Jammed Finger (Sprain or Fracture)
Jammed Finger (Sprain or Fracture) | Denver, Colorado
A jammed finger is a common hand injury we have all experienced at some point in our lives. As you might imagine, I treat a lot of these in my hand surgery practice in metropolitan Denver, Colorado.
The difficult part with a jammed finger is knowing whether the injury represents serious damage to your finger or is something that will heal on its own in a few weeks. Unfortunately, there are no magic tricks to make this diagnosis at home, and getting the answer wrong can lead to serious consequences for the longterm health of your hand.
Jammed Finger Symptoms & Diagnosis
Figure 1 - A PIP joint following a fracture-dislocation. While this appeared in clinic to be a basic jammed finger, X-rays told us a very different story. This patient needed surgical fixation.
As with any traumatic injury, the primary symptom of a jammed finger is pain. Regardless of whether you have sustained a sprain or fracture, the joint will be painful, swollen, and stiff. This is why it’s so hard to evaluate at home.
X-rays and an examination by a hand specialist are absolutely crucial to confirm your diagnosis. X-rays will determine the presence or absence of a fracture and any associated instability of your joint. A careful examination of your tendons will determine if any of them have pulled away from the bone with the injury. Both of these more severe types of joint sprain can cause long-lasting, often irreversible dysfunction in your finger if not identified and treated right away.
Additional tests or imaging other than X-rays are typically not required for this injury. If X-rays reveal a particularly severe fracture, a CT scan is occasionally required for surgical planning purposes.
Jammed Finger Treatment
This is why a proper diagnosis is so important. Treatment for a jammed finger will range from immediate unrestricted range of motion all the way to surgical fixation and prolonged splinting. These treatments could not be more divergent and getting it right makes all the difference.
If you are diagnosed with a simple sprain, I tell my patients the two keys to your recovery are 1) regaining your motion and 2) preventing re-injury. The sprained ligaments will slowly heal over 4-6 months, and the faster you get your full motion back, the better you will feel. It is not uncommon for these injuries to be sore and swollen for many months while healing.
If you have an associated large fracture that destabilizes the joint, you will often require surgery. The particular type of surgery will depend on your fracture pattern. Similarly, if one of your tendons dissociates from the bone, you may require surgery or a prolonged period of time in a splint.
Additional Information
This is a basic overview of the ubiquitous ‘jammed finger.’ If you have more specific questions about this injury, or you just want to learn more, read on below as I answer many of my patients’ most common questions. You can also reference my ‘deep dive’ articles to the right of the FAQs for more information on the topic.
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The Basics
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A jammed finger is a common term for an injury affecting the knuckles of the finger. Most often this affects the proximal interphalangeal (or PIP) joint The general term ‘jammed finger’ can encompass a variety of injuries all the way from a simple sprain to a tendon injury to a fracture dislocation of the joint.
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A jammed finger is a traumatic injury that can be caused by just about anything. In my practice, I most commonly see it from athletic injuries such as basketball or wrestling.
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While I most commonly see these injuries in patients who participate in high-impact athletic activities, anyone is at risk for a jammed finger. I frequently see these even from basic falls or unintentional accidents around the home.
Jammed Finger Symptoms & Diagnosis
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The primary symptom of a jammed finger is pain after a traumatic injury. The most frequently affected joint is the PIP joint. Oftentimes, there will be associated swelling, stiffness and even bruising in the injured area.
If you notice that your finger is crooked in any way, please report immediately to the emergency room for further evaluation and immediate treatment.
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Unfortunately, there is no way to tell without an x-ray. Even fairly dramatic fracture-dislocations of the PIP joint can just look like a swollen finger from the outside. It is very important to have X-rays and an examination with a trained hand specialist early after an injury in which your finger was jammed.
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The diagnosis of a finger sprain is crucial. This requires a trained hand specialist and X-rays. It is critical early on after your injury to determine whether you have a basic sprain or a more serious injury. More serious injuries include tendon disruption from the bone or fracture dislocation of the joint. These can be detected on examination by a hand specialist in combination with X-rays of your finger.
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Additional testing beyond an X-ray and examination is not typically needed. In cases of severe fracture patterns, a CT scan may be helpful for preoperative planning.
Jammed Finger Treatment
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It depends. As you understand by now, the diagnosis is everything. The majority of jammed fingers are just a finger sprain. A finger sprain can be treated without surgery.
However, a finger sprain can masquerade as a severe tendon injury or fracture-dislocation of the joint. These often need surgery.
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I tell my patients the two keys to treating a finger sprain are 1) regaining/maintaining your motion at the injured joint and 2) preventing re-injury. The sprained ligaments will slowly heal over 4-6 months, and the faster you get your full motion back, the better you will feel.
Without immediate motion, the injured joint will get very stiff. Set aside dedicated time throughout the day to gently move the injured joint back and forth.
It is also critical to avoid re-injury. Take a break from athletic activities that could jam the finger. Use buddy taping or buddy straps to support the injured finger through the day.
The key here is patience. It is not uncommon for these injuries to be sore and swollen for 4-6 months while healing from even the most basic sprain injury.
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If you have sustained an injury to your finger, there are several at-home treatments to start right away before you can get in to see a doctor. Let’s walk through how to treat your finger (or any injury) with what is commonly known as R.I.C.E. therapy.
R - Rest. If your finger hurts following an injury, try to stop using it as much as possible. Some gentle motion that is not painful is fine, but eliminating activity from the injured finger will help with the initial stages of pain and inflammation.
I - Ice. It can be very helpful to use ice on the injured finger. Be sure you have a protective layer between the ice and your skin (eg, dish towel, clothing). Do not ice the area for more than 20 minutes at a time. I typically recommend icing in a “20 minutes on, 20 minutes off” pattern.
C - Compression. Of all the stages of R.I.C.E., be the most careful with compression. Some find that some gentle compression feels good after an injury for extra stabilization. In general, we would recommend accomplishing this by using an elastic wrap bandage (Brand example: ACE wrap). However, it is crucial that you don’t stretch the elastic wrap bandage while you wrap. This will provide too much compression, and if your finger swells, you can develop a painful or even permanently damaging condition. If you are interested in using compression, be sure to gently apply the bandage and re-evaluate frequently to ensure it is not becoming too tight with your finger swelling. Never apply compression before going to sleep for the night.
E - Elevation. This is the most important one. I wish this were first in the mnemonic, but then it would spell E-R-I-C. Anyways, elevate, elevate, elevate. The higher the better. When you can, keep the finger above the level of the heart. When that’s not possible, keep your finger above your elbow. Gravity is your friend! The more you elevate your injured finger, the less swelling you will experience. The less swelling you experience, the less pain you will have. This is particularly crucial in the first few days after an injury.
Jammed Finger Surgery
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If your jammed finger is more than a simple sprain, it could be a central slip (tendon pulled off the bone) injury or a fracture-dislocation of the joint.
Most central slip injuries do not need surgery if caught early, though they do require prolonged immobilization and therapy. Most, if not all, fracture-dislocations will require surgery.
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A central slip injury occurs when one of your extensor tendons (straightens your finger) pulls off the bone in your finger after a jamming injury.
If diagnosed within the first couple of weeks after injury, the typical treatment for this is six weeks in a splint, followed by several weeks of hand therapy to get the finger rehabbed.
Late diagnosis or failure of initial treatment could require surgery and may lead to suboptimal outcomes.
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A fracture-dislocation involves a fracture at the joint level that destabilizes the joint. This requires surgery to fix.
The exact nature of your surgery would depend on the pattern of broken bones. The surgical options range from wire fixation to external fixator to plates and screws.
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PIP joint fracture-dislocations are highly traumatic to the finger. These generate significant instability, followed by significant stiffness to the injured finger. Almost all who experience this injury will have some degree of permanent stiffness to their finger.
To minimize this effect, hand therapy after this injury is absolutely critical. There simply is no other way to maximize the motion and function of your finger following such a traumatic injury.
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This really will depend on your fracture pattern and the type of surgery needed.
In broad terms, your fracture will take 6-8 weeks to heal. You will be mostly or completely immobilized at the injured joint during this time. You may be permitted to work on motion at adjacent finger and hand joints, depending on the severity of the fracture.
Once the bone has healed enough, your recovery will rapidly shift to motion. These injuries get very stiff and most end up permanently stiff in some way. To minimize this, the 6-12 week window of recovery will be all about motion.
Once your motion is close to normal, we will also begin to strengthen the hand. All in all, the immediate, intensive recovery period is about 4 months. The finger may remain sore and somewhat swollen throughout the first year after injury.
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All surgeries have risks, many of which are generic to surgery itself. I go over these in detail with you before surgery as part of the informed consent process. Examples include bleeding, infection, damage to surrounding tendons/nerves/vessels, anesthesia risks, or failure of the procedure.
As discussed previously, stiffness is universal with this injury. This is less a risk of surgery and more a side effect from this injury. In many cases, some degree of permanent stiffness is expected after this injury.
Another risk to understand is nonunion. This is a risk of treating any broken bone. In this situation, something goes awry in the biological bony healing process and your bone fails to heal. This often requires a repeat, more involved surgery to fix.
Big risk factors for nonunion include smoking, diabetes, and obesity. If you use tobacco and break a bone, you will want to quit immediately. Nicotine constricts the tiny blood vessels required to form new bone across a fracture repair site.