Diagnostic Considerations

Always check active extension at the proximal interphalangeal (PIP) joint against resistance. Failure to perform an adequate assessment of the stability of reduction is a concern. Failure to diagnose persistent subluxation or tissue trapped in a joint because of the absence of gross deformity is also a concern.

Be suspicious of decreased range of motion (ROM) to avoid missing an open dislocation that was reduced before presentation. Be suspicious of any lacerations near interphalangeal joints in a patient with a jammed finger.

In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

Chronic deformity
Collateral ligament injury
Hand soft tissue infections, acute hand arthritis

Differential Diagnoses

Workup

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Media Gallery

Carpometacarpal joint dislocation.
Carpometacarpal joint dislocation.
Volar proximal interphalangeal (PIP) joint dislocation.
Dorsal thumb interphalangeal dislocation.
Dorsal thumb interphalangeal dislocation.
Aluminum foam splints.
Hand dislocation. Dorsal aluminum foam splint.
Buddy taping.
Acute dorsal proximal interphalangeal joint fracture-dislocation.
Acute dorsal proximal interphalangeal fracture-dislocation. A concentric reduction could not be maintained in a splint.
Complex second metacarpophalangeal dislocation in a skeletally immature patient (same patient as in the next 2 images). Note the position of the finger and dimpling of skin on volar hand.
Radiograph of the hand of a patient with complex second metacarpophalangeal dislocation (same patient as in the previous and next images).
Intraoperative photo of the second metacarpophalangeal joint (same patient as in the previous 2 images). Note the displaced volar plate between the metacarpal head and the proximal phalanx.
Boutonniere deformity.
Normal lateral band location, dorsal to the axis of rotation of the proximal interphalangeal joint.
After central slip disruption, lateral bands migrate volar to the axis of rotation of the proximal interphalangeal joint.
Lateral view of relevant finger anatomy.
Anteroposterior radiograph displaying a gamekeeper's fracture.
Lateral radiograph displaying a gamekeeper's fracture.
Ruptured ulnar collateral ligament.
Completed UCL repair using suture anchors for fixation (same patient as in the image above).
Radiograph displaying a stress test of a torn ulnar collateral ligament.
Complex unstable fracture of the proximal phalanx.
Displaced fourth and fifth metacarpal fractures, anteroposterior view.
Displaced fourth and fifth metacarpal fractures, lateral view.
Fourth and fifth metacarpal fractures, oblique view.
Fourth and fifth metacarpal fractures after intramedullary pinning, anteroposterior view.
Fourth and fifth metacarpals after intramedullary pinning, lateral view.
Digital block.

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Author

Jeff Chan, MD, MS, FACEP Clinical Instructor in Surgery (Emergency Medicine), Stanford University School of Medicine

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, National Medical Association

Disclosure: Nothing to disclose.

Igor Boyarsky, DO, FACEP, FAAEM Emergency Room Physician, Kaiser Permanente Southern California

Igor Boyarsky, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Anti-Aging Medicine, American Academy of Emergency Medicine, American College of Emergency Physicians, American Osteopathic Association

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 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.

Acknowledgements

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

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.

Gerard A Malanga, MD Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine

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, American Institute of Ultrasound in Medicine, International Spine Intervention Society, and North American Spine Society

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Genzyme Honoraria Speaking and teaching; Prostakan Honoraria Speaking and teaching; Pfizer Consulting fee Speaking and teaching

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

Disclosure: Medscape Salary Employment

Hand Dislocation Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

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