Finger dislocation

How would this injury occur? 

A dislocation of a joint is where the two bones are no longer aligned with each other because the ligaments that support the joint and hold the bones in place give way, allowing the bones to slip out of position.  Most finger dislocations occur as a result of a fall or a sporting incident such as a ball to the end of the finger. A dislocation can happen at any joint in the finger or thumb and commonly occurs in ball sports such as netball, basketball, cricket, Oztag , touch football or AFL.  Some dislocations will be associated with a fracture in the bones involved, known as an avulsion.

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What are the signs and symptoms? 

There may be a deformity, crooked or misshapen appearance of the finger. Pain, swelling, bruising and difficulty moving the finger are common. A feeling of instability, looseness or floppiness may occur. An open dislocation, is where a dislocation causes a break in the skin, forming an open wound.

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Why is treatment important?

Immediate medical attention is required to assess the dislocation and realign the joint back into its normal position. A simple dislocation can be relocated back into position easily, however a complicated dislocation may require a local or general anaesthetic to relocate back into normal position. This is most safely done in the emergency department. It is not wise to reduce the dislocation yourself as you may injure underlying structures. You cannot tell without an X ray if you have a fracture as well as a dislocation. An open dislocation (where the skin is broken) needs to be seen at the Emergency department as it may require a joint washout, to prevent risk of infection and to stitch the skin closed.

When should you see your Accredited Hand Therapist? 

The sooner you are able to see your AHT the better. Should the ligaments not heal correctly, there is a risk that the joint will become unstable and of dislocating again. An unstable joint may affect the function of the finger. Early hand therapy can help minimise this risk of instability by fitting of an appropriate custom-made orthosis for a period of 4-6 weeks.    You will then be guided through safe movement exercises at the right timing, not too early nor too late in the healing process.

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Should I get an x-ray? 

If you have had an x-ray, bring it to your first HT appointment. However, your AHT can send you for an x-ray.  In the case of concerning instability you may be refer you to a specialist doctor, if required.

How long until I play sport again? 

Your AHT will determine when you can safely return to sport. A simple dislocation will be protected in a custom made orthosis for 4-6 weeks. Your therapist may make a playing splint if it is safe for early return to your sport. A complicated dislocation that involves a fracture, may be held back from sport longer.

You can find a practitioner of Hand Therapy in your area by visiting the AHTA website home page and click on “Looking for an Accredited Hand Therapist?”.  All you will need is your post code and you’re on the way to having your sports hand injury treated with excellent care.

Brief case

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-Lenny was playing basketball when a ball that he was attempting to intercept was deflected, causing his R little finger to hyperextend.  

-The middle bone of the finger was displaced too far back, causing a dorsal dislocation of the PIPJ. –Lenny went to hospital to have an X ray to check the bones.  The PIP joint was relocated into position. A temporary, bulky aluminium splint was taped on preserve the relocated joint until he could see a Hand Therapist 

-Lenny attended his local AHT the next day.  Following as assessment, he had compression applied to his little finger to help the swelling, and a protective finger orthosis was custom–made to protect the injury and rest the joint. 

- At his next treatment one week later, Lenny’s AHT taught him how to massage his finger to help with the soft tissue swelling and to make the finger feel less firm. He also was shown very careful active motion exercises to do daily. 

- As the weeks progressed, Lenny was allowed out of the orthosis, at around 4 weeks, for very light personal care, but no forceful clenching yet.  His AHT fitted a soft protective sleeve fitted to replace the firm orthosis, as his R little finger joint became more stable.