Is it just a ‘jarred’ finger?

Anyone that has played ball sports has most likely had a ‘jarred’ finger at some point. Whilst sometimes you can ‘shake it out’ and get on with it, what most people don’t realise is that sometimes it is more than a jarred finger.

The PIP joint

The middle joint in your finger (known as the PIP joint) is the most commonly dislocated or sprained joint in the hand. It is commonly injured in sports such as netball, basketball, cricket and afl (with a huge influx of women’s afl players in recent years!).

The PIP joint has a thick ligament at the front (volar plate) which stops the finger bending backwards but allows it to bend into a fist, and ligaments on each side which stop sideways movements (collateral ligaments, just like the knee!).

The PIP joint is prone to both dislocating and becoming stiff and if not treated properly can get stuck in a bent position…the perfect position for getting in the way of catching a ball!

Unfortunately finger injuries are often mistreated and dismissed as a ‘jarred’ finger, particularly if no fracture is seen on X-ray. I often have patients come to me a month or two after their injury with a stiff, swollen and painful finger, and this delay in presentation results in a slower rehab and often sub-optimal outcome.

Diagnosis

X-rays are an important and effective way of assessing injuries of the PIP joint. Anything more than a mild sprain should undergo an X-ray to check for any fractures and assess the alignment of the finger.

A clinical assessment by an experienced Physiotherapist or Hand Therapist will provide further information in regards to the stability and stiffness of the injury in order to guide treatment.

Types of PIP joint injuries:

• Ligament sprain. Can range from mild (grade 1) to a complete tear (grade 3). Grade 1 sprains are the ‘jarred’ fingers which usually get better within a week or two. Grade 2 and 3 sprains often require 2-6 weeks of splinting (which MUST be combined with exercises to prevent stiffness).
• Avulsion fracture. Sometimes the thick ligament at the front of the PIP joint chips off a piece of bone. This can usually be treated with a splint and Hand Therapy unless the fracture is too large or ‘unstable’ which would require surgery.
• Dislocation +/- fracture. This will always put a lot of stress through the ligaments and will likely result in ligament sprains of the volar plate and collaterals or a fracture (or both).

Treatment

The two most important factors to consider with treatment of PIP joint injuries is stability and stiffness. There is a fine balance between immobilizing the finger enough for the PIP joint to form scar and become ‘stable’ BUT not enough for it to become stiff and stuck.

• Control swelling. Swelling is a normal part of healing but excessive swelling will limit the amount the finger will move. Compression tape, ice and gentle exercise can help reduce swelling.
• Splint/tape. Depending on the severity of the injury and which structures are damaged, your Physiotherapist or Hand Therapist will make you a special splint to protect the joint and allow healing. For less severe injuries buddy taping may be enough protection.
• Exercises. Exercises are essential in the rehab process and are usually started immediately to prevent stiffness from developing. It is much easier to prevent stiffness than treat it. Exercises obviously need to be safe so should be guided by your Physiotherapist or Hand Therapist.
• Return to sport/work. To ensure your finger isn’t re-injured in the first catch you take on your return to play, custom splints or tape can be used to support and protect the injured joint.
• Surgery. Sometimes surgery is required to regain stability of the PIP joint. Post-operative rehab is very important to manage the wound and scar tissue and regain full movement and strength.

So if you have ‘jarred’ your finger make sure you seek treatment immediately to save yourself from a  stiff finger!

Learn more about Sophie Crapper by visiting http://www.opsmc.com.au/person/sophie-crapper/