Dislocated Finger: Causes, Treatment, Rehabilitation, and Prevention

How do you treat a dislocated finger?

A dislocated finger requires immediate, careful reduction, ideally performed by a medical professional, followed by a structured period of immobilization and progressive rehabilitation to restore full function and prevent long-term complications.

Understanding Finger Dislocations

A dislocated finger occurs when the bones of a finger are forced out of their normal alignment at a joint. This is a common injury, particularly in sports or activities involving hand impact. The fingers are composed of phalanges, connected by interphalangeal joints (proximal interphalangeal - PIP, and distal interphalangeal - DIP) and the metacarpophalangeal (MCP) joints connecting the fingers to the hand. Dislocations typically result from hyperextension, hyperflexion, or direct impact, tearing or stretching the joint capsule and surrounding ligaments.

Common causes include:

• Direct impact: Such as catching a ball improperly.
• Falls: Landing on an outstretched hand.
• Repetitive stress: Less common, but can weaken joint structures over time.

Immediate First Aid (What NOT to Do)

Upon suspecting a dislocated finger, the immediate priority is to protect the injured joint and seek professional medical attention.

What to do:

• Immobilize the finger: Gently support the hand and finger to prevent further movement. A small splint or even a rolled newspaper can provide temporary support.
• Apply ice: To reduce swelling and pain. Wrap ice in a cloth and apply for 15-20 minutes at a time.
• Elevate the hand: Keeping the hand above heart level can help minimize swelling.
• Seek medical attention immediately: This is crucial. A medical professional (doctor, athletic trainer, emergency room staff) is best equipped to assess the injury, rule out fractures, and perform a proper reduction.

What NOT to do:

• Do not attempt to "pop" the finger back into place yourself. Self-reduction can cause significant further damage, including fractures, nerve damage, blood vessel damage, or tearing of ligaments and tendons, complicating recovery and potentially leading to chronic instability or pain.
• Do not ignore the injury. Untreated dislocations can lead to chronic pain, stiffness, instability, and even permanent deformity.

Medical Treatment: Reduction Techniques

The primary treatment for a dislocated finger is reduction, which is the process of repositioning the bones back into their correct anatomical alignment. This should always be performed by a trained medical professional.

Closed Reduction:

• This is the most common method. After numbing the area with a local anesthetic (e.g., lidocaine injection) to minimize pain and muscle spasm, the physician will gently manipulate the finger to realign the joint.
• The specific technique varies depending on the joint dislocated (PIP, DIP, or MCP) and the direction of the dislocation (e.g., dorsal, volar). The goal is to apply controlled traction and specific movements to guide the bone back into place without excessive force.
• Successful reduction is often confirmed visually, by palpation, and sometimes with a post-reduction X-ray to ensure proper alignment and rule out any new fractures.

Open Reduction:

• In some complex cases, a closed reduction may not be possible. This can occur if a bone fragment, a tendon, or other soft tissue is entrapped within the joint, preventing proper realignment.
• In such instances, open reduction surgery is required. This involves a surgical incision to directly visualize the joint, remove any obstructions, and precisely realign the bones. This procedure is typically performed by an orthopedic surgeon.

Post-Reduction Care and Immobilization

After successful reduction, the finger must be immobilized to allow the joint capsule and surrounding ligaments to heal. The duration and method of immobilization depend on the severity of the dislocation and the specific joint involved.

Splinting:

• A custom or pre-fabricated splint is often used to hold the joint in a slightly flexed position, typically for 2-6 weeks. The goal is to protect the healing tissues while preventing excessive stiffness.
• Splints can be dorsal (on the back of the hand/finger) or volar (on the palm side), designed to limit movement in the direction of the original dislocation.
• Regular cleaning of the skin under the splint is important, and the splint should be kept dry.

Buddy Taping:

• For less severe dislocations, or as a transition from rigid splinting, buddy taping may be used. This involves taping the injured finger to an adjacent healthy finger.
• The healthy finger acts as a dynamic splint, providing support and protection while allowing limited, controlled movement.
• Ensure the tape is not too tight, which can impair circulation. Place a small piece of gauze or cotton between the fingers to prevent skin irritation.

Rehabilitation: Restoring Function and Strength

Rehabilitation is a critical phase to restore full range of motion, strength, and dexterity to the injured finger. This process is often guided by a physical therapist or occupational therapist.

Early Phase (Protection & Gentle Motion):

• Once initial pain and swelling subside, and the physician clears the joint for movement (often after 2-3 weeks of immobilization), gentle active range of motion (AROM) exercises begin.
• Example exercises: Gentle flexion and extension of the affected joint, avoiding movements that recreate the original dislocation mechanism. The goal is to prevent stiffness without stressing the healing tissues.

Progressive Strengthening:

• As healing progresses, strengthening exercises are introduced. These focus on the intrinsic muscles of the hand and forearm muscles that control finger movement.
• Isometric exercises: Gentle contractions without movement (e.g., pressing the finger against a stable object).
• Isotonic exercises: Using light resistance (e.g., squeezing a soft ball, using therapeutic putty, or small weights for finger curls).
• Grip strength exercises: Gradually increasing resistance as tolerated.

Functional Training:

• This phase focuses on restoring fine motor skills and dexterity.
• Examples: Picking up small objects, manipulating buttons, typing, and engaging in sport-specific or work-related activities that require precise finger movements.
• Proprioceptive exercises (e.g., textured balls) can help restore joint awareness.

Potential Complications and When to Seek Further Medical Attention

While most dislocated fingers heal well with proper treatment, complications can occur. It's important to be aware of these and know when to seek further medical advice.

Potential complications:

• Fracture: A bone break occurring concurrently with the dislocation.
• Chronic instability: The joint remains loose and prone to re-dislocation.
• Stiffness: Limited range of motion, especially if immobilization is too prolonged or rehabilitation is inadequate.
• Chronic pain: Persistent discomfort in the joint.
• Nerve or blood vessel damage: Though rare, these can occur during the initial injury or improper reduction.
• Osteoarthritis: Long-term degeneration of the joint cartilage, especially if the injury involved cartilage damage.

Seek further medical attention if you experience:

• Increased pain or swelling after initial treatment.
• Numbness, tingling, or unusual coldness in the finger.
• Signs of infection (redness, pus, fever).
• Inability to move the finger through its full range of motion after rehabilitation.
• Recurrent dislocations.

Prevention Strategies

While not all dislocations are preventable, certain measures can reduce the risk, especially for athletes or those engaged in high-risk activities.

• Protective gear: Wearing appropriate gloves or taping fingers (prophylactic buddy taping) in sports like basketball, volleyball, or football.
• Proper technique: Learning and practicing correct hand positioning and catching techniques in sports.
• Strength and flexibility: Maintaining good hand and finger strength and flexibility can help joint resilience.
• Awareness: Being mindful of surroundings and avoiding situations where fingers could be caught or impacted.

Conclusion

A dislocated finger is a common but potentially debilitating injury that requires prompt and professional medical attention. Self-reduction is strongly discouraged due to the high risk of further damage. Proper medical reduction, followed by a structured period of immobilization and comprehensive rehabilitation, is essential for restoring optimal function, minimizing complications, and ensuring a successful return to daily activities and sports. Always prioritize expert care and adhere strictly to rehabilitation protocols to safeguard the long-term health of your finger joints.