Finger Dislocation

A finger dislocation will be painful and start to swell almost immediately. It will be difficult to bend or straighten the finger at the injured joint.

A dislocation means that bones that meet at a joint have become displaced and are no longer aligned with each other.

Each joint in the finger has a different function, and each has different anatomy. Each phalanx has a different joint surface, and different way that tendons attach and pass over or under the joint to allow movement and stability. To make things more complicated, the way the phalanges align in each finger is slightly different as well.

When enough force is applied to a finger joint, like from a fall, or being hit by a ball, the tissues that hold the joint stable and intact, will tear or break, and the phalanges will no longer align.

The bones can dislocate in a variety of directions, and are described based upon where the distal phalanx (the bone closest to the fingertip) has ended up compared to the proximal bone (the one closest to the palm).

The anatomic terms often used are:

• Dorsal or posterior - towards the back or knuckle of the hand
• Volar, palmar, or anterior - toward the palm of the hand
• Radial - towards the side of the hand where the radius bone at the wrist is located, the side towards the thumb
• Ulnar - towards the side of the hand where the ulna bone at the wrist is located, the side towards the little finger (or pinkie finger)

Because of its anatomy, the fact that it can flex more than the other joints in the finger, the PIP joint is most likely to dislocate.

It takes some force to dislocate a finger joint, and it is common to have associated injuries including phalangeal fractures around the joint surface, tendon injuries, and occasionally artery or nerve damage.

Finger joint dislocations occur because of an injury, most often due to a fall, or a failed attempt to catch a ball. The finger hyperextends, damaging the joint and dislocating the bone due to the applied force.

Infants and children have bones that are not fully calcified. Their tendons and joints tend to be stronger than the immature bone, and often their injuries are to the bone’s growth plate.

How do you know if a finger is dislocated?

A finger dislocation will be painful and start to swell almost immediately. The patient will often see that the bones are out of alignment, and it will be difficult to bend or straighten the finger at the injured joint.

Can you move a slightly dislocated finger?

While it is possible to slightly dislocate a finger, most often the bones at the joint have moved out of alignment and the tendons that attach to the bone don’t allow the bones to realign. The patient should be able to move the joints above and below the injured one, but not the injured one itself.

The diagnosis of a finger joint dislocation is often made clinically, meaning the health care provider can diagnose the injury by speaking with the patient to learn the story behind the injury and examining the finger. The physical exam will include not only examining the whole finger and the injured joint, but also making certain there is no associated nerve or artery damage.

Typically, an X-ray is taken of the finger to make certain that no fractures are present. Flecks of bone can get stuck in between the dislocated phalanges and make it difficult to relocate the joint.

If the injury occurs at an athletic event, the trainer or other health care professional on the field, may make the diagnosis and then attempt to reduce (relocate) the dislocation immediately. This will also often be attempted if there are signs of artery damage.

Children with finger or hand injuries usually have X-rays taken before an attempt at treatment, because growth plate fractures can mimic dislocations. Unfortunately, in young children, some bones may not have enough calcium in them so that they can be seen on X-ray.

How to fix a dislocated finger?

Treatment of a dislocated finger is aimed at returning the phalanges to their normal position and reducing the joint.

Most often this can be done at the bedside with gentle traction, and manipulating the phalanges back into place. A digital anesthetic (medicine injected into the finger to numb the nerve) may be used to help with pain control during the procedure.

If the reduction is successful, an X-ray is taken to confirm the alignment of the phalanges and to again look for small fractures that may affect healing and the stability of the joint.

Once reduced, the finger is placed into a splint to protect it from reinjury and dislocating again. The splint may be left in place for weeks until the joint heals.

While a finger joint dislocation may seem to be a minor injury, these joints are very complex to allow the fingers to function and perform fine motor movements. Each joint has its own potential complication based upon its unique anatomy, and referral to an orthopedic or hand surgeon is often made for follow up care and rehabilitation. The goal is a normal joint with full range of motion.

The initial reduction of a dislocation can often occur on the playing field, in the doctor’s office, urgent care, or emergency department. However, the dislocation can be complicated by a variety of factors and may require an emergent orthopedic or hand surgeon consultation and an operation to repair the injury.

Some complications include:

Dislocation with phalanx fracture that does not allow the joint to be reduced, or if it is reduced, causes it to be unstable and dislocate again

• Open dislocation where the skin over the joint is damaged and there is risk of infection
• Damage to the nerves or arteries of the finger
• Dislocations with tendon damage
• Inability to reduce the dislocation. There are a variety of reasons this may occur. Examples include fractured bone fragments getting stuck in the joint, or a tendon or ligament getting trapped in the joint, not allowing reduction to occur.

How to pop a dislocated finger back in place

It is not recommended to attempt to “pop” a dislocated finger back into place instead of seeking medical care. Initial first aid should include icing and elevating the injured hand. The anatomy of the finger is complex and maneuvers used by a health care professional to reduce the dislocated joint depend upon the joint involved, the direction of the dislocation, and the presence of any other injuries.

How do you splint a dislocated finger?

After the joint is reduced, the finger is usually splinted to protect the joint and prevent recurrent dislocation. The placement of the splint depends on the joint that was damaged. The splint that is used could be aluminum and fashioned at the bedside, or it could be a commercially manufactured one made of plastic and foam that is adjusted to fit.

How long should you splint a dislocated finger?

It takes a significant amount of time for a dislocated joint to heal. A PIP joint dislocation may be kept in a splint for 2-3 weeks, while a DIP joint dislocation may be in a splint for 10-14 days. A decision should be made with an orthopedic or hand surgeon about how long to leave the splint in place. There is a balance between maximizing joint stability and increasing stiffness and loss of range of motion.

The recovery time for range of motion and hand use may be only a few weeks, but it may take many months for the stiffness of a dislocated finger joint to resolve.

What exercises help dislocated finger recovery?

Finger and hand exercises will be recommended by the orthopedic or hand surgeon often in association with a physical or occupational therapist. These exercises usually start once the joint is mostly or fully healed. Common exercises to promote full range of motion of the damaged joint include:

• Passive finger stretching
• Individual finger lifting
• Fist making
• Muscle strengthening exercises of both the muscles located in the hand (intrinsic muscles) and those located in the forearm (extrinsic muscles). The fingers only contain the muscle tendons and not the muscles themselves.

Finger dislocations can damage any of structures within the finger, including the joint surfaces of the bone, the volar plate (a thickened ligament that helps stabilize the palm side of the joint), ligaments, and tendons.

Acute complications include an inability to reduce the dislocation and associated fractures. These may require surgery to repair the finger.

Open dislocations where the skin overlying the dislocated joint is damaged, may cause infection of the joint and bone (osteomyelitis).

Chronic stiffness is a common complication.

Chronic pain and swelling.

Scarring of the tissues surrounding the joint causing decreased range of motion and flexion contractures (a joint that is so scarred that it can neither be flexed or straightened).

Volar plate injuries (a band of tissue at the base of a phalanx that helps stabilize the joint) that can cause a variety of deformities of the finger and looseness of the joint.

Other chronic deformities include:

• Boutonniere deformity describes a finger that is flexed at the PIP joint and hyperextended at the DIP joint. It is a complication of a PIP dislocation that causes a tear in part of the tendon (central slip) overlying the joint.
• Mallet deformity can occur with a dislocated DIP joint with associated tendon rupture, or bony fracture where the tendon attaches that prevents the DIP joint from fulling extending and causes the tip of the finger to droop.
• Swan neck deformity describes a finger that has PIP joint hyperextension, and flexion at the distal DIP joint and flexion of the MCP joint. This is most commonly seen in arthritis, but is a complication of finger dislocations that have volar plate damage.

What happens if you leave a dislocated finger untreated?

If a dislocated finger is left untreated, the joint will scar and not allow the tendons to move it. The other joints in the finger may also be affected so that the finger may not be functional. Each finger of the hand depends on the others to work normally. If a finger is stuck in an abnormal position, it may not allow the rest of the hand to grasp normally and may affect power and function. The abnormal finger may also get in the way when attempting everyday activities.