Wednesday, November 24

Finger injuries

As a particularly exposed part of the body, fingers can take a beating in any sport -- just ask the Philadelphia 76ers' Allen Iverson, who will miss three to six weeks with a broken thumb. "Fingers are basically bone, tendon and skin," says Dr. Susan Scott, a member of the Association of Professional Team Physicians (PTP) and a hand and wrist specialist for the New York Knicks and Rangers." There is very little fat to cushion them from impact."

Join Dr. Scott as she talks about injuries to the finger and why they can take a long time to fully heal.

What type of finger injuries can occur?

Dr. Scott: Everything from a benign jamming injury or sprain to a dislocation right on up to a severe fracture that is angulated or occurs in multiple places. This injury needs to be operated on and stabilized.

How do these injuries typically occur?

Dr. Scott: A lot of these injuries, especially in basketball, occur when the ball is mis-caught and it hits the finger end-on or an athlete falls on the hand or wrist. Also, you can injure your fingers by jamming them on a piece of equipment or into another person's hand or shoulder. These are the most common injuries that we see.

Where do these injuries happen on the finger?

Dr. Scott: Each finger has three bones -- the distal (fingertip), middle, and proximal phalanges -- and, like other joint structures in the body, it's stabilized by ligaments and tendons. When the finger receives a blow to the tip, the ligaments and tendons can be stretched and torn, and one or more of three joints can be injured: the distal interphalangeal (or DIP; the first knuckle), proximal interphalangeal (or PIP; the middle knuckle), and metacarpophalangeal (MCP; the knuckle at the base of the finger).

Probably the most vulnerable area is the PIP joint. One of the reasons it is the most commonly injured area is that it's a little bit more exposed than the other joints and doesn't have much protection around it. The PIP joint also has a very large arc of motion, which means that the range of the joint is huge - it goes from full extension or zero degrees to perhaps to 110 or 115 degrees of flexion, well past 90. So it's a very high-demand joint and is required for all finger motion - from fine dexterity, like threading a needle, to catching a football.
The red arrow denotes the distal interphalangeal (DIP) joint; the orange arrow, the proximal interphalangeal (PIP) joint; and the yellow arrow, the metacarpophalangeal (MCP) joint. Side note: this X-ray image shows a fractured metacarpal bone (below the little finger).

How are finger injuries treated?

Dr. Scott: I think it's important to have an X-ray if you have a finger injury where the symptoms of pain persist. Not necessarily the first day after the injury because everybody gets a little swelling and soreness. Of course, you always ice the injury and elevate it initially because that will help the swelling go down, but after a short time if those symptoms don't improve and your motion isn't gradually getting better, then you should have an X-ray. So that leads us to the first and most important thing, which is to get an accurate diagnosis. If the injury is a simple sprain, which means surgery and immobilization aren't required, then the best thing to do is to remember that scar tissue can be your enemy. Therefore, you want to keep the finger moving as much as you can to reduce the formation of scar tissue.

We will treat the injury surgically in instances where the bone is displaced or broken and the position of the bone after it's broken does not really seem satisfactory for healing properly on its own. If an injury does require surgery, usually it is casted afterwards or immobilized so it can heal. Many times when a finger is broken, a patient will notice that, besides having pain and difficulty moving it, the alignment of the finger is a little bit off. When they go to make a fist, instead of the fingers lining up beautifully in the palm, one of the fingers may be pointing or crossed with the border finger next to it. That is a tip-off to the injury being a more significant one and when we treat these injuries, not only do we want to fix the bone but we want to make sure that alignment is as perfect as we can get it because fingers function together. When the alignment is off the functioning of the fingers and the hand can be thrown off as well.

Q: I play soccer and I just had a pulled hamstring. I really want to know what to do for this kind of painful injury. Also, how long do I need to be out of action?
-- Jimmy Villegas, Dallas, TX

A: From Dr. Bert Mandelbaum, former team physician for the U.S. World Cup soccer team:
"Hamstring injuries are quite common in soccer. The best treatment is a combination of rest, ice, compression with an Ace bandage and slow stretching and rehabilitation. It may take several weeks to get back to running and soccer. Don't forget to cross-train and ride the bike. Anti-inflammatories such as Ibuprofen can be very helpful. Get back to soccer with a slow, steady progression."

Do you have a question for a team physician? Click here to ask. And check out more "Ask the Pro Doc" answers to users' questions.

Sprain and strains, or stretching type injuries of the ligaments don't usually result in misalignment. Not always, but in general sprains exhibit more minor degrees of tearing of the ligaments or supporting tendons. This results in internal bleeding where the tear occurs and that's what can cause the prolonged swelling and the pain. But this ordinarily doesn't require surgical correction. The downside is that here you are five months later and it's still a little stiff and it's probably big in comparison to you uninjured joints. This joint enlargement you might get from a sprain may well last forever. Even a year from now you'll know that you did something to that finger that you didn't do to any other finger.

The swelling lasts so long because the finger is basically bone, tendons and skin. There is really very little fat to cushion things or hide scar tissue that gets deposited. The enlargement of the joint you see initially is the bleeding and your body's response to it but over the long-term that swelling is replaced by scar tissue which causes the enlargement and the inflexibility. So for most injuries, certainly the ones that don't require surgery, we really encourage people to move the fingers as soon as you can. You'll do yourself a favor but not putting it in a splint or babying it for a prolonged period of time. Most finger injuries, even those addressed surgically, should show significant improvement in 4 to 8 weeks.

Can anything be done to prevent finger injuries?

Dr. Scott: As far as prevention goes, I think it is important to buddy-tape the injured finger to an uninjured finger next to it to help prevent reinjury in terms of the more common sprains and strains. At least in the first few weeks, it is more vulnerable to injury because your positioning won't be exactly the same, your rapidity of motion will be different so you'll be inclined to bump it or bang it more often. So try to lay off it for a while and when you do go back to activities, protect it by buddy-taping it to the next finger. And as athletes and competitors, we sometimes have to live with these injuries and endure things like swollen fingers and large knuckles for our entire lives.

Dr. Susan M.C. Scott, a member of the Association of Professional Team Physicians (PTP), is a hand and wrist specialist for the New York Knicks and Rangers. Dr. Scott received her undergraduate degree from Princeton University and her medical degree from Columbia University College of Physicians and Surgeons in New York. In addition, Dr. Scott completed her internship in General Surgery at the Roosevelt Hospital in and her fellowship in Hand Surgery at St. Luke's-Roosevelt Hospital Center, both in New York City.

The information, including opinions and recommendations, contained in this website is for educational purposes only. Such information is not intended to be a substitute for professional medical advice, diagnosis or treatment. No one should act upon any information provided in this website without first seeking medical advice from a qualified medical physician.

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