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Forum Name: Bone trauma and fractures

Question: Finger fracture, what could this be?


 shel - Mon Aug 31, 2009 10:25 pm

A week and half ago I was catching a ball and it hit the tip of my ring and little finger on the left hand. It hurt quite badly, swelling, bruising, pins n needles. I went to the ER, xrays taken. They suspected, but not 100 percent sure, a fracture on the top and inside of my ring finger, the joint above the knuckle. They said something about lucency? on the xray. They placed a metal type splint on the finger and said follow up with the family doctor.

I saw him today, he didn't examine the finger and I didn't have a chance to tell him where it hurt the most. He took xrays and said there is crack around the top and sort of too the side. Suggested I buddy tape the fingers, not use the splint, and use one of those tiny exercise balls you squeeze to exercise my finger.

While at home I was looking at my finger. It's not visible to the eye (unless because of swelling hiding it?) but if I trace my finger along the inner part of the joint above the knuckle, ring finger, along the side that is facing my middle finger, I can feel a hard bump or more roundness. Maybe bone I was feeling? I felt my good finger on my right hand in the exact same area and it is nowhere near as large, round feeling compared to my injured finger. Could this be a bone jutting out or something to do with the fracture? It is quite painful in that area.

I have iced my finger to keep the swelling down.

Should I be seeing an orthopedic for a finger fracture? I live in Canada so to see an orthopedic I need a referral from another doctor. Thanks for your help.
 Tom Plamondon PA-C - Wed Sep 02, 2009 8:55 pm

User avatar Hello,
There are two main concerns with a distal finger fracture. If the fracture is close to the knuckle then the tendons which attach there can be involved in the injury. This would be a case to see an orthopedist.
The other concern is too long immobilization. Typically, less than 3 weeks in buddy taping or splint provide the best hand function results.

Take care.
 shel - Fri Sep 11, 2009 7:09 pm

Update and more questions. Thanks for the last reply.

The day after I saw my family doctor he phoned me and decided it wasn't fractured.

However I still have this large bump, bulge on the side of the finger. If I gently touch it and move the top part of my finger up and down I can hear and feel a clicking type noise in that bulged area. Could this be tendon or bone clicking? Finger continues to be quite painful.

If I try to make a fist, my ring finger will not curl or bend down. It is quite painful. I could possibly force it with the other hand but wouldn't risk doing that.Also the pinky finger which is not injured will not bend down. My middle finger will bend but the joint closest to the nail will not curl under. The index and thumb are fine. I was wondering if you have an injured finger can it affect the fingers next to it?
 Tom Plamondon PA-C - Tue Sep 15, 2009 8:18 pm

User avatar Hello,
Since there is no fracture, you can start gentle passive range of motion with the three involved fingers. Warming the tissue with a heating pad before stretching will help. It will take 3 weeks to gain full motion.
Take care.
 shel - Fri Oct 09, 2009 6:42 pm

It's been about 6-7 weeks since this injury and I'm still having problems. That bulge/lump has not gone away. I can still feel clicking in that area when I wiggle the finger. I still have pain that worsens with movement. I cannot make a fist. My good fingers bend but the injured ring finger stays straight. I don't mean straight up, sticks straight out when making a fist and the joint closest to the nail does not curl. I have tried soaking it in warm water and gentle movements and no improvement with the above. I did see my family doctor yesterday and he 'doesn't know." I've also discovered a tiny raised lump on top and slightly to the side of joint below the finger nail. Both bumps are not visible to the eye.

For the past three days I have started to experience pain and achiness radiating into my hand and forearm directly below the ring and pink finger. This is something new.

Could this be a tendon problem?

Should I be seeing a specialist? Or?
 Tom Plamondon PA-C - Sun Oct 11, 2009 8:37 pm

User avatar Hello,
Since this finger is not progressing or healing, you may need to see a hand specialist. Certainly, the tendon or joint capsule can be damaged.
In any event, the range of motion, strength, appearance (including bony appearance via x-ray) will need to be re-evaluated and then develop a treatment plan. If the finger does not require surgical repair you may benefit from occupational therapy and splinting (to regain flexion).

Take care and keep us posted.
 shel - Sat Jan 30, 2010 9:41 pm

Update and more questions..

My family doctor sent me for physiotherapy, which I did for two months. The therapist did ultrasound treatments plus exercises to do at home. The ultrasound didn't make a difference.

My movement is much better, however I still have the lump/bump on the inside of the joint that is above the knuckle( lump/bump facing the middle finger) and the one on top closest to the nail. Clicking still continues in the bump area (middle joint) when bending. Pain and pins n' needles worse when bending and haven't improved, slowly become worse.Both symptoms radiating into hand.

Physiotherapy did give me a small compression type stocking to wear on the finger which I do at times but not finding a difference.

I mentioned this to my family doctor but not much is said. I continue to do my exercises even though painful upo movement. . I also asked my family doctor about seeing a hand specialist two months ago but he didn't think it was necessary. I live in Canada so you have to get a referral through a family doctor to see a specialist.

Is is it possible that a nerve or tendon has been affected or injured with the type of symptoms I described? Should I be seeing a specialist? If so I will try again to get a referral.

Thanks for your help!
 Dr. A. Saif - Sat Feb 27, 2010 4:16 pm

User avatar Dear Shel,

It is as Tom says, difficult to know exactly what a patient means without having the patient in front of you. Even simple terms (like the "top" of the finger...or the "knuckle" or the "inside"), clearly obvious to you as the person describing the injury is confusing to me. I apologise, as is clear to me you are trying to describe as accurately as possible the exact location of the problem you feel, but to me the "top" of your finger is way away from the "knuckle", the "inside" could mean the center of the finger or the "inner side"...the side towards the little finger anatomically. Pardon me if that sounds thick, but hey, who said I was specialist? er what?... I did? oh ...so I am...hmmm.

But...I have a picture of your injury, in my head. You injured this 5 months ago you say, as a ball struck the tip of your finger. You don't say whether the ball struck it end-on or just bent the finger back. Two possible consequences are 1) a mallet injury affecting the finger joint furthest away from your hand, generally if the ball struck your finger end on. You have bent finger tip that can not straighten and needed splintage for 6 weeks or so. Not you?

Then there is option 2) More likely. you had a hyper-extension injury to the joint of your finger nearer to the hand (not the knuckle, the joint in the middle of the finger). This seems to have damaged the "volar plate", a strong ligament in front of the finger that stops your finger going too far back.

Consequences? Pain...check, swelling that can last a year or longer (can't get ring back on?)... check, stiffness that improves a little with exercise...check. Numbness and pins and needles...what?...ah...that's not part of the injury pattern typically.But as it has lasted more than a few months, suggests damage to a digital nerve. this may recover, or may not. If there if significant damage, recovery if it occurs can take upto 8 months. If the digit is not absolutely numb, then chances of recovery I would say are good.

Best wishes

Saif
 shel - Sat Feb 27, 2010 6:13 pm

Dr. Saif,

Thank you for your help and sorry about the confusion. I know it's difficult without me being in front of someone. I will try to explain better..

I sort of remember the ball bending my finger backwards, not hitting the tip.

The problem area of my ring finger is the PIP joint (joint just above the knuckle) and the area with the most pain, symptoms (described below) is the inner side of this PIP joint that faces towards the middle finger anatomically.

This inner joint has a bump/lump that I can only feel by touch, not visible to the eye.

When I bend my ring finger I can feel a clicking sensation in the inner side of the PIP joint plus pins n' needles, pain etc. My finger does not become stuck or locked but does click. Pain is radiating into the top of my hand.

The injury is 7 months old now and still bugging me.

My concerns are the lump/bump that hasn't gone away, the clicking sensation, pins n' needles and pain radiating into my hand.

I wasn't sure if the clicking I feel when bending the finger is due to some type of damage or this lump/bump.

I have not seen a specialist about my finger and wasn't sure if I should due to the above symptoms, especially the pins n' needles.

I hope this explanation helped.

Thank you for your help!
 Dr. A. Saif - Sun Feb 28, 2010 2:12 pm

User avatar Dear Shel,

Ah so you have the "Volar plate injury" described in scenario two. Pain at seven months is a bit of a problem, and I would wonder if there is need for surgical exploration, to see if the ligament is now within the joint. You see with most injuries, pain and swelling for a long time is not uncommon. A bump may even persist. The volar plate is a strong part of the capsule...a ligament that prevents the finger going too far back. Imagine a sheet of tissue that attached to the front of the PIP joint. If is stretched, it may tear. No problem usually, it can heal. Occasionally the torn end ends up within the joint. This may need surgical exploration. An MRI may sometimes be helpful. Stiffness and swelling/bump may be present even if surgery is successful, but pain should improve.

The pins and needles may, as I say represent a digital nerve nerve irritation, or perhaps a neuroma...

Saif
 shel - Thu Mar 04, 2010 3:56 pm

Thank you Dr. Saif for your input and help :)

I did see my family doctor and he will be referring me to a sports medicine doctor. I asked about a referral to an orthopedic (wasn't sure if it would be better to see an orthopedic about this type of injury??) but he didn't interested in referring me to one.

It will take 8-9 weeks to get in to see the sports medicine doctor. Hopefully I will get some help with this.

shel
 shel - Thu Apr 22, 2010 12:14 pm

Update and questions...

I saw the sports medicine doctor last week. He figures I have partial or beginning of swan neck deformity of the finger. He took an xray which showed that lump on the inside of the pip joint that faces towards the middle finger anatomically.

He figures I may need surgery (injury is 9 months old now)I will be referred to a plastic surgeon.

I looked up swan neck deformity and my finger does not look nearly as bad as what I have seen on the internet.

To me it doesn't look like it but then again I'm not an expert and he said its partial or beginnings of swan neck deformity?

He said the clicking in that lump area could be the tendons overcompensating.

I do notice pain, soreness on top of the finger (pip joint down to knuckle) and into the hand.

Is it the extensor tendons that are affected with this condition? And partial swan neck deformity means?

I mentioned I have gone for physiotherapy, ultrasound etc but the sports medicine doctor doesn't think that will help it now although to keep it moving so I don't lose total function.

I know my problem is not an emergency. The wait time to see plastic surgeons are long (in Canada- possibly many months or a year)but I guess it depends on the problem.

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