Collateral Ligament Tears of the Finger
In each of the fingers (index, middle, ring and pinky) there are three joints called the distal interphalangeal (DIP), proximal interphalangeal (PIP), and metacarpophalangeal (MCP) joint. The thumb has two joints, the interphalangeal (IP) and MCP joint. Collateral ligaments are like leather bands of strong tissue connecting the bones in each of those joints that help to stabilize the joint throughout movement.
Injury to the collateral ligament occurs when there is a force in a direction different from the normal motion of the joint that is large enough to tear the ligament. This is most commonly caused by a fall onto an outstretched hand, a finger getting caught on something, or a dog leash wrapped around a finger that gets pulled. Patients often self-diagnose themselves with a “jammed finger." Extreme trauma can actually cause the joint to dislocate.
Patients with collateral ligament injuries of the finger may experience pain and tenderness on the side of the finger joint. A feeling of instability may be present when opening and closing the fingers and pinching objects. In addition, patients may notice swelling or bruising at the affected area.
Initial evaluation of the injury starts with a physical exam of the fingers in order to assess for ligament instability or laxity. Provocative testing of the ligament will be performed by applying stress to the ligament at the involved joint(s) of the affected finger and comparing it to the unaffected finger. An assessment is made to determine whether the ligament is sprained (stretched or partially torn) or if it's completely torn. This is based on the degree of gapping or instability.
An x-ray will typically be ordered to rule out a fracture.
When determining treatment for this type of injury, a variety of important factors are considered. These include the classification of the injury, the degree of the tear, the specific joint and finger of the injured ligament, and the presence of a fracture.
Most collateral ligament injuries may be treated with nonsurgical management. Patients who have relatively stable joints are typically treated with consistent buddy taping of the finger to provide support and stabilization while maintaining joint mobility. Buddy taping involves taping or strapping the injured finger above and below the affected ligament to an adjacent finger, thereby providing a “buddy system.” Unstable joints may be treated with splinting followed by buddy taping.
Hand/physical therapy is often gradually initiated in order to allow the ligament to properly heal. Hand/physical therapy is vitals towards reducing stiffness and regaining mobility and strength. Unfortunately, collateral ligament injuries tend to take an extended period of time to heal, usually no less than 6 weeks, and often up to several months.
Surgery may be recommended depending on the location of the ligament tear, the presence of a displaced avulsion fracture, or if nonsurgical management is unsuccessful. Surgery is often indicated for complete tears to the collateral ligament of the index finger given the ligament plays an important role in finger pinch. Repair of the ligament involves making a small incision over the affected ligament and using suture and anchors to secure the ligament into a proper position. If there is a displaced avulsion fracture, surgery may be considered to realign the avulsed fragment of bone and fix it back into proper position with a small screw.
Dr. Steven Lee has revolutionized the treatment of ligament tears and collateral ligament tears specifically with his pioneering of Internal Bracing of the Hand. Internal bracing utilizes an innovative strong suture tape construct with new bone anchors in order to increase the strength of the repair or reconstruction, thereby significantly quickening the rehabilitation process, and allow earlier return to sports and daily function. Please feel free to ask Dr. Lee about his specific expertise with this method. Learn more about Internal Bracing here.
As in the non-operative treatment of these injuries, the recovery period after surgery can be unusually prolonged, and can take at least 3 months to heal. Swelling may be present for much longer, and to a certain extent, may always be there whether surgery was performed or not.
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After surgery, patients will usually be placed into a finger splint on the affected finger, with an adjacent finger included, for additional support. Patients usually follow up in office 7-10 days after surgery for a wound check and if there are stitches, to check if they are ready for removal.
Depending on the extent of surgery performed, patients will continue to be splinted for up to 3 - 6 weeks. After this period of immobilization, to allow for healing, patients are usually transitioned to buddy taping and initiated on a course of gradual hand/occupational therapy to restore mobility to the fingers.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City and Scarsdale.