Hand and finger dislocations: Difference between revisions

Latest revision as of 17:35, 14 December 2022

Background

Distal interphalangeal dislocation (DIP), proximal interphalangeal dislocation (PIP), and metacarpophalangeal dislocation (MCP) joints of the finger shown.

Volar/anterior finger anatomy.

Lateral finger anatomy.

Hand Anatomy

Volar = anterior = palmar
Dorsal = posterior

Types

Hand and finger dislocations

Finger dislocations
Thumb dislocations
- Interphalangeal dislocation (thumb) (IP)
- Metacarpophalangeal dislocation (thumb) (MCP)
Hand dislocations
- Carpometacarpal dislocation

Clinical Features

Right fifth phalanx dislocation.

See individual injury types for specific clinical features
In general, there is some history of traumatic injury with pain at the dislocated joint

Differential Diagnosis

Hand and finger injuries

Distal finger
Other finger/thumb
- Boutonniere deformity
- Mallet finger
  - Swan neck deformity
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
Hand
- Dupuytren contracture
Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
General

Evaluation

Workup

Diagnosis

Management

See individual injury type for specific management
In general, dislocations should be emergently reduced and then splinted

Disposition

See individual injury type for specific disposition
In general, dislocations should all have orthopedic outpatient follow up after successful reduction

External Links

References

Authors:

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+==Background==
+[[File:DIP, PIP and MCP joints of hand.jpg|thumb|Distal interphalangeal dislocation (DIP), proximal interphalangeal dislocation (PIP), and metacarpophalangeal dislocation (MCP) joints of the finger shown.]]
+[[File:Gray337.png|thumb|Volar/anterior finger anatomy.]]
+[[File:Gray338.png|thumb|Lateral finger anatomy.]]
+{{Hand anatomy}}
 ==Types==
 {{Hand and finger dislocation types}}
-==DIP Joint==
+==Clinical Features==
-*Uncommon due to firm attachment of skin and subq tissue to underlying bone
+[[File:Dislocated Finger.jpg|thumb|Right fifth phalanx dislocation.]]
-*When dislocations do occur usually are dorsal
+*See individual injury types for specific clinical features
-===Reduction===
+*In general, there is some history of traumatic injury with pain at the dislocated joint
-*Digital nerve block
-*Apply longitudinal traction/ hyperextension followed by dorsal pressure to phalanx base
-*Irreducible cases due to entrapment of avulsion fx, profundus tendor or volar plate
-===Management===
-*Splint in slight flexion w/ dorsal splint x3wk
-==PIP Joint==
+==Differential Diagnosis==
-*Common; due to axial load and hyperextension
+{{Hand and finger injury DDX}}
-*Dorsal dislocation occurs when volar plate ruptures
-*Lateral dislocations occur when one of collateral ligaments ruptures w/ at least partial avulsion of volar plate from middle phalanx
-===Reduction===
-*Same as for DIP joint
-===Management===
-*Stable Reduction: 3wk of immobilization in 20-30 deg of flexion
-*Unstable reduction: Surgery
-**Displacement occurs during active range of motion
-**Displacement occurs during passive stressing of joint
-**>20 deg of deformity and instability w/ lateral testing
-==MCP Joint==
+==Evaluation==
-*Usually due to hyperextension forces that rupture volar plate causing dorsal dislocation
+===Workup===
-*Two types:
-**Simple: subluxation
-***Joint appears hyperextended to 60-90 deg
-**Complex: dislocation
-***MCP joint is in moderate hyperextension w/ metacarpal head prominent in palm
-***Volar plate is interposed in MCP joint space
-***X-ray may show seasamoid within joint space (pathognomonic)
-****Closed reduction is not possible
-===Reduction===
-*Do NOT hyperextend joint (may convert subluxation into complete dislocation)
-*Flex the wrist to relax the flexor tendon
-*Apply pressure over dorsum of proximal phalanx in distal and volar direction
-===Management===
-*Splint w/ MCP joint in flexion
-*Refer to hand surgeon
-==CMC Joint==
+===Diagnosis===
-*Uncommon due to strong ligaments and insertions of wrist flexors/extensors
+<gallery mode="packed">
-**Cause is usually result of high-sped mechamisms
+File:MCCdislocation.png|[[Metacarpophalangeal dislocation (thumb)|MCP dislocation of thumb]]
-*Dislocates usually dorsally and associated w/ fracture(s)
+File:Dislocated Finger XRay.png|[[Proximal interphalangeal dislocation (finger)|PIP dislocation of right fifth phalanx]]
-===Reduction===
+</gallery>
-*Traction and flexion w/ simultaneous longitudinal pressure on metacarpal base
-===Management===
-*Refer to hand surgeon
-==Thumb ==
+==Management==
-===IP Joint===
+*See individual injury type for specific management
-*Uncommon
+*In general, dislocations should be emergently reduced and then splinted
-*Dislocations often associated w/ open injuries
-====Reduction====
-*Median nerve block
-*Reduce similar to IP joint of other digits
-====Management====
-*Immobilization in mild flexion for 3wk is usually all that is required
-===MCP Joint===
-*Like other MCP joint dislocations, may be simple or complex
-====Reduction====
-*Radial and median nerve blocks
-*Pressure directed distally on base of prox phalanx w/ metacarpal flexed and abducted
-====Management====
-*Stable reduction: Immobilize in thumb spica w/ MCP joint in 20 deg flexion for 4wk
-*Unstable reduction: ORIF
-===MCP Ulnar Ligament Rupture===
+==Disposition==
-*Also known as gamekeeper's thumb or skier's thumb
+*See individual injury type for specific disposition
-*Ulnar ligament ruptures at insertion into prox phalanx (due to radial deviation of MCP)
+*In general, dislocations should all have orthopedic outpatient follow up after successful reduction
-*X-ray (perform before joint stressing)
-**Bony avulsion from insertion of UCL into proximal phalanx
-**Associated condylar fracture
-**Proximal phalanx volar subluxation and radial deviation suggests complete UCL rupture
-*Exam
-**Swelling and localized tenderness over ulnar border of joint
-**Weakness of pinch
-**Partial versus complete rupture
-***Valgus stress testing with joint in full extension and in 30 deg of flexion
-****>35 deg of joint laxity or 15 deg of laxity beyond that present in uninjured thumb is consistent w/ complete UCL rupture
-====Management====
+==See Also==
-*Partial rupture
+*[[Hand and Finger Diagnoses (Main)]]
-**Immobilize in [[thumb spica]] for 4wk
-*Full rupture
-**Referral within 1wk
-==Differential Diagnosis==
+==External Links==
-{{Hand and finger injury DDX}}
-==See Also==
-*[[Hand and Finger Diagnoses (Main)]]
 ==References==
+<references/>
+[[Category:Orthopedics]]
-[[Category:Ortho]]