Diagnosis: Finger Sprain (Ligamentous Injury)
A jammed finger during volleyball with no fracture on radiographs is most commonly a finger sprain—an injury to the collateral ligaments, volar plate, or joint capsule of the interphalangeal or metacarpophalangeal joints.
Clinical Context
Finger injuries are extremely common in volleyball, accounting for 53% of all volleyball-related injuries, with upper extremity injuries representing 71.3% of total volleyball accidents 1, 2. Most volleyball finger injuries occur during ball contact without opponent contact (59% of cases) 2.
Specific Diagnostic Considerations
When radiographs are negative for fracture, the differential diagnosis includes:
Most Common Injuries:
- Collateral ligament sprains of the PIP or MCP joints (most frequent) 3
- Volar plate injuries without bony avulsion 3
- Joint capsule injuries 3
- "Jammed finger" (general term for ligamentous sprain/strain) 4, 5
Less Common but Important to Exclude:
- Mallet finger (closed rupture of extensor tendon at DIP joint)—the most common closed finger injury in ball sports 6
- Jersey finger (flexor digitorum profundus avulsion)—more common in contact sports like rugby 6
- Central slip injuries of the extensor mechanism 3
- Pulley system injuries 3
Clinical Examination Pearls
Look for these specific findings to narrow the diagnosis:
- Point tenderness over collateral ligaments suggests ligament sprain 3
- Inability to actively extend DIP joint indicates mallet finger 6
- Inability to actively flex DIP joint suggests jersey finger 6
- Joint instability with stress testing indicates complete ligament rupture 3, 4
- Swelling and ecchymosis at the joint line supports ligamentous injury 4
Advanced Imaging Indications
MRI is the ideal modality for evaluating soft-tissue injuries when diagnosis is unclear or surgical planning is needed 3:
- MRI sensitivity/specificity for collateral ligament tears: 100% sensitivity, 94-100% specificity 3
- MRI for volar plate tears: Can diagnose tears not involving bone, preventing contractures or joint laxity 3
- MRI for tendon injuries: 92-100% sensitivity for flexor tendon injuries; 28-85% sensitivity for extensor injuries 3
Ultrasound can be used as an alternative for dynamic assessment:
- Allows direct visualization of joint malalignment without fracture 3
- Can diagnose pulley system injuries 3
- Useful for dynamic examination of ligament integrity 3
Common Pitfalls
- Underestimating "simple jams": These can represent complete collateral ligament ruptures requiring operative treatment 4
- Missing mallet finger: Patients may present days/weeks later if not recognized acutely 5
- Inadequate treatment: Errors in diagnosis or insufficient treatment lead to misalignment and permanent functional impairment 6
- Assuming negative radiographs mean minor injury: Significant ligamentous and tendon injuries occur without fracture 3
Treatment Implications
- Most finger sprains can be treated conservatively with splinting and occupational therapy 4
- Complete collateral ligament ruptures at PIP joint may require operative treatment (controversial but recommended by some experts) 4
- Mallet finger, jersey finger, and large-fragment injuries typically require operative treatment 4