What to do after injuring a finger during sports?

Ring Finger Injury During Football Tackle

Obtain immediate 3-view radiographs of the injured finger (PA, lateral, and oblique views) to rule out fracture, dislocation, or avulsion injury before assuming this is a simple soft tissue injury. 1

Initial Assessment and Imaging

This mechanism—finger caught in a jersey during tackling—is classic for jersey finger (flexor digitorum profundus avulsion) or fracture-dislocation of the proximal interphalangeal (PIP) or distal interphalangeal (DIP) joints. 1

Mandatory First Step: Plain Radiographs

• A minimum 3-view radiographic series is required (posteroanterior, lateral, and oblique) as 2-view examinations miss significant pathology in finger injuries 1
• Radiographs identify fractures, avulsion fragments at tendon insertion sites, joint dislocations, and articular surface involvement 1
• Large avulsion fragments may require open reduction and internal fixation, making early radiographic detection critical 1

Key Radiographic Findings to Assess

• Bony avulsion at the DIP joint (mallet finger): If >1/3 of articular surface is involved, palmar displacement of distal phalanx is present, or interfragmentary gap >3mm exists, surgical fixation is indicated 1
• Fracture-dislocation: Any articular involvement requires assessment for operative reduction to achieve <2mm residual step-off and prevent post-traumatic arthritis 1
• Avulsion at flexor tendon insertion (jersey finger): Bony fragments indicate need for surgical reattachment 1

If Radiographs Are Negative or Equivocal

Clinical Examination Guides Next Steps

• If radiographs are normal but clinical examination reveals inability to actively flex the DIP joint (suggesting jersey finger), proceed to MRI without IV contrast to evaluate for complete tendon rupture requiring urgent surgical repair 1
• MRI has sensitivity of 28-85% for detecting extensor and flexor tendon injuries and is the ideal modality for surgical planning 2

Alternative Conservative Approach

• If clinical suspicion for fracture persists despite negative initial films, immobilize in a splint and repeat radiographs in 10-14 days to detect occult fractures that become visible with bone resorption 1, 3
• However, this delays diagnosis and may compromise outcomes for injuries requiring early surgical intervention 1

Critical Pitfalls to Avoid

Do not assume this is a "simple sprain" without radiographic evaluation—the jersey-catching mechanism frequently causes avulsion injuries that appear deceptively benign on examination but require surgical repair. 1

Do not immobilize and observe without imaging first—delayed diagnosis of jersey finger (flexor tendon avulsion) beyond 7-10 days significantly worsens surgical outcomes and may result in permanent loss of DIP flexion. 1

Do not obtain only 2 views—this misses up to 15% of fractures and dislocations in finger injuries. 1

Immediate Management Pending Imaging

• Splint the finger in position of comfort (slight flexion) to limit pain and prevent further injury 1
• Do not attempt to straighten or manipulate the injured finger, as this may worsen fracture displacement or convert a partial tendon tear into complete rupture 1
• Activate emergency medical services or arrange urgent orthopedic/hand surgery evaluation if the finger appears blue, extremely pale, or grossly deformed, as these indicate vascular compromise or complex dislocation 1