Finger Injuries in Basketball Players
Finger injuries occur in almost all sports and are particularly common in basketball players. Injuries to the fingers in basketball players range from minor injuries requiring little or no treatment to severe fractures and dislocations that can require surgery. The key to correctly assessing and treating these injuries is to determine the exact diagnosis and initiate treatment as quickly as possible. Time is of the essence in achieving a good result.
Finger injuries can result in a variety of symptoms including pain, swelling, stiffness, deformity, and change in position. However, the severity of the symptoms does not always correlate with the severity of the injury. A minor injury requiring minimal treatment can produce significant pain and swelling, and in some instances, the symptoms of a major injury are minimal pain, swelling, and stiffness. Consequently, it is important that an orthopedist or hand specialist evaluate all finger injuries.
A physical examination and x-rays are two key components that help to accurately assess and diagnose finger injuries that occur during sporting events. Preferably, this evaluation should take place within the first 24 to 48 hours after the injury occurs. Taping an injured finger, followed by a doctor's visit weeks later when symptoms do not resolve, delays appropriate treatment and often results in a poor outcome and can lead to surgery that would have otherwise been unnecessary.
RICE (rest, ice, compression, elevation) and immobilization with a splint are essential, immediate treatments for almost all finger injuries. Continued immobilization, however, is not appropriate for all injuries and can be detrimental for certain injuries because it can lead to unnecessary stiffness. The only way to determine the type of treatment needed is to obtain a physical examination and x-rays. A patient with an injury significant enough to cause pain, swelling, stiffness, or deformity (such as a bent or crooked finger tip) should have an x-ray.
One of the most common injures in basketball players is known as a mallet finger (Fig. 1). This injury typically occurs when the ball hits the end of the extended (straight) finger causing a sudden and forceful flexion (bending) of the distal interphalangeal (DIP) joint (the last joint of the finger). This mechanism results in a rupture, or tearing, of the extensor tendon from the bone. It is followed by pain and swelling at the DIP joint and a bent position with the inability to extend the tip of the finger. A mallet finger will not heal without appropriate treatment. If left untreated, the injury can lead to permanent swelling, deformity, discomfort, and can cause additional problems in the finger.
The proximal interphalangeal (PIP) joint (middle knuckle joint of the finger) is the site of many serious injuries including ligament and tendon tears, fractures, and dislocations. These injuries can often be accompanied by avulsion or chip fractures, which occur when a small piece of bone is torn away from the remaining larger bone by a tendon or ligament (Fig. 2). These small fractures are indicators of a major ligament or tendon injury and often have different treatment protocols than routine fractures. In many cases, continued immobilization of an avulsion or chip fracture is not indicated and can even be harmful.
The PIP joint and the metacarpophalangeal (MP) joint (knuckle joint) are often dislocated. The dislocated joint can often be reduced (put back in place) on the playing field; however, all dislocated joints require further evaluation and x-rays to assess for tendon, ligament, joint, and bone injury that may not be immediately apparent. Any joint that cannot be reduced should be considered an emergency and requires immediate attention. One of the most common injuries to the PIP joint occurs on the palm side of the hand to a large, strong ligament known as the volar plate. Any injury that causes hyperextension can result in a sprain (tear) of the volar plate with or without a small avulsion or chip fracture. This injury can lead to significant long-term pain, stiffness, and swelling if not treated appropriately.
On the basketball court or on the football field, there is no sure way to differentiate a significant injury from a minor injury. Taping an injured finger is not always the answer and minor swelling and pain does not always mean a minor injury. For that reason, finger injuries should be evaluated by an orthopedist within the first 24 to 48 hours after injury.
David C. Rehak, MD