Dislocated Finger

What is a dislocated finger?

A dislocated finger is the result of one of the bones in the finger being pulled apart or sideways out of alignment. Finger dislocations usually occur when the finger is bent too far backward. Although a common injury, finger dislocations that are not treated properly can result in chronic pain, stiffness, poor function, and deformity.

A dislocated finger is usually painful, swollen, red, visibly crooked, may be numb or tingling, and may be difficult to move.

Once an X-ray has confirmed the dislocation, treatment often includes pain control via anesthetics, a reset of the joint, and splinting. Surgery may be necessary in cases of joint dislocation or associated fractures.

You should go immediately to an urgent care or emergency room, where a physician can "reduce" - put the finger back into place - safely. Simple dislocations typically require just buddy tape to a nearby finger. Complicated fractures (need an x-ray) would need immobilization with a splint. Following reduction, the doctor should ensure that blood is flowing to the tips of the finger properly. If he/she cannot put it back into place, they should consult a hand surgeon.

Symptoms of a dislocated finger

Due to damage and associated disruption of structures within the finger, the following symptoms are likely.

• Swelling: Swelling surrounding the affected joint may be short or prolonged. The trauma to the joint disrupts the normal joint architecture and can lead to fluid shifts, thus producing the swelling.
• Redness: The affected joint may appear red due to disturbed tissue.
• Pain: Even minor structural damage to the joint as well as the associated swelling can lead to feelings of pain in the affected area.
• Numbness and tingling: Branches of the radial, ulnar, and median nerves course across the joints extending to the ends of the fingers. If these branches are compressed, you may experience a sensation of numbness and tingling.
• Functional impairment: This symptom can occur for a variety of reasons. The swelling in the affected area may inhibit movement without any underlying tendon or ligament problems. If you experience a dorsal dislocation or bend the finger too far backward, you might damage the flexor tendon, which allows us to bend our fingers toward our palm. In the case of lateral dislocation, the ligaments on the sides of the fingers, called the collateral ligaments, may be disrupted.

Causes of a dislocated finger

The fingers, not including the thumb, contain three joints. The joint closest to the palm is the metacarpophalangeal joint. The joint midway down the finger is the proximal interphalangeal joint. The joint closest to the fingertip is the distal interphalangeal joint. The proximal interphalangeal joint is the one that is most commonly dislocated.

Types of dislocations

Dislocations of the hand can be subcategorized into dorsal, lateral, or volar dislocations, indicated by the direction of joint movement. Knowledge of the subcategory of dislocation allows the physician to apply the right direction of pressure when re-locating the joint as well as splinting.

• Dorsal dislocation: A dorsal dislocation occurs if the joint is dislocated toward the back of the hand. This would occur if the finger was hyperextended and bent too far backward. A dorsal dislocation of the proximal interphalangeal joint is the most common finger dislocation.
• Lateral dislocation: A lateral dislocation is the result of a finger is pulled too far sideways.
• Volar dislocation: A volar dislocation is if the joint is pulled too far forward, or toward the palm. This type of dislocation rarely occurs and only ever does if the finger is simultaneously rotated.

Who is most likely to be affected

Finger dislocations commonly occur among young adults participating in sports activities such as basketball and football, but also occur around the home. Males experience this injury up to four times more often than females.

Treatment options and prevention for dislocated finger

Treatment will depend on the severity and type of dislocation, as well as further details of the diagnosis, described below. Treatments typically include some element of pain control and may include other non-surgical or surgical measures.

Diagnosis

To diagnose a dislocated finger, a physician will usually take X-rays of your finger from multiple angles in order to visualize the entirety of the joint. Imaging the finger is important for determining treatment, such as if the joint is amenable to closed reduction or popping it back into place. The joint should not be popped back into place if there is a fracture in any of the surrounding bones. Furthermore, imaging can help distinguish between a dislocated and jammed finger. A jammed finger will not have evidence of dislocation on X-rays or changes in any of the surrounding tendons.

Pain control

The mainstay of therapy of a dislocated finger is closed reduction. Pain control and anesthesia is an important first step in closed reduction. In older children and adults, a digital nerve block is usually sufficient for anesthesia. In a digital nerve block, an anesthetic is injected locally into the nerve of the finger so that you don't feel pain in that area. Young children may require procedural sedation for closed reduction of dislocated joints.

Resetting the joint and splinting

Once the physician has determined the direction of the dislocation, he or she will apply force in the appropriate direction to reset the joint in place. All closed reductions are followed by the application of an immobilization splint. The type of dislocation also determines how long you should wear a splint.

• Dorsal dislocation of the middle joint of the finger requires splinting for about three to five days.
• Dorsal dislocation of the joint closest to the tip of the finger necessitates a splint for two to three weeks.
• A volar dislocation of the middle joint requires a splint for about four weeks.

Surgery

Surgery may be indicated in cases of joint dislocation. Some potential reasons to pursue surgical management include a fracture in the surrounding bones, continuous joint instability despite the closed reduction, or failure to reduce the joint despite multiple attempts.

When to seek further consultation for dislocated finger

You should seek further consultation if you experience finger trauma, as you will likely need X-rays to determine the diagnosis. You should seek immediate attention if the dislocation is so bad that the bone protrudes through the skin.

If you experience additional dislocation

You should also be aware that once a finger is dislocated, that joint has a higher chance of dislocating in the future with trauma or injury. After dislocating a joint of the finger, pain and stiffness can last for months.