Jammed Finger Treatment & Management

  • Author: Michael E Robinson, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Feb 28, 2010
 

Acute Phase

Rehabilitation Program

Physical Therapy

  • Volar plate sprain: Treatment of a mild finger hyperextension injury usually requires only 1-2 weeks of protective buddy taping to an adjacent finger in addition to the institution of early ROM exercises. Taping should continue during athletic or at-risk activities until full pain-free ROM is obtained. Volar plate disruptions that involve fractures of the middle phalanx should be treated as dislocations.
  • Dorsal dislocation: Simple dorsal PIP dislocations, including those with small middle phalanx fractures, are generally stable following reduction. The usual treatment is dorsal splinting with the joint in 10-30° of flexion for 2 weeks. Such an extension block splinting limits further injury to the volar plate (see image below). The stabilizing tape on the middle phalanx can be removed to allow the finger to flex but not for it to fully extend. Place 2 stabilizing tapes on the proximal phalanx to hold the splint in place. Aluminum foam splints are commonly used, and some commercial devices are available; Coban wrapping (3M Health Care, St Paul, Minn) can be used to control swelling. Following the initial treatment period, begin ROM exercises. Continue protective splinting or buddy taping for 4-6 weeks during athletic or at-risk activities. Extension block splint with the proximal interphalExtension block splint with the proximal interphalangeal joint at 30°.
  • Collateral ligament injury: Partial collateral ligament tears may be treated with buddy taping and early ROM exercises. Lateral dislocations are also typically treated with dorsal splinting in slight flexion for 2 weeks. Additionally, buddy taping to the digit that is ipsilateral to the injured ligament is recommended to help control joint stability. Initiate ROM exercises after 2 weeks. Continue protective buddy taping of the digit for sports activities until pain-free function returns.
  • Boutonniere deformity: Treatment of an acute central slip injury consists of splinting the PIP joint in full extension for 6 weeks (see image below); DIP joint ROM exercises are encouraged. Typically, an aluminum foam splint is placed over the dorsum of the joint. Some commercial splints are available, including dynamic spring devices (see image below). After 6 weeks, ROM exercises are initiated. The use of a static splint at night or a dynamic ROM splint device for an additional 2 weeks is often recommended. The use of protective splinting in extension is advised during sports or at-risk activities for 4-6 weeks or until full pain-free function is restored. Proximal interphalangeal joint that has been splinProximal interphalangeal joint that has been splinted in extension for the treatment of a central slip injury. Dynamic spring extension splint for the treatment Dynamic spring extension splint for the treatment of a boutonniere finger deformity.

Surgical Intervention

  • Any dislocation that cannot be easily reduced by the usual means may indicate the interposition of soft-tissue structures. This should prompt consultation with an orthopedic surgeon for open reduction.[4, 5, 6]
  • Fracture-dislocations that are unstable, exhibit persistent subluxation of the middle phalanx, or involve large portions of the articular surface should be referred for surgical fixation.[6, 7]
  • Grossly unstable collateral ligament injuries may be considered for surgical repair.
  • Surgical reconstruction is the treatment of choice for chronic boutonniere deformity.[3, 8]
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Contributor Information and Disclosures
Author

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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, 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: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding

References

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

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

  3. 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.

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

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

  6. 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]. Oct 2006;31(8):1349-54. [Medline].

  7. 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]. Oct 2007;32(8):1242-50. [Medline].

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

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

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

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

  12. Lindley SG, Rulewicz G. Hand fractures and dislocations in the developing skeleton. Hand Clin. Aug 2006;22(3):253-68. [Medline].

  13. Rettig AC. Epidemiology of hand and wrist injuries in sports. Clin Sports Med. Jul 1998;17(3):401-6. [Medline].

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