eMedicine Specialties > Sports Medicine > Wrist and Hand

Hand Dislocation: Follow-up

Author: Jeff Chan, MD, MS, FACEP, Clinical Instructor, Stanford University; Staff Physician, Department of Emergency Medicine, Regional Medical Center of San Jose
Coauthor(s): Eleby R Washington III, MD, FACS, Associate Professor, Department of Surgery, Division of Orthopedics, Charles R Drew University of Medicine and Science; Igor Boyarsky, DO, Director of Triage, Assistant Professor, Department of Emergency Medicine, King-Drew Medical Center, University of California at Los Angeles
Contributor Information and Disclosures

Updated: Mar 27, 2009

Follow-up

Return to Play

Athletes with simple dorsal dislocations of the PIP joint may return to play with buddy taping or splinting as soon as the same game if a stable reduction is achieved, unless their position places unusual demands on the finger (eg, quarterbacks, pitchers with an injury to the dominant hand).

Athletes with dorsal fracture-dislocations of the PIP joint and dislocations that are unstable in extension require a minimum of 3-4 weeks (the time during which extension block splinting is required) before return to play. Open reduction or volar plate repair necessitates 6 weeks away from sports. Patients with volar PIP dislocations are more likely to be kept from rapid return by associated injuries and problems with reduction. Injury to the central slip of the extensor tendon is common with volar dislocations and necessitates splinting the DIP joint in extension for approximately 6 weeks. If this does not interfere with function, the athlete may return to play, although ball handlers may have some difficulty with the splint.

Patients with volar dislocations requiring open reduction may return to play after a few days of immobilization if the central slip is intact. As with dorsal dislocations, if internal fixation or repair of structures around the joint is required, the athlete may be out for 6 weeks. Most DIP dislocations should not require time away from play, except for a few days postoperatively if open reduction or I & D is necessary.

Athletes with MCP joint or CMC joint dislocations generally remain out of sports for 6-8 weeks. This is the time that the extension block splinting or extension cobra casting is needed, plus a period to arrange for full functional mobilization of the fingers, hand, and wrist with appropriate return of grip and wrist flexion and extension strength.

Complications

Joint stiffness, flexion deformity, and instability may develop from the injury or from immobilization during treatment. Boutonniere deformity may result from an undiagnosed/untreated central slip injury associated with volar PIP dislocation. Overly forceful attempts at reduction may result in phalangeal fractures. Associated intra-articular fractures may predispose to degenerative joint disease (DJD).

Prevention

A limited role for prevention of these hand dislocations is possible, because they always occur to some degree in contact sports. Taping of the fingers in high-risk contact sports, such as football, may help to prevent these injuries. Failure to adequately treat the jammed finger with an isolated partial collateral ligament tear may predispose the athlete to reinjury and possible dorsolateral dislocation. Finger injuries should be adequately assessed by the team physician or trainer and buddy-taped or splinted as necessary to allow healing and prevent recurrence.

Prognosis

The prognosis is good in simple PIP dislocations and most DIP dislocations as well as volar dislocations with the central slip intact (rotatory subluxations). Frequently, some loss of ROM occurs, but with adequate rehabilitation, a functional range can be maintained. The prognosis is fair in volar dislocations with avulsion of the central slip, if the diagnosis is made at the time of initial evaluation and proper treatment initiated; however, the prognosis is fair to poor in dorsal fracture-dislocations.

The prognosis is poor in any dislocation that is incompletely reduced for more than a few days and is very poor for a dorsal fracture-dislocation or a volar dislocation with central slip injury if the diagnosis is not made and appropriate treatment instituted early in the course of the injury. The prognosis is good in most early treated MCP joint and CMC joint dislocations. Delay in diagnosis and treatment may progressively worsen the prognosis. Long-term sequelae of hand dislocations with injury to the joint surface include instability, ankylosis, and arthrosis.

Education

All athletes in high-risk sports should know to have significant finger injuries evaluated and treated by the team physician or trainer at the time they occur. This helps to avoid some of the morbidity from fracture-dislocations, boutonniere injuries, and incompletely reduced dislocations. In addition, all athletes who sustain these injuries should be made aware of the importance of timely follow-up, of the expected duration of immobilization, and of the rehabilitation plan, goals, and timetable.

Miscellaneous

Medicolegal Pitfalls

  • Missing a boutonniere injury associated with a volar PIP dislocation
    • Always check active extension at the PIP joint against resistance. Failure to adequately assess stability of reduction is a concern.
    • Some of these hand dislocation injuries sublux in extension and require extension block splinting.
    • Grossly unstable joints require surgical intervention.
    • Ensure early follow-up for re-examination and repeat radiography in questionable cases.
    • Failure to diagnose persistent subluxation/tissue trapped in a joint because of the absence of gross deformity is a concern.
    • Always check the lateral radiograph for joint congruency/rotation.
    • Be suspicious of decreased ROM to avoid missing an open dislocation because it has been reduced before presentation.
    • Be suspicious of any lacerations near interphalangeal joints in a patient with a jammed finger.
 


More on Hand Dislocation

Overview: Hand Dislocation
Differential Diagnoses & Workup: Hand Dislocation
Treatment & Medication: Hand Dislocation
Follow-up: Hand Dislocation
Multimedia: Hand Dislocation
References
Further Reading
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References

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Further Reading

Related eMedicine Topics

Best Evidence

Clinical Trials

National Guidelines Clearinghouse

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Keywords

hand dislocation, broken finger, dislocated finger, injured finger, proximal interphalangeal joint dislocation PIP joint dislocation, distal interphalangeal joint dislocation, DIP joint dislocation, carpometacarpal joint dislocation, CMC joint dislocation, metacarpophalangeal joint dislocation, MCP joint dislocation

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Contributor Information and Disclosures

Author

Jeff Chan, MD, MS, FACEP, Clinical Instructor, Stanford University; Staff Physician, Department of Emergency Medicine, Regional Medical Center of San Jose
Jeff Chan, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Eleby R Washington III, MD, FACS, Associate Professor, Department of Surgery, Division of Orthopedics, Charles R Drew University of Medicine and Science
Eleby R Washington III, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, International College of Surgeons, and National Medical Association
Disclosure: Nothing to disclose.

Igor Boyarsky, DO, Director of Triage, Assistant Professor, Department of Emergency Medicine, King-Drew Medical Center, University of California at Los Angeles
Igor Boyarsky, DO is a member of the following medical societies: American Medical Association, American Medical Student Association/Foundation, American Osteopathic Association, American Society of Addiction Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Gerard A Malanga, MD, Founder and Director, New Jersey Sports Medicine Institute; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Sports Medicine Fellowship Director, Mountainside Hospital; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Medical Director, Consultant, Horizon Healthcare Worker's Compensation Services, Blue Cross and Blue Shield Worker's Compensation
Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Cephalon Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Henry T Goitz, MD, Fellowship Director, Sports Medicine, Department of Orthopedic Surgery, Henry Ford Hospital
Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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