What are the causes of finger ligament tears. How are collateral ligament injuries diagnosed. What treatment options are available for finger ligament tears. When is surgery necessary for finger ligament injuries. How long does recovery take after a finger ligament tear. What are the potential complications of untreated collateral ligament injuries. How can finger ligament tears be prevented in sports and daily activities.

Understanding Collateral Ligament Injuries of the Fingers

Finger injuries are remarkably common, accounting for approximately 20% of emergency department visits related to trauma. Among these, collateral ligament injuries play a significant role. While ulnar collateral ligament tears of the thumb are well-known, collateral ligament injuries in other fingers have been historically underreported. However, clinical experience suggests these injuries occur more frequently than previously believed.

Collateral ligament tears can affect any digit, though the radial collateral ligament (RCL) of the index finger is most commonly reported in literature. Recent advancements in MRI techniques and a deeper understanding of collateral ligament anatomy have improved the diagnostic accuracy for these injuries.

Anatomy of Finger Collateral Ligaments

Finger collateral ligaments typically range from 4-8 mm in width and 12-14 mm in length. There are two types of collateral ligaments:

• Proper collateral ligaments: Originate from small depressions on either side of the metacarpal head and insert at the palmar aspect of the proximal phalanx.
• Accessory collateral ligaments: Arise from the same depression as proper collateral ligaments but in a more palmar location, extending to attach to the plantar plate.

The proper collateral ligaments, often simply referred to as collateral ligaments, play a crucial role in joint stability and protection. They are taut during flexion and relaxed during extension, while the accessory collateral ligaments exhibit the opposite behavior.

Mechanisms of Finger Ligament Tears

Collateral ligament injuries typically occur due to excessive stress on the ligament that overcomes its viscoelastic properties. This can happen in various situations:

• Sports injuries, particularly in contact sports like wrestling or football
• Falls onto an outstretched hand
• Hyperextension or lateral force applied to the finger
• Repetitive stress injuries in certain occupations or activities

Is there a difference in injury patterns between sports-related and non-sports-related finger ligament tears. Sports-related injuries often result from acute trauma with high force, while non-sports injuries may be due to lower force incidents or repetitive stress. However, the fundamental mechanism of exceeding the ligament’s capacity to withstand stress remains the same.

Diagnostic Imaging for Collateral Ligament Injuries

Magnetic Resonance Imaging (MRI) has become the gold standard for diagnosing collateral ligament injuries of the fingers. The key to accurate diagnosis lies in understanding the oblique course of the ligament when the fingers are in their usual extended position during MRI scanning.

MRI Techniques for Finger Ligament Evaluation

Two main approaches are used in MRI evaluation of finger collateral ligaments:

1. Standard technique: Images are obtained with fingers in extension. The interpreter must follow the ligament from proximal to distal as they move from dorsal to palmar in the coronal plane.
2. Flexion technique: Described by Theumann et al., this approach obtains scans with the metacarpophalangeal (MCP) joint in flexion, allowing visualization of the collateral ligament on a single orthogonal axial slice.

While the flexion technique offers elegant visualization, it’s not practical for routine imaging as it can complicate the evaluation of other anatomical structures. Therefore, the standard technique with fingers in extension remains the most common approach in clinical practice.

Clinical Presentation and Diagnosis of Finger Ligament Tears

Patients with collateral ligament injuries often present with the following symptoms:

• Pain at the affected joint, typically the metacarpal-phalangeal joint (MPJ)
• Swelling and bruising around the injured area
• Instability of the joint, particularly when stress is applied
• Difficulty gripping or performing fine motor tasks
• Possible deformity in severe cases

How can healthcare providers differentiate between a collateral ligament tear and other finger injuries. A thorough physical examination, including stress testing of the affected joint, can provide initial clues. However, imaging studies, particularly MRI, are often necessary for definitive diagnosis and to rule out other conditions such as fractures or tendon injuries.

Treatment Options for Finger Ligament Tears

The treatment of collateral ligament injuries depends on the severity of the tear and the patient’s individual circumstances. Options include:

Conservative Treatment

For partial tears or stable complete tears, non-surgical management may be appropriate:

• Immobilization: Using a splint or cast to allow the ligament to heal
• Physical therapy: To restore range of motion and strength
• Pain management: NSAIDs or other pain relief medications as needed
• Gradual return to activities as healing progresses

Surgical Intervention

Surgery may be necessary in cases of:

• Complete ligament tears with significant instability
• Tears associated with avulsion fractures
• Failed conservative treatment
• High-demand patients (e.g., athletes) requiring rapid return to activity

Surgical techniques may include direct repair of the ligament, reconstruction using grafts, or reattachment of avulsed bone fragments.

When is surgery absolutely necessary for finger ligament tears. Surgery is typically required when there is significant joint instability that cannot be managed conservatively, or when associated injuries (such as avulsion fractures) necessitate surgical intervention. The decision for surgery should be made on a case-by-case basis, considering factors such as the patient’s age, occupation, and activity level.

Recovery and Rehabilitation After Finger Ligament Injury

The recovery process following a finger ligament tear can vary depending on the severity of the injury and the treatment approach. Generally, it involves:

1. Initial immobilization: 3-6 weeks, depending on the injury severity
2. Gradual range of motion exercises: Typically starting around 4-6 weeks post-injury or surgery
3. Strengthening exercises: Introduced as healing progresses, usually around 6-8 weeks
4. Return to normal activities: Often possible by 10-12 weeks, though full recovery may take several months

How long does it typically take to regain full function after a finger ligament tear. While basic activities may be resumed within 2-3 months, full recovery, especially for high-demand activities or sports, can take 4-6 months or longer. The timeline can vary significantly based on individual factors and the specific nature of the injury.

Potential Complications and Long-term Outcomes

While most finger ligament injuries heal well with appropriate treatment, potential complications can include:

• Chronic instability of the affected joint
• Stiffness and reduced range of motion
• Development of osteoarthritis in the injured joint
• Persistent pain or weakness
• Deformity in severe or improperly treated cases

What factors influence the long-term prognosis of finger ligament injuries. Several factors can affect the outcome, including:

• Severity of the initial injury
• Timeliness and appropriateness of treatment
• Patient compliance with rehabilitation protocols
• Individual healing capacity and age
• Presence of associated injuries or pre-existing conditions

Proper diagnosis, timely treatment, and dedicated rehabilitation can significantly improve the chances of a full recovery and minimize long-term complications.

Prevention Strategies for Finger Ligament Injuries

While not all finger ligament injuries can be prevented, certain strategies can help reduce the risk:

• Proper warm-up and stretching before physical activities
• Use of appropriate protective gear in sports and high-risk occupations
• Technique training to avoid excessive stress on fingers during activities
• Strengthening exercises for hand and finger muscles
• Avoiding overuse and taking regular breaks during repetitive tasks
• Maintaining overall hand health through proper nutrition and hydration

How effective are taping techniques in preventing finger ligament injuries. Taping can provide additional support and may help prevent injuries, particularly in sports settings. However, it should not be relied upon as the sole preventive measure and is most effective when combined with proper conditioning, technique, and use of appropriate equipment.

Advances in Treatment and Future Directions

Research in the field of finger ligament injuries continues to evolve, with several promising areas of development:

Biological Augmentation

The use of platelet-rich plasma (PRP) and other biological agents to enhance healing is being studied. These treatments aim to accelerate the natural healing process and potentially improve outcomes.

Minimally Invasive Surgical Techniques

Advancements in arthroscopic and minimally invasive surgical techniques may allow for more precise repairs with less tissue disruption, potentially leading to faster recovery times.

Improved Imaging and Diagnostic Tools

Ongoing refinements in MRI technology and the development of new imaging modalities may further improve the accuracy of diagnosis and treatment planning.

Personalized Treatment Protocols

As our understanding of individual factors affecting healing improves, treatment protocols may become more personalized, optimizing outcomes for each patient.

What role might regenerative medicine play in the future treatment of finger ligament injuries. Regenerative medicine, including stem cell therapies and tissue engineering, holds promise for enhancing ligament healing and potentially even regenerating damaged ligaments. While still in early stages, these approaches could revolutionize treatment in the coming years, offering hope for improved outcomes and faster recovery times.

Special Considerations for Athletes and High-Risk Occupations

Certain populations, such as athletes and individuals in high-risk occupations, face unique challenges when it comes to finger ligament injuries:

Athletes

• May require more aggressive treatment to facilitate rapid return to play
• Often benefit from sport-specific rehabilitation programs
• May need to consider protective equipment or taping techniques for ongoing injury prevention

High-Risk Occupations

• May need to address workplace ergonomics and safety measures
• Might require job modification during recovery
• Could benefit from occupation-specific strengthening and prevention programs

How do treatment approaches differ for elite athletes compared to recreational athletes or non-athletes. Elite athletes often receive more aggressive treatment, including earlier surgical intervention if indicated, and may undergo accelerated rehabilitation protocols. The goal is to minimize time away from competition while ensuring adequate healing. However, this approach must be balanced against the risk of re-injury or incomplete healing, which could jeopardize long-term career prospects.

Patient Education and Self-Care for Finger Ligament Injuries

Proper patient education is crucial for optimal outcomes in finger ligament injuries. Key points to emphasize include:

• The importance of following immobilization and activity restriction guidelines
• Proper techniques for home exercises and rehabilitation
• Signs and symptoms that should prompt medical attention
• Realistic expectations for recovery timelines
• Strategies for adapting daily activities during recovery

What role does patient compliance play in the success of treatment for finger ligament injuries. Patient compliance is a critical factor in successful outcomes. Adherence to treatment protocols, including proper immobilization, attendance at physical therapy sessions, and completion of home exercises, can significantly impact healing time and the quality of recovery. Non-compliance may lead to prolonged recovery, incomplete healing, or even the need for additional interventions.

In conclusion, finger ligament tears, particularly collateral ligament injuries, are more common than once thought. With advancements in diagnostic imaging and treatment techniques, these injuries can be accurately diagnosed and effectively managed. Whether through conservative treatment or surgical intervention, the goal is to restore stability, function, and strength to the affected digit. As research continues to evolve, we can expect further improvements in treatment outcomes and potentially new approaches to managing these challenging injuries.

Collateral Ligament Injuries of the Fingers

Clinical History: A 16 year-old male presents for MRI of the hand following a wrestling injury. The patient complains of pain at the metacarpal-phalangeal joint (MPJ) of the small finger. Consecutive (1A) fat-suppressed T2-weighted images of the small finger MPJ from dorsal to palmar and a (1B) single fat-suppressed proton density-weighted axial image are provided. What are the findings? What is the diagnosis?

1a

1b

Figure 1

Findings

2a

2b

Figure 2:

The (1A) consecutive coronal images demonstrate a bulky retracted radial collateral ligament (arrows) on the first two, most dorsal slices. The ulnar collateral ligament (blue arrows) demonstrates proximal edema but is intact. On the 3rd image, attenuated midsubstance radial collateral ligament (RCL) fibers are present (red arrowhead). A fluid filled gap is present at the normal distal insertion site of the RCL on the final provided slice (red arrowhead). The normal distal ulnar collateral ligament (UCL) (blue arrowhead) is well seen on the final slice. Marrow edema within the distal metacarpal (asterisks) is compatible with a bone bruise. The (2B) proton density-weighted axial image at the level of the metacarpal head confirms the bulky retracted fibers (arrow) of the RCL.

Diagnosis

Complete retracted distal tear of the radial collateral ligament at the small finger metacarpal-phalangeal joint.

Introduction

Injuries to the fingers are quite common, as it has been estimated that 20% of emergency department visits are due to traumatic finger injuries.¹ Many such injuries involve the collateral ligaments, the best known of these being the ulnar collateral ligament tear of the thumb. Collateral ligament injuries in the fingers are thought to be less common and are relatively less reported in the literature. But clinical experience indicates that these injuries are much more frequent than once believed. ² Although the majority of reported cases involve the RCL of the index finger³, collateral ligament tears have been described in all digits.^4,5 Though some reports describe relatively low accuracy and sensitivity for MRI in the evaluation of digital collateral ligament injuries⁶, advances in technique and a proper understanding of collateral ligament anatomy allow these injuries to be routinely diagnosed with MRI.

Anatomy and Physiology

Finger collateral ligaments range in width from 4-8 mm and measure 12-14 mm in length.⁷ Proper and accessory collateral ligaments are present. The proper collateral ligaments originate from small depressions along either side of the metacarpal head and their origins lie approximately one-third of the way down from the dorsal surface of the metacarpal head. The ligaments course obliquely to insert at the palmar aspect of the proximal phalanx. Throughout this web clinic, the proper collateral ligaments will be referred to for simplicity as collateral ligaments. The accessory collateral ligaments arise at the same depression as the proper collateral ligaments but in a more palmar location. These structures extend in a palmar direction to attach firmly to the plantar plate.⁸

3

Figure 3:

Lateral 3D renderings of the metacarpophalangeal joint of the index finger demonstrate the proper radial collateral ligament (pRCL) and accessory collateral ligament (aRCL) in extension and flexion.

The collateral ligaments passively restrain the joint by preventing excess motion, but also are innervated in such a way that their nerves send signals to adjacent muscles that influence active protection of the joint in the event of stress.⁹ The collateral ligaments are taut in flexion and relaxed in extension whereas the accessory collateral ligaments are taut in extension and more relaxed in flexion. The collagen fibers of the ligaments are able to elongate under stress to reach maximum stiffness. Excessive stress overcomes this viscoelastic elongation resulting in ligamentous disruption.

Normal MRI Appearance:

The key anatomical point when evaluating the collateral ligaments on MRI is recognition of the oblique course of the ligament when the fingers are in their usual extended position for MRI scanning. Theumann et al. described a novel MR approach in which scans are obtained in flexion of the MCP, in which case the collateral ligaments can be visualized on a single orthogonal axial slice (Figure 4). Though an elegant technique, this approach is not practical for routine imaging as other anatomical structures become more difficult to evaluate. Therefore, in routine clinical practice, images are obtained with the fingers in extension, and the interpreter of MRI must recognize that the ligament should be followed from proximal to distal as one moves from dorsal to palmar in the coronal plane (Figure 5).

4

Figure 4:

A 3D rendering of a finger demonstrates how a collateral ligament can be visualized in its entirety on a single imaging slice by performing an axial image through the flexed finger.

5a

5b

Figure 5:

Consecutive 3mm thick fat-suppressed T2-weighted coronal images (5A) from dorsal to palmar at the ring finger MCP joint demonstrate the normal appearance of the proximal, mid, and distal components of the collateral ligaments (arrows). The accessory collateral ligaments are best seen on axial images at the level of the metacarpal head. On (5B) a fat-suppressed proton density-weighted axial image, the accessory collateral ligament (arrows) is best seen on the ulnar side, coursing from its origin just palmar to the proximal ulnar collateral ligament (asterisk) to its attachment to the plantar plate (P).

Although not routinely necessary, knowledge of the oblique course of the collateral ligaments allows depiction of the ligaments in their entirety through the use of oblique image reconstructions, a feature that is readily available on a number of modern PACS solutions. By creating an angled coronal slice along the typical course of the ligaments, revealing images can be obtained even when utilizing conventional 2D datasets (Figure 6).

6a

6b

Figure 6:

A fat-suppressed T2-weighted coronal oblique reformatted image (6A) of the ring finger MCP joint (same patient as in 5) demonstrates the normal radial and ulnar collateral ligaments from proximal to distal (arrowheads). The T2-weighted sagittal reference image (6B) indicates the imaging plane utilized.

MRI of Collateral Ligament Tears of the Fingers

The literature is relatively inconsistent in its descriptions of incidence and locations of collateral ligament tears of the fingers.^10,11 In our experience at Radsource, radial collateral ligament tears are more common than those on the ulnar side. The index (Figure 7) and small fingers (Figure 2) are most commonly affected, presumably because they are not buttressed on both sides by adjacent fingers. Ulnar collateral ligament tears are most common at the index finger as it is susceptible to unsupported radial deviation, but high grade radial collateral ligament tears of the index finger (Figure 8) are imporant to recognize as if not properly treated such tears are more likely to result in significant functional impairment with loss of pinch and grasp strength. ¹²

7a

7b

Figure 7:

A fat-suppressed T2-weighted coronal image from a 26 year-old male who suffered a twisting injury to the index finger reveals a thickened and edematous proximal UCL (arrow) compatible with a relatively mild partial tear. No ligamentous gap is seen. Avulsive marrow edema is present deep to the ligament origin and bone bruising is evident along the radial aspect of the joint (asterisks), the latter presumably due to valgus force. The thickened and edematous proximal UCL (arrow) is confirmed in its typical dorsal location on a fat-suppressed proton density-weighted axial image at the level of the metacarpal head.

8a

8b

Figure 8:

A 58 year-old female presents two weeks after injury to the index MCP joint from a fall when playing tennis. 2 consecutive fat-suppressed T2-weighted coronal images (8A) from dorsal to palmar are provided. On the first image, an undersurface partial tear (arrow) is seen at the proximal attachment of the RCL. On the next more palmar slice, stripped ligamentous tissue (arrow) is noted to extend more proximally than is typical. Joint instability is apparent on a corresponding fat-suppressed T2-weighted sagittal image (8B), with clear palmar subluxation of the proximal phalanx (asterisk). A bone bruise (arrow) is apparent within the dorsal aspect of the metacarpal head.

Collateral ligament tears at the MCP joints can be proximal, distal, or least commonly midsubstance (Figure 9). One particular pattern of injury is quite important to recognize. In some cases of collateral ligament tears of the MCP joint, ligamentous tissue can become interposed between its attachment site and the sagittal band or extensor hood, resulting in a “Stener-like lesion”.¹³ We have seen this appearance at multiple digits, but most commonly the tear involves the RCL of the small finger. Such cases (Figures 10-13) result in a ligament tear that can never reattach with conservative treatment, and as with similar lesions at the MCP joint of the thumb, are an absolute indication for surgical repair.

9a

9b

Figure 9:

MRI of the long finger MCP joint in a 43 year-old male 5 weeks after injury with persistent pain and instability despite conservative therapy. Consecutive fat-suppressed T2-weighted coronal images from dorsal to palmar (9A) demonstrate a thickened edematous proximal RCL likely due to retracted ligamentous fibers (arrow) on the most dorsal image. The middle image reveals a near-complete midsubstance ligamentous gap (arrow). The 3rd, most palmar view demonstrates residual intact ligamentous fibers at the distal insertion (arrow). A coronal oblique reconstruction (9B) demonstrates the entirety of the ligament with its midsubstance defect (arrow). The normal UCL (asterisk) is well seen on this oblique view.

10a

10b

Figure 10:

STIR coronal (10A) andn axial (10B) images from a 75 year-old male injured in a fall demonstrate a complete distal tear of the small finger MCP joint RCL with displaced ligamentous tissue (arrows). The displaced ligament clearly lies peripheral to the radial sagittal band (arrowheads) on the axial view.

11a

11b

Figure 11:

A 47 year-old male plumber presented 4 weeks after striking the dorsum of his hand after falling from a ladder. He complained of a tender mass between the ring and small metacarpal heads. A STIR coronal image (11A) reveals a retracted distal tear of the RCL at the small finger MCP joint. As a mass was suspected, the study included post-contrast images. A post-coontrast fat-suppressed T1-weighted axial view demonstrates enhancement which nicely delineates the torn retracted RCL (arrow 11B). The RCL clearly lies superficial to the radial sagittal band (arrowheads).

12a

12b

Figure 12:

Operative photos from another patient with a “Stener-like” lesion of the small finger MCP joint RCL. The RCL (arrow) was distally torn and retracted to lie peripheral to the radial sagittal band (asterisk). The involved structures are outlined in 12B (red-sagittal band, green-RCL). Photos courtesy of Sunil Thirkannad, MD, Kleinert Kutz Hand Center, Louisville, KY.

13

Figure 13:

3D dorsal radial views of the 5th metacarpophalangeal joint demonstrate the mechanism of the Stener-like lesion. The normal position of the radial collateral ligament is depicted deep to the radial sagittal band (left image). With a sufficient abduction stress the radial collateral ligament tears white arrow (middle image), and with progressive ulnar deviation the radial collateral ligament (arrowhead) can displace superficial to the radial sagittal band (asterisk), which prevents apposition of the torn ligament and spontaneous healing.

Treatment

Conservative treatment such as splinting and buddy taping is recommended by most surgeons for stable partial collateral ligament tears and for tears with non-displaced or minimally displaced avulsion fractures. In such cases splinting is typically required for 3-6 weeks. Typical indications for operative intervention include the presence of intra-articular fractures, large avulsion fragments, and Stener-like lesions. However, any high grade collateral ligament tear with joint instability should be considered for surgical repair, as there is a well known risk of chronic instability and secondary osteoarthritis in patients with such tears that are treated conservatively (Figure 14). Ligaments left to heal conservatively often appear thicker due to scarring and disorganized collagen, but these thicker structures lack the strength of a normal collateral ligament. Highly active individuals such as athletes or people whose work demands active gripping are candidates for operative intervention, as are patients with chronic tears who have failed conservative therapy.

14a

14b

14c

Figure 14:

A 65 year-old female with a history of long finger MCP joint RCL tear treated conservatively presents with pain and swelling at the joint. STIR (14A) and proton density-weighted coronal (14B) images reveal thickening of the proximal RCL (arrows) at the long finger MCP joint with metacarpal marrow edema on the STIR image and increased signal within the ligament on the proton density-weighted view. Loss of joint space is apparent. The T1-weighted sagittal image (14C) demonstrates prominent subchondral degenerative changes at the metacarpal head (arrow).

Although arthroscopic repair of MCP collateral ligaments has been described¹⁴, the vast majority of surgeries for MCP collateral ligament injuries are performed as open procedures, typically utilizing interference screws or anchors. The joint is approached dorsolaterally, incising the extensor apparatus at the junction of the extensor tendon and the sagittal band. The ligament should be reattached in 45 degrees of flexion in order to achieve correct tensioning, and post-operatively the patient is typically splinted in 30-45 degrees of flexion.¹⁵ Surgical results are generally excellent with patients often achieving full recovery in 10-11 weeks without residual laxity. As with most other body parts in the musculoskeletal system, MRI can be of benefit in the evaluation of post-operative patients who have persistent symptoms (Figure 15).

15a

15b

15c

Figure 15:

A radiograph at the time of initial injury in a 46 year-old female who suffered a RCL proximal avulsion fracture (arrow) at the small finger MCP joint. The patient returned for MR imaging 2 years after surgery with complaints of recurrent instability. STIR (15B) and proton density-weighted (15C) coronal images demonstrate an intact ligamentous repair (arrows) with proximal artifact from a metallic anchor. Though the ligament is intact it appears longer and more lax than a typical collateral ligament, perhaps accounting for instability in this patient.

Conclusion

Collateral ligament injuries at the MCP joints of the fingers are under-unreported in the literature, but are routinely encountered in a busy musculoskeletal radiology practice. The key to accurate diagnosis is the understanding of the anatomy and the oblique course of the collateral ligaments with the fingers in extension. Knowledge of this anatomy allows the astute interpreter of MRI to diagnose the injury and gauge the degree of severity, including ligamentous retraction or gaps. In rare cases, a “Stener-like” lesion may be found, and in this situation surgery is required to achieve an acceptable clinical result.

References

1. Clark DP, Scott RN, Anderson IW. Hand problems in an accident and emergency department. J Hand Surg (Br) 1985;10(3):297–299. ↩
2. Delaere OP, Suttor PM, Degolla R, et al. Early surgical treatment for collateral ligament rupture of the metacarpophalangeal joints of the fingers. J Hand Surg (Am) 2003; 28A:309–315. ↩
3. Gaston RG, Lourie GM. Radial collateral ligament injury of the index metacarpophalangeal joint: an underreported but important injury. J Hand Surg (Am). 2006;31(8):1355–61. ↩
4. Dray G, Millender LH, Nalebuff EA. Rupture of the radial collateral ligament of a metacarpophalangeal joint to one of the ulnar three fingers. J Hand Surg Am 1979;4:346-350. ↩
5. Ishizuki M. Injury to collateral ligament of the metacarpophalangeal joint of a finger. J Hand Surg Am 1988;13:444-448. ↩
6. Lutsky K, Levi D, Beredjiklian P. Utility of MRI for diagnosing complete tears of the collateral ligaments of the metacarpophalangeal joints of the lesser digits. HAND (2014) 9:112–116. ↩
7. Dy CJ, Tucker SM, Kok PPL, Hearns KA, Carlson MG. Anatomy of the radial collateral ligament of the index metacarpophalangeal joint. J Hand Surg Am. 2013;38(1):124e128. ↩
8. Theumann NH, Pfirrmann CW, Drape JL, et al. MR Imaging of the Metacarpophalangeal Joints of the Fingers. Part I. Conventional MR Imaging and MR Arthrographic Findings in Cadavers. Radiology 2002; 222:437–445. ↩
9. Rozmaryn LM. The Collateral Ligament of the Digits of the Hand: Anatomy, Physiology, Biomechanics, Injury, and Treatment. J Hand Surg Am. 2017;42(11):904e915. ↩
10. Lourie GM, Baston RG, Freeland AE. Collateral Ligament Injuries of the Metacarpophalangeal Joints of the Fingers. Hand Clin 22 (2006) 357–364. ↩
11. Theumann NH, Pessis E, Lecompte M. MR imaging of the metacarpophalangeal joints of the fingers: evaluation of 38 patients with chronic joint disability. Skeletal Radiol (2005) 34:210–216. ↩
12. Doyle JR, Atkinson RE. Rupture of the radial collateral ligament of the metacarpophalangeal joint of the index finger: a report of three cases. J Hand Surg (Br) 1989;14(2):248–50. ↩
13. Coffey MJ, Stadnick ME, Thirkannad SM. Stener-like lesion in the little finger (letter). The Journal of Hand Surgery Vol. 34E No. 2 April 2009 ↩
14. Abernathie BL, Lovy AJ, Koehler SM, Hausman MR. Arthroscopic Repair of Collateral Ligaments in Metacarpophalangeal Joints. Arthrosc Tech. 2015 Apr; 4(2): e97–e100. ↩
15. Kang L, Rosen A, Potter HG, Weiland AJ. Rupture of the Radial Collateral Ligament of the Index Metacarpophalangeal Joint: Diagnosis and Surgical Treatment. The Journal of Hand Surgery / Vol. 32A No. 6 July–August 2007. ↩

Finger Sprains: Symptoms, Causes, Diagnosis, Treatment

Written by WebMD Editorial Contributors

Medically Reviewed by Jabeen Begum, MD on September 21, 2022

• Sprained Finger Causes
• Sprained Finger Symptoms
• Sprained Finger Diagnosis
• Sprained Finger Treatment

A sprained finger is when you either stretch or tear one of the ligaments in your finger.   A ligament is a band of soft tissue. Most connect the outside surface of one bone to another bone.

A sprain is different from a strain, which is an injury to one of your muscles or tendons, the cords of tissue that connect your muscles to your bones.

Common causes of finger sprains include:

• An injury that causes your finger either to bend too far or bend in the wrong direction. If your finger bends backwards, it’s called “hyperextension.” For example, you might accidentally bend your finger in these ways during physical activities — especially in sports that involve using your hands, like basketball. You might accidentally jam your finger into a piece of equipment like the ball, or into another player, causing a sprain.
• Falling on your hand. You’re more likely to get a sprain if you have problems with balance or coordination, which makes you more likely to fall, or if you have weak ligaments.

If your finger is sprained, you might have:

• Pain in one of your finger joints when you try to move or use it
• Stiffness in your finger or having a hard time straightening or bending it
• Tenderness in your joint when you touch the area
• Swelling in one of your finger joints

Sometimes athletes who get sprained fingers ignore the injury. But the pain can be severe, and left untreated, it could get worse.

Your doctor will do a physical exam of your finger. You may also get imaging tests like an X-ray, and, in less common cases, an MRI.

If you do have a finger sprain, your doctor will assign it a grade based on how severe it is:

Grade 1: Your joint is stable but you have some stretching or microtearing in your ligament.

Grade 2: You have some mild instability in your joint and partial tearing in your ligament.

Grade 3: There’s significant instability in your joint and you’ve either severely or completely torn your ligament.

There are different treatments to help you feel better.

RICE therapy

Your doctor may recommend RICE therapy to manage your symptoms. RICE stands for Rest, Ice, Compression, and Elevation:

Rest: If a specific sport or activity caused your sprain, take a break from it for a while to help your finger heal.

Ice: Within the first 24 hours of your injury, you should apply ice to the area for 15 minutes at a time. If your symptoms last longer than that, you can do this for several days after the injury, too. This will ease any swelling or inflammation in your joint, and help ease the pain. Don’t put the ice directly on your skin. Instead, put it in a plastic bag or a cloth.

Compression: Your doctor may recommend that you wear an elastic compression bandage around your finger to provide support and prevent swelling.

Elevation: During the first 24 hours after your injury, try to keep your injured hand elevated to reduce swelling.

Your doctor may also suggest:

• Anti-inflammatory medication (such as aspirin, ibuprofen, or naproxen) to help with your pain.
• A finger splint.
• Buddy taping, which is when you tape it to the finger next to it If you do buddy taping, make sure to tape your middle finger to your index finger and your ring finger to your pinky.
• Surgery, if your injury is severe, meaning your ligament is completely torn or a piece of your bone has broken off.

Top Picks

First Aid and Treatment

Content

• 1 Finger Tendon Rupture: First Aid and Recovery
  • 1.1 Finger Tendon Rupture: First Aid and Treatment
    • 1.1.1 First Aid

    9 0005 1.1.2 Treatment

  • 1.2 What is a tendon rupture?
  • 1.3 Symptoms of a tendon rupture
  • 1. 4 First aid for a tendon rupture in the finger
    • 1.4.1 Stop the bleeding
    • 1.4.2 Fix the finger
    • 1.4.3 Apply ice to the damaged area
    • 1.4.4 Perform repair procedures
  • 1.5 How and where to treat a tendon rupture on the finger?
    • 1.5.1 First aid
    • 1.5.2 Treatment
  • 1.6 Rehabilitation after tendon rupture treatment
    • 1.6.1 Individual approach
    • 1.6.2 Physiotherapy
    • 1.6.3 Exercise
    • 1.6.4 Restriction of work
    • 1.6.5 Diet
  • 1.7 Exercise regimens after tendon rupture treatment
    • 1.7.1 Restorative physiotherapy techniques
    • 1.7.2 Stretching and strengthening exercises
    • 1.7.3 Important tips
  • 1.8 How to prevent tendon rupture ?
  • 1.9 Factors affecting recovery after tendon rupture treatment
  • 1.10 How long does it take for a tendon rupture to heal?
  • 1.11 Alternative Treatments for Tendon Rupture
  • 1. 12 Q&A:
    • • 1.12.0.1 What is a finger tendon tear and how does it happen?
      • 1.12.0.2 What are the symptoms associated with a tendon rupture in the finger?
      • 1.12.0.3 How to give first aid in case of tendon rupture on the finger?
      • 1.12.0.4 What are the treatments for a tendon rupture in the finger?
      • 1.12.0.5 How long does it take to recover after surgery for a tendon rupture in a finger?
      • 1.12.0.6 What complications can arise from a tendon rupture in the finger?
  • 1.13 Need for surgery for a torn tendon in the finger
  • 1.14 Related videos:

Learn how to deal with a torn tendon in the finger Tse hands, what could be the consequences and how to speed up the process of recovery. Tips and recommendations from experienced professionals in the article on our website.

An accident in which a tendon rupture occurs in the finger, often occurs in professional athletes, people engaged in physical labor, and also when falling on the hand. It is characterized by acute pain, swelling and impaired motor functions of the finger.

In such a situation, it is necessary to quickly and competently provide first aid, and then contact a specialist who will determine the extent of the injury and prescribe treatment.

There are several methods of treatment: conservative, in which measures are taken to strengthen the tissues and restore function of the finger, and surgical, which includes cutting the wound and connecting the torn sections of the tendon.

It is important to remember that self-medication can lead to complications and aggravate the condition. Contact the professionals!

Finger tendon rupture: first aid and treatment

First aid

If there is a tendon rupture in the finger, the first thing to do is to stop the bleeding, if any. To do this, it is necessary to bandage the injured finger or apply a pressure bandage. No ointment, other than an antiseptic, should be applied so as not to disrupt the body’s natural healing response.

Ice or any other cold object can then be used to reduce swelling and pain. Note that cooling should be carried out for 20 minutes every 2-3 hours during the first day. Also, with a rupture of the tendon on the finger, you can use pain medications in the form of analgesics, of course, on the recommendation of a doctor.

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Treatment

After giving first aid, the patient should see a doctor. Sometimes a doctor can do without surgery if the injury is not too serious. For this, kinesio taping, laser treatment, massage, physiotherapy are used. If the rupture of the tendon is too serious, surgical intervention is required, during which the affected area of ​​the tendon will be stitched.

After the operation, the patient is given a course of rehabilitation, which may include antibiotics, a cast or splint, therapeutic exercises, massage, and physiotherapy. Everything is individual, based on the severity of the injury and the patient’s condition. It is important to follow all the doctor’s prescriptions and not to exercise without his permission.

What is a tendon rupture?

Tendon rupture is an injury to the tendon that occurs as a result of sudden physical exertion or injury. Such injury can occur during jumps, falls, bumps, and other accidents.

Tendon is an elastic connective tissue that connects muscles to bones. It is responsible for the transfer of force from the muscles to the bones when performing movements. When a tendon ruptures in the area of ​​the finger, movements become difficult and painful, as the muscles cannot transfer force to the bones.

Symptoms of a tendon rupture in the finger may include, but are not limited to, a sharp pain, swelling, bruising, difficulty moving the finger, and crackling sounds when moving.

Symptoms of a tendon rupture

A tendon rupture in the finger is a serious injury and presents with several characteristic symptoms.

• Pain syndrome: pain at the site of a tendon rupture can be very severe, especially when moving a finger. The pain worsens during exercise on the arm and can lead to painful muscle spasms.
• Edema: tendon rupture is accompanied by swelling of the tissue at the site of injury, which can lead to limited movement of the finger.
• Bruising: Bruising may occur at the site of tendon rupture. It indicates the presence of internal hemorrhage and requires immediate medical attention.
• Mobility restriction: tendon rupture in the finger can lead to limited finger movement and difficulty performing daily tasks.

If you notice these symptoms, you should contact a specialist for a thorough examination and determine further treatment.

First aid for tendon rupture in the finger

Stop the bleeding

If there is bleeding, apply pressure to the wound. To avoid squeezing the arteries and blood vessels, the dressing should be applied above the level of the wound. If the bleeding is severe, you should immediately call an ambulance.

Lock the finger

Lock the finger in order for the tendon to heal. For the first time, you can use an impromptu splint made of matches and a bandage. In the presence of special clamps, the finger must be fixed by them.

Apply cold to the injured area

Cold can be applied to the injured area to reduce tissue swelling and pain. Cold can be used as a compress or ice massage. Do not apply cold for more than 15-20 minutes at a time.

Perform recovery procedures

After first aid, a series of procedures should be performed to restore motor functions. These include various exercises for the hand and finger, physiotherapy.

It is important to remember that tendon rupture is a serious injury that requires comprehensive treatment. It is necessary to contact specialists and follow their recommendations for treatment and rehabilitation after injury.

How and where to treat a tendon rupture in the finger?

First Aid

If a tendon ruptures in the finger, contact a surgeon immediately. Prior to the arrival of medical help, first aid should be given:

1. Stop bleeding if it occurs;
2. Applying cold to the injured area will help reduce swelling and pain;
3. Fix the finger with a special bandage.

Treatment

Treatment of a tendon rupture in the finger begins with diagnosis and examination. After this procedure, a decision is made on further treatment, which may include:

• Immobilization of the injured finger with a cast or special support;
• Intensive care of the patient’s body condition;
• Surgery to repair the tendon.

In most cases, the treatment of a tendon rupture in the finger is successful and restores the function of the finger.

Method of treatment Advantages Disadvantages

Immobilization	Quick recovery of the finger after repair of damage;	May cause discomfort in everyday life and also does not provide full finger mobility.
Surgery	Provides full recovery of the finger and its functions;	May be unsafe for the patient, does not guarantee full recovery in some cases.

Rehabilitation after tendon rupture treatment

Individual approach

Recovery after tendon rupture requires an individual approach to each patient. The rehabilitation doctor develops a program of rehabilitation classes that takes into account the type of gap, age and general condition of the patient.

Physical Therapy

A key component of the rehabilitation program is physical therapy to help restore function to the torn tendon and speed up the healing process. This may be laser therapy, electrical stimulation and other methods prescribed by a doctor.

Exercises

Exercises to strengthen the muscles around the tendon become part of the rehabilitation program. They help restore range of motion and restore strength to a torn tendon.

• Exercises for the development of fingers at least from the palmar part.
• Stretching the muscles of the finger with a bandage, expander and other devices containing means for developing the muscles of the fingers.
• Squeezing various objects such as a ball or kettlebell to strengthen the muscles.

Restriction of work

It is possible that for some time after treatment, patients will have to reduce the load on the hand with a torn tendon. It can be certain movements, as well as work with super-heavy objects. The purpose of this limitation is to prevent re-rupture and speed up the recovery process.

Diet

Some foods help accelerate tissue healing, including tendons. It is important to learn how to eat right so that you can get the necessary nutrients for quick healing. For example, you need to consume enough protein, vitamin C and zinc.

Exercise charts after tendon rupture treatment

Rehabilitation physiotherapy techniques

After tendon rupture treatment on the finger, it is necessary to start rehabilitative physical therapy. The main objective of this procedure is to restore and strengthen the functionality of the damaged tendon.

There are several types of rehabilitation physiotherapy. One of them is the Felder technique, which includes a set of stretching and strengthening exercises. Another popular method is the Cox technique, which is based on a variety of stretching exercises and the slow development of an injured tendon.

Stretching and strengthening exercises

Each technique includes stretching and strengthening exercises for the injured tendon. One such exercise is hand massage. This massage helps to strengthen the muscles, improve blood circulation in the injured limb and return the tendon to its normal state.

Another effective exercise is hand gymnastics. Simple movements, such as squeezing and expanding the hand, help restore hand mobility and strengthen the injured tendon.

Important Tips

• Start with light exercises. Although stretching and strengthening exercises can help repair a damaged tendon, you should start with light exercises. Do not try to immediately move on to more complex ones.
• Don’t overdo it. Active physical therapy will help speed up recovery, but don’t overdo it – it can be harmful. Don’t forget the measure.

How to prevent tendon rupture?

A tendon rupture in the finger is an unpleasant and painful phenomenon, so it is best to prevent it in advance.

Keep your hands in good shape. Do exercises and workouts regularly to strengthen the muscles in your hand and fingers. This helps increase the level of tendon flexibility and strength.

Be careful. Wear gloves while doing manual labor. This can protect your hands from injuries and bruises that can lead to tendon rupture in your fingers.

Watch your health. Alcohol abuse and smoking impair blood circulation in the body, which can reduce the strength of the tendons and make them less elastic.

Be attentive to your body. If you have any pain or discomfort in your hand, then consult a doctor and undergo a preventive examination. Tendon problems detected early can be successfully treated and a possible rupture can be avoided.

Factors affecting recovery after tendon rupture treatment

Proper treatment and first aid in case of tendon rupture is only the first step towards recovery. The results of treatment and the speed of recovery may depend on several factors:

• Location and nature of the rupture – it is important to determine how serious the tendon rupture was, as this determines the possibility of functional load on the arm after its treatment;
• Depth and length of the tear – this can affect the difficulties during the rehabilitation process;
• Age of victim – for older patients, recovery from treatment may be slower and more difficult;
• General health – Associated health problems such as diabetes, heart disease, or obesity can slow down the healing process;
• Time elapsed before treatment – the longer you stay inactive, the more difficult it will be to repair the tendon and return the hand to normal.

Most often, after going through all the stages of treatment and rehabilitation, recovery after a rupture of the tendon of the finger occurs completely, subjected to normal functional load.

How long does it take for a tendon rupture to heal?

The time it takes for a torn tendon to heal depends on many factors, such as the location of the injury, the age and general health of the patient, and the treatment chosen.

A tendon rupture usually takes weeks to months to heal. In the first few days after the injury, the patient must remain calm and wear a plaster cast or other fixative. During this period, the doctor may prescribe pain medication and apply ice to the affected area.

Once healing begins, regular exercise and manipulation is important to maintain tissue flexibility and strength. In some cases, a rehabilitation course may be required, which can last several months.

If the pain worsens, seek immediate medical attention. Prolonged lack of treatment or the wrong treatment method can lead to loss of mobility and a decrease in the patient’s quality of life.

Alternative Treatments for Tendon Rupture

In addition to conventional medicine, there are alternative treatments for tendon rupture that can help speed healing and reduce pain.

• Acupuncture – injections of needles into certain points can improve blood circulation and stimulate the process of tissue regeneration.
• Massage – Special massage techniques can improve blood flow and reduce swelling, which will reduce pain and speed healing.
• Homeopathy – Some homeopathic remedies can help reduce pain, speed up healing, and improve the mobility of the affected finger.
• Phytotherapy – Herbal treatment can help speed healing and reduce tissue inflammation.

In any case, before using any alternative treatment for tendon rupture, it is imperative to consult a specialist and clarify possible contraindications.

Q&A:

What is a finger tendon rupture and how does it happen?

A torn tendon in the finger is an injury to the connective tissue that connects muscles to bones. Usually, a tendon rupture in the finger occurs when the hand moves sharply or falls on the fingers.

What are the symptoms associated with a tendon rupture in the finger?

The main symptoms of a tendon rupture in the finger are: pain when moving the finger, swelling, bruising, feeling of weakness in the finger, limited movement.

How to give first aid for a tendon rupture in the finger?

In case of a tendon rupture on the finger, it is necessary to: stop the bleeding (if any), apply a fixing bandage to the finger on which the tendon is damaged, apply cold compression, call an ambulance.

What are the treatments for a tendon rupture in the finger?

Treatment of a tendon rupture in the finger may include: conservative therapy (treatment without surgery), surgical therapy (surgery), rehabilitation measures, physiotherapy, massage, therapeutic exercises.

How long does it take to recover after surgery for a tendon rupture in a finger?

The duration of rehabilitation after surgery for tendon rupture on the finger depends on the complexity of the operation, the general physical condition of the patient, the timing of the start of treatment and other factors. On average, rehabilitation can last from several weeks to several months.

What complications can arise from a tendon rupture in the finger?

Complications of a tendon rupture in the finger can be different: impaired finger movement, reduced hand function, impaired sensation in the finger, infections, arthritis, and others.

Need for surgery for a torn tendon in the finger

A torn tendon in the finger is a serious injury that can lead to partial or complete immobility of the finger. In some cases, surgery may be required to restore the functionality of the finger.

Surgery may be needed if the tendon is torn halfway or completely and cannot heal on its own. Also, surgery is necessary if the vessels or nerves in the area of ​​damage are damaged.

If the damage to the tendon is not too serious and the treatment was carried out in time, then surgery may not be required. In this case, the restoration of the functionality of the finger can be achieved with the help of a period of rehabilitation and the use of special painkillers.

In any case, the decision on the need for surgery is made by the surgeon, who examines and diagnoses the injury. The causes and features of the injury may be different, so each case requires an individual approach to treatment and a decision on the need for surgery.

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Finger tendon rupture: treatment and symptoms

Why is a finger tendon rupture dangerous? The mobility of the hand is provided by the coordinated work of the flexors and extensors. The first are on the palmar surface of the hand, the second – on its back side. Fingers do not have muscles, so their movements are carried out through connective tissues. Flexors can be superficial or deep. Some of them are on the middle phalanges, others are on the nails. Tendon injuries occupy the first place among the injuries of the hands and fingers. About 30% of them are accompanied by complete or partial tendon ruptures. This is due to the special arrangement of tissues, which makes them easy to damage.

Classification

Injuries to the ligaments of the thumb reduce the functionality of the hand by 50%, the index and middle – by 20%. They are most common among people who prefer amateur sports activities. Depending on the presence of skin damage, tendon ruptures are divided into open and closed. The first occur when injured with piercing-cutting objects. The latter are diagnosed in athletes. The tendon is damaged when it is overstretched.

Tears are divided into partial and complete, the severity of the injury is assigned depending on the number of torn fibers. Total damage is more difficult to cure. Rupture of one ligament is considered isolated, several – multiple. We are talking about a combined injury in case of damage to muscle tissues, blood vessels and nerve endings.

When prescribing treatment, it is important to determine the age of the injury. A subcutaneous rupture that occurred less than 3 days ago is considered fresh. Injuries that occurred more than 3 days ago are called stale. Those that happened 21 or more days ago are old.

Common causes of injury

Tendon and joint capsule injuries can be traumatic or degenerative in origin. The latter type is the result of tissue thinning, the first occurs with a sharp rise in weight. Sports injury can have a mixed origin.

Provoking factors are:

• a short break between workouts;
• lack of warm-up during class;
• reassessment of one’s capabilities;
• non-compliance with safety regulations.

The risk group includes people who are overweight and the elderly.

Characteristic signs

The symptoms of a finger ligament tear are determined by its location. Damage to the tissues located on the anterior surface of the hand is accompanied by a violation of flexion functions. In this case, the fingers acquire an overbent position. When the tendons of the back of the hand are injured, extensor abilities suffer. Damage to the nerve endings can lead to numbness and paresthesia. If at least one of the symptoms listed above appears, you should consult a doctor. Fresh injuries heal faster than old ones.

If a person notices that the function of the hand is seriously impaired, they should apply a sterile dressing and a cold compress. This prevents hemorrhage and the development of swelling. The limb must be raised above the head, this will slow down the speed of blood flow.

In the emergency room, the initial treatment of the wound is carried out, including the application of antiseptic solutions to the skin, stopping bleeding and suturing. After that, a tetanus toxoid vaccine is given and antibacterial drugs are administered. If a rupture of the extensor tendon of the finger is detected, the patient is sent to the surgeon. Without the operation, the brush may lose its function.

Therapeutic measures

Treatment of extensor tendon injuries can be carried out not only surgically, but also conservatively. However, this does not apply to flexor injury. In case of finger injuries, long-term wearing of a cast or other fixing device is indicated.

Injuries occurring in the area of ​​the wrist are treated exclusively with surgery. The ends of the torn ligament are sewn together. If the damaged tissues are located in the area of ​​the distal interphalangeal joint, the splint is applied for 5-6 weeks.

Faster recovery of finger functions is observed after the extensor tendon suture operation.

A post-surgery fixation device is required to keep the joint in an extended position. You will have to wear it for at least 3 weeks. The splint must be worn on the finger at all times. Its early removal can contribute to the rupture of the scar that has begun to form, as a result of which the nail phalanx will again assume a bent position. In such cases, repeated splinting is indicated. During the treatment period, it is recommended to be under medical supervision.

In boutonniere-type deformity, the joint is fixed in a straight position until the damaged tissues are completely healed. The suture is necessary for reduction and complete rupture of the tendon. In the absence of treatment or improper splinting, the finger assumes a bent state and freezes in this position. It is necessary to follow all the instructions of the traumatologist and wear a splint for at least 2 months. The doctor will tell you exactly when it will be possible to remove it.

An extensor tendon rupture at the level of the metacarpal, carpal joint, and forearm requires surgery. Spontaneous muscle contraction leads to a tightening of the tendons and a significant divergence of the damaged fibers.

The operation is performed under local anesthesia. First, the bleeding is stopped, after which the torn ligament is sutured to the distal phalanx. If the injury is accompanied by a fracture, the bone fragment is fixed with a screw. The needle in the finger plays the role of a retainer.

Sutures and a tight cast or plastic splint are then applied. Postoperative immobilization helps avoid rupture of the repaired tendon.

Surgical intervention is performed on an outpatient basis, after its completion the patient can recover home.

Recovery period

Rehabilitation for finger flexor tendon rupture includes:

• massage;
• exercise therapy;
• taking medications.

Rubbing accelerates the process of repairing damaged tissues, increases their strength. The ligament must be worked out with the fingertips, the load must be increased gradually. Movements are carried out along the damaged section of the tendon.