Management of Finger Sprain
For a finger sprain, immediately apply functional support with buddy taping to the adjacent finger, begin early active range-of-motion exercises within 48-72 hours, and use NSAIDs or acetaminophen for pain control while avoiding prolonged immobilization. 1
Initial Assessment and Diagnosis
Before treating as a simple sprain, you must rule out injuries that masquerade as sprains:
- Examine for mallet finger (inability to actively extend the distal interphalangeal joint), which requires continuous splinting for 6-8 weeks 2, 3
- Check for profundus tendon avulsion (inability to flex the distal interphalangeal joint), which requires surgical repair 2, 3
- Assess for volar plate injury at the proximal interphalangeal (PIP) joint, which presents with tenderness over the volar aspect and may show avulsion fracture on lateral x-ray 3
- Obtain anteroposterior, lateral, and oblique x-rays to exclude intra-articular fractures and avulsion injuries that appear as "minor sprains" 4, 3
Critical pitfall: Six common athletic injuries are frequently misdiagnosed as simple sprains but require specific treatment—missing these leads to permanent impairment despite later reconstructive procedures 3
Acute Phase Management (First 48-72 Hours)
- Apply ice for 20-30 minutes per application using ice and water in a bag surrounded by a damp cloth, without direct skin contact to prevent cold injury 1
- Use NSAIDs (ibuprofen, naproxen, or diclofenac) for pain and swelling control—these are equally effective as opioids but with significantly fewer side effects 1
- Acetaminophen is equally effective as NSAIDs for pain, swelling, and range of motion if NSAIDs are contraindicated 1
- Avoid prolonged immobilization beyond 10 days, as this leads to worse functional outcomes compared to early mobilization 1
Functional Support Strategy
Buddy taping is the preferred method for finger sprains:
- Tape the injured finger to an adjacent uninjured finger using soft padding between the digits 5
- Continue buddy taping for 4-6 weeks during activities to provide stability while allowing joint motion 1
- Buddy taping is superior to rigid splinting for uncomplicated ligamentous sprains, as it permits early movement and prevents stiffness 5, 6
For PIP joint sprains specifically, Kinesio taping demonstrates better outcomes than rigid splinting for edema reduction, nighttime pain, and joint range of motion with higher patient compliance 6
Exercise and Rehabilitation Protocol
Begin active range-of-motion exercises as soon as tolerated (typically 48-72 hours):
- Start with gentle flexion and extension exercises multiple times daily to maintain joint mobility 1
- Progress to strengthening exercises focusing on grip strength and individual finger strength once pain allows 1
- Include proprioceptive training to restore coordination and prevent recurrent injury 1
Exercise therapy initiated early reduces the prevalence of chronic instability and accelerates recovery 1
What NOT to Do
- Do not use RICE (Rest, Ice, Compression, Elevation) as the sole treatment—it has no positive influence on pain, swelling, or function when used alone 1, 7
- Do not immobilize in a rigid splint for more than 10 days unless there is a specific indication (such as mallet finger or fracture), as prolonged immobilization causes worse outcomes 1
- Do not prescribe opioid analgesics—they provide no better pain relief than NSAIDs but cause significantly more adverse effects 1
When to Refer for Surgical Evaluation
Immediate referral is indicated for:
- Complete collateral ligament ruptures at the PIP joint (joint instability >20 degrees with stress testing) 2
- Large-fragment fracture-dislocations or joint incongruity after reduction 2
- Open extensor mechanism injuries 2
- Mallet finger with large bony avulsion fragments (>30% of articular surface) 2
- Profundus tendon avulsions (inability to flex the distal interphalangeal joint) 2