Finger injuries are common in most sports. The fingers are vulnerable to injury because of their location (easily exposed to injury) and their structure.
Fingers are composed of three small bones (phalanges) with two joints separating the three bones. The first row of joints is known as the proximal interphalangeal (PIP) joints. The second row of joints is known as the distal interphalangeal (DIP) joints.
Their function is controlled by their structure. Fingers can bend (flex) and straighten (extend) because of their joint design. However, they are susceptible to injury because they have limited bone-to-bone contact within the joint and are primarily stabilized by collateral ligaments (on either side of the joint) and a joint capsule.
Mechanism of Injury
The proximal and distal interphalangeal joints are strong as long as the movements of the fingers are flexion and extension. If a sideways force is applied to one of these finger joints, the joint is susceptible to either a sprain, subluxation (partial dislocation), or dislocation.
A sprain can also result from a force directly on the end of the finger. If a force on the end of the finger (hit from a basketball or baseball) exceeds the tension strength of the ligaments and/or joint capsule, an injury will occur.
Collateral ligament injuries can range from a mild sprain to a rupture resulting in a dislocation with associated fracture. The severity of the injury is dependent on the size of the external force.
Treatment for a Finger Sprain
A minor sprain will result in mild localized swelling to the joint with some tenderness upon flexion and extension of the injured joint. This type of injury can be easily treated with application of ice (every two hours for the first 48 hours) and protective taping until the pain subsides.
A moderate sprain will present with functional limitations due to the increased amount of swelling and pain. Rather than localized swelling, a moderate sprain can present with swelling throughout the joint and finger. The amount of swelling alone will affect the ability to effectively bend the finger.
If a moderate sprain is suspected, an x-ray should be performed to rule out a possible fracture. Once a fracture is ruled out, then a specific treatment and rehabilitation plan can be performed.
As with any acute injury, the individual should ice the injured area every two hours for the first 48 hours. With a sprained finger, cold water immersion is recommended as the cold water is more effective at cooling all of the injured tissue while applying hydrostatic pressure from the effect of the water.
This can be performed by utilizing a large cup or pan filled with water and ice. Care should be taken to not make the water temperature too cold. If the temperature is uncomfortable, room temperature water can be added to increase the temperature.
Protective Buddy Tape Job for the Fingers
The injured finger should also be protected through a buddy tape job. Half-inch tape strips are applied to the bones carefully taping the injured finger to a healthy finger next to it. If possible, tape the injured finger to a larger finger rather than a smaller one.
The purpose of the protective tape job is to ensure that any force that may hit the end of the fingers is absorbed by the healthy finger rather than the injured finger. The protective tape needs to be applied until the injured finger is pain free. This may take up to several weeks.
Care should be taken to tape over the phalanges and not to restrict the joints. As the ligaments begin to heal, the range of motion of the injured joint will continue to increase. Tape applied directly over the joint will restrict the joint’s ability to move.
As the swelling and pain decrease, the individual can then take proactive steps to begin to strengthen the injured finger. Gripping exercises are a good way to strengthen the muscles of the fingers. A rolled-up old sock works well as a gripping tool.
Increasing Finger Strength
Roll up an old sock and place it in the palm of the injured hand. Wrap the fingers over the sock and gradually increase the grip strength as much as possible without causing pain to the injured finger. Hold the grip for ten seconds and then slowly release extending the fingers. This can be repeated ten times every waking hour.
Following the steps of immediate cold water immersion, protective taping, and grip strength exercises will provide the individual with the tools necessary for a full recovery.