eMedicine Specialties > Sports Medicine > Wrist and Hand
Jammed Finger: Treatment & Medication
Updated: Nov 20, 2007
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
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 5). 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.
- 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 6); 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 7). 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.
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.
Medication
Nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics are generally used to treat the pain that is associated with a PIP joint injury.
Nonsteroidal anti-inflammatory drugs
NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. The mechanism of action of these agents is not known, but NSAIDs may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.
Ibuprofen (Motrin, Ibuprin)
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis
Adult
400-800 mg PO tid with food
Pediatric
10 mg/kg PO tid with food
Coadministration with aspirin increases the risk of inducing serious NSAID-related side effects; probenecid may increase the concentrations and, possibly, the toxicity of NSAIDs; may decrease the effect of hydralazine, captopril, and beta-blockers; may decrease the diuretic effects of furosemide and thiazides; monitor PT duration closely (instruct patients to watch for signs of bleeding); may increase the risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; patients who have peptic ulcer disease, recent GI bleeding or perforation, renal insufficiency, or high risk of bleeding
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Category D in third trimester of pregnancy; caution in patients with congestive heart failure, hypertension, and decreased renal and hepatic function; caution in the presence of anticoagulation abnormalities or during anticoagulant therapy
Ketoprofen (Oruvail, Orudis, Actron)
For the relief of mild to moderate pain and inflammation.
Small dosages are initially indicated in small and elderly patients and in those with renal or liver disease. Doses over 75 mg do not increase therapeutic effects.
Administer high doses with caution and closely observe the patient for response.
Adult
25-50 mg PO q6-8h prn; not to exceed 300 mg/d
Pediatric
3 months to 12 years: 0.1-1 mg/kg PO q6-8h
>12 years: Administer as in adults
Coadministration with aspirin increases the risk of inducing serious NSAID-related side effects; probenecid may increase the concentrations and, possibly, the toxicity of NSAIDs; may decrease the effect of hydralazine, captopril, and beta-blockers; may decrease the diuretic effects of furosemide and thiazides; monitor PT duration closely (instruct patients to watch for signs of bleeding); may increase the risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Category D in third trimester of pregnancy; caution in patients with congestive heart failure, hypertension, and decreased renal and hepatic function; caution in the presence of anticoagulation abnormalities or during anticoagulant therapy
Naproxen (Naprelan, Anaprox, Naprosyn, Aleve)
For the relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis
Adult
500 mg PO, followed by 250 mg q6-8h; not to exceed 1.25 g/d
Pediatric
<2 years: Not established
>2 years: 2.5 mg/kg/dose PO; not to exceed 10 mg/kg/d
Coadministration with aspirin increases the risk of inducing serious NSAID-related side effects; probenecid may increase the concentrations and, possibly, the toxicity of NSAIDs; may decrease the effect of hydralazine, captopril, and beta-blockers; may decrease the diuretic effects of furosemide and thiazides; monitor PT duration closely (instruct patients to watch for signs of bleeding); may increase the risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Category D in third trimester of pregnancy; acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug.
Narcotic analgesics
Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma or who have sustained injuries.
Acetaminophen and codeine (Tylenol #3)
For the relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis
Adult
30-60 mg/dose based on codeine q4-6h; not to exceed 12 tab/24 h
Pediatric
Codeine dose: 0.5-1 mg/kg/dose
Acetaminophen: 10-15 mg/kg/dose q4-6 h
The toxicity of this drug increases when administered concurrently with CNS depressants; coadministration with aspirin increases the risk of inducing serious NSAID-related side effects; probenecid may increase the concentrations and, possibly, the toxicity of NSAIDs; may decrease the effect of hydralazine, captopril, and beta-blockers; may decrease the diuretic effects of furosemide and thiazides; monitor PT duration closely (instruct patients to watch for signs of bleeding); may increase the risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency
Pregnancy
Precautions
Category D in third trimester of pregnancy; acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug
Hydrocodone bitartrate and acetaminophen (Vicodin ES, Lortab, Lorcet-HD)
Drug combination that is indicated for moderate to severe pain
Adult
1-2 tab or cap PO q4-6h prn
Pediatric
<12 years: 10-15 mg/kg/dose acetaminophen PO q4-6h prn; not to exceed 2.6 g/d acetaminophen
>12 years: 750 mg acetaminophen PO q4h; not to exceed 10 mg hydrocodone bitartrate per dose or 5 doses/24 h
Coadministration with phenothiazines may decrease the analgesic effects; toxicity increases with CNS depressants or tricyclic antidepressants
Documented hypersensitivity; high altitude cerebral edema (HACE) or elevated intracranial pressure (ICP)
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Tablets contain metabisulfite, which may cause hypersensitivity; caution in patients who are dependent on opiates because this substitution may result in acute opiate-withdrawal symptoms; caution in the presence of severe renal or hepatic dysfunction
Propoxyphene and acetaminophen (Darvocet-N 100, Wygesic)
Drug combination that is indicated for mild to moderate pain
Adult
1-2 tab PO q4h prn; not to exceed 600 mg/d
Pediatric
Not established
May increase serum concentrations of MAO inhibitors, tricyclic antidepressants, carbamazepine, phenobarbital, and warfarin
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in patients who are dependent on opiates because the substitution may result in acute opiate withdrawal symptoms; caution in the presence of severe renal or hepatic dysfunction
More on Jammed Finger |
| Overview: Jammed Finger |
| Differential Diagnoses & Workup: Jammed Finger |
 Treatment & Medication: Jammed Finger |
| Follow-up: Jammed Finger |
| Multimedia: Jammed Finger |
| References |
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References
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Rockwood CA, Green DP, Bucholz RW, eds. Rockwood and Green's Fractures in Adults. 3rd ed. Philadelphia, Pa: JB Lippincott; 1991.
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.
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].
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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].
Hoffman DF, Schaffer TC. Management of common finger injuries. Am Fam Physician. May 1991;43(5):1594-607. [Medline].
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].
Cornwall R, Ricchetti ET. Pediatric phalanx fractures: unique challenges and pitfalls. Clin Orthop Relat Res. Apr 2006;445:146-56. [Medline].
Kawamura K, Chung KC. Fixation choices for closed simple unstable oblique phalangeal and metacarpal fractures. Hand Clin. Aug 2006;22(3):287-95. [Medline].
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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].
Further Reading
Keywords
sprained finger, dislocated finger, finger sprain, finger dislocation, jammed digit dislocated digit, sprained digit, finger injury, digit injury, finger trauma, proximal interphalangeal joint trauma, PIP joint trauma, proximal interphalangeal joint dislocation, PIP joint dislocation, proximal interphalangeal joint, PIP joint
