Finger injuries
 

Finger injuries in athletics are very common. Most of these injuries are small however, some can be major. It is very important, especially in the skeletally immature athlete, to not miss a potentially debilitating injury.
An Athletic Trainer will be the front line medical professional with athletes and many times will treat the injury immediately after it has occurred.The history should include mechanism of injury, previous injury, whether the joint was dislocated (out of place) and if so, how it was reduced.
Any finger injury that is sustained should be seen by a physician and have x-rays performed. These patients are very susceptible to developing debilitating joint arthritis later in adulthood.
The joints of the finger are comprised of the two bones, ligaments, and tendons. The dynamic interaction of these structures maintains the stability of the finger joints.
The most common joint injured the proximal-interphalangeal (PIP) joint (the middle joint of the finger). The most common mechanism of injury is hyperextension. The joint is straightened too far. Other common mechanisms of injury are torsion and axial loading. The distal interphalangeal (DIP) (joint near the finger nail) is injured less often due to the small size of the distal phalanx (finger bone). Its small size means that it would take a major force moment to injure this joint.
A hyperextension mechanism to any joint of the finger, either to the PIP or DIP, can result in a sprain of the volar or palmar plate. The volar plate is a very thick ligament that prevents hyperextension injuries. If the force is sufficient enough, the joint may be dislocated. The most common dislocation of the PIP results in dorsal (upward) displacement of the middle phalanx.
A simple hyperextension may result in a small avulsion (chip) fracture of the volar plate. This injury is most often treated with immobilization. In contrast, a hyperextension that results in dislocation can produce a much larger fragment. The fragment needs surgical treatment to repair.

 

       

Volar Plate Avulsion Fracture         Loose fragment avulsion fracture
 

Finger joint stability is also provided by the collateral ligaments. The collateral ligaments provide stability side-to-side. These ligaments are often injured in athletics. The stability of the joint needs to be assessed with the appropriate joint stress tests. Depending upon the amount of joint laxity, treatment will be determined.
Treatment for collateral ligament injuries ranges from buddy taping (taping one finger to another next to it) to splinting with a finger immobilizer.
Young teenage or pre-teens should be x-rayed to rule out a collateral ligament avulsion fracture. In an adult, the ligament will most often be sprained. A child however, is more likely to have the ligament avulsed from the bone. If this is the case, stressing the ligament before x-rays can result in displacement of the ligament-bone fragment. This injury may result in surgical fixation of the avulsed fragment to ensure proper healing.

collateral avulsion fracture

A less common injury to the finger may result in a boutonnière deformity. This injury is the result of an axial load on the tip of the finger. The load results in the deformity shown in this picture. This injury is characterized by incomplete extension of the PIP and hyperextension of the DIP. The fibers of the central slip of the finger extensor tendon rupture. The lateral bands of the same tendon move palmar, flexing the DIP. This injury may result in surgical intervention to repair the damage. Most often, the injury is not severe enough for surgery and splinting for 12 weeks is appropriate.