By Fadel Taazieh, Site Coordinator, PT, DPT
We rely on our hands and fingers to accomplish everyday tasks that sometimes we take for granted. We need them to grasp, pinch, lift and push, but unfortunately, injuries occur and prevent us from doing so. Even the simplest task requires a series of bones, joints, and muscles moving in sync to accomplish each action. An injury to any of the finger’s bones can impact normal function, making it difficult to bend or straighten the finger interfering with daily and recreational activities.
Main Bones of the Finger
There are three main bones of the finger, except for the thumb, which only has two. The index through small fingers has a proximal, middle, and distal phalanx, beginning from the bottom to each finger’s tip. The thumb only has a proximal and distal phalanx. A joint is formed where each bone connects to the other to allow movement. The hand’s bones connect to the proximal phalanx of each finger, forming the metacarpophalangeal (MCP) joint, more commonly known as your knuckles. Between the proximal and middle phalanx forms the proximal interphalangeal (PIP) joint. Lastly, between the middle and distal phalanx forms the distal interphalangeal (DIP) joint. The thumb has 2 joints comprising of the metacarpophalangeal (MCP) and interphalangeal (IP) joints.
Common injuries to the bones of the finger include dislocations, fractures, and crushing injuries. The orthopedic surgeon will obtain X-rays, and CT scans to reveal the injury’s severity and determine the appropriate treatment course. If the fracture has good alignment or is barely visible on imaging, the first treatment usually involves immobilization with a cast or brace. This prevents the fracture from shifting and limits the use of the injured finger by the patient. In some cases, the fracture is not aligned or has multiple fragments prompting surgical intervention to restore the original anatomy.
Open reduction surgery involves pins, screws, and/or plates to hold the fracture in place to allow healing in proper alignment. In closed reduction surgery, the fracture can be set without cutting into the skin and is most effective as soon as the bone breaks. Seeking medical attention immediately after injury to any finger’s bones is key to ensure the best outcome.
Whether an individual is treated with immobilization or surgery, hand therapy is usually required to restore the range of motion, strength, and dexterity of the injured finger. Following an initial evaluation, the Hand Therapist will develop a care plan based on the specific injury and diagnosis. Stiffness and swelling are common with any injury to the bones of the finger. Beginning ROM exercises and managing swelling early on can lead to better functional outcomes. Hand Therapists can also fabricate custom splints to improve either bending or straightening of the fingers. The patient will wear the splint for a specific duration of time throughout the day as prescribed by the therapist.
JOI Doctors are currently offering ASAP fracture and injury care. This is a new option for patients who would like to avoid the emergency room if they have suffered a fracture or soft tissue injury. To learn more about this service, read this article about fracture and injury care. Make an appointment by calling (904)JOI-2000.