Acute Phase
Rehabilitation Program
Physical Therapy
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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. [11] 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.
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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.
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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.
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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 splinted in extension for the treatment of a central slip injury.
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. [12, 13, 14, 15]
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. [14, 16, 17]
Grossly unstable collateral ligament injuries may be considered for surgical repair.
Surgical reconstruction is the treatment of choice for chronic boutonniere deformity. [7, 18, 19]
Return to Play
The time frame for an athlete's return to play is dependent on the severity of the finger injury. An athlete with a mild PIP joint sprain without ligamentous disruption may be permitted to return to play after being evaluated on the sideline, provided the finger is properly buddy-taped. Those individuals with more severe sprains or dislocations/fractures may be recommended to remain out of competition for a longer period (2-6 wk). Protective splinting or buddy taping is advised during athletic or at-risk activities until full pain-free function is restored.
Prevention
Most cases of jammed finger injuries are not preventable in sports activities.
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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.
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Volar plate disruption with a stable, nondisplaced avulsion fracture of the middle phalanx.
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Dorsal dislocation of the proximal interphalangeal joint.
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Typical boutonniere deformity.
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Extension block splint with the proximal interphalangeal joint at 30°.
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Proximal interphalangeal joint that has been splinted in extension for the treatment of a central slip injury.
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Dynamic spring extension splint for the treatment of a boutonniere finger deformity.
