Health Information

Hand Therapy Guide (II) (by Clare Black)

Finger injuries - PIP Joint Injuries

Hand Therapy Guide (II).pdf.pdf

Finger Injuries - PIP Joint Injuries

 

Mechanism of Injury

A dorsal dislocation occurs through hyperextension and axial load.


A volar dislocation or central slip injury occurs with a flexion force.

 

Symptoms

PIP joint instability or mal-alignment, or both.


If the central slip is injured there will be a loss of active extension or boutonniere
deformity, or both.

 

 1.png

Dorsal dislocation / Volar plate injury

2.png

Boutonniere deformity following central slip injury

 

Diagnosis

Diagnosis is made by assessing joint laxity, range of motion and with an x-ray.

 

Referral

Referrals shall be made as soon as possible. If the PIP joint was dislocated, a referral should be made immediately post-reduction.

 

Management

For a volar plate avulsion fracture or dorsal dislocation, the PIP joint is protected with a splint or buddy taping depending on the stability of the joint. Volar plate avulsion fractures are stabilised in flexion and may require to be splinted in this position.


As soon as comfortable or stability allows, commence active PIP joint extension to
prevent a fixed flexion deformity.

 

For volar dislocations, central slip injuries or collateral ligament injuries the PIP joint is
splinted in extension.


Mobilise into flexion if no central slip avulsion fracture. 

 

Oedema management and joint protection are imperative to a good outcome.

 

Splinting Options

 Dorsal finger splint.png

Dorsal finger splint for volar plate avulsion fracture

Oval 8 splint for dorsal.png

Oval 8 splint for dorsal dislocation

 

Buddy splint.png

 Buddy splint 

Extension splint.png 

 Extension splint
for central slip
injury

Mobilising splint.png

 Mobilising splint
to improve joint
stiffness