HENDERSON

Finger injuries can encompass everything from a benign jamming injury or sprain to a dislocation to a severe fracture that occurs in multiple places and requires surgery.

A lot of these injuries occur when the ball is caught the wrong way 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, such as a base, or into another person's hand or shoulder. Seattle's Rickey Henderson left Wednesday's game with a jammed left index finger after being shaken up sliding head-first into third.

Each finger has three bones -- the distal (fingertip), middle, and proximal phalanges -- and, like other joint structures in the body, it is 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).

The most vulnerable area is the PIP, or middle, joint. One of the reasons it is the most commonly injured area is that it is 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 well past 90. So it is a very high-demand joint and is required for all finger motion, from fine dexterity, like threading a needle, to catching a football.

SYMPTOMS

Often 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 off. When they make a fist, instead of the fingers lining up beautifully in the palm, one of the fingers may be pointing or crossed with the finger next to it. That is a tip-off that the injury is more significant. When we treat these injuries, not only do we want to fix the bone, 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.

Sprain and strains, or stretching-type injuries of the ligaments, do not usually result in misalignment. In general, sprains exhibit more minor degrees of tearing of the ligaments or supporting tendons. This results in internal bleeding where the tear occurs, which causes prolonged swelling and pain. This ordinarily does not require surgical correction, but what is interesting is that five months later the finger still might be a little stiff and bigger in comparison to the rest. Even a year later, that finger will look and feel a little different.

A common injury to the fingertip is called a mallet finger deformity, which results from a rupture of the tendon that extends or straightens to the last joint (DIP) of the finger. This injury can occur from a direct injury to the fingertip or from catching the finger in the jersey of an opponent. Often undetected, this injury can result in a permanent inability to straighten the fingertip. Wearing a special splint for six weeks can greatly improve the final result.

With finger sprains, the swelling lasts so long because the finger is basically bone, tendons, and skin. There is very little fat to cushion things or hide scar tissue that is deposited. The enlargement of the joint you see initially is the bleeding and the body's response to it. But over the long term that swelling is replaced by scar tissue which causes the enlargement and the inflexibility.

TREATMENT

If you are wearing a ring at the time of the injury, try to remove the ring before the joint becomes too swollen. You should always ice the injury and elevate it initially because that will help the swelling go down. But if after a short time those symptoms do not improve and your motion is not gradually getting better, then you should have an X-ray. If the injury is a simple sprain, which means surgery and immobilization are not 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.

Surgery is required in instances where the bone is displaced or broken and the position of the bone after it is broken indicates it will not heal properly on its own. If an injury does require surgery, usually it is put in a cast afterwards or immobilized with a splint.

For finger injuries that do not require surgery, it is important to move the fingers as soon as you can to avoid long-term enlargement and inflexibility. You will do yourself a favor by not putting the finger in a splint or babying it for a prolonged period of time. Most finger injuries, even those addressed surgically, should show significant improvement in four to eight weeks.

PREVENTION

It is important to ?buddy-tape? the injured finger to an uninjured finger next to it to help prevent re-injury. In the first few weeks, it is more vulnerable to injury because your positioning will not be exactly the same, your rapidity of motion will be different, and you will be inclined to bump it or bang it more often. It may be best not to play for a short time. Unfortunately, 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.

The information, including opinions and recommendations, contained in the Web site is for general 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 on this Web site without first seeking medical advice from a qualified medical physician with whom they have a confidential doctor/patient relationship.