Fingers

Fingers, or digits, are the organs that we as humans use to manipulate, feel and move the objects that we need to live.

The use of our fingers and thumb set us apart from other primates.

Each finger has 3 bones connected with a complex network of joints and ligaments. Ligament injury and joint dislocation can inhibit function in the short term but if managed well shouldn’t impact long term function.

Other injuries involving the fingers include fracture, mallet and trigger fingers. These are outlined in more detail via the buttons below.

LIGAMENT INJURY

You may have a central slip injury if the middle knuckle of your finger looks bent. A central slip injury occurs when an important ligament on the back of the finger is broken, making it difficult to fully straighten the finger. This important tendon is called the ‘central slip’. Sometimes it’s just sore around the back of the knuckle and then, over the next few days to weeks, it becomes more and more difficult to straighten the finger.

Tell me more about central slip injury.

If you have a central slip injury, the joint will be swollen, sore and tender across the back. The X-ray will be clear, but this doesn’t mean that nothing is wrong, as X-rays will not show up a soft tissue injury like a central slip.

It is important to get the right treatment for a central slip injury, as it progressively worsens when left untreated and becomes what is called a ‘boutonnière’ (or button-hole deformity). As the middle joint bends further down, the fingertip bends gradually further back until the finger is quite crooked. 

 

What causes a central slip injury?

Central slip injuries are caused when the middle knuckle of the finger (proximal interphalangeal joint) is forcibly bent forwards. This often happens when the finger punches something, is hit by a ball or is knocked forcefully. The joint may pop out of place but doesn’t normally stay dislocated or look out of place later on. It commonly occurs amongst people who have rheumatoid arthritis without trauma. A cut to the back of the finger joint area can cause a central slip injury if it goes all the way through the tendon.

 

How do I know if I have a central slip injury to my finger?

Following a bad knock to the finger, the finger will be sore and swollen and you will notice that it is difficult to straighten the middle joint. This may not be obvious or noticeable at the time of the injury, and often gradually gets worse in the following days and weeks. The sorest spot to touch will be right on the back of the middle joint. The fingertip may start to bend backwards, and the X-ray will be normal.

 

How can physiotherapy help with central slip injuries?

The central slip needs to be splinted with the joint held out completely straight to heal properly. It will need a splint to hold it in that position constantly for up to six weeks. If the finger has already become stiff and you’re unable to straighten the finger fully with the other hand because the injury is a few days’ or weeks’ old, you will need two splints—one to straighten the finger and then a second splint to hold it straight for the six weeks.

Once the tendon is healed, the joint will be stiff and need to be stretched. Your physiotherapist will assess how much support and exercise is needed for healing. At this point, you can do strengthening and mobility exercises to restore 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 central slip injuries?

Most central slip injuries do not need an operation to fix them—a splint and graduated exercises are all that is needed to return the finger to normal or near-normal functioning. The best results are achieved when a well-fitting splint is applied straightaway by a physiotherapist experienced in finger injuries and custom-made splinting. Occasionally, surgery is required to fix these central slip injuries, and this is more often the case when a delay in treatment occurs. If the central slip injury is caused by a cut, surgery is usually required to repair the tendon.

 

What can I do at home?

The injury initially needs to be supported straight by a splint at all times. Central slip injuries often need to avoid any bending while the tendon heals. 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 regain movement and strength.

 

How long until I feel better?

Pain should resolve as soon as the finger is appropriately splinted. You will be able to do most of your everyday activities while you are wearing the splint. Mild central slip tears recover within weeks of treatment. More severe injuries take up to 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 resolve, but rarely reduce function in the meantime.

 

Source: Choose.physio

DISLOCATED FINGER

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.

 

Source: Choose.physio

FINGER FRACTURE

A finger fracture is another word for a broken bone in a finger. Each finger is made up of three bones, and it’s possible to break any of them with a heavy knock or having something heavy fall on them. You can often still move your finger even if one of the bones is broken, due to the way it’s organised. A bruise in the finger is a fairly good sign that you might have a break of some size in one of the finger bones

What causes a finger fracture?

Finger fractures can occur from a direct blow, such as a ball in sport or falling over, or jamming your finger between two hard objects. A finger will also break when it is forced too far in the wrong direction. Depending on the type and severity of the fracture, the treatment process can be very varied. Symptoms are pain and swelling at the fracture site, bruising, sometimes (but not always) loss of movement and pain to touch at the point of the fracture.

 

How do I know if I have fractured my finger?

Finger fractures vary quite widely in severity. Some fractures will be very obvious—misshapen, painful or short. Smaller fractures are easily overlooked at first, and become more obvious when the finger is still sore a few days after the injury happened. If your finger is still sore a few days or a week after the injury, it is advisable to get it checked out. Your physiotherapist will assess your finger and send you for an X-ray if a fracture is suspected.

 

How can physiotherapy help with a fractured finger?

A physiotherapist can ensure your finger fracture is correctly diagnosed and managed. In most cases, they will provide you with a splint to hold your fracture still and in the correct position until it heals. You may require gentle compressive taping to reduce the swelling as well. Some more severe, rotated or unstable fractures will require surgery to fix them.

Physiotherapy is required in the rehabilitation stage of a finger fracture. Your physiotherapist will monitor your progress and incorprate the following into your rehabilitation.

  • Timing decisions: you will need to start moving the finger at the right time to get your movement back without interrupting the bone healing
  • Exercise: you will be given a graduated exercise program to regain the movement and strength at the right time
  • Mobilisation and soft tissue techniques: hands on techniques, such as joint mobilisation and massage, will help you to regain the joint movement and reduce any discomfort in the finger, especially if it is a little stiff
  • Swelling management: you may require some form of compression in the event of ongoing swelling
  • Return to work and sport: the timing of your return to sport and work will depend upon your injury, your recovery and the demands placed on your finger at sport and work
  • Brace and tape: a brace or tape may assist you to return safely to sport or work earlier

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 fractured fingers?

Most finger fractures are treated with splinting and exercises. If your finger is slightly rotated, crossing over the other fingers, or if the fractured finger is shorter than the same one on the other side, you may need an operation to put the bone back into the right position for a good result.

There are a few other reasons why you might need an operation to get your hand working again after a finger fracture, and it’s very important to get the right advice on this at the beginning.

With correct splinting and physiotherapy treatment, most people achieve full movement, strength and function. If surgery is required, physiotherapy is essential after the operation, to make sure the finger gets its movement back quickly and safely.

 

What can I do at home?

The type and stability of the fracture will indicate what is safe to do. Appropriate splinting or taping as guided by your physiotherapist will ensure that you achieve good healing. At an appropriate time, regular exercises and return to activity and sport are essential to improve movement and strength.

In the early stages, it is important to keep swelling to a minimum. Elevate your hand at regular intervals throughout the day. Anything that is not included in a splint is usually safe to move, such as the wrist, elbow and the shoulder. Keep these joints moving to avoid any stiffness.

 

How long until I feel better?

Pain should improve soon after the finger is appropriately splinted. Timing to start movement varies depending on the fracture type, but may be allowed immediately. Other fractures may need to be immobilised for six weeks and may take 2–3 months to achieve 80–90 per cent strength. The final discomforts and weaknesses may take longer to resolve, but rarely reduce function in the meantime.

 

Source: Choose.physio

MALLET FINGER

Mallet finger is the deformity when you are unable to straighten the fingertip. A mallet finger can be as simple as a small bend all the way up to a completely dropped fingertip. Signs and symptoms of a mallet finger include recent injury to the fingertip, such as a knock, or pain, redness or swelling in the area below the fingernail. It is often painless, depending on the cause.

What causes mallet finger?

A mallet finger is an injury to the last finger joint only. If left untreated, or poorly treated, a mallet finger can progress to a swan neck deformity affecting the whole finger. In a swan neck deformity, the middle finger joint gradually bends backwards as the muscles and ligaments adjust to the fingertip bending forwards. This looks unusual, and most importantly, leads to difficulty bending the finger in day-to-day activities. The first signs of this will be an uncomfortable snapping of the tendons as you try to bend the finger.

Mallet finger occurs when the tendon that holds the fingertip straight is torn, pulled away from the bone or cut through the skin. The tendon (terminal extensor) is often torn or pulled away from the bone when the tip of the finger is forced bent by a ball or when the fingertip is caught in the bedsheets, as an example.

A cut or laceration to the back of the finger can go straight through the tendon, which will also cause mallet finger. Mallet finger occurs more easily in people with weakened tendons, from rheumatoid arthritis, for example.

 

How do I know if I have a mallet finger?

Mallet finger may be painful or swollen, but is sometimes neither. The tip of the finger will drop down because the tendon or bone is no longer connected. When the actual tendon is ruptured, the condition can be relatively painless. If a piece of the bone is pulled off, it is normally a bit more swollen and sore.

A mallet finger can be diagnosed by the appearance of the finger with the drop of the fingertip and your history of how the injury occurred. An X-ray may be taken, which will show if the injury is an avulsion fracture or a tendon rupture. It will also show if there is a fractured bone, which could also cause the finger to look like a mallet.

 

How can physiotherapy help with a mallet finger?

Your physiotherapist will assist you by making a moulded thermoplastic splint to extend the finger. This will be worn full time for 6–8 weeks to allow the tendon or bone to heal back together. Your physiotherapist will show how you can clean and look after your finger while wearing the splint during that time. If the finger bends during this time, it will damage the healing, so you need to be comfortable in the splint and be shown how to take care of the skin for that period of time.

After the first eight weeks, you will continue the splint part time, often overnight while you regain your movement. For a further month or two, a splint should be worn during sport.

Surgery to repair a mallet finger is required when the bone fragment is large, when the fingertip has moved position a little or when the cause is a laceration.

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 mallet finger injuries?

Splinting treatment usually allows the tendon or bone to heal effectively. Most patients regain full movement and strength at the completion of treatment, but some patients will not get their finger perfectly straight. The results are best when splinting is commenced early, when the splint is holding the finger in exactly the right position and is worn for the right amount of time.

It’s quite important that the finger is dead straight or bent a little bit backwards in the splint. If your finger is sitting in the splint in a slightly bent position, then the finger will heal up bent.

 

What can I do at home?

A properly moulded splint worn continuously is the best treatment. It is important to follow the instructions of your physiotherapist during the splinting phase to get the best result. This may include regular appointments to check you are managing well with your splinting and your skin is in good condition.

When the tendon is strong enough to hold the fingertip straight, you will be given a schedule to gradually wean out of the splint safely. If you are playing sport with your splint on, you need to strap it on firmly with sports tape to make sure it doesn’t fly off.

 

How long until I feel better?

You will be wearing your splint full time for 6–8 weeks. You will then start exercises to gradually increase the movement in the tip of the finger and gradually reduce the time you are wearing your splint. It usually takes around 3–4 weeks to regain maximal movement and strength of the finger. 

 

Source: Choose.physio

TRIGGER FINGER

Trigger finger is a condition that causes the finger or thumb to ‘click’ or ‘lock’ when it is bent. The finger can start off by catching a little bit, which you notice when you go to open the hand, or first thing in the morning. Trigger finger progresses to actually getting locked in a bent position, requiring the other hand to pull it out straight again. In the most severe cases, the finger is stuck in a bent position, and medical assistance is required to straighten the finger.

Tell me more about trigger finger

If you have trigger finger, you may notice a tender spot in the palm of the hand or on the front of the thumb under the webbing. This tenderness indicates the position of a nodule, or a thickening of the tendons to the fingers, as this is the cause of the triggering.

Tendons glide smoothly up and down to bend and straighten the fingers. The tendons pass underneath pulleys, or little roofs, which hold them in place under the skin. In trigger finger, a nodule forms that catches as the tendon moves in and out through the sheath.

What causes trigger finger?

Trigger finger can be naturally occurring with age, and it can be caused by repetitive finger movement or gripping. Trigger finger occurs more often in people with other inflammatory conditions, such as arthritisdiabetes or gout.

Repetitive bending or gripping of the fingers can cause irritation of the tendon and the sheath around it, which results in thickening and nodule formation. The nodule catches on the edges of the sheath as the tendon moves the finger open and closed. The trigger is caused when enough tension is put on the finger to force the nodule back under the pulley.

How do I know if I have trigger finger?

You will feel a clicking sensation in the palm of your hand when you bend and straighten your finger, or in more severe cases, you will be unable to straighten your finger from a bent position without the help of your other hand. Often you will be able to feel a small lump in the palm of your hand at the base of your finger or thumb—this is usually quite painful. Trigger finger is diagnosed in a clinical setting with a hand assessment and further testing is rarely required.

How can physiotherapy help with trigger finger?

A physiotherapist with experience in treating hand injuries can make a special splint for you to wear, which limits the amount you can bend your trigger finger. This stops the tendon from ‘clicking’ or ‘locking’, and so stops the irritation from occurring. This splint will be small and minimally intrusive. There are various designs that will be suitable depending on your job and hand activities during the day. Most people are able to go about their normal activities with minimal disruption while wearing a splint for trigger finger.

This splint needs to be worn full time for 4–10 weeks until the clicking has resolved. Your physiotherapist will guide you as to when you can wean out of your splint. Other physiotherapy techniques that can be helpful include massage, stretches and tendon gliding exercises to enhance the recovery, although the mainstay of treatment is the splint.

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 trigger finger?

Physiotherapy is usually very effective in treating trigger finger. Splinting for up to 10 weeks has been known to show a 90 per cent success rate in resolving trigger finger. A corticosteroid injection can be helpful when combined with splinting, if the splint alone is not enough to settle your symptoms. In some severe cases that do not respond to splinting, a small surgery to open up the pulley may be needed.

 

What can I do at home?

Wearing your splint full time is the most important thing you can do for your trigger finger. Your physiotherapist will give you special tendon gliding exercises as part of your treatment, which you need to complete daily. It is also important that you avoid repetitive gripping, especially if it causes firm pressure in the palm of your hand over the affected area.

How long until I feel better?

Pain should resolve as soon as the finger is appropriately splinted, as this should stop any clicking or locking. Trigger finger can take up to 10 weeks of splinting before it gets better. The painful nodule in the palm of your hand can take even longer to get better—it may take up to several months even after the trigger finger has resolved.

 

Source – Choose.physio