Finger Dislocation

Overview

A finger dislocation is an injury in which the bones of the finger are displaced from their normal position at the joint. This occurs when the ligaments that hold the joint together are stretched or torn, allowing the bones to separate. Finger dislocations are among the most common hand injuries and can affect any of the finger joints, though the proximal interphalangeal (PIP) joint is most frequently involved.

The fingers contain three joints: the metacarpophalangeal (MCP) joint where the finger meets the palm, the proximal interphalangeal (PIP) joint in the middle of the finger, and the distal interphalangeal (DIP) joint near the fingertip. Each joint can potentially be dislocated, but the PIP joint accounts for approximately 80% of all finger dislocations due to its anatomy and exposure to injury.

Finger dislocations typically result from traumatic forces that bend or twist the finger beyond its normal range of motion. Common mechanisms include falls, sports injuries, workplace accidents, and motor vehicle collisions. The injury can range from a simple dislocation involving only joint displacement to complex dislocations involving fractures, tendon injuries, or vascular damage.

Prompt recognition and appropriate treatment are crucial for optimal recovery. While some finger dislocations may appear minor, improper treatment can lead to chronic pain, stiffness, arthritis, and permanent disability. With appropriate care, most finger dislocations heal well, allowing patients to return to normal activities within several weeks to months.

Symptoms

The symptoms of finger dislocation are usually immediately apparent after the injury occurs. The severity of symptoms can vary depending on the location of the dislocation, presence of associated injuries, and time elapsed since the injury.

Primary Physical Symptoms

Functional Symptoms

Visible Deformity

• Obvious joint displacement: Finger appears crooked or bent at an abnormal angle
• Joint misalignment: Bones visibly out of their normal position
• Finger shortening: Affected finger may appear shorter than normal
• Unnatural finger position: Finger held in a fixed, abnormal posture

Immediate Symptoms

• Sudden, severe pain: Often described as sharp or throbbing
• Immediate loss of function: Unable to bend or straighten the finger
• Visible deformity: Joint appears out of place
• Rapid swelling: Joint becomes swollen within minutes
• Bruising: Discoloration around the injury site

Associated Symptoms

• Numbness or tingling: If nerves are affected
• Color changes: Finger may appear pale or blue if circulation is compromised
• Temperature changes: Finger may feel cold
• Weakness: Reduced grip strength
• Inability to make a fist: Cannot close hand completely

Symptoms by Joint Location

PIP Joint Dislocation (Most Common):

• Finger bent at middle joint
• Prominent knuckle appearance
• Severe pain with any movement attempt
• Swelling concentrated at middle joint

DIP Joint Dislocation:

• Fingertip appears bent or crooked
• Pain at tip of finger
• Difficulty with pinching motions
• May be associated with nail bed injury

MCP Joint Dislocation:

• Finger appears separated from palm
• Limited finger flexion
• Pain extending into palm and wrist
• Possible tendon entrapment

Complications Symptoms

• Vascular compromise: Cold, pale, or blue finger
• Nerve injury: Persistent numbness or tingling
• Tendon injury: Inability to bend or straighten finger after reduction
• Skin injury: Open wounds or lacerations
• Fracture: Additional bone pain and instability

Chronic Symptoms (If Untreated)

• Persistent stiffness and limited range of motion
• Chronic pain and aching
• Joint instability
• Development of arthritis
• Permanent deformity
• Reduced grip strength

Causes

Finger dislocations result from traumatic forces that exceed the normal range of motion of the finger joints. Understanding the mechanisms of injury helps in both prevention and treatment planning.

Sports-Related Causes

• Ball sports: Basketball, volleyball, football - direct impact from ball
• Contact sports: Football, hockey, rugby - player-to-player contact
• Gymnastics: Falls onto outstretched hands
• Rock climbing: Finger caught in holds or equipment
• Martial arts: Blocking or grappling movements
• Baseball/softball: Ball striking extended finger

Accident-Related Causes

• Falls: Landing on outstretched hand or extended finger
• Motor vehicle accidents: Hand caught during impact
• Workplace injuries: Machinery accidents, crushing injuries
• Home accidents: Door slamming on finger, furniture-related injuries
• Bicycle accidents: Hand caught in spokes or during falls

Mechanism of Injury

Hyperextension Injuries:

• Finger bent backward beyond normal range
• Most common mechanism for PIP joint dislocations
• Often occurs when finger catches on clothing or equipment
• Can result in dorsal or volar dislocations

Axial Loading:

• Force applied along the length of the finger
• Common in ball sports when ball strikes fingertip
• Can cause either dislocation or fracture
• Often affects DIP or PIP joints

Lateral Stress:

• Sideways bending of the finger
• Can damage collateral ligaments
• May result in unstable dislocations
• Common in grappling sports

Rotational Forces:

• Twisting motion applied to finger
• Can cause complex injury patterns
• Often involves multiple structures
• May be difficult to reduce

Age-Related Factors

Children and Adolescents:

• Growth plate injuries may occur instead of dislocations
• More likely to have associated fractures
• Playground and sports injuries common
• May be less obvious due to incomplete ossification

Adults:

• Pure ligamentous injuries more common
• Work-related and sports injuries predominate
• May have pre-existing joint disease

Elderly:

• More likely to have associated fractures
• Falls are common mechanism
• Healing may be slower
• Pre-existing arthritis may complicate injury

Occupational Causes

• Manual labor: Machinery, tools, heavy lifting
• Healthcare workers: Patient handling injuries
• Musicians: Overuse or acute injuries
• Construction workers: Tool and equipment injuries
• Athletes (professional): Sport-specific mechanisms

Predisposing Factors

• Previous finger injuries: Weakened ligaments
• Joint hypermobility: Increased risk of dislocation
• Rheumatoid arthritis: Joint instability
• Connective tissue disorders: Weak ligaments
• Repetitive stress: Weakened joint structures

Associated Injuries

Finger dislocations may be accompanied by:

• Fractures: Avulsion fractures or joint surface damage
• Tendon injuries: Extensor or flexor tendon damage
• Vascular injuries: Damage to digital arteries
• Nerve injuries: Digital nerve damage
• Skin injuries: Lacerations or abrasions

Risk Factors

Several factors can increase the likelihood of sustaining a finger dislocation. Understanding these risk factors can help with prevention strategies and injury awareness.

Activity-Related Risk Factors

• Contact sports participation: Football, hockey, basketball, rugby
• Ball sports: Volleyball, basketball, baseball, handball
• Racquet sports: Tennis, badminton, squash
• Gymnastics and acrobatics: High risk of falls
• Rock climbing and mountaineering: Finger stress and trauma
• Martial arts: Grappling and striking activities

Occupational Risk Factors

• Manual labor jobs: Construction, manufacturing, farming
• Healthcare workers: Patient transfer and handling
• Musicians: Repetitive finger use and positioning
• Food service workers: Knife and equipment handling
• Mechanics: Tool use and machinery operation

Demographic Risk Factors

• Age: Peak incidence in teens to young adults (15-30 years)
• Gender: Males have higher risk due to increased sports participation
• Activity level: Active individuals at higher risk
• Hand dominance: Dominant hand slightly more at risk

Medical Risk Factors

• Previous finger injuries: History of finger fractures or dislocations
• Joint hypermobility syndrome: Excessive joint flexibility
• Connective tissue disorders: Ehlers-Danlos syndrome, Marfan syndrome
• Rheumatoid arthritis: Joint instability and inflammation
• Osteoarthritis: Degenerative joint changes

Anatomical Risk Factors

• Long, slender fingers: More susceptible to injury
• Joint structure variations: Anatomical predisposition
• Ligament laxity: Naturally loose joints
• Previous surgical interventions: Altered joint mechanics

Environmental Risk Factors

• Poor equipment maintenance: Faulty sports or work equipment
• Inadequate protective gear: Lack of proper hand protection
• Slippery or uneven surfaces: Increased fall risk
• Poor lighting conditions: Reduced visibility leading to accidents
• Weather conditions: Wet or icy conditions

Behavioral Risk Factors

• Risk-taking behavior: Aggressive play or work practices
• Fatigue: Reduced reaction time and coordination
• Alcohol or substance use: Impaired judgment and coordination
• Inadequate training: Poor technique in sports or work activities
• Ignoring safety protocols: Not following safety guidelines

Equipment-Related Risk Factors

• Ill-fitting protective gear: Gloves or guards that don't fit properly
• Worn or damaged equipment: Compromised protective effectiveness
• Inappropriate equipment use: Using tools or gear incorrectly
• Lack of protective equipment: Not using available safety gear

Training and Conditioning Risk Factors

• Inadequate warm-up: Insufficient preparation before activity
• Poor conditioning: Weak muscles and poor coordination
• Rapid increase in activity: Sudden increase in training intensity
• Inadequate recovery: Insufficient rest between activities
• Poor technique: Improper movement patterns

Seasonal Risk Factors

• Sports seasons: Increased activity during specific sports seasons
• Holiday activities: Increased home improvement and recreational activities
• Weather-related activities: Skiing, ice skating, outdoor sports
• School year: Increased sports participation among students

Diagnosis

The diagnosis of finger dislocation typically involves a combination of clinical evaluation and imaging studies. A systematic approach is essential to identify the type of dislocation, assess for associated injuries, and plan appropriate treatment.

Clinical Assessment

History Taking:

• Mechanism of injury: How the injury occurred
• Time of injury: When the dislocation happened
• Pain severity and location: Detailed pain description
• Previous attempts at reduction: Any manipulation attempts
• Previous hand injuries: History of finger or hand problems
• Functional limitations: What activities are affected

Physical Examination:

• Visual inspection: Look for obvious deformity and swelling
• Palpation: Gentle examination of bones and joints
• Range of motion: Active and passive movement assessment
• Neurovascular assessment: Check circulation and nerve function
• Stability testing: Assess ligament integrity (after reduction)

Imaging Studies

X-rays (Primary Imaging):

• Standard views: Posteroanterior, lateral, and oblique
• Pre-reduction imaging: Document injury before treatment
• Post-reduction imaging: Confirm successful reduction
• Stress views: Assess stability after reduction
• True lateral views: Essential for accurate assessment

Advanced Imaging (When Indicated):

• CT scan: Complex fracture-dislocations
• MRI: Suspected soft tissue injuries
• Ultrasound: Dynamic assessment of reduction
• Fluoroscopy: Real-time reduction guidance

Classification of Dislocations

By Direction:

• Dorsal dislocation: Most common, finger bent backward
• Volar dislocation: Finger bent forward, more serious
• Lateral dislocation: Sideways displacement
• Rotational dislocation: Twisting displacement

By Complexity:

• Simple dislocation: No associated fractures
• Complex dislocation: Associated fractures or soft tissue injury
• Open dislocation: Skin is broken
• Closed dislocation: Skin remains intact

By Stability:

• Stable dislocation: Remains in place after reduction
• Unstable dislocation: Tendency to re-dislocate
• Irreducible dislocation: Cannot be reduced by closed methods

Differential Diagnosis

• Finger fractures: May appear similar on examination
• Tendon injuries: Can cause similar functional deficits
• Ligament sprains: May have similar pain and swelling
• Septic arthritis: Can cause joint swelling and pain
• Inflammatory arthritis: May cause joint deformity

Neurovascular Assessment

Vascular Evaluation:

• Capillary refill: Should be less than 2 seconds
• Color and temperature: Compare to uninjured fingers
• Pulse assessment: Digital artery palpation
• Allen's test: For digital artery patency

Neurological Evaluation:

• Sensation testing: Light touch and two-point discrimination
• Motor function: Finger flexion and extension
• Digital nerve assessment: Radial and ulnar digital nerves
• Tinnel's sign: Check for nerve injury

Special Considerations

Pediatric Considerations:

• Growth plate injuries may be mistaken for dislocations
• Incomplete ossification makes interpretation difficult
• May require comparison views of uninjured hand
• Consider child abuse in suspicious cases

Chronic Dislocations:

• Dislocations present for more than 3 weeks
• May require open reduction
• Increased risk of complications
• Advanced imaging often needed

Documentation

• Detailed description of deformity
• Pre-reduction examination findings
• Reduction technique used
• Post-reduction examination
• Patient education provided
• Follow-up plan established

Treatment Options

Treatment of finger dislocations depends on the location, type, and complexity of the injury. The primary goals are to restore normal anatomy, maintain stability, and preserve function while minimizing complications.

Emergency Management

Initial Assessment:

• Immediate evaluation: Check circulation and nerve function
• Pain management: Provide appropriate analgesia
• Immobilization: Splint finger in position found
• Ice application: Reduce swelling and pain
• Elevation: Raise hand above heart level

Contraindications to Immediate Reduction:

• Open dislocations requiring surgical washout
• Associated fractures needing operative fixation
• Vascular compromise requiring emergency surgery
• Multiple attempts at reduction already performed
• Uncertain diagnosis or complex injury pattern

Non-Surgical Treatment

Closed Reduction:

• Anesthesia: Digital block or conscious sedation
• Reduction technique: Gentle traction and manipulation
• Verification: Clinical and radiographic confirmation
• Stability testing: Assess joint stability after reduction
• Documentation: Record successful reduction

Reduction Techniques by Joint:

PIP Joint Dorsal Dislocation:

• Apply longitudinal traction to finger
• Gently flex finger while maintaining traction
• Push middle phalanx back into place
• Test stability in all planes of motion

PIP Joint Volar Dislocation:

• More complex reduction required
• May require extension followed by flexion
• Often requires surgical reduction
• Higher risk of complications

DIP Joint Dislocation:

• Similar technique to PIP joint
• Smaller forces required
• Check for nail bed injuries
• Assess extensor tendon function

Immobilization

Splinting Protocols:

• Position: Functional position with slight flexion
• Duration: Typically 3-6 weeks depending on injury
• Type: Dorsal or volar splints as appropriate
• Buddy taping: For stable reductions
• Progressive mobilization: Gradual return to activity

Splinting by Joint:

• PIP joint: 15-20 degrees flexion for 3 weeks
• DIP joint: Extension splinting for 2-3 weeks
• MCP joint: 50-70 degrees flexion

Surgical Treatment

Indications for Surgery:

• Irreducible dislocations: Cannot achieve closed reduction
• Unstable reductions: Re-dislocates despite proper immobilization
• Open dislocations: Require surgical washout
• Associated fractures: Need internal fixation
• Vascular injury: Requiring surgical repair
• Chronic dislocations: Old injuries needing reconstruction

Surgical Procedures:

• Open reduction: Direct visualization and reduction
• Internal fixation: Pins, screws, or plates as needed
• Ligament repair: Suturing torn ligaments
• Tendon repair: Addressing associated tendon injuries
• Arthrodesis: Joint fusion for severe injuries
• Arthroplasty: Joint replacement in selected cases

Rehabilitation

Early Phase (0-2 weeks):

• Pain and swelling management
• Proper splint care and compliance
• Elevation and ice application
• Gentle active motion of uninvolved joints
• Grip strengthening of unaffected fingers

Intermediate Phase (2-6 weeks):

• Progressive range of motion exercises
• Buddy taping for protection
• Gentle strengthening exercises
• Scar tissue mobilization
• Gradual return to daily activities

Late Phase (6+ weeks):

• Advanced strengthening programs
• Sport-specific rehabilitation
• Work conditioning programs
• Protective equipment fitting
• Return to full activity

Complications Management

Early Complications:

• Failed reduction: May require surgical intervention
• Re-dislocation: Often requires operative stabilization
• Vascular compromise: Emergency surgical consultation
• Nerve injury: Serial examination and possible repair
• Infection: Antibiotics and possible surgical drainage

Late Complications:

• Chronic stiffness: Intensive hand therapy
• Post-traumatic arthritis: Activity modification, injections
• Chronic instability: Possible ligament reconstruction
• Complex regional pain syndrome: Multidisciplinary pain management

Special Considerations

Pediatric Treatment:

• Growth plate considerations
• Shorter immobilization periods
• Careful reduction techniques
• Close follow-up for growth disturbances

Elderly Patients:

• Higher risk of associated fractures
• Slower healing and rehabilitation
• May require longer immobilization
• Consider underlying medical conditions

Prevention

While not all finger dislocations can be prevented, many strategies can significantly reduce the risk of injury. Prevention efforts should focus on education, proper technique, protective equipment, and environmental safety.

Sports Prevention

Protective Equipment:

• Proper gloves: Well-fitting gloves for appropriate sports
• Finger guards: Protective splints for high-risk activities
• Wrist guards: For sports with fall risk
• Equipment maintenance: Regular inspection and replacement
• Proper sizing: Ensure all protective gear fits correctly

Training and Technique:

• Proper coaching: Learn correct techniques for sports activities
• Gradual progression: Avoid rapid increases in training intensity
• Skill development: Focus on fundamental skills before advanced techniques
• Conditioning programs: Build strength and flexibility gradually
• Rules education: Understand and follow sport-specific safety rules

Pre-Activity Preparation:

• Adequate warm-up: 10-15 minutes of progressive activity
• Stretching: Focus on hand, wrist, and forearm flexibility
• Strength training: Regular hand and forearm strengthening
• Balance training: Improve proprioception and coordination
• Mental preparation: Stay focused and alert during activities

Workplace Safety

• Safety training: Regular education on hand safety protocols
• Protective equipment: Use appropriate gloves and guards
• Machine guarding: Proper safety devices on equipment
• Regular breaks: Avoid fatigue that can lead to accidents
• Ergonomic assessment: Optimize work station design
• Incident reporting: Learn from near-misses and accidents

Home Safety

• Safe storage: Keep tools and sharp objects properly stored
• Proper lighting: Ensure adequate illumination in work areas
• Regular maintenance: Keep equipment in good working order
• Child safety: Protect children from hand injury hazards
• Emergency preparedness: Know first aid for hand injuries

Activity-Specific Prevention

Ball Sports:

• Practice proper catching techniques
• Use appropriately sized balls
• Maintain good hand position
• Develop quick reflexes and hand-eye coordination
• Avoid reaching for balls beyond safe range

Contact Sports:

• Learn proper blocking and tackling techniques
• Avoid leading with hands in dangerous situations
• Use protective padding when available
• Practice safe falling techniques
• Maintain awareness of other players

Recreational Activities:

• Use proper equipment for each activity
• Follow safety guidelines and recommendations
• Stay within skill level capabilities
• Avoid activities when fatigued or impaired
• Consider lessons for new activities

Lifestyle Factors

• Physical fitness: Maintain overall strength and flexibility
• Nutrition: Support bone and soft tissue health
• Hydration: Maintain adequate fluid intake
• Sleep: Ensure adequate rest for optimal performance
• Stress management: Reduce factors that may impair concentration

Previous Injury Prevention

• Complete rehabilitation: Fully recover from previous injuries
• Protective taping: Support previously injured fingers
• Strength maintenance: Continue exercises after recovery
• Activity modification: Adjust activities based on injury history
• Regular assessment: Monitor for signs of re-injury

Environmental Safety

• Surface conditions: Avoid slippery or uneven surfaces
• Weather considerations: Adjust activities for conditions
• Equipment inspection: Check playing surfaces and equipment
• Emergency planning: Know location of medical facilities
• Communication: Have emergency contact information available

Education and Awareness

• Injury recognition: Learn to identify serious hand injuries
• First aid training: Basic emergency care for hand injuries
• When to seek help: Understand when professional care is needed
• Risk assessment: Evaluate activity-specific risks
• Continuous learning: Stay updated on safety recommendations

When to See a Doctor

Finger dislocations require prompt medical attention to ensure proper healing and prevent complications. Knowing when to seek immediate care versus when urgent care is sufficient can make a significant difference in treatment outcomes.

Seek Immediate Emergency Care

• Open dislocation: Bone visible through skin or obvious wound
• Vascular compromise: Finger appears blue, white, or very pale
• Complete numbness: Total loss of sensation in the finger
• Inability to move finger: Complete loss of function
• Severe deformity: Obvious major displacement of bones
• Signs of infection: Fever, red streaking, severe swelling
• Multiple finger injuries: Several fingers affected simultaneously

Seek Urgent Medical Care (Same Day)

• Obvious finger dislocation: Visible joint displacement
• Severe pain: Pain that interferes with all activities
• Significant swelling: Rapid onset of major swelling
• Color changes: Finger appears dusky or discolored
• Cold finger: Affected finger feels cold compared to others
• Partial numbness: Decreased sensation in finger
• Unable to bend or straighten: Significant loss of motion

Schedule Appointment Within 24-48 Hours

• Suspected dislocation: Possible joint displacement
• Persistent pain: Ongoing discomfort after initial injury
• Functional limitations: Difficulty with normal hand use
• Swelling not improving: Continued or worsening swelling
• Concern about injury severity: Uncertainty about need for treatment

Post-Treatment Follow-up

Return Immediately If:

• Finger becomes blue, white, or very pale
• Complete loss of sensation develops
• Severe increase in pain occurs
• Signs of infection appear
• Splint or cast becomes too tight
• Finger re-dislocates

Scheduled Follow-up Care:

• Initial follow-up: 1-2 weeks after treatment
• X-ray check: Verify maintenance of reduction
• Splint adjustment: Modify immobilization as needed
• Therapy referral: Begin rehabilitation when appropriate
• Return to activity clearance: Assessment for activity resumption

Situations Requiring Specialist Referral

• Complex dislocations: Multiple injuries or difficult reductions
• Failed reduction: Cannot achieve or maintain proper position
• Associated fractures: Bone breaks with dislocation
• Tendon or nerve injury: Damage to other structures
• Chronic instability: Recurrent dislocations
• Poor healing: Complications during recovery

Red Flags Requiring Immediate Attention

• Circulation problems: Any signs of poor blood flow
• Nerve damage: Persistent numbness or tingling
• Infection signs: Fever, red streaking, pus
• Compartment syndrome: Severe swelling with extreme pain
• Multiple trauma: Other significant injuries present

Special Populations

Children:

• Any suspected finger dislocation requires evaluation
• Growth plate injuries may appear as dislocations
• Consider non-accidental trauma in suspicious cases
• May require sedation for proper examination

Elderly Patients:

• Higher risk of associated fractures
• May have delayed healing
• Consider underlying medical conditions
• May need modified treatment approaches

Athletes:

• Need assessment for return to sport
• May require protective equipment
• Consider sport-specific rehabilitation
• Timeline for return to competition

Telemedicine Considerations

While finger dislocations typically require in-person evaluation, telemedicine may be appropriate for:

• Initial assessment of injury severity
• Post-treatment follow-up visits
• Rehabilitation guidance
• Return to activity decisions
• Medication adjustments

What to Expect During Medical Care

• Thorough examination: Assessment of injury and surrounding structures
• Imaging studies: X-rays to confirm diagnosis and guide treatment
• Pain management: Appropriate medications for comfort
• Reduction procedure: Realignment of dislocated joint
• Immobilization: Splinting or casting to protect healing
• Follow-up planning: Schedule for monitoring progress

Related Conditions

Finger dislocations are often associated with other hand and finger injuries, and understanding these relationships is important for comprehensive care and accurate diagnosis.

Commonly Associated Injuries

• Avulsion fractures
• Volar plate injuries
• Collateral ligament tears
• Extensor tendon ruptures
• Flexor tendon injuries
• Digital nerve injuries

Long-term Complications

• Post-traumatic arthritis
• Chronic pain syndromes
• Complex regional pain syndrome
• Joint contractures
• Boutonniere deformity
• Swan neck deformity

Differential Diagnoses

• Mallet finger
• Trigger finger
• Dupuytren's contracture
• Rheumatoid arthritis
• Psoriatic arthritis
• Septic arthritis

Related Hand Conditions

• Wrist fractures
• Metacarpal fractures
• Carpal tunnel syndrome
• De Quervain's tenosynovitis
• Ganglion cysts

Systemic Conditions

• Ehlers-Danlos syndrome
• Marfan syndrome
• Joint hypermobility syndrome
• Osteogenesis imperfecta

Frequently Asked Questions

References

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3. Rettig AC. Athletic injuries of the wrist and hand: part I: traumatic injuries. Am J Sports Med. 2003;31(6):1038-1048.
4. Kiefhaber TR, Stern PJ. Upper extremity tendonitis and overuse syndromes in the athlete. Clin Sports Med. 1992;11(1):39-55.
5. American Society for Surgery of the Hand. The Hand: Examination and Diagnosis. 3rd ed. Churchill Livingstone; 1990.