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Winter sports season is upon us and most sporting people will be familiar with the pain of a ball hitting their finger the wrong way! You may have bent it back into position, strapped it up and kept playing or left the field for the ice pack immediately. So what can you damage when a ball hits your finger and what should you do?
Finger and thumb sporting injuries can affect various structures in the finger; ligaments – which join bone to bone, tendons – which join muscle to bone; the bone itself, or a combination of these. Joint injuries can occur at either joint of the finger, the Proximal Interphalangeal Joint (PIPJ or middle joint) or the Distal Interphalangeal Joint (DIPJ or end joint). The middle joint of the thumb (MCPJ) is also commonly at risk.
The DIPJ has tendons inserting on both sides to flex and extend the fingertip. Injuries at this joint include:
Mallet finger – This injury occurs when a ball hits the tip of the finger and the finger hyper flexes. It can avulse the bone or the tendon at top of the finger and the finger may present with a bent tip. Though not always painful treatment is essential to prevent deformity and includes 6 weeks at least in a splint.
Jersey finger – if the finger is stuck in the other direction, or caught on a player’s shirt “Jersey finger” the tendon and bone on the volar or front side of the fingertip may avulse. This results in difficulty bending the fingertip. These injuries require surgery and therapy and must be commenced immediately thereafter.
At the middle of the finger is the Proximal Interphalangeal Joint. This joint is like a box surrounded by stabilising ligaments, a volar plate and dorsal tendon. If a ball hits this joint the surrounding structures can be damaged causing a range of potential fractures, deformities and instabilities in the finger.
Volar plate injury – This occurs when the finger is bent backward too far. You may or may not see it dislocate. The ligamentous structure on the front side of the finger is damaged perhaps with or without a bone avulsion. These injuries require therapy with splinting and specific targeted exercises for 6-8 weeks.
Central slip injury – If bent too far forward a central slip injury may result and you may not be able to straighten your finger. Splinting with your therapist is essential to prevent a deformity developing.
Gamekeepers/Skiers thumb – when the thumb is pulled to far away from the hand the ligament joining the bones may be damaged or ruptured. This was often seen in rifle shooters (gamekeepers) with skiers where the pole can pull their thumb out too far. A ligament injury at this joint can be of varying severity. If minor, a period of splinting will assist return of thumb function. If the thumb is dislocated the ligament may be ruptured and require surgical repair.
Many other combinations of ligament, tendon and bone injuries are possible in the fingers and thumb. Many fractures and bony breaks are possible in addition to these joint, ligament and tendon injuries and will require early management to prevent long term complications including pain, arthritis and deformity.
What to do if you have a finger injury?
If you notice your finger dislocate with and there is an obvious change in shape do not keep playing. If you have a sharp pain do not keep playing. You have likely damaged one of the complex structures in the finger. Strapping it is not enough.
RICE: Rest the finger and apply and ice pack. Gentle compression will assist and elevation with aid resolving the swelling. Making a prompt appointment with your Occupational Therapist at Specialist on Hand will assist in evaluating the damage you have done to your finger. An X-ray may be required and your therapist can arrange this for you. You may also like to visit your GP for review.
Most finger injuries are managed in a splint to immobilise or protect the damaged structures for up to 6-8 weeks. Your therapist will progress a graded movement programme throughout this time to restore your movement and get you back on the sporting field.
Playing on, pushing through pain and leaving your finger injury untreated can result in a permanently painful, deformed or unstable finger.
Leaving you off the field for longer! If in doubt, make an appointment to see one of our hand therapists who will evaluate your injury and provide you with the appropriate treatment to get you back in the game as soon as possible.