What is the treatment for a Proximal Interphalangeal (PIP) sprain?

Treatment of Proximal Interphalangeal (PIP) Joint Sprain

Begin functional treatment immediately with buddy taping or a dorsal blocking splint for no more than 3 weeks, combined with early active range of motion exercises to prevent the devastating complication of PIP joint contracture. 1, 2

Critical Timing Principle

The PIP joint is uniquely vulnerable to stiffness, and prolonged immobilization beyond 3 weeks leads to extensor and flexor contractures that significantly reduce hand function. 1 The early healing process is complete by 3 weeks, after which active motion must be initiated. 1

Initial Management (First 3 Weeks)

Splinting Approach

• Use buddy taping to the adjacent finger as the preferred method, which allows some controlled motion while protecting the injured ligament 2, 3
• Alternatively, apply a dorsal finger block splint that immobilizes only the PIP joint while keeping the MCP and DIP joints free 2
• Position the PIP joint in 15-30 degrees of flexion (the "intrinsic plus position"), NOT in full extension, as this prevents collateral ligament contracture 1
• Kinesio taping demonstrates superior outcomes compared to rigid splinting, with better edema reduction, improved range of motion, and less nighttime pain 3

Pain and Swelling Control

• NSAIDs may be used for short-term pain relief and to reduce swelling 4, 5
• Paracetamol is equally effective as NSAIDs with potentially fewer side effects 4, 5
• Avoid relying on RICE protocol alone, as it has no proven benefit for pain, swelling, or function 4, 6, 5

Exercise Therapy (Begin Immediately Within Pain Tolerance)

• Start supervised exercise therapy as soon as possible, even during the initial 3-week protection phase, focusing on gentle active range of motion of adjacent joints 4, 6
• After 3 weeks, aggressively progress to active PIP joint flexion and extension exercises 1
• Include proprioception training, strength exercises, and coordination exercises 4, 6
• Supervised exercises provide superior outcomes compared to unsupervised home programs 6

Common Pitfalls to Avoid

• Never immobilize the PIP joint for longer than 3 weeks, as this is the most common cause of permanent stiffness and disability 1
• Do not splint the entire finger or hand - only immobilize the PIP joint while keeping the MCP and DIP joints mobile 7, 2
• Avoid the traditional "position of function" (slight flexion at all joints) - instead use the intrinsic plus position for PIP joint injuries 1
• Maintain high clinical suspicion for missed extensor tendon injuries (central slip), as these are frequently overlooked in what appears to be a simple sprain 8
• If passive extension deficit develops within 1-2 weeks, suspect a boutonnière deformity from missed central slip injury and refer immediately 8

Special Considerations

• A flexion contracture of even one PIP joint significantly reduces the functional capacity of the entire hand, making aggressive prevention of stiffness paramount 1
• Some residual stiffness in the PIP joint after treatment is acceptable if the joint is pain-free and properly aligned, though not ideal 7
• For pediatric patients, Kinesio taping shows statistically significant better outcomes than splinting for edema reduction (p<0.021) and nighttime pain (p<0.013) 3

Return to Activity

• Functional treatment allows faster return to normal activities compared to rigid immobilization 4, 6
• Continue buddy taping during sports activities for 4-6 weeks total to prevent re-injury 4