What are the common causes of ruptured ligaments in fingers. How can you recognize the symptoms of a finger ligament injury. What treatment options are available for ruptured finger ligaments. How long does recovery from a finger ligament injury typically take. What are potential long-term effects of untreated ligament injuries in fingers.

Understanding Finger Ligament Anatomy and Function

Ligaments play a crucial role in finger function and stability. These tough, fibrous tissues connect bones to other bones, providing support and limiting excessive movement at the joints. In the fingers, several key ligaments work together to enable precise movements while maintaining joint integrity.

The main ligaments in each finger include:

• Collateral ligaments: Located on either side of each finger joint, providing lateral stability
• Volar plate: A thick ligament on the palmar side of each joint that prevents hyperextension
• Accessory collateral ligaments: Reinforce the collateral ligaments for additional support

Understanding this complex anatomy is essential for properly diagnosing and treating ligament injuries in the fingers. When these ligaments are damaged or ruptured, it can lead to joint instability, pain, and loss of function.

Common Causes of Finger Ligament Injuries

Finger ligament injuries often occur during sports activities or accidents. Some of the most common causes include:

1. Ball sports: Getting hit by a ball in basketball, volleyball, or baseball
2. Contact sports: Fingers getting caught in opponents’ clothing or equipment
3. Falls: Landing on an outstretched hand or individual finger
4. Workplace accidents: Crushing injuries or repetitive strain
5. Everyday mishaps: Jamming a finger in a door or while catching an object

These incidents can cause ligaments to stretch beyond their normal range, resulting in sprains or complete tears. The severity of the injury depends on the force applied and the direction of the impact.

Mechanism of Injury

Ligament injuries typically occur when a finger is bent backwards (hyperextended) or sideways with significant force. This can cause the ligaments to stretch or tear, compromising the stability of the finger joint. In some cases, the ligament may even pull off a small piece of bone where it attaches, known as an avulsion fracture.

Recognizing Symptoms of Finger Ligament Injuries

Identifying a ligament injury in the finger is crucial for proper treatment. Common symptoms include:

• Pain: Especially when moving the affected joint or applying pressure
• Swelling: Often immediate and localized around the injured area
• Bruising: May develop within hours or days after the injury
• Stiffness: Difficulty moving the finger through its normal range of motion
• Instability: The joint may feel loose or unstable when manipulated
• Deformity: In severe cases, the finger may appear bent or misaligned

The severity of these symptoms can vary depending on the extent of the ligament damage. A minor sprain may cause only mild discomfort, while a complete rupture can result in significant pain and instability.

Grading Ligament Injuries

Finger ligament injuries are typically classified into three grades:

1. Grade I (Mild): Ligament is stretched but not torn; minimal loss of function
2. Grade II (Moderate): Partial tear of the ligament; some joint instability
3. Grade III (Severe): Complete rupture of the ligament; significant instability

Accurately assessing the grade of injury is essential for determining the appropriate treatment plan and expected recovery time.

Immediate First Aid for Finger Ligament Injuries

When a finger ligament injury occurs, prompt first aid can help minimize damage and promote healing. The RICE protocol is the recommended initial approach:

• Rest: Avoid using the injured finger to prevent further damage
• Ice: Apply cold packs for 15-20 minutes every 1-2 hours to reduce swelling
• Compression: Use a light elastic bandage to compress the injured area
• Elevation: Keep the hand elevated above heart level to minimize swelling

It’s important to seek medical attention promptly, especially if there is significant pain, swelling, or deformity. A healthcare professional can properly assess the injury and recommend appropriate treatment.

What to Avoid

Certain actions can potentially worsen a finger ligament injury:

• Heat application in the first 48-72 hours
• Massage of the injured area
• Alcohol consumption, which can increase swelling
• Continuing to use the injured finger for strenuous activities

Avoiding these actions can help prevent complications and support the healing process.

Diagnostic Procedures for Finger Ligament Injuries

Accurate diagnosis is crucial for effective treatment of finger ligament injuries. Healthcare providers may use several methods to assess the extent of the damage:

• Physical examination: Checking for swelling, tenderness, and joint stability
• Stress testing: Carefully manipulating the joint to assess ligament integrity
• X-rays: To rule out fractures or identify avulsion injuries
• Magnetic Resonance Imaging (MRI): For detailed soft tissue imaging in complex cases
• Ultrasound: Can be useful for visualizing ligament tears in real-time

These diagnostic tools help determine the severity of the injury and guide treatment decisions. In some cases, a combination of techniques may be necessary for a comprehensive assessment.

Differential Diagnosis

It’s important to distinguish ligament injuries from other finger conditions that may present similarly:

• Tendon injuries
• Fractures
• Dislocations
• Arthritis flare-ups

A thorough examination and appropriate imaging can help ensure an accurate diagnosis and appropriate treatment plan.

Treatment Options for Finger Ligament Injuries

Treatment for finger ligament injuries varies depending on the severity of the injury and the specific ligament affected. The primary goals of treatment are to promote healing, restore function, and prevent long-term complications.

Conservative Treatment

For mild to moderate ligament injuries, conservative treatment is often sufficient:

• Splinting or buddy taping to immobilize the injured finger
• Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and swelling
• Physical therapy to improve range of motion and strength
• Gradual return to activities as healing progresses

Most Grade I and many Grade II injuries can be successfully managed with these non-surgical approaches.

Surgical Intervention

Severe ligament injuries or those that don’t respond to conservative treatment may require surgery:

• Ligament repair: Stitching torn ligaments back together
• Reconstruction: Using grafts to replace severely damaged ligaments
• Fixation of avulsion fractures: Reattaching bone fragments with pins or screws

Surgery is typically followed by a period of immobilization and structured rehabilitation to restore function.

Rehabilitation and Recovery Process

Proper rehabilitation is crucial for optimal recovery from finger ligament injuries. The process typically involves several phases:

1. Protection phase: Immobilization to allow initial healing
2. Early mobilization: Gentle exercises to prevent stiffness
3. Progressive strengthening: Gradually increasing resistance exercises
4. Functional training: Practicing tasks specific to daily activities or sports

The duration of each phase varies depending on the severity of the injury and individual healing rates. A typical recovery timeline might look like this:

• Mild sprains: 2-4 weeks
• Moderate tears: 4-8 weeks
• Severe injuries or post-surgical recovery: 8-12 weeks or longer

Throughout the rehabilitation process, it’s important to follow the guidance of healthcare professionals to avoid re-injury and ensure optimal healing.

Therapeutic Modalities

Various therapeutic techniques may be employed during rehabilitation:

• Manual therapy: Soft tissue mobilization and joint manipulation
• Ultrasound: To promote tissue healing and reduce inflammation
• Electrical stimulation: For pain management and muscle re-education
• Heat therapy: To improve tissue flexibility in later stages of healing

These modalities, when used appropriately, can complement exercise-based rehabilitation and support the recovery process.

Preventing Finger Ligament Injuries

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

• Proper technique: Learning and practicing correct form in sports and work activities
• Equipment: Using appropriate protective gear, such as gloves or tape
• Conditioning: Strengthening hand and finger muscles to improve joint stability
• Awareness: Being mindful of potential hazards in the environment
• Warm-up: Properly warming up before engaging in strenuous activities

For athletes and workers in high-risk occupations, specific preventive measures may be recommended by sports medicine professionals or occupational health experts.

Taping and Bracing

Prophylactic taping or bracing can provide additional support to finger joints:

• Athletic tape: Can be used to limit excessive joint movement
• Finger sleeves: Provide compression and mild support
• Custom splints: May be recommended for individuals with recurrent injuries

While these methods can offer some protection, they should not be relied upon as the sole means of injury prevention.

Long-Term Outlook and Potential Complications

The long-term prognosis for finger ligament injuries is generally good, especially with proper treatment and rehabilitation. However, some potential complications can occur:

• Chronic instability: If ligaments heal in an elongated position
• Stiffness: Due to prolonged immobilization or scar tissue formation
• Osteoarthritis: Increased risk in joints that have suffered significant injury
• Deformity: Particularly in cases of untreated or severe injuries

Regular follow-up with healthcare providers and adherence to rehabilitation protocols can help minimize these risks and optimize long-term outcomes.

Monitoring Progress

Ongoing assessment is important to ensure proper healing and function:

• Regular range of motion measurements
• Strength testing as healing progresses
• Functional assessments for return to sport or work activities
• Periodic imaging to evaluate ligament healing in complex cases

By closely monitoring progress, healthcare providers can adjust treatment plans as needed and address any emerging concerns promptly.

Understanding the complexities of finger ligament injuries, from their causes and symptoms to treatment options and long-term outlook, is crucial for anyone dealing with this type of injury. Whether you’re an athlete, a worker in a high-risk occupation, or simply someone who has experienced an unfortunate accident, proper care and attention to these injuries can make a significant difference in recovery and future hand function. Always consult with healthcare professionals for personalized advice and treatment plans tailored to your specific situation.

Ligament Injuries In The Fingers – Hand – Conditions – Musculoskeletal – What We Treat

What is a ligament injury in the fingers?

A ligament injury in a finger is when one or more of the ligaments supporting a finger joint is overstretched and damaged. Physiotherapy is important following a ligament injury in the finger.

How does a ligament injury in the fingers happen?

Ligaments are injured when they are overstretched. This can occur if a finger is bent back with force. This is common in the sports and may be caused by a ball hitting the finger or if a finger gets caught on a fellow competitor’s clothing, a net or the ground.

Above: Soft tissue massage and mobilisations of the finger tendons and joints

What are the symptoms of a ligament injury in the fingers?

When a ligament supporting a finger joint is injured pain is felt in the finger. It is often made more painful if the joint is moved or if the finger is touched where the ligament is injured. Shortly after the injury the finger will become swollen and then bruised. Other symptoms may include:

• reduced range of movement
• stiffness
• weakness
• deformity
• biomechanical problems

What should I do if I have a ligament injury in my finger?

If you have or suspect you have a ligament injury in your finger, you should begin the RICE regime (Rest, Ice, Compression, and Elevation). Rest involves not using your finger. Ice should be applied to the injured site for 15–20 minutes every 1–2 hours using a bag of frozen peas in a moist cloth or towel or by submerging the finger in a cup of ice with a little bit of water.
Compression can be applied with a firm elastic bandage around the finger. Elevation involves lying or sitting with the injured site resting comfortably on a chair or pillows so that it is above the level of the heart. You should continue the RICE regime until your initial assessment with your physiotherapist. This should be arranged for as soon as possible following the injury (within the first couple of days).

Physiotherapy treatment for a ligament injury in the fingers.

Physiotherapy is very important in the treatment of an injured ligament within a finger. Initially, your physiotherapist will assess which tissues have been damaged and the extent of this damage. Referral for an X-ray may be required to determine whether any of the bones are damaged. From the assessment, your physiotherapist can devise a treatment plan specific to you.

Treatment may involve wearing a splint, electrotherapy to decrease pain, swelling and promote healing. Your physiotherapist will also provide you with a graduated programme of stretching and strengthening exercises to improve joint movement and strength. When you do return to normal activity or participation in sports your physiotherapist will advise you on protective measures such as taping techniques, splints and supports to protect the injured ligament/s.

Other treatment includes:

• Wax therapy
• Massage
• Soft Tissue Treatment
• Proprioceptive Exercise

What shouldn’t I do if I have a ligament injury in my finger?

If you have or suspect you have a ligament injury in your finger, you should not perform activities which increase blood flow to the injured area. These activities include hot showers, heat rubs, massage and the consumption of alcohol. These may increase swelling around the injured ligament and potentially prolong your recovery.

Can there be any long-term effects from a ligament injury in the fingers?

Most ligament injuries within a finger heal without complication in a matter of weeks. However, a proportion of injuries can result in longer-term effects, depending on the severity of the injury and extent of damage. When a ligament supporting a finger joint is injured, a piece of the bone it attaches can sometimes be chipped-off. This may prolong your recovery. Recovery may also be prolonged if the ligament is completely torn as surgery may be required to repair the ligament.

To arrange a physiotherapy assessment call Physio.co.uk on 0330 088 7800 or book online.

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Acute Finger Injuries: Part I. Tendons and Ligaments

JEFFREY C. LEGGIT, LTC, MC, USA, AND CHRISTIAN J. MEKO, CAPT, MC, USA

Improper diagnosis and treatment of finger injuries can cause deformity and dysfunction over time. A basic understanding of the complex anatomy of the finger and of common tendon and ligament injury mechanisms can help physicians properly diagnose and treat finger injuries. Evaluation includes a general musculoskeletal examination as well as radiography (oblique, anteroposterior, and true lateral views). Splinting and taping are effective treatments for tendon and ligament injuries. Treatment should restrict the motion of injured structures while allowing uninjured joints to remain mobile. Although family physicians are usually the first to evaluate patients with finger injuries, it is important to recognize when a referral is needed to ensure optimal outcomes.

The severity of acute finger injuries is often underestimated, which can lead to improper treatment. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. Part I of this two-part article focuses on common tendon and ligament injuries of the finger. Part II¹ discusses common finger fractures, dislocations, and thumb injuries.

Family physicians can manage most finger injuries; however, knowledge of referral criteria is important to ensure optimal outcomes. Treatment should restrict the motion of injured structures while allowing uninjured joints to remain mobile. Patients should be counseled that it is not unusual for an injured digit to remain swollen for some time and that permanent deformity is possible, even after treatment. Table 1 summarizes the evaluation and treatment of common ligament and tendon injuries.

Clinical recommendation	Evidence rating	References
Patients with finger injuries should receive a minimum of anteroposterior, true lateral, and oblique radiographic views.	C	5
Patient compliance should be monitored when treating mallet finger with splinting, because it is imperative for successful outcomes. All splints for mallet finger achieve similar results.	B	15
Patients with confirmed or suspected jersey finger should be referred to an orthopedic or hand surgeon.	C	18
A low threshold for referral should exist for collateral ligament injuries in children, because the growth plate often is involved.	C	7,11

Injury	Examination	Treatment	Referral criteria
Central slip extensor tendon injury (may cause a boutonniére deformity over time)	Tender at dorsal aspect of the PIP joint (middle phalanx)	Splint the PIP joint in full extension for six weeks.	Avulsion fracture involving more than 30 percent of the joint or inability to achieve full passive extension
	Inability to actively extend the PIP joint
Collateral ligament injury (usually at the PIP joint)	Maximal tenderness at involved collateral ligament	Stable joint: buddy tape for two to four weeks. Do not leave fifth digit exposed if ring finger is taped.	Unstable joint or injury in a child
	Test stability of joint while the finger is in 30 degrees of flexion and the MCP joint is flexed.
Extensor tendon injury at the DIP joint (mallet finger)	Tender at dorsal aspect of the DIP joint	Splint the DIP joint continuously for six weeks.	Avulsion fracture involving more than 30 percent of the joint or inability to achieve full passive extension
	No active extension of the DIP joint
FDP tendon injury (jersey finger)	Tender at volar aspect of the DIP joint	Splint finger and refer to orthopedic or hand surgeon.	All
	Inability to flex the DIP joint
	DIP joint should be isolated during the examination.
Volar plate injury (usually at the PIP joint)	Maximal tenderness at the volar aspect of involved joint	Splint at 30 degrees of flexion and progressively increase extension for two to four weeks.Buddy tape at the joint if injury is less severe.	Unstable joints or large avulsion fragments
	Test for full flexion and extension as well as collateral ligament stability.

Basic Anatomy of the Finger

The anatomy of the finger is complex, but a basic knowledge is necessary to properly treat acute injuries. The index, middle, ring, and fifth digits have proximal, middle, and distal phalanges and three hinged joints: distal interphalangeal (DIP), proximal interphalangeal (PIP), and metacarpophalangeal (MCP). The thumb has a distal and proximal phalanx as well as an interphalangeal and MCP joint. The joints sit in volar plates (collateral ligaments attached to dense fibrous connective tissue), which provide joint stability.^2,3

The dorsal extensor tendon divides into a central slip that extends the PIP joint and then into two lateral bands that extend the DIP joint. The volar tendons include the flexor digitorum superficialis and the flexor digitorum profundus. The flexor digitorum superficialis tendon attaches to the base of the middle phalanx and flexes the PIP joint. The flexor digitorum profundus tendon is located under and splits the flexor digitorum superficialis tendon. It attaches to the base of the distal phalanx and flexes the DIP.⁴Figure 1 illustrates the basic anatomy of the finger, including joints, ligaments, and tendons.

Evaluation

Neurovascular and active flexion/extension testing will reveal clues to tendon and ligament injuries as well as subtle rotational abnormalities. The neurovascular evaluation should include two-point discrimination and capillary refill assessments. The physician should evaluate active flexion and extension by asking the patient to open and close his or her fist.

Clinical examination alone cannot diagnose fractures, and treatment protocols depend on radiography results. Patients with finger injuries should receive oblique, anteroposterior, and true lateral radiographic views.⁵ True lateral radiography is the most effective way to examine anatomic joint congruity.^6,7 Ultrasonography is emerging as an effective tool to evaluate soft tissue structures.⁸

The evaluation of finger injuries during an athletic event differs from an evaluation in the office. The primary goal on the field is to detect neurovascular compromise and determine if the athlete can safely continue participation. All on-field evaluations must be readdressed in the office for a more thorough examination including radiography. Failure to do so increases the risk of future dysfunction.

Common Injuries

Several techniques may be used to diagnose common ligament and tendon injuries. Most injuries require splinting and follow-up to evaluate the healing process.

EXTENSOR TENDON INJURY AT THE DIP JOINT

Injury to the extensor tendon at the DIP joint, also known as mallet finger (Figure 2), is the most common closed tendon injury of the finger. Mallet finger usually is caused by an object (e.g., a ball) striking the finger, creating a forceful flexion of an extended DIP. The extensor tendon may be stretched, partially torn, or completely ruptured or separated by a distal phalanx avulsion fracture.⁹

Patients with mallet finger present with pain at the dorsal DIP joint; inability to actively extend the joint; and, often, with a characteristic flexion deformity. It is important to isolate the DIP joint during the evaluation to ensure extension is from the extensor tendon and not the central slip. The absence of full passive extension may indicate bony or soft tissue entrapment requiring surgical intervention.^4,7,10 Bony avulsion fractures are present in one third of patients with mallet finger.^11,12

If no avulsion fracture is present on radiographs, the DIP joint should be splinted in a neutral or slight hyper-extension position for six weeks¹³; the PIP joint should remain mobile. A Cochrane review^14,15 confirmed that all available splints achieve similar results. Furthermore, the use of surgical wires (i.e., fixing the affected joint in a neutral position by drilling a wire through the DIP joint to the PIP joint) did not improve clinical outcomes.^14,15Figure 3 describes different types of splints.

The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.

Physicians should advise patients with mallet finger not to flex the DIP joint during treatment; the splinting period must restart every time flexion occurs. A Cochrane review¹⁵ showed that patient compliance is the most important factor in the success of splint treatments. The distal phalanx should be supported during splint changes.¹⁶ This is difficult to achieve alone, and the patient may need to return to the physician’s office for splint changes. Necrosis of the skin can occur if the DIP joint is overextended during splinting. If the skin blanches, the DIP joint is overextended. Allowing the skin to “breathe” for 10 to 20 minutes between splint changes minimizes the risk of maceration.

Patients may continue to participate in athletic events during the splinting period, and physicians should follow up with patients every two weeks to ensure compliance. After six weeks of splinting, the joint should be reexamined. If active extension is present, splinting can be limited to when the patient is sleeping and during athletic events for another six weeks.

Conservative treatment is successful for up to three months, even with delayed presentation. ¹¹ Referral criteria include bony avulsions involving over 30 percent of the joint space or the inability to achieve full passive extension. Despite proper treatment of mallet finger, permanent flexion of the fingertip is possible. The finger can become deformed if the injury is left untreated.¹⁷

FLEXOR DIGITORUM PROFUNDUS TENDON INJURY

Disruption of the flexor digitorum profundus tendon, also known as jersey finger (Figure 4), commonly occurs when an athlete’s finger catches on another player’s clothing, usually while playing a tackling sport such as football or rugby. The injury causes forced extension of the DIP joint during active flexion. The ring finger is the weakest finger and accounts for 75 percent of jersey finger cases.¹⁸ The injury can occur if the force is concentrated at the middle phalanx or at the distal phalanx.

A patient with jersey finger may present with pain and swelling at the volar aspect of the DIP joint and the finger may be extended with the hand at rest. There may be a tender fullness if the tendon has been retracted. The digitorum profundus tendon should be evaluated by isolating the affected DIP joint (i.e., holding the affected finger’s MCP and PIP joints in extension while the other fingers are in flexion) and asking the patient to flex the DIP joint.^18,19 If the digitorum profundus tendon is damaged, the joint will not move. The flexor digitorum superficialis tendon should be evaluated by holding the unaffected fingers in extension and asking the patient to flex the injured finger.¹⁹ An injured flexor digitorum superficialis tendon will produce no movement. Figure 5 illustrates these techniques.

The prognosis for patients with jersey finger worsens if treatment is delayed and if severe tendon retraction is present.²⁰ Patients with confirmed or suspected jersey finger should be referred to an orthopedic or hand surgeon for treatment.¹⁸

CENTRAL SLIP EXTENSOR TENDON INJURY

Central slip extensor tendon injury occurs when the PIP joint is forcibly flexed while actively extended; it is a common injury in basketball players. Volar dislocation of the PIP joint also can cause central slip ruptures.²¹

The PIP joint should be evaluated by holding the joint in a position of 15 to 30 degrees of flexion. If the PIP joint is injured, the patient will be unable to actively extend the joint; however, passive extension should be possible. Tenderness over the dorsal aspect of the middle phalanx will be present. A delay in proper treatment may cause a boutonnière deformity (flexion of the PIP joint coupled with hyperextension of the DIP and MCP joints) (Figure 6). A boutonnière deformity usually develops over several weeks as the intact lateral bands of the extensor tendon slip inferiorly. Occasionally, boutonnière deformities occur acutely.

The PIP joint should be splinted in full extension for six weeks if there is no avulsion or if the avulsion involves less than one third of the joint. All available splints (Figure 3) can be used to treat PIP injuries, except for the stack splint, which is used only for DIP injuries. As with mallet finger, extension of the PIP joint must be maintained continuously. If full passive extension is not possible, the physician should refer the patient to an orthopedic or hand surgeon.

Patients with PIP joint injuries may continue to participate in athletic events during the splinting period, although some sports are difficult to play with a fully-extended PIP joint. Splinting duration is the same as with mallet finger.

COLLATERAL LIGAMENT INJURIES

Forced ulnar or radial deviation at any of the interphalangeal joints can cause partial or complete collateral ligament tears. The PIP joint usually is involved in collateral ligament injuries, which are commonly classified as “jammed fingers.”

Collateral ligament injuries present as pain located only at the affected ligament. The injury should be evaluated by applying valgus or varus stress to the involved joint in 30 degrees of flexion while the MCP joint is flexed at 90 degrees; an extended MCP joint will tighten the collateral ligaments, inhibiting the evaluation. The physician should compare the laxity of the injured finger with an unaffected finger. Radiography may demonstrate an avulsion fracture at the ligamentous insertion point.

If the joints are stable and no large fracture fragments are present, the injury can be treated with buddy taping (i.e., taping the injured finger, above and below the joint, to an adjacent finger) (Figure 7). If the ring finger is involved, it should be secured to the fifth digit, because the fifth digit is naturally extended and easily injured if exposed.

Patients with collateral ligament injuries may continue participating in athletic events as symptoms allow. If joints are unstable with active ranges of motion, patients should be referred to an orthopedic or hand surgeon. A low threshold for referral should exist for collateral ligament injuries in children, because the growth plate often is involved.^7,11

VOLAR PLATE INJURY

Hyperextension of a finger joint, such as a dorsal dislocation, can injure the volar plate (Figure 8). The PIP joint usually is affected, and collateral ligament damage often is present. The volar plate can be partially or completely torn, with or without an avulsion fracture.¹¹ The subsequent loss of joint stability may allow the extensor tendon to gradually pull the joint into hyperextension, causing deformity.

Maximal tenderness will be located at the volar aspect of the affected joint. Full extension and flexion will be possible if the joint is stable. The collateral ligaments should be tested as with collateral ligament injuries. Radiographs may show an avulsion fragment at the base of the involved phalanx.

A stable joint without a large avulsion fragment should be splinted with a progressive extension splint (“block splint”) (Figure 9) starting at 30 degrees of flexion^7,22 for two to four weeks, depending on injury severity; buddy taping should follow. Increasing the extension of a dorsal aluminum splint weekly will progressively increase range of motion. ²² In less severe injuries, the injured joint should be buddy taped. This will restrict some extension and provide support. These two techniques may allow a patient to continue participating in athletic events sooner; however, participation depends on the athlete’s sport and position; it is difficult to play some sports with a flexed PIP joint. Referral criteria include an unstable joint or a large avulsion fragment.

Injuries / tears / avulsions of the flexor and extensor tendons of the fingers – Injuries of the hands – Treatment and recovery

For the proper functioning of the hand, the coordinated work of the flexor and extensor tendons of the fingers is necessary. There are no muscles in the fingers, so their flexion and extension is realized due to the tendons of the muscles that are located on the forearm. The flexor tendons are located on the palmar surface of the hand, the extensor tendons are located on the back side directly under the skin. Each finger has two flexor tendons, superficial and deep. The deep flexor attaches to the nail phalanges and is responsible for bending them, while the superficial flexor attaches to the middle phalanges. Injuries to the flexors and extensors of the fingers are quite common due to the predominantly superficial location of the tendons. When the flexors of the fingers are injured, the end of the tendon located proximally is pulled, because of this it is very difficult to find the ends of the tendon when it breaks. When the extensor is injured, the tendon practically does not move, therefore, it is easier to treat.

Types of injuries

• Tears and avulsions of tendons
  Injuries to the flexors and extensors of the fingers of the hand are accompanied by a violation of their integrity with direct or indirect impact. In case of damage, a rupture and complete detachment of the tendon from its place of attachment to the bone fragment is possible.

  Injury Qualification:

  • Open and closed – depending on the violation of the integrity of the skin
  • Partial and complete – depending on the degree of damage
  • Fresh, stale and old – depending on the statute of limitations of the injury
  • Combined, isolated, and multiple – depending on the number of lesions
• Inflammatory processes
  • Tenosynovitis of the hand is an acute or chronic inflammation that occurs in the synovial membranes of the fibrous sheaths of the tendons of the muscles of the hand and fingers. Tendovaginitis is accompanied by a crunch during movements, a slight swelling along the affected tendon sheath
  • Tenosynovitis (or de Quervain’s disease) is a disease in which inflammation of the tendons of the thumb occurs. The pain associated with this ailment arises from the friction of the swollen tendons against the walls of the tunnel intended for their movement, at the base of the thumb and under it, as well as along the edge of the wrist joint. It is manifested by aching pain in the wrist area.
  • Knott’s disease (trigger finger, spring finger) is a disease of the flexor tendons of the fingers and their surrounding ligaments, the characteristic feature of which is a clicking that occurs when the fingers move. As the disease progresses, finger extension becomes almost impossible.

Symptoms

With ruptures or separations, the following symptoms are observed:

• In case of damage to the tendons on the palmar surface of the hand or fingers, there is a violation of the function of flexion, due to which the fingers are in an overextended state
• Injuries to the dorsum of the hand impair the extension function of one or more fingers
• Numbness of fingers and other sensory disorders (with nerve damage)
• Finger deformity
• Edema
• Hemorrhage
• Tendon injury
• Visible soft tissue injury (open injury)

Which doctor to contact

• Orthopedic traumatologist
• Surgeon

Diagnostics

• Detailed examination by a traumatologist of the injury site, diagnostic tests (flexion-extension of the fingers in one sequence or another)
• X-ray of fingers
• Ultrasound examination (ultrasound)
• Magnetic resonance imaging

Treatment

With damage to the extensor, two treatment options are possible: conservative and surgical. Damage at the level of the fingers can be cured without surgery, but subject to prolonged wearing of a cast or plastic splint. In all other cases, as well as with injuries of the flexor tendons, surgical treatment is indicated. The operation is a complex surgical intervention, often using microsurgical techniques. It consists in dissecting the skin and suturing the ends of the torn tendon under local or conduction anesthesia. In the postoperative period, the arm is necessarily fixed with a plaster cast.

When the ends of the tendons are crushed or torn, they are excised. In order to avoid postoperative flexion contracture, operations are performed to lengthen the tendon in the tendon-muscular part or its Z-shaped lengthening proximal to the area of ​​damage.

In some cases, with chronic injuries of the flexor tendons of the fingers (the presence of tendon defects 2 or more centimeters long), the patient is shown tendon plasty, or plasty with preliminary formation of the tendon canal using temporary tendon arthroplasty with a silicone endoprosthesis. Most often, plastic surgery is performed in conjunction with other surgical interventions (tendon revision, tenolysis, etc.).

After any method of treatment of injuries of the extensor and flexor fingers of the hand, rehabilitation is necessary. For 3-5 weeks, the tendons grow together quite firmly, after which you can remove the plaster cast and, under the supervision of a doctor, begin recovery procedures.

Restoration of all necessary functions of the fingers includes: physiotherapy exercises for the development of the hand, physiotherapy, massage, salt baths and other procedures prescribed by a doctor.

In Moscow, you can make an appointment with qualified specialists at the NCC Clinic No. 2 (Central Clinical Hospital of the Russian Academy of Sciences). Waiting for you.

Finger tendon rupture: operation in Moscow

This is a closed injury to the extensor apparatus of the finger, most often at the level of the distal interphalangeal joint.

Most common tendon injury. The injury occurs as a result of a sharp unexpected flexion (impact) on the nail phalanx of the finger, in the distal interphalangeal joint. As a result, overstretching and rupture of the thin extensor tendon of the finger occurs. In some cases, there is a detachment of the bone fragment, to which the extensor tendon is attached. As a result, extension of the nail phalanx of the finger is impossible. The so-called “finger-hammer” is formed. In some cases, due to tendon degeneration, tendon rupture occurs with little effort.

Prices for treatment of extensor tendon rupture

Extensor tendon rupture

Anesthesia

90 112

Anesthesia for surgical treatment
Local anesthesia (the operation is performed under the supervision of an anesthesiologist)	10,000₽
Intravenous sedation (TVVA)	20,000 RUB
General anesthesia (KETN). The duration of the operation is from 2 to 8 hours.	40 000₽

Hospital stay

901 19 7 000₽

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Benefits of treatment at the ART Clinic

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Briefly about the procedure

Duration of the operation

1 hour

Aneste

local anesthesia

Suture removal

after 6-7 days

Hospitalization

1 day

Examination

2-3 times

Rehabilitation

After suture removal

Contact person

All specialists

Subcutaneous rupture of the extensor tendon of the finger occupies a leading position among all injuries of the hand. The very moment of rupture may not be accompanied by severe pain. The tear of the tendon leads to the fact that the hand ceases to perform its function normally, and the finger acquires a hammer-like appearance. In some cases, the rupture occurs during a finger injury and is accompanied by a detachment of a fragment of the bone of the nail phalanx at the site of tendon attachment.

Seeking help from a hand reconstruction specialist in a timely manner makes it possible to restore the integrity of a damaged finger tendon in case of spontaneous rupture or injury due to injury. The Art Clinic performs surgical treatment of tendon rupture.

What can cause a tendon rupture in the hand

Often the cause of injury is a sharp blow or bending of the phalanx of the finger. The extensor tendon of the finger is overstretched and torn, sometimes with a fragment of bone. As a result of an injury to the phalanx, the finger takes on a hammer-like appearance. The finger stops flexing on its own.

Other causes of finger tendon rupture:

• tendon degenerative processes;
• ignoring safety regulations during manual work;
• excessive sports activities, short interval between workouts;
• unsuccessful falls, blows.

Rupture can occur both with a single impact on the hand, and after prolonged loads, several blows.

Symptoms of injury

A tendon rupture in the little finger, middle finger or other finger is not always immediately recognizable. In most cases, at the time of injury, a person hears a click, but does not feel severe pain. It is possible to suspect subcutaneous tendon rupture by characteristic symptoms:

• finger does not extend on its own, but can be straightened by using the other hand;
• edema appears at the site of injury;
• pain in the finger.

Pain is especially intense when a bone fragment is torn off.

Treatment at the Art Clinic

At the Art Clinic, the treatment of finger tendon rupture is performed by surgical methods. The operation does not require special preparation and long recovery. The reconstruction of the damaged tendon is performed under local anesthesia. The operation lasts up to 60 minutes, the patient’s stay in the clinic is from several hours to a day.

If an injury has occurred, the finger has become like a hammer, you should not hesitate to contact the Art Clinic for help. Call the specified phone number or leave a request on the website to find out the price of treatment in Moscow and sign up for an initial consultation.

More about the procedure

Symptoms of extensor tendon rupture

As a rule, an extensor injury is not accompanied by severe pain. Sometimes people notice only after a while that there is no active extension of the nail phalanx.

The finger can be painlessly extended with the other hand, but cannot be extended by itself. Swelling and soreness are possible, especially when a bone fragment is torn off.

Features of the operation

The priority method of treatment is the fixation of the nail phalanx with a needle for 5-6 weeks. The needle sinks under the skin and allows you to use your finger in everyday life. After removal of the pin within a few weeks, the movement in the joint is completely restored. This operation is most effective in the first week after the injury.

A more complex operation is required if:

• a bone fragment is torn off more than 30% of the width of the articular surface
• palmar distal phalanx subluxation
• injury more than 3 weeks ago

In these cases, the torn tendon is sutured to the distal phalanx. If there is a fracture, the bone fragment is fixed with a pin. The nail phalanx is fixed in the position of moderate hyperextension with a needle passed through the joint so as not to tear the tendon suture.

Preparing for surgery

There are no special recommendations for preparing for surgery. On the day of surgery, do not eat or drink liquids in the morning. If you take medication regularly, take it with one sip of water.