A common (and painful!) injury with ball sports is dislocation of the proximal interphalangeal joint (PIP joint). From the time pre-season training starts until after the grand final, we see increased numbers of people from all football codes and skill levels visiting our rooms with painful, stiff, swollen fingers. Of course, this injury is not restricted to sports players; sometimes falling over, hitting a gate or the toss of a horse’s head while you’re holding the rope is enough to dislocate a joint. While dislocations can occur in many different joints, this blog will address dislocations of the PIP joint.

Many people get their joint relocated or ‘popped back into place’ immediately after the injury. Due to the risk of entrapment of surrounding structures like ligaments, nerves or arteries and the chance of doing more damage, we don’t recommend it. The safest approach is to go to the emergency department if possible, to have their finger relocated by a doctor.

It is always a good idea to get your finger X-rayed. Your joint is a strong, stable one designed to move in one plane only; when you dislocate this joint you have managed to damage some very tough soft tissues. As such it is wise to get an X-ray to check for fractures, including avulsions which can occur when a ligament or tendon breaks a piece of bone off due to excessive force.

As we’ve mentioned, your PIP joint is held together by strong ligaments which prevent excessive movement. If the joint is dislocated, then a tear in one or more structures is likely. It is worthwhile to have this assessed in order to determine the structures damaged, and their severity. Left alone, they may not heal properly. If they don’t heal then the joint may continue to dislocate easily, be painful, and deformities which affect both the appearance and use of your hand may develop. Sometimes injuries can worsen with time and require surgery when they could have been effectively managed in a shorter time if they had been treated early.

Common treatment strategies include compression bandaging to reduce swelling, splinting of the finger with thermoplastic to protect healing tissues, and neoprene splints to protect the joint while still allowing movement.

A common deformity we see which result from injuries to the PIP joint is a Boutonniere deformity. It results from a volar dislocation and causes an extensor tendon to fail.

boutonniere

Image courtesy of www.merckmanuals.com

Another common deformity is the swan-neck deformity which results from a dorsal dislocation and damages the volar plate, a tough sheet of ligament designed to prevent the joint from hyperextending.

pipdis

Image courtesy of www.eatonhand.com

The good news is that we treat these on a very regular basis and have great knowledge in the best treatment for each individual finger injury. Treatment can make result in huge improvements to your hand, both in terms of how it looks and how well it works.