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Jammed Finger

  • Author: Thomas H Trojian, MD; Chief Editor: Sherwin SW Ho, MD  more...
 
Updated: Dec 09, 2015
 

Background

The layman's term "jammed finger" often refers to injuries that are incurred around the proximal interphalangeal (PIP) joint of the fingers (see image below). Although imprecise in its diagnostic accuracy, jammed finger aptly describes a constellation of injuries that are related to varying degrees of axial loading across the PIP joint.

Anatomy of the proximal interphalangeal joint. The Anatomy of the proximal interphalangeal joint. The central slip passes directly over the joint and inserts on the base of the middle phalanx. The lateral bands pass around the joint, combine with the retinacular ligaments, and unite to form the extensor tendon that attaches on the distal phalanx. Lateral motion is minimized by the collateral ligaments, and extension is limited to 0º by the thick volar plate.

(See also the Medscape Reference articles Finger Nail and Tip Injuries [in the Plastic Surgery section], Interphalangeal Dislocations [in the Emergency Medicine section], Mallet Finger and Boutonniere Deformity [in the Orthopedic Surgery section], and Mallet Fracture [in the Sports Medicine section], as well as Assessing the Hands and Wrists in Elderly People on Medscape Education.)

Injury to the PIP joint is common in athletic activities, especially ball-handling sports, but this condition is often minimized by players and coaches. The anatomy of the PIP joint is complex, and several types of injuries can result in permanent disability if they are left undiagnosed or mistreated. The sports medicine practitioner must develop a working knowledge of these common injury patterns so that timely and appropriate treatment can be provided.

For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Also, see eMedicineHealth's patient education articles Broken Finger, Finger Dislocation, and Finger Injuries.

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Epidemiology

Frequency

International

Finger injuries are common (38%) in individuals younger than 5 years. Most of these occur at home (59%), commonly (48%) because of jamming between 2 closeable opposing surfaces and mostly (79%) in doors at home and at school.[1]

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Functional Anatomy

The PIP joint is a hinge joint that permits a range of motion (ROM) from 0-120°[2, 3, 4] (see image below). Relatively thick collateral ligaments provide lateral stability. Unlike the metacarpophalangeal (MCP) joint, the tension of these ligaments does not vary during ROM.

Anatomy of the proximal interphalangeal joint. The Anatomy of the proximal interphalangeal joint. The central slip passes directly over the joint and inserts on the base of the middle phalanx. The lateral bands pass around the joint, combine with the retinacular ligaments, and unite to form the extensor tendon that attaches on the distal phalanx. Lateral motion is minimized by the collateral ligaments, and extension is limited to 0º by the thick volar plate.

The volar plate forms the floor of the joint and separates the joint space from the flexor tendons. The volar plate is ligamentous at its origin on the proximal phalanx and cartilaginous in its insertion onto the middle phalanx.

Dorsally, the central slip of the extensor tendon acts to stabilize the joint and to extend the middle phalanx. The lateral bands, joined by the retinacular ligaments of the intrinsic hand muscles, go around the joint to form the distal extensor tendon and also contribute to joint stability.

The common mechanism of injury at the PIP joint involves the simultaneous application of hyperextension forces with some degree of longitudinal compression.

Volar plate disruption (see image below)

  • Mild forces may rupture the volar plate at its distal insertion on the middle phalanx; the articular surfaces remain intact. This is a stable injury. Local pain and edema generally produce only short-term disability.
  • Occasionally, fractures of the middle phalanx at the attachment of the volar plate occur. These fractures usually involve less than 30-40% of the joint surface and are thought to be stable due to maintenance of collateral ligament integrity. (See also the Medscape Reference article Phalangeal Fracture Surgery.)
    Volar plate disruption with a stable, nondisplaced Volar plate disruption with a stable, nondisplaced avulsion fracture of the middle phalanx.

Dorsal dislocation (see image below)

  • If the force of injury is great enough, rupture of the volar plate may occur along with longitudinal splitting in the collateral ligament structures, allowing complete dorsal displacement of the middle phalanx. Simple dislocations are readily reduced, often by the player, coach, or trainer on the field. Following reduction, most dorsal dislocations are stable.
  • Fractures at the base of the middle phalanx also occur in association with dorsal dislocations. If a fracture involves more than 40-50% of the articular surface, collateral ligament support is lost. Combined with the coexistent volar plate disruption, this reduction of collateral ligament support represents a major loss of joint stability. These injuries are often unstable, exhibiting persistent subluxation of the middle phalanx.
    Dorsal dislocation of the proximal interphalangeal Dorsal dislocation of the proximal interphalangeal joint.

Collateral ligament injury

See the list below:

  • Angular forces may cause partial or complete rupture of a collateral ligament. When combined with volar plate rupture, lateral dislocation can occur. Most lateral dislocations are easily reduced and do not demonstrate gross instability.
  • Because of scar-tissue formation in the healing ligament, these injuries often result in enlargement of the PIP joint ("fat knuckle"). This may be of cosmetic concern to some patients, but good functional recovery can usually be expected.

Boutonniere deformity (see image below)

  • The term "boutonniere" comes from the French word for "buttonhole." This injury involves a disruption of the central slip of the extensor tendon at its insertion on the middle phalanx. The mechanism of injury is a blow to the dorsum of the PIP joint, such as when an athlete's hand is stepped on. Occasionally, a small fleck fracture of the middle phalanx is seen at the central slip insertion. Volar dislocation of the PIP joint is thought to be a component in many cases.
  • Little deformity may be noted immediately after an injury that results in a boutonniere deformity. The lateral bands may still act weakly to aid joint extension. Left untreated, the central slip retracts and the lateral bands displace volarly below the axis of rotation, becoming flexors of the PIP joint. Thus, the classic deformity of PIP joint flexion and distal interphalangeal (DIP) joint hyperextension is produced. Once a deformity becomes chronic or fixed, it presents a difficult surgical challenge, with potentially permanent functional deficits.
  • Because volar dislocations may be reduced spontaneously or before the office visit and because the symptoms and signs of such injuries may be subtle, practitioners must maintain a high index of suspicion for central slip disruption when evaluating any PIP joint injury. Patients may have more pain dorsally, and there is usually weakness or the inability to fully extend the PIP joint.
    Typical boutonniere deformity. Typical boutonniere deformity.
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Contributor Information and Disclosures
Author

Thomas H Trojian, MD Professor of Family Medicine, Sports Medicine Fellowship Director, Department of Family Medicine, Associate Chief, Division of Sports Medicine, Drexel University College of Medicine; Lead Team Physician, Drexel Athletics

Thomas H Trojian, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Society of Teachers of Family Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Melissa Mascaro, MD Fellow in Sports Medicine, University of Connecticut School of Medicine

Disclosure: Nothing to disclose.

Giselle Aerni, MD Assistant Professor of Family Medicine, University of Connecticut Health Center; Associate Fellowship Director of Primary Care Sports Medicine Fellowship, University of Connecticut School of Medicine; Assistant Team Physician, University of Connecticut; Team Physician, WNBA CT Sun

Giselle Aerni, MD is a member of the following medical societies: American College of Sports Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Leslie Milne, MD Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine

Leslie Milne, MD is a member of the following medical societies: American College of Sports Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Michael E Robinson, MD Consulting Staff, Department of Orthopedics, Division of Primary Care Sports Medicine, Permanente Medical Group and Kaiser Hospital

Michael E Robinson, MD is a member of the following medical societies: American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

References
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  2. Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries. Philadelphia, Pa: WB Saunders Co; 1992.

  3. Rockwood CA, Green DP, Bucholz RW, eds. Rockwood and Green's Fractures in Adults. 3rd ed. Philadelphia, Pa: JB Lippincott; 1991.

  4. Robinson ME, Sallis RE, Massimino F, eds. Fracture diagnosis and management of common injuries. ACSM's Essentials of Sports Medicine. St Louis, Mo: Mosby; 1997. 509-16.

  5. Simpson PM, McCabe B, Bendall JC, Cone DC, Middleton PM. Paramedic-performed digital nerve block to facilitate field reduction of a dislocated finger. Prehosp Emerg Care. 2012 Jul-Sep. 16(3):415-7. [Medline].

  6. Paschos NK, Abuhemoud K, Gantsos A, Mitsionis GI, Georgoulis AD. Management of proximal interphalangeal joint hyperextension injuries: a randomized controlled trial. J Hand Surg Am. 2014 Mar. 39 (3):449-54. [Medline].

  7. Houshian S, Chikkamuniyappa C. Distraction correction of chronic flexion contractures of PIP joint: comparison between two distraction rates. J Hand Surg [Am]. 2007 May-Jun. 32(5):651-6. [Medline].

  8. Freiberg A, Pollard BA, Macdonald MR, Duncan MJ. Management of proximal interphalangeal joint injuries. Hand Clin. 2006 Aug. 22(3):235-42. [Medline].

  9. Hamilton SC, Stern PJ, Fassler PR, Kiefhaber TR. Mini-screw fixation for the treatment of proximal interphalangeal joint dorsal fracture-dislocations. J Hand Surg [Am]. 2006 Oct. 31(8):1349-54. [Medline].

  10. Ellis SJ, Cheng R, Prokopis P, et al. Treatment of proximal interphalangeal dorsal fracture-dislocation injuries with dynamic external fixation: a pins and rubber band system. J Hand Surg [Am]. 2007 Oct. 32(8):1242-50. [Medline].

  11. Hamada Y, Hibino N, Tonogai I, Konishi T, Satoura M, Yamano M. Staged external fixation for chronic fracture-dislocation of the proximal interphalangeal joint: outcomes of patients with a minimum 2-year follow-up. J Hand Surg Am. 2012 Mar. 37(3):434-9. [Medline].

  12. Hoffman DF, Schaffer TC. Management of common finger injuries. Am Fam Physician. 1991 May. 43(5):1594-607. [Medline].

  13. Claudet I, Toubal K, Carnet C, Rekhroukh H, Zelmat B, Debuisson C. [When doors slam, fingers jam!] [French]. Arch Pediatr. 2007 Aug. 14(8):958-63. [Medline].

  14. Cornwall R, Ricchetti ET. Pediatric phalanx fractures: unique challenges and pitfalls. Clin Orthop Relat Res. 2006 Apr. 445:146-56. [Medline].

  15. Kawamura K, Chung KC. Fixation choices for closed simple unstable oblique phalangeal and metacarpal fractures. Hand Clin. 2006 Aug. 22(3):287-95. [Medline].

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  17. Theivendran K, Pollock J, Rajaratnam V. Proximal interphalangeal joint fractures of the hand: treatment with an external dynamic traction device. Ann Plast Surg. 2007 Jun. 58(6):625-9. [Medline].

  18. Prucz RB, Friedrich JB. Finger joint injuries. Clin Sports Med. 2015 Jan. 34 (1):99-116. [Medline].

 
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Anatomy of the proximal interphalangeal joint. The central slip passes directly over the joint and inserts on the base of the middle phalanx. The lateral bands pass around the joint, combine with the retinacular ligaments, and unite to form the extensor tendon that attaches on the distal phalanx. Lateral motion is minimized by the collateral ligaments, and extension is limited to 0º by the thick volar plate.
Volar plate disruption with a stable, nondisplaced avulsion fracture of the middle phalanx.
Dorsal dislocation of the proximal interphalangeal joint.
Typical boutonniere deformity.
Extension block splint with the proximal interphalangeal joint at 30°.
Proximal interphalangeal joint that has been splinted in extension for the treatment of a central slip injury.
Dynamic spring extension splint for the treatment of a boutonniere finger deformity.
 
 
 
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