DESCRIPTIONA finger dislocation is an injury to any finger joint causing adjoining finger bones to be displaced from their normal position so they no longer touch each other. Fractures and ligament sprains frequently accompany this dislocation. Any of the many finger bones, ligaments that hold the finger bones in place, and the soft tissue surrounding the dislocation site, including the periosteum (covering of the bone), nerves, tendons, blood vessels, and connective tissue, are involved. Appropriate health care includes manipulating the joint by a trained professional to reposition the child's bones; surgery (sometimes) to restore the joint to its normal position and repair the child's torn ligaments and tendons. Acute or recurring dislocations may require surgical reconstruction or eventual replacement of the joint.
SIGNS & SYMPTOMSExcruciating pain in the child's finger at the time of injury.
Loss of function in the dislocated joint.
Severe pain when the child attempts to move the injured finger.
Visible deformity if the dislocated finger has locked in the dislocated position. The child's bones may spontaneously reposition themselves and leave no deformity, but the damage is the same.
Tenderness over the dislocation.
Swelling and bruising at the injury site.
Numbness or paralysis beyond the dislocation from pinching, cutting, or pressure on the child's blood vessels or nerves.
CAUSESDirect or indirect blow to the child's hand, finger, or thumb.
End result of a severe finger sprain.
RISK FACTORSContact sports, especially basketball, baseball, and soccer.
Previous finger or hand dislocation or sprain.
Arthritis of any type (rheumatoid, gout).
Poor muscle conditioning in the child's hand.
PREVENTING COMPLICATIONS OR RECURRENCEYour child should protect vulnerable joints with protective devices or tape and should condition the hand muscles.
MEDICAL TESTSYour own observation of symptoms. X-rays of the child's hand and wrist.
At the time of injury: shock; pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels, and connective tissue.
After treatment or surgery: impaired blood supply to the dislocated area; death of bone cells due to interruption of the blood supply; infection introduced during surgical treatment; excessive bleeding around the dislocation site; continuing recurrent dislocations with progressively less severe injuries; prolonged healing if activity is resumed too soon; an unstable or arthritic joint following repeated injury or surgery.
Complete healing of a child's injured ligaments requires a minimum of 6 weeks.
FIRST AIDUse instructions for R.I.C.E., the first letters of rest, ice, compression, and elevation. See Appendix 39 for details.
After removal of the child's splint or cast, begin daily rehabilitation exercises.
Tape the child's injured finger to adjacent fingers, if instructed to do so by your doctor.
Your doctor may prescribe general anesthesia or local anesthesia to make joint manipulation possible during surgery; acetaminophen or aspirin to relieve moderate pain; narcotic pain relievers for severe pain; antibiotics to fight infection, if surgery is necessary.
If surgery is not necessary, your child does not have to restrict activity except for the limitations imposed by immobilization of the hand. If surgery is necessary, the child can resume normal activities gradually.
DIET & FLUIDS
OK TO GO TO SCHOOL?Yes, when condition and sense of well-being will allow.
CALL YOUR DOCTOR IF
Your child has signs or symptoms of a dislocated finger.
Any of the following occur after treatment: numbness, paleness, or coldness in the child's finger--this is an emergency; swelling above or below the splint or cast; blue or gray skin color, particularly under the fingernails.
Any of the following occur after surgery: increased pain, swelling, or drainage in the surgical area; signs of infection, including headache, muscle aches, dizziness, or a general ill feeling and fever.
Finger dislocations that can be "popped" back into normal position occur repeatedly.