By: Kathleen Bartlett, MS, VATL, ATC

With every on-field injury resulting in an obvious deformity, invariably the question of a fracture versus dislocation arises. Although these are serious injuries, they are not the only injuries to watch out for. There seems to be a false assumption that if the injured part is not broken or dislocated, then the athlete can return to play. When it comes to fingers, there are many injuries that can become permanent problems if not treated promptly. The earlier any injury is diagnosed and treated, the better the outcome will be, and generally, the less expensive. 

When considering injuries that affect the fingers, it is also imperative to examine the hand and wrist. Because the anatomy is very complex, with many tendons, nerves and bones in a small space. Each finger has 3 bones (the thumb has 2 bones), and the hand/palm has 5 metacarpal bones that align with each finger. There are tendons attached to each bone in each finger, allowing it to flex and extend, as well as nerves and blood supply in each finger. There are also ligaments that hold the bones together and in place. Lacerations and sprains are the most common, less serious hand injuries. Other hand injuries included fractures, dislocations, and tendon and ligament injuries.

Types of Finger Injuries

Tendon injuries, which can cause deformity and limit dexterity, often go untreated, especially in children. Generally, the finger is hit by a ball, smashed on the ground or caught in an opponent’s jersey or helmet. More often than not, the athlete is unsure how the injury actually occurred, just that their finger was tangled up between equipment and/or another person and now it hurts. The injury may stop hurting after only a few days, so the athlete may not complain to a parent, coach or athletic trainer to seek treatment. The primary complaint is their finger looks “funny” and they cannot bend and/or straighten part of it. Finger tendon deformities include swan neck, boutonniere, mallet finger and jersey finger. All of these occur in the middle and end joints of the fingers (the proximal and distal interphalangeal joints).

Mallet finger is an injury to the extensor tendon. With this injury, the athlete cannot straighten the last joint of the finger. Jersey finger is the opposite – it involves the flexor tendon, so the athlete cannot bend the tip of the finger. Both deformities can be due to an injury of the tendon itself, or can occur when a small piece of the bone chips off from where the tendon attaches. These can be treated conservatively by splinting the finger for several weeks and allowing the bone and tendon to heal. Surgical intervention can also be used to reattach the tendon. If the condition appears to be mild and goes untreated, it becomes more likely that surgery will be required to fix the injury. This may or may not be practical, depending on how much it affects the athlete’s function in sport or everyday life.

Swan neck and boutonniere deformities are more obvious since they affect the middle joint of the finger. In a swan neck deformity, the middle joint is over-straightened and will not bend, or be hard to bend, without assistance. In a boutonniere deformity, the middle joint is bent and will not straighten, or be very difficult to straighten. Also, the distal joint will not bend towards the palm. These deformities can be mild, meaning the person still has motion in the joint, or severe, where the joint will not move at all. Again, conservative treatment with splinting may work if it is treated early enough. If treatment is delayed, surgery may be necessary. If untreated, the deformity may likely get worse and the athlete may lose more motion and function that could be permanent. They may also have pain when gripping for a prolonged period of time, such as when writing or gripping.

Treatment

For all of these conditions, after splinting, rehabilitation is recommended to regain finger motion and strength. This can include such treatment as massaging the stiff joint, passively moving the joint using the other hand, and exercises to strengthen the joint such as squeezing a ball and using rubber bands for resistance. When deciding the best treatment for the athlete, it is important to consider their lifestyle. Fingers are important, but some professions and sports require more dexterity than others. More severe deformities can become a problem when it comes to typing, using cell phones, and gripping. For the average athlete, it may not personally matter much if one finger is slightly deformed and needs some assistance to bend. Also, a mild deformity may not be visible to the naked eye. Each athlete should personally consider their best option.

References:

• Boutonniere and Swan Neck Deformities (PIP Joint Deformities). HTTP://HANDTOELBOW.COM/PIP-JOINT-DEFORMITY/ 12/20/16
• Arnheim, D., Prentice, W. Principles of Athletic Training 10th ed. P 682-686. 
• Finger Injuries. Emedicinehealth.com/finger_injuries. 12/21/16

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CHKD's sports medicine program offers the most comprehensive care for your young athlete. From diagnosis and treatment to customized rehabilitation plans, we specialize in physical therapy and injury prevention programs for active children and teens. Our team is composed of pediatric orthopedic surgeons, sports medicine specialists, physician assistants, certified athletic trainers and pediatric sports medicine physical therapists.