A simple "finger sprain" may turn out to be a complicated fracture-dislocation. Rule one is to have all finger injuries examined by a physician. Rule two is always to have an X-ray taken.
The three bones that make up each finger are the most commonly broken bones in the body. Many of the tendons attached to these finger bones can tear with or without a fracture, and the three joints - the DIP (distal interphalangeal), PIP (proximal interphalangeal) and MCP (metacarpal phalangeal) - can also suffer injury. Keep a few basics in mind when caring for finger injuries:- How the injury occurred. Was the finger pushed too far backward or forward?
- Location of pain.
- Presence or absence of instability. Stable joints don't allow movement beyond their normal range. But when a muscle or tendon tears, there is increased movement.
Broken finger
Contrary to popular belief, broken bones - especially fingers - can move when they are broken. There is immediate pain, and the finger hurts with or without movement. Swelling exists, and the finger has a "twisted" look.
Gently feel each of the bones of the injured finger. Pinpoint tenderness usually indicates a fracture. Ask the victim to make a half-fist with each hand and compare nail alignments for malrotation.
These injuries require a physician for X-rays. Splint the finger in a flexed position. Buddy taping is rarely sufficient for a broken finger.
Dislocated finger
These are common. Motion of the joint is usually impossible, and there may be some degree of circulation and sensation loss.
The first reaction may be to pull it back to where it belongs. This is exactly what to do if medical care is more than two hours away. This is called reducing a dislocation, and is most easily done right after the injury before pain and swelling become significant. Dislocations at the knuckle of the index finger and at the base of the thumb usually require surgery, and some medical experts warn about trying reduction on these two joints.
After getting the victim's consent, grasp the end of the injured finger with one hand, and the rest of the finger in the other. Pull the end of the finger first in the direction it is pointing, then while maintaining traction swing it back in line. This is not as easy as it sounds, but it does work. Never try to force a stubborn dislocation back into place. You may need to wrap the end of the victim's finger with a handkerchief or gauze to help keep your grip. Another description of how to reduce a finger dislocation: hold the fingertip in a lightly flexed position and apply traction to the tip while pushing the end of the dislocated bone back into place.
After reducing, splint it in a slightly flexed position. Check the circulation and sensation before and after reduction. Buddy taping may be used. Seek medical attention for a follow-up X-ray. Remember that reduction of a finger dislocation should only be attempted if you are more than two hours from medical help.
Mallet finger
Immediate pain, swelling in the last joint, and the inability to straighten the fingertip help identify a mallet finger. The classic sign of the fingertip "drooping" may not immediately appear because of the swelling or may not show up for one to two weeks later. This injury happens when the tendon at the top of the last finger is torn. It usually happens when a ball hits the fingertip or the fingertip hits the ground or hard object.
Splint the last or end finger joint out straight. The middle finger joint should remain free. For extreme tenderness or marked deformity seek medical attention.
Jersey tear
Sudden pain after getting the finger caught in a belt loop or while a football player grabs a jersey. The finger is bent backward beyond its normal range. The victim cannot flex the fingertip joint. Tenderness and swelling alone will not prevent finger flexing.
The victim can wait 24 hours before seeing a physician. However, this tendon tear needs surgery, and waiting more than five days can jeopardize the surgery's success.
Sprained fingers
The joints nearest the fingertip both have a ligament on either side of the joint. This injury can have severe pain and swelling over the joint.
Feel both sides of the joints for tenderness. Pain will be directly over the side of the joint rather than below the joint. Grasp the fingertip of the injured finger and stress the joint for excess movement. This test shows pain or weakness in ligaments that is not noticeable with normal fist flexing.
Use cold and compression on the finger and seek medical advice. If the joint is stable, splint the finger in a slightly flexed position until the pain stops. Protect the finger by buddy taping. If the joint is unstable or the pain is on top of the joint, definitely seek medical attention.
Blood under the fingernail
When a fingernail has been crushed, blood collects under the nail. This condition is usually very painful because of the pressure created by blood pressing against the nail. Making a hole in the nail with a hot paper clip relieves the pain and also prevents the nail from falling off in the future.
Alton Thygerson is a professor of health sciences at Brigham Young University.