A dislocation is when the two bones that form a joint shift away from each other. One bone can ‘pop’ out of joint, if it’s a ball-and-socket type joint. Or, in the case of a finger, one bone shifts off the saddle-type seat it is normally sitting in. A joint can dislocate and immediately ‘go back in’ or it can remain out of place, in which case, the finger will look misshapen or short. A bone may shift halfway out of place and then back again, and this is called a ‘subluxation’.
Tell me more about finger dislocation.
The amount of soft tissue damage to the supporting structures around a joint varies with every injury, and how many times it has happened before. Dislocations can be once-off situations but they can also be reoccurring due to the soft tissues around the joint becoming stretched out on previous occasions of injury. Dislocations occur more commonly in people with flexible joints or conditions such as Ehlers-Danlos syndrome.
Dislocated fingers are usually sore and swollen for days, weeks and months afterwards, depending on the level of injury and the treatment applied. In the longer term, a dislocated finger can result in either a stiff finger with reduced movement, or a loose joint that is prone to further injury and feelings of giving way. It is quite easy to mistake a dislocation for a fracture and vice-versa, as the symptoms are similar, and therefore an X-ray is advisable.
What causes dislocation?
A finger dislocation happens when the finger is either bent too far back or bent forwards quickly with a lot of force. A strong ligament on the front of the finger (the volar plate) and possibly other ligaments around the joint are torn, allowing the bone to shift out of position. The level of force required to do this is reasonably high, and it can just as easily break a bone. Both injuries are similar in seriousness and an X-ray is required.
Dislocations often happen when a ball hits the end of a finger while playing sport, but can also happen by stubbing your finger on something.
How do I know if I have dislocated my finger?
If your finger is fully dislocated it will be quite painful, will appear short or misshapen and you will feel that and have to put it back in place. If it has been ‘subluxed’, it will return to its normal position on its own. Your finger may be swollen around the middle joint (proximal interphalangeal joint), tender on the palm side and tender when the finger gets pushed straight. You may find the finger is also weak and has difficulty with functional tasks.
If your finger is still sore a few days after a knock, it is advisable to have it checked out. Your physiotherapist will be able to test the extent of the damage and the stability of the finger. They may send you for an X-ray to check for bony injuries.
How can physiotherapy help with dislocated fingers?
A volar plate injury, a moderate ligament injury or a fracture needs to be supported to heal. The position of the splint depends on what is injured. A dislocation will often need to be held in a bent position to make sure the joint stability is restored. A fracture will often be splinted with the finger straight to prevent the finger from healing up bent.
Exercises will be commenced at the right time to make sure that your injury heals up properly, but the finger doesn’t get stiff from staying in the one position for too long. Swelling will be improved by gentle compression tape.
Your physiotherapist will assess how much support and exercise is optimal for healing and function. Once your ligaments and/or bone is healed and stable it can be stretched and strengthened back to normal movement and function.
It’s important to note that not all physiotherapists are specialised in the area of hand therapy. For the best treatment outcome, find a physio who specialises in this area.
How effective is physiotherapy for dislocated fingers?
Splinting and exercises are all that are needed for most dislocated fingers. Significant problems following a dislocation are loss of stability in the joint (leaving it vulnerable to further dislocations) and stiffness (due to the wrong splint, or a delay in starting the exercises).
It is common to have ongoing swelling—this is relatively normal and can last for many months. In severe, unstable dislocated fingers, surgery may be required to stabilise the joint for a better result.
What can I do at home?
The type and extent of the injury, and the stability of the joint, indicates what is safe to do. Volar plate injuries often need to avoid straightening for a brief period, while central slip injuries must remain straightened. Appropriate splinting or taping as guided by your physiotherapist will ensure that you achieve a good result. At an appropriate time, regular exercises and return to activity and sport are essential to improve movement and strength. Protecting and splinting, or buddy taping and exercises, need to be done at the correct timing according to the stage of healing for them to be effective.
How long until I feel better?
Pain should resolve as soon as the finger is appropriately splinted or buddy taped. The movement improves within the first weeks. Mild grade 1 injuries recover within days to weeks of treatment. More severe injuries take six weeks of constant splinting and may take 2–3 months to achieve 80–90 per cent strength. The final discomforts and weaknesses may take longer to go away, but rarely reduce function in the meanwhile.