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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Finger Collateral Ligament Injury | Steven Lee, MD

Description:

In each of the fingers (index, middle, ring and pinky) there are three joints called the distal interphalangeal (DIP), proximal interphalangeal (PIP), and metacarpophalangeal (MCP) joint. The thumb has two joints, the interphalangeal (IP) and MCP joint. ​ Collateral ligaments are like leather bands of strong tissue connecting the bones in each of those joints that help to stabilize the joint throughout movement. 

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Injury to the collateral ligament occurs when there is a force in a direction different from the normal motion of the joint that is large enough to tear the ligament.  This is most commonly caused by a fall onto an outstretched hand, a finger getting caught on something, or a dog leash wrapped around a finger that gets pulled.    Patients often self-diagnose themselves with a “jammed finger.” Extreme trauma can actually cause the joint to dislocate.  

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Symptoms:

Patients with collateral ligament injuries of the finger may experience pain and tenderness on the side of the finger joint.  A feeling of  instability may be present when opening and closing the fingers and pinching objects.  In addition, patients may notice swelling or bruising at the affected area.

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Testing:

Initial evaluation of the injury starts with a physical exam of the fingers in order to assess for ligament instability or laxity. Provocative testing of the ligament will be performed by applying stress to the ligament at the involved joint(s) of the affected finger and comparing it to the unaffected finger.  An assessment is made to determine whether the ligament is sprained (stretched or partially torn) or if it’s completely torn.  This is based on the degree of gapping or instability. 

An x-ray will typically be ordered to rule out a fracture.   

Treatment Options:

​When determining treatment for this type of injury, a variety of important factors are considered. These include the classification of the injury, the degree of the tear, the specific joint and finger of the injured ligament, and the presence of a fracture.

Most collateral ligament injuries may be treated with nonsurgical management.  Patients who have relatively stable joints are typically treated with consistent buddy taping of the finger to provide support and stabilization while maintaining joint mobility.  Buddy taping involves taping or strapping the injured finger above and below the affected ligament to an adjacent finger, thereby providing a “buddy system.”  Unstable joints may be treated with splinting followed by buddy taping. 

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Hand/physical therapy is often gradually initiated in order to allow the ligament to properly heal.  Hand/physical therapy is vitals towards reducing stiffness and regaining mobility and strength.   Unfortunately, collateral ligament injuries tend to take an extended period of time to heal, usually no less than 6 weeks, and often up to several months.  

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Surgical Treatment:

Surgery may be recommended depending on the location of the ligament tear,  the presence of a displaced avulsion fracture, or if nonsurgical management is unsuccessful. Surgery is often indicated for complete tears to the collateral ligament of the index finger given the ligament plays an important role in finger pinch. Repair of the ligament involves making a small incision over the affected ligament and using suture and anchors to secure the ligament into a proper position.  If there is a displaced avulsion fracture, surgery may be considered to realign the avulsed fragment of bone and fix it back into proper position with a small screw. 

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Dr. Steven Lee has revolutionized the treatment of ligament tears and collateral ligament tears specifically with his pioneering of Internal Bracing of the Hand.   Internal bracing utilizes an innovative strong suture tape construct with new bone anchors in order to increase the strength of the repair or reconstruction, thereby significantly quickening the rehabilitation process, and allow earlier return to sports and daily function.  Please feel free to ask Dr. Lee about his specific expertise with this method.  Learn more about Internal Bracing here.

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As in the non-operative treatment of these injuries, the recovery period after surgery can be unusually prolonged, and can take at least 3 months to heal.  Swelling may be present for much longer, and to a certain extent, may always be there whether surgery was performed or not.

Learn more about scheduling surgery.

Recovery Expectations:

After surgery, patients will usually be placed into a finger splint on the affected finger, with an adjacent finger included, for additional support. Patients usually follow up in office 7-10 days after surgery for a wound check and if there are stitches, to check if they are ready for removal.

Depending on the extent of surgery performed, patients will continue to be splinted for up to 3 – 6 weeks. After this period of immobilization, to allow for healing, patients are usually transitioned to buddy taping and initiated on a course of gradual hand/occupational therapy to restore mobility to the fingers.

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Immediate Post-Operative Instructions

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Please refer to the following pages for more information:

• What should I expect after surgery? 

• What foods or supplements should I have after surgery?

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*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables.  It is provided as an educational service and is not intended to serve as medical advice.  Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.

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*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City and Scarsdale.

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₽

See full price list

Benefits of treatment at the ART Clinic

0002 A team of highly qualified specialists with extensive experience

Modern minimally invasive methods of operations and reconstructions

Affordable prices, promotions, discounts, installments

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.