What is the appropriate treatment for a female patient with acute pain and swelling of the right index finger after lifting her baby?

Treatment of Acute Finger Pain and Swelling After Lifting

For a patient with acute pain and swelling of the right index finger after lifting her baby, the appropriate treatment is initial conservative management with rest, ice application, NSAIDs for pain relief, and buddy taping or splinting to restrict motion of the injured finger while keeping adjacent joints mobile. 1

Initial Assessment Priorities

Before initiating treatment, you must determine the specific injury pattern through focused examination:

• Palpate for well-localized tenderness that reproduces the patient's pain to identify the injured structure (tendon, ligament, or joint capsule) 2
• Test active range of motion against resistance to assess tendon integrity—inability to actively flex or extend suggests tendon rupture requiring surgical referral 1
• Evaluate passive range of motion to distinguish between tendon injury (preserved passive motion) versus joint capsule or ligament injury (restricted passive motion) 3
• Obtain radiographs (oblique, anteroposterior, and true lateral views) as the mandatory first imaging study to exclude fracture or avulsion injury, even with minimal trauma history 4, 3

First-Line Conservative Treatment

Implement the following measures immediately for soft tissue finger injuries:

• Relative rest: Avoid activities that reproduce pain (gripping, lifting, pinching) but do not completely immobilize the finger, as this accelerates muscle atrophy 2, 5
• Ice application: Apply ice through a wet towel for 10-minute periods multiple times daily to reduce acute swelling and provide short-term pain relief 4, 2
• NSAIDs: Prescribe oral NSAIDs (ibuprofen 400-600mg three times daily or naproxen 500mg twice daily) or topical NSAIDs for acute pain management 2, 5
• Buddy taping or splinting: Restrict motion of the injured finger while allowing uninjured adjacent joints to remain mobile—this is the cornerstone of treatment for tendon and ligament injuries 1

Splinting Technique

The specific splinting approach depends on the injury location identified during examination:

• For proximal interphalangeal (PIP) joint injuries: Splint in 15-30 degrees of flexion to protect the volar plate and prevent hyperextension deformity 6
• For flexor tendon injuries: Splint the finger in flexion to reduce tension on the injured tendon 4
• For extensor tendon injuries: Splint in extension to allow tendon healing 4
• Duration: Maintain splinting for 2-3 weeks for ligament sprains, with gradual mobilization thereafter 1

Red Flags Requiring Immediate Referral

Refer urgently to hand surgery if any of the following are present:

• Inability to actively flex or extend the finger, suggesting complete tendon rupture 1
• Open wounds over the injury site, raising concern for open joint injury or tendon laceration 1
• Fracture or avulsion fragment on radiographs, particularly at tendon insertion sites 4, 6
• Volar plate rupture with dorsal dislocation of the PIP joint, which requires surgical repair in the acute phase 6

Expected Recovery Timeline and Follow-Up

• PIP joint sprains commonly result in prolonged swelling lasting 6-12 months, with 63% of patients achieving complete resolution of swelling within one year 7
• At resolution of swelling, 47% of patients still report limitations in range of motion and 41% have limitations in activities of daily living 7
• Schedule follow-up at 2 weeks to reassess range of motion and ensure no late complications such as flexion contracture or hyperextension deformity 6
• If symptoms persist beyond 6-8 weeks despite appropriate conservative treatment, consider advanced imaging (ultrasound or MRI) to evaluate for occult tendon tear, ligament rupture, or foreign body 8

Critical Pitfalls to Avoid

• Do not assume absence of fracture based solely on mechanism—obtain radiographs in all cases, as avulsion fractures at tendon insertions are common and alter management 4, 3
• Do not overlook foreign body penetration (thorns, splinters) in patients with unclear trauma history, particularly if swelling persists without improvement—this can cause chronic osteomyelitis even with normal inflammatory markers 9
• Do not allow complete immobilization of the entire hand—only the injured finger should be restricted, as prolonged immobilization of uninjured joints causes stiffness and dysfunction 1
• Warn patients about prolonged recovery—finger sprains typically cause swelling and stiffness lasting many months, and failure to set realistic expectations leads to patient dissatisfaction 7