Treatment for Finger Hyperextension Injuries
The treatment for finger hyperextension injuries should include early finger motion through a complete range of motion to minimize stiffness, followed by appropriate immobilization based on injury severity.
Assessment of Hyperextension Injuries
When evaluating finger hyperextension injuries, particularly at the proximal interphalangeal (PIP) joint, a systematic assessment should be performed:
Clinical examination variables 1:
- Location of pain
- Presence of swelling and bruising
- Joint stability
- Range of mobility
Radiographic assessment should be performed for high-risk clinical presentations, but may be unnecessary for low-risk presentations 1
Treatment Algorithm
1. Initial Management
Early finger motion: Instruct patients to move fingers regularly through a complete range of motion to minimize stiffness 2
- This is extremely cost-effective and does not adversely affect adequately stabilized fractures
- Critical for preventing finger stiffness, which directly affects patient outcomes
Pain management:
- Thermal modalities (heat/cold) may be used for pain relief 2
- Ice application in the first 3-5 days post-injury can be beneficial
2. Immobilization Based on Injury Type
For Palmar Plate Avulsion Injuries:
- Extension splinting at 0 degrees for 7-10 days, followed by buddy taping and active range of motion until 3 weeks post-injury 3
- This approach has shown good to excellent results with minimal risk of developing hyperextension laxity or flexion contracture
For Volar Plate Ruptures:
- Conservative or surgical management based on severity 4
- Conservative management typically involves appropriate splinting and exercise therapy
- Surgical intervention may be necessary for severe ruptures
3. Rehabilitation Phase
Protected mobilization: After initial immobilization period, implement protected movement with buddy taping for up to 6 weeks post-injury 3
Task-specific practice: Incorporate task-specific exercises to improve motor function and activities of daily living 2
Joint protection techniques: Instruct patients in proper joint protection methods 2
Assistive devices: Provide as needed to help with activities of daily living 2
Special Considerations
Trapeziometacarpal joint involvement: Consider providing splints for patients with OA involving this joint 2
Prevention of complications: The two main late complications to prevent are chronic post-traumatic hyperextension deformity and flexion contracture 4
Pediatric patients: In children, treatment decisions can often be based on clinical examination using a standardized evaluation protocol, potentially avoiding unnecessary radiographs 1
Important Caveats
There is insufficient high-quality evidence from randomized trials comparing different immobilization durations and approaches for hyperextension injuries 5
Despite limited evidence, early finger motion appears to be a critical component of treatment to prevent stiffness 2
For more complex injuries involving dislocations or significant collateral ligament damage, treatment approaches may differ from those for simple hyperextension injuries 3