It’s an extremely common pathology, usually the result of a sporting accident.
The most frequent mechanism is the turning over of fingers during ball sports such as volleyball, basketball, handball or rugby.
The most frequently traumatized finger is the ring finger, but all fingers can be affected.
SYMPTOMS AND CLINICAL EXAMINATION
The patient may hear a cracking or popping sound in the finger. Finger swelling is very rapid in the proximal interphalangeal joint.
Pain is severe when the finger is mobilized.
FURTHER TESTS
X-rays of the finger are essential to identify any injury more severe than a sprain, i.e. a dislocation of the finger (the joint is no longer in place) or a fracture of the finger.
X-rays often show a small bone tear at the base of the second phalanx, corresponding to a ligament tear and therefore indicative of a sprain.
Most doctors mistakenly refer to this small bone tear as a fracture of the second phalanx.
In fact, this small bone tear corresponds to the disinsertion of a powerful ligament known as the palmar plate, which must be treated as a sprain.
However, if the fragment is very large, it’s a fracture, and the treatment is different from that for a sprain.
A hand surgeon must therefore be consulted quickly to distinguish between a ligamentous bone tear and a fracture of the base of the phalanx.
In the case of a finger sprain, no further tests are necessary.
TREATMENT
Sprains of the proximal interphalangeal joints of the fingers are never treated by emergency surgery.
Pain is relieved by appropriate analgesic treatment, and may persist for three to six months after the trauma, becoming nothing more than climatic pain (reappearance of painful discomfort in wet weather).
Swelling of the joint is sometimes sequential and permanent. Unfortunately, there is no effective treatment to reduce joint swelling, which is initially linked to the oedema caused by the trauma, and is rapidly replaced by thicker ligament scarring, giving the finger its characteristic swollen appearance.
The most important part of the treatment is probably rehabilitation, since the main consequence of this kind of trauma is stiffness if the finger is immobilized for long periods.
The finger can therefore be immobilized in a segmental splint for pain relief for a maximum of two weeks. After these two weeks, it is very important to mobilize the finger as much as possible, even if this is painful.
The aim is to recover as much of the joint’s range of motion as possible, before joint adhesions form, limiting the finger’s mobility.
A physiotherapist can be called in to restore the finger’s mobility more quickly, and custom-made thermoformed splints can be used to mobilize the finger effectively.
CONCLUSION
Properly treated, a sprain of the proximal interphalangeal joint of the fingers should not leave any functional after-effects.
It is therefore essential to mobilize the fingers as quickly as possible, even if this is painful.
Full recovery of joint mobility can take up to three months.
In the long term, it is not uncommon to see patients with excellent finger joint mobility, but a finger that may remain painful over time, and a joint that may be permanently swollen.
Fortunately, in the majority of cases, this type of accident, if properly treated, leaves no functional or cosmetic after-effects.
Resumption of ball sports (volleyball, basketball, handball or rugby) is possible from the sixth week onwards, under cover of either a syndactilie or a strapping of the finger.
