The joints of the thumb and fingers are small and relatively mobile affording our hands a great deal of dexterity. Normal function of the fingers requires a balance of joint mobility together with joint stability. Not enough movement and our hands become stiff, whereas a loss of stability leaves us unable to apply any force with our hands.
Unfortunately, we have a bad habit of putting our hands in harms way and sprains or dislocations of the small joints of the thumb and fingers are quite common injuries.
Simple Finger Dislocation
The most common type of finger dislocation is when the proximal inter-phalangeal joint dislocates dorsally (towards the back of the finger), usually as a result of a hyperextension injury. This commonly occurs in ball sports such as football and netball, but also in contact or collision sports.
An attempt at putting these dislocations back in joint on the sidelines by an appropriately trained professional (doctor, therapist, trainer) is very reasonable as this will immediately relieve pain. Return to the field following this however, is not advisable. The problem is that it is very hard to tell if the injury is a simple dislocation or a more complicated injury with associated fractures of the neighbouring bones. These more complicated injuries are often very unstable and return to play can result in significantly more damage.
A thorough examination combined with an x-ray will determine exactly what damage has been done to the joint and only then can an informed plan about definitive management be made. Early assessment is critical to ensure the appropriate management is instituted and you get the best long-term result for your hand.
The vast majority of these injuries can be managed without surgery but care is still required to limit further injury and obtain the best long-term result for your finger. Often referral to a hand therapist for assistance in balancing your rehabilitation is the fastest and most reliable way of getting a good result.
Complex Finger Dislocation
Finger dislocations can be a little more complicated sometimes. This can be due to any number of factors:
- Associated fractures of the bones around the dislocated joint
- Dislocation in an unusual direction
- A dislocation that is unable to be put back in place
- An open dislocation (where the joint is exposed via a traumatic wound)
These injuries require urgent referral to a hand surgeon for assessment, as treatment will often be quite different to that for a simple dislocation. Surgery may be required and close liaison between your surgeon and hand therapist is critical to achieving a successful outcome in these more difficult injuries. Dr Alexander works closely with a number of hand therapists around Adelaide and will ensure you rehab is tailored specifically to your needs.
Thumb Injuries (Gamekeeper’s or Skier’s Thumb)
The most common thumb sprain is an injury to the ulnar collateral ligament at the metacarpo-phalangeal joint. These injuries tend to occur when we are gripping something in our fist and the thumb gets pulled away from the hand.
Traditionally this injury was known as gamekeeper’s thumb as it was seen in individuals who had repeatedly used a twisting motion to break the necks of animals. These days it is seen more commonly as an acute sporting injury such as in skiers (after the ski pole gets stuck in the ground), cyclists (on their handlebars) and in a variety of ball sports.
The stability of this ligament is critical to maintain our ability to pinch against the thumb – without it the thumb just falls away from your finger. Most of these injuries are partial ligament ruptures (sprains) and can be well managed non-operatively with the use of a supportive splint for a period of time. More severe injuries however, if not managed appropriately can lead to chronic instability and long-standing disability of the hand. Early assessment by an experienced hand therapist or hand surgeon is important to ensure that the best management of your injury is instituted in a timely manner.
Surgery for these more severe injuries can be performed to reattach the torn ligament back to the bone and can reliably achieve a stable and functional thumb. (video)Following surgery your thumb will be placed into a splint for a period of time to protect the repair and allow it to heal, however the repair is strong enough that you will be able to start some early range of motion exercises under the guidance of your hand therapist.
There are of course a number of other ligamentous injuries that can occur around the hand. Like the more common injuries above, it is important to get these injuries assessed sooner rather than later. Most injuries can be managed relatively easily when they first occur but it can be much more difficult to achieve a good outcome if presentation is delayed.
For sporting injuries sustained over the weekend – sportsmed’s weekend injury clinic at our Stepney Healthcare Hub is the perfect place for immediate and comprehensive assessment (including x-rays if required). No referral or appointment is required, and if needed, a fast-tracked referral onto an orthopaedic surgeon can be made to ensure your injury is managed the right way from the start.