit
- Possible anesthesia or paresthesia in the distal aspect of the involved digit
- Range of motion, function, and stability of involved joint
- Detailed neurovascular examination of entire involved hand
Restriction in active flexion and extension, especially against resistance, suggests tendinous or ligamentous rupture or intraarticular osteochondral fragment.
- Test the integrity of the volar plate by passive hyperextension
- Test the collateral ligaments by exerting radial and ulnar stress.
Skin laceration after a blunt hyperextension injury suggests volar plate rupture.
Causes
- Axial compression or lateral forces directed to the digit
- Forced hyperextension or hyperflexion of digit from traumatic athletic injury, entrapment of finger between objects, or a fall
- Predisposition to ligamentous injury possible in those with lax ligaments (eg, Down syndrome)
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