My finger got an owie

[Kyobanim]

Sparring tonight I blocked a kick with my hand and missjudged it. Instead of slapping the kick away the foot contacted the finger tips on my right hand jamming them in. on initial inspection the middle finger was deformed at the first joint; the part connected to the hand was below the rest of the finger. It looked like the end of the finger was riding over the top of the knuckle. The ring finger was just sore as hell. First thing I did was grab both fingers and pull, probably stupid but That's what I did.

That hurt like shit but the finger was now sorta normal. Both fingers immediately swelled at the first joint and slightly beyond in both directions.

This happened at approx 7PM. It is now 2 hours later and the swelling is down slightly on the ring finger. The joint feels "full" but I can bend it with minimal pain. The middle finger is still swollen and hurts just above the first joint to type, use a pencil, hold a glass, etc. The pain is throbbing continuously and sharp when doing one of the foresaid items. There is also sharp pain at the top joint on this finger. I can bend it about an inch before the pain at the joint says fook you.

I see only a slight darkening on the backside of the middle finger at the joint. I didn't use to worry about this type of thing but since I'm getting a little older I thought I'd ask for an opinion from all the docs here. Pics in a minute.

[Sacamuelas]

You know, of course, that the safest way to confirm this injury is to get to a local Doc and get an exam/x-ray.

That being said-
Can you extend the finger straight (fully extended) against active resistance? I assume by your above report on ROM that you can close (flex) the finger and open/extend (straighten) the finger when no active resistance is being applied. I am also assuming from your lack of stating it otherwise in your original post that the joint remains stabile during the ROM test.

Is the finger stable laterally when you exam it? Is there any crepitus (grating feeling/sound) when palpated and/or during range of motion functions tested? Is there any specific point tenderness?

If you are thinking it is just a jammed/dislocated finger that you reduced at the initial scene, then you do want to at least rule out a central extensor tendon tear which requires a specific type splinting ( fully extended verses the old standard buddy splint in a slight flexed position) to prevent a permanent "crooked" finger (Boutonniere deformity) after healing if that type injury is present. That is why I ask about the ability to extend the finger under resistance.

[Eagle5US]

Sounds like you had a slight "bayonet dislocation" of your MPJ-in addition to the extensor tendon injury, there is a tendency to have avulsion fractures of volar plates which impair the healing process for the attachment points of your tendons...eventually impairing full function (as in my case-boo hoo :boohoo )
Wait about a week, get a film, make sure you have no avulsion fractures.

Hope you get better-

Eagle

[Sacamuelas]

Kyo-
What you described as "the end of the finger riding over the top of the knuckle " is called a dorsal dislocation at your PIJ (proximal interphalangeal Joint). This involves a volar plate injury as Eagle has stated. This injury usually can and is reset at the scene just like you did. In and of itself, it is normally stabile and will heal with the following treatment even if a small fracture is noted: Usual treatment is dorsal splinting with the joint in 10-30° of flexion for 2 weeks. The splinting will limit further damage to the volar plate disruption. You can modify the tape job on the splint to allow for a slight flexing motion while still preventing complete extension. To do this you just place 2 pieces of tapes only on the proximal phalanx (I labeled it #1) to hold the splint in place instead of having a piece on #1 and a piece on the middle phalanx (labeled #2) as shown in the pic. After the initial two weeks, initiate ROM exercises. Continue protective splinting or buddy taping for 4-6 weeks during athletics or at-risk activities.

The one major risk is the end state that Eagle and I both mentioned. From everything I have read, the specific injury that causes this needs to be ruled out early in the healing process, so I will offer a slightly different suggestion than Eagle about waiting a week if your self-exam indicates its potential. The central tendon that actually extends your middle finger above the joint you dislocated can become injured in severe dislocation injuries. This causes the tendon to split into two lateral halves right down the longitudinal middle of your finger on the side away from your palm(dorsal). What happens is that the two separated sides of the original tendon will retract laterally around the side of the bone and end up located more on the palm side (IOW, move toward the volar side of the joint) of your finger and then heal attached below the axis of rotation for the joint. This effectively causes the tendons to function as flexors instead of extenders and thus the permanent loss of extension function as Eagle described and I warned about. Your finger ends up looking like pic #2 permanently with only the ability to flex it.

The way to check for this type injury is listed in my prior post. Passive extension can sometimes be seen initially after this injury due to the minor support from the two split sides of the torn tendon. However, weakness and or lack of ability to extend the finger under resistance are a strong indicator that this injury is in play.
If it is, you should splint it extended as shown in pic #3 below immediately (not after a week) to prevent this tendon migration as discussed above. If it becomes chronic or heals that way, it may mean permanent loss of function even after surgical attempts at correction.
If you have weakness to extension or no ability to extend under resistance - I suggest you go get medical follow-up soon. FWIW, here is what I have found as the recommended treatment for this type injury . Treatment of an acute central slip injury consists of splinting the PIJ in full extension for 6 weeks. Ideally, the splint should allow for the more distal interphalangeal joint (away from hand) adequate range of motion. A splint is placed over the dorsum of the joint. After 6 weeks, ROM exercise is started. The use of protective splinting in extension is advised during sports or at-risk activities for 4-6 weeks or until full pain-free function is restored.

[Eagle5US]

No sweat Saca on the difference in suggestions. Every time we tried early films on mine-the hand dudes said we had to wait. When such a small joint fills with blood early on, they found it extremely difficult to discern the volar plate fracture / avulsion. Early won't hurt certainly.
This statement: on initial inspection the middle finger was deformed at the first joint; the part connected to the hand was below the rest of the finger made me thik it was the MPJ instead of the PIPJ.
THanks for chiming in...you'll be "orthomuelas" before you know it.

Eagle

[Kyobanim]

I appreciate ya'lls' input. I've never really stopped to analyze an injury, it's usually off to the hospital. This is more fun. :D

After reading all that and looking at my sausage fingers, I'm going to the doc tomorrow. The swelling has almost doubled in size but I've gained ROM, with pain. The swelling has extended to the knuckles on the hand but that is probably to be expected. Yellowish tint to the skin. (Is that from the swelling?)
Pic 1= hand 24 hours after injury Pic2=closeup Pic3=ROM extended Pic 4=ROM bent to the point of sharp pain.

[ghuinness]

I thought you said you would go in this morning (tuesday) if the swelling didn't go down?

[Kyobanim]

The world got i the way. I know, I know. I am definately going tomorrow morning.

[Gypsy]

How's the owie Kyobanim? :munchin

[Kyobanim]

Got in to see the Doc this morning. Xray shows the ring finger knuckle chipped above the joing on the side. The boney part is chipped. I was at the xray place when the diag took place so I didn't get to talk to my Doc but they are sending me to a ortho. Question: Why would I need to see an ortho? Wouldn't splinting work until healed? When I get home tonight I'll scan it if I can.

[Kyobanim]

Here's the x-ray that shows the chip. Doesn't look like much to me. Also looks like some other type of deformity on the bone.

[Team Sergeant]

Right then, lets suck it up, move out and draw fire!

I'm not sure you'll ever recover from that! :boohoo

Chipped finger, what's next, stubbed toes? :D

Team Sergeant




(I wish I had the x-rays when I broke my left arm, I could scratch my left elbow with my left hand..... now that was an owie!)

Edit:
You may want to delete this whole thread Before NDD sees it.

[Kyobanim]

Someone has to run around and be the target. :munchin


I don't understand why I need to se an ortho. I figured splint it for a week or two and I'm back in business. If I have to go ortho, I'd rather have my hip fixed.

[ghuinness]

Someone has to run around and be the target. :munchin


I don't understand why I need to se an ortho. I figured splint it for a week or two and I'm back in business. If I have to go ortho, I'd rather have my hip fixed.

I had to do the same thing. The Ortho then sent me to a hand-specialist. If I hadn't had surgery and opted for a cast that would have been done by the Physiotherapist (PT). If I understand the process, the Ortho has to approve the PT. Ypu can't go directly to a PT.