April 9, 2024
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April 9, 2024
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It happens in the blink of an eye: an errant basketball pass to an innocent bystander; reaching for something in a drawer and hitting the back wall instead; falling and somehow injuring a pinky. A minor-appearing accident leads to a swollen, painful and stiff finger.

What’s the diagnosis? Should you put one of those “alumafoam” splints on it? Rub some dirt on it and keep playing?

Is it broken? Fractured? Jammed?

What is a jammed finger, anyway?

The expression “jammed finger” is not a medical term at all, rather an example of regional dialect. In Pittsburgh, for example, the same injury would be called “stoved,” as in, “I stoved my finger playing ball the other day.”

Why would Pittsburghers say such an odd thing? Some theorize the term evolved from the German word verstaucht for “sprained.” Scottish etymology (“stave”) has also been proposed. Or, it could just be one of those weird things about Pittsburgh. (See also: “yinz.”)

The point is, whether you call it “jammed,” “stoved,” or “busted,” these are all colloquial terms. They do not indicate any medical diagnosis; rather they are lay terminology referring to a swollen, painful injured finger. Typically, this injury is at the PIP (proximal interphalangeal) joint (aka the second-smallest joint in the finger).

“Broken” is the lay term for “fractured,” and the terms are interchangeable—meaning when the bone has at least a crack in it. Displaced fractures are those where the pieces of the bone are not aligned anatomically; these are usually more serious than non-displaced fractures. Fractures with the bone still aligned normally are called non-displaced fractures.

An unfortunate myth persists that nothing can or needs to be done for finger fractures. While in many cases the treatment does not need to be invasive or overwhelming, it is important that all hand fractures are properly managed. As a great hand surgeon once said, “The treatment of hand fractures can be complicated by deformity from under-treatment, stiffness from over-treatment, and both resulting from poor treatment.”

Many people with a PIP joint injury think that it will just get better on its own. Much of the time, that is correct. Most of these injuries are relatively minor injuries—sprains. A sprain is an injury that occurs when a joint is forced beyond its normal range of motion. The ligaments, tough fibers of tissue that maintain joint stability, can be stretched, partially torn, or even completely torn in a sprain. In most cases, the body can reassemble this tissue.

Many people with a jammed finger recall other times they had a similar injury; they just left it alone for a short period and it got better. They figure this injury will be the same. However, it is not always that simple—and when this logic goes wrong, it goes very wrong.

The first problem is that fractures don’t announce that they are fractures. A common misconception is that “if you can move it, it isn’t broken.” Many people have delayed going to the doctor based on this exact assumption, only to learn their lesson the hard way. Fractures can be subtle—sometimes they look exactly like a sprain, and can only be differentiated with an X-ray reviewed by a keen eye. Some fractures don’t require much treatment, but others certainly do—and even the most subtle finger fracture can cause tremendous problems if treated improperly.

The second problem is that not all sprains are alike. Sometimes, even with no bony fracture, a finger injury requires a specific type of treatment to prevent stiffness and/or deformity. There is a commonly injured ligament in the thumb, for example, called the UCL (ulnar collateral ligament), which, if torn, often heals incorrectly and sometimes requires a long period of casting or even surgery to repair. While the injury is technically a sprain, it is far more serious than the name implies.

Finally, even in those minor sprains that would have gotten better by themselves, it is helpful to have an expert assess the situation and devise a treatment plan. Those ubiquitous blue-and-silver alumafoam splints can cause tremendous stiffness.

A hand specialist goes through six years of musculoskeletal training after medical school to learn detailed diagnostic techniques including physical examinations of individual tendons and ligaments to properly diagnose these injuries. They know when and how to initiate motion after one of these injuries to prevent stiffness and deformity.

Even minor finger sprains often tend to linger longer than people think they will. Patients commonly present six to eight weeks after injury, stating, “This should have gotten better by now.” It can take a long time for the PIP joint to recover, and the PIP is so crucial to hand function that it’s often called the “soul of the hand.”

People often expect the injury to improve rapidly based on the healing time they noticed for a prior comparable injury. One problem with that logic is that they used to be younger; accumulating birthdays has a nefarious side effect of slowing healing, especially at the PIP joint.

The PIP joint in particular can be so frustrating that hand surgeons often quip that it “can’t take a joke,” or that PIP doesn’t really stand for “proximal interphalangeal” but rather “presents incredible problems.”

Still, most finger injuries are able to be treated successfully with minimal intervention when seen acutely. When the patient’s presentation is delayed, things can become more challenging.

For these reasons and more, it is recommended to see a hand specialist for a hand injury—even if an X-ray is negative. Finger injuries require the correct treatment to recover properly. Overtreating can be just as detrimental as undertreating.

If you have a finger injury, it’s critical to see a hand specialist as early as you can. Delayed treatment could lead to less-predictable outcomes, as ligaments and bones begin to heal in whatever position they are in (correct or not) in as little as one to two weeks. The sooner the doctor and patient are able to initiate the correct treatment plan, the sooner the patient can resume their normal activities, in most cases with full and painless range of motion.

Joseph A. Rosenbaum, M.D., is a board-certified, fellowship-trained hand and upper extremity specialist orthopedic surgeon. He serves as the clinical director of hand surgery at Holy Name Medical Center and sees patients in Teaneck.

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