From the Guidelines
Hyperextension finger injuries should be initially evaluated with radiography to detect any fractures or dislocations, and treatment should focus on the RICE protocol, pain management, and protection of the injured finger. For mild hyperextension injuries, the RICE protocol is recommended: rest the finger, apply ice for 15-20 minutes every 2-3 hours for the first 48 hours, compress with a light bandage, and elevate the hand above heart level when possible 1. Over-the-counter pain medications like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) can help manage pain and reduce inflammation.
Key Considerations
- Buddy taping the injured finger to an adjacent healthy finger using medical tape with a small piece of gauze between the fingers provides stability and protection during healing, which typically takes 2-6 weeks depending on severity.
- More severe injuries with significant pain, deformity, inability to move the finger, or persistent symptoms beyond a few days require medical evaluation as they may indicate fractures, complete ligament tears, or tendon injuries requiring specialized treatment such as splinting, casting, or surgery 1.
- Proper healing is crucial to prevent long-term complications like chronic pain, stiffness, or instability in the affected finger.
Radiographic Evaluation
- A standard 3-view radiographic examination of the hand is usually sufficient to show most fractures and dislocations of the metacarpals and phalanges 1.
- For phalangeal injuries, an internally rotated oblique projection, in addition to the standard externally rotated oblique, increases diagnostic yield for phalangeal fractures 1.
- In patients with suspected finger tendon injuries, radiographs are used to detect fracture fragments, as large fragments may require open reduction and internal fixation 1.
From the Research
Hyperextension Finger Injury
- Hyperextension finger injuries can occur in various joints, including the proximal interphalangeal (PIP) joint and the distal interphalangeal (DIP) joint 2, 3.
- The treatment of hyperextension injuries of the PIP joint is often conservative, with immobilization and early motion being used to manage the injury 2.
- A clinical decision guide has been developed to diagnose and treat hyperextension injuries of the long fingers in children, which can help reduce unnecessary radiographs and improve patient care 4.
- The mechanism of injury can affect the pattern of injury, with hyperflexion trauma leading to plastic deformation or rupture of the extensor tendon, and hyperextension leading to a bony dorsal edge fracture with articular involvement 3.
Diagnosis and Treatment
- The diagnosis of hyperextension finger injuries can be based on a clinical examination using a standardized evaluation protocol, which can help identify low-risk injuries and avoid unnecessary radiographs 4.
- The treatment of hyperextension injuries can vary depending on the severity of the injury, with some cases requiring immobilization and others requiring surgical intervention 2, 5.
- The use of a clinical decision guide can help improve treatment decisions and reduce the risk of late complications 4.
Associated Injuries
- Hyperextension injuries can be associated with other injuries, such as fractures, dislocations, and soft tissue injuries 4, 5, 6.
- The pattern of bone bruising can predict soft tissue injury, with certain patterns being associated with a higher risk of cruciate ligament injury 6.
- The presence of a "double sulcus" sign on lateral radiographs can be a marker for ACL injury 6.