Comprehensive Guide to Proximal Interphalangeal Joint (PIPJ) and Distal Interphalangeal Joint (DIPJ) Dislocations

Overview

PIPJ (Proximal Interphalangeal Joint) and DIPJ (Distal Interphalangeal Joint) dislocations occur when the bones in the fingers are forced out of their normal alignment due to trauma or excessive force. These joints are critical for finger motion, and dislocations can impair hand function, causing pain, swelling, and deformity. Dislocations are typically classified by the direction in which the joint is displaced.

Anatomy of the Proximal Interphalangeal Joint (PIPJ) and Distal Interphalangeal Joint (DIPJ)

• PIPJ: This is the joint between the proximal (closest to the hand) and middle phalanges (bones) of the finger. It allows for flexion and extension, enabling the finger to bend.
• DIPJ: This joint is located between the middle and distal (fingertip) phalanges. It primarily enables fine control and movement at the fingertip.

Both joints are stabilised by ligaments, tendons, and muscles. The collateral ligaments on either side of these joints prevent lateral dislocation, while the volar plate stabilises the joint from hyperextension.

Types of PIPJ and DIPJ Dislocations

1. Dorsal Dislocation:
   1. Mechanism: The most common type of dislocation, where the distal bone (phalanx) moves upward or backward relative to the proximal bone.
   2. Cause: Often occurs when a finger is forced into hyperextension, such as during a fall or while playing sports.
   3. Injury Pattern: The volar plate may be torn, leading to instability.
2. Volar Dislocation:
   1. Mechanism: Less common, with the distal bone moving downward or toward the palm.
   2. Cause: Typically occurs due to a strong flexion force applied to the fingertip.
   3. Injury Pattern: There may be damage to the central slip of the extensor tendon, affecting finger extension.
3. Lateral Dislocation:
   1. Mechanism: The joint moves sideways, either toward the thumb (radial) or away from it (ulnar).
   2. Cause: Usually results from a blow to the side of the finger, often seen in sports injuries.
   3. Injury Pattern: Collateral ligament damage is common.

Prevalence of PIPJ and DIPJ Dislocations in Different Populations

• Athletes: PIPJ and DIPJ dislocations are common in sports such as basketball, football, and volleyball, where the fingers are at high risk of being jammed or hyperextended.
• Manual Labourers: People involved in manual tasks, construction, or trades often experience these dislocations due to frequent use of their hands in high-force situations.
• General Population: These dislocations are less common among non-athletic or sedentary individuals but can still occur due to accidents like falls.
• Elderly: These injuries may be more common in the elderly due to weaker ligaments, decreased bone density, and slower reflexes.

Prompt reduction (repositioning) and appropriate rehabilitation are key to restoring function and avoiding long-term issues such as joint stiffness or instability.

Access Ortho offers urgent care for orthopaedic injuries. Contact Access Ortho today for an appointment with the Orthopaedic team. 

Symptoms and Causes

Common Causes of PIPJ and DIPJ Dislocations

• Trauma or impact injuries: A direct blow to the finger, such as catching a ball or an object striking the hand, can cause dislocation.
• Hyperextension: Sudden and excessive backward bending of the finger (common in sports like basketball, volleyball, or football) can lead to dorsal dislocation.
• Sudden flexion force: A strong downward force applied to a bent finger, as when the finger gets caught in equipment or machinery, can cause volar dislocation.
• Lateral force: A sideways blow or twisting force can result in lateral dislocation, especially in sports involving hand contact, such as rugby or combat sports.

Risk Factors for Interphalangeal Joint Dislocations

• Participation in sports: Athletes, especially in sports like basketball, volleyball, or football, are at a higher risk due to the frequent jamming and sudden forces applied to the fingers.
• Previous dislocations or joint instability: Prior injury to the finger joints or ligaments increases the likelihood of future dislocations.
• Occupational hazards: Individuals whose jobs require heavy manual labour or involve frequent use of tools, machinery, or repetitive hand motions (e.g., construction workers) are at higher risk.
• Poor coordination or reflexes: People who have slower reaction times or less motor control are more likely to sustain finger injuries in accidents.
• Joint hypermobility: People with naturally loose or overly flexible joints (such as in conditions like Ehlers-Danlos syndrome) are more prone to joint dislocations.

Signs and Symptoms of PIPJ and DIPJ Dislocations

• Pain and tenderness: Sharp pain at the joint immediately after the injury, worsening with movement or pressure.
• Visible deformity: The finger may appear crooked, bent at an abnormal angle, or shortened (especially with dorsal or volar dislocations).
• Swelling and bruising: The injured finger will swell quickly, and bruising may appear around the joint.
• Limited range of motion: The individual will be unable to move the affected finger or will experience significant pain with movement.
• Numbness or tingling: Damage to surrounding nerves may cause numbness or tingling in the finger.
• Joint instability: After initial pain subsides, the joint may feel loose or unstable, particularly if the ligaments are torn or severely stretched.

Potential Complications of Untreated Interphalangeal Joint Dislocations

• Chronic joint instability: If the ligaments or supporting structures do not heal properly, the joint may remain unstable, leading to repeated dislocations or long-term weakness.
• Arthritis: Joint damage or untreated dislocations can lead to post-traumatic arthritis, causing long-term pain and stiffness in the affected finger.
• Permanent deformity: If the dislocation is not reduced (realigned) in a timely manner, the bones may heal improperly, leading to malalignment and deformity.
• Joint stiffness and contractures: Lack of proper rehabilitation or prolonged immobilisation can result in stiffness, making it difficult to bend or extend the finger through the full range of motion.
• Tendon or ligament damage: Severe dislocations can damage the tendons or ligaments around the joint, potentially requiring surgical intervention to restore function.
• Nerve damage: In some cases, nearby nerves may be compressed or damaged during the injury, leading to long-term numbness or weakness in the finger.
• Prompt diagnosis is essential to prevent these complications and ensure full recovery of finger function.

Access Ortho is a private fracture clinic offering affordable orthopaedic care to patients with acute injuries. Seeking specialist medical advice for an injury will minimise the risk of complications.

Diagnosis and Tests

How Are PIPJ and DIPJ Dislocations Diagnosed?

Diagnosing PIPJ and DIPJ dislocations typically involves a combination of patient history, physical examination, and radiology to assess the extent of the injury and identify any associated damage.

1. Patient History:

The healthcare provider will ask about the mechanism of injury, such as whether the finger was jammed, hyperextended, or struck by an object.

2. Physical Examination:

The clinician will inspect the finger for signs of deformity, swelling, and bruising.

Active and passive movement will be assessed, although movement may be limited or painful.

The provider will palpate (feel) the finger to detect any abnormalities, such as joint displacement or tenderness over specific structures like ligaments or tendons.

Imaging Techniques Used for Interphalangeal Joint Injuries

1. X-rays:
   1. Standard X-rays: The primary imaging method used to confirm a dislocation and evaluate any associated fractures. X-rays provide a clear view of the bones and the alignment of the joints.
      1. Dorsal dislocation: The middle or distal phalanx is displaced backward.
      2. Volar dislocation: The phalanx is displaced toward the palm.
      3. Lateral dislocation: A sideways shift of the joint can be visualised.
   2. X-rays also help to assess any fractures in the phalanges or avulsion fractures (where a small bone fragment is pulled off by a tendon or ligament).
2. Stress Views:
   1. In some cases, special stress X-rays may be taken. These are images taken while the joint is manipulated under gentle pressure, revealing hidden instability or subtle ligament injuries that may not be visible on standard X-rays.
   2. Stress views are useful for assessing ligamentous integrity, particularly when there is concern for chronic instability or collateral ligament injury.
3. Ultrasound:
   1. Though less commonly used, ultrasound may be used to assess soft tissue structures in real-time. It is useful for diagnosing soft tissue injuries associated with dislocations.
4. MRI (Magnetic Resonance Imaging):
   1. MRI is typically reserved for complex cases or when there is suspected soft tissue damage that may not be visible on X-rays (e.g., torn ligaments, tendon injuries, or significant joint capsule damage). It provides detailed images to assess the soft tissues, including tendons, ligaments, and cartilage.

Physical Examination Procedures for Assessing PIPJ and DIPJ Dislocations

1. Inspection:
   1. The clinician will visually assess the finger for deformities, swelling, and bruising. A dislocated joint may appear visibly out of place, and the skin may be stretched or puckered over the dislocation.
   2. Any signs of open wounds or skin breaches, which might indicate a compound dislocation, will be carefully evaluated.
2. Palpation:
   1. The joint and surrounding structures are gently palpated to identify areas of tenderness, abnormal bone alignment, or possible fractures.
   2. The examiner will feel for the position of the dislocated joint and assess whether the joint feels stable or unstable.
3. Range of Motion Testing:
   1. The provider may ask the patient to attempt movement of the joint (if tolerable) to assess active range of motion.
   2. Passive motion testing (where the clinician moves the joint) may be done carefully to determine joint stability. However, in acute dislocations, this may be painful and is usually avoided until after imaging.
4. Collateral Ligament Testing:
   1. The clinician may perform a stress test to evaluate the integrity of the collateral ligaments on either side of the PIPJ or DIPJ, particularly in lateral dislocations.
   2. A gentle valgus (outward) or varus (inward) stress is applied to the joint to assess for ligamentous laxity or tearing.
5. Neurovascular Examination:
   1. The nerves and blood vessels in the finger are assessed to ensure there is no damage. This involves checking for numbness, tingling, or changes in colour and temperature in the finger, which could indicate compromised circulation or nerve injury.

Prompt imaging and a thorough physical examination allow the medical provider to determine the best course of treatment and prevent long-term complications such as chronic instability or stiffness. The staff at Access Ortho specialise in the care of dislocations, fractures, sprains and strains. 

Specific Considerations

Differences Between PIPJ and DIPJ Dislocations

• Anatomical Differences:
  • PIPJ Dislocations: These involve the proximal interphalangeal joint (located between the proximal and middle phalanges). The PIPJ allows for significant flexion and extension and plays a major role in gripping and grasping movements. Due to the joint’s large range of motion and reliance on ligamentous support, dislocations here are more common and often more severe.
  • DIPJ Dislocations: These occur at the distal interphalangeal joint, located between the middle and distal phalanges. The DIPJ primarily controls finer fingertip movements. Dislocations at this joint are typically less common but can affect fine motor skills.
• Functional Differences:
  • PIPJ Dislocations: Often cause greater impairment in hand function due to their critical role in power grip and dexterity. Damage to the volar plate or collateral ligaments can lead to chronic instability.
  • DIPJ Dislocations: These tend to affect activities involving precision and fingertip manipulation. Although they can be painful, they generally cause less functional impairment compared to PIPJ dislocations unless associated with fractures or tendon injuries.

Associated Injuries: Ligament Tears, Avulsion Fractures, and Volar Plate Injuries

1. Ligament Tears:
   1. Collateral Ligaments: These ligaments provide lateral stability to both the PIPJ and DIPJ. A forceful blow or twisting motion can lead to a tear in these ligaments, often seen in lateral dislocations. Ligament tears may cause chronic instability and, if severe, require surgical intervention.
   2. Central Slip Tendon Injury: A central slip tendon injury occurs when the central slip of the extensor tendon, which runs over the top of the middle phalanx (the middle bone of the finger), is damaged or torn, leading to problems with finger extension (e.g., boutonnière deformity).
2. Avulsion Fractures:
   1. Cause: When a ligament or tendon pulls off a small piece of bone during a dislocation, this is called an avulsion fracture. This is common in PIPJ dislocations, particularly in dorsal injuries, where the volar plate or collateral ligament avulses a bone fragment.
   2. Complications: Avulsion fractures may lead to prolonged healing times and stiffness and sometimes require surgical fixation if large fragments are involved.
3. Volar Plate Injuries:
   1. Volar Plate: The volar plate is a thick ligament on the palm side of the PIPJ and DIPJ that prevents hyperextension. A dorsal dislocation often tears this structure, leading to joint instability.
   2. Injury Impact: Damage to the volar plate can result in hyperextension deformities, joint instability, and chronic pain if not properly managed. In severe cases, volar plate tears can contribute to joint stiffness or deformities such as a swan-neck deformity.

Impact of PIPJ and DIPJ Dislocations on Hand Function and Daily Activities

• PIPJ Dislocations:
  • Hand Function: The PIPJ plays a critical role in grip strength, coordination, and hand function. Dislocations here can severely limit activities requiring hand strength and coordination, such as lifting objects, gripping tools, or typing.
  • Daily Activities: Simple tasks like opening jars, buttoning clothes, or using utensils can become difficult due to pain, swelling, and joint stiffness. Occupational tasks, especially for manual workers, are often impaired until the joint is fully rehabilitated.
  • Long-term Effects: Chronic stiffness or instability can affect hand function even after recovery, making tasks that require finger dexterity more difficult.
• DIPJ Dislocations:
  • Hand Function: Although DIPJ dislocations affect the fingertip joint, they have less impact on gross motor function. However, fine motor skills, like typing, writing, or handling small objects, may be significantly affected.
  • Daily Activities: Precision-based tasks, such as using a smartphone, typing, or sewing, can become challenging due to impaired fingertip motion or pain.
  • Long-term Effects: Stiffness in the DIPJ may limit fingertip extension and flexion, affecting dexterity and making precise movements difficult.

Chronic Instability Following Interphalangeal Joint Dislocations

Causes of Chronic Instability:

• Ligament Damage: If ligaments are torn or stretched during the dislocation and not properly treated, the joint may remain loose or unstable, leading to repeated dislocations or joint subluxations (partial dislocations).
• Inadequate Rehabilitation: Failure to properly rehabilitate the joint, including strengthening and stabilising the surrounding muscles and ligaments, can result in persistent instability.
• Improper Healing: In cases where the joint was not adequately reduced or immobilised, improper healing can lead to a misaligned joint and contribute to chronic instability.

Consequences of Chronic Instability:

• Frequent Re-dislocations: A weakened or unstable joint is more prone to future dislocations with minor trauma or during activities involving grip or twisting motions.
• Pain and Swelling: Ongoing instability can cause chronic pain, recurrent swelling, and joint discomfort during daily activities.
• Arthritis: Chronic instability often leads to wear and tear of the joint surfaces, increasing the risk of developing post-traumatic arthritis. This can cause long-term stiffness, pain, and reduced mobility.
• Deformities: Long-term instability can result in finger deformities, such as a swan-neck or boutonnière deformity, which can further impair function.

Managing chronic instability may require further interventions, including physiotherapy or even surgery to reconstruct damaged ligaments or stabilise the joint. To minimise complications, it is important to get specialist care for PIPJ and DIPJ dislocations. Access Ortho only treats orthopaedic injuries and are specialists in this area. Contact Access Ortho today to make an appointment to ensure you are receiving expert Orthopaedic care.

Management and Treatment

Immediate First Aid for PIPJ and DIPJ Dislocations

1. Stop the Activity: If the dislocation occurs during sports or other physical activity, stop immediately to prevent further injury.
2. Immobilisation: Keep the finger still in the position it was found. Avoid trying to move or force it back into place without medical help, as this can worsen the injury.
3. Ice Application: Apply ice to the injured finger to reduce swelling and numb the area, using a barrier (like a cloth) between the ice and skin. Ice should be applied for 15-20 minutes at a time.
4. Elevation: Keep the hand elevated above heart level to reduce swelling.
5. Seek Medical Attention: Promptly visit a healthcare provider or emergency department for proper reduction (realignment) and assessment of the injury.

Closed Reduction Techniques for Interphalangeal Joint Dislocations

Relocations should be done by a medical provider as soon as possible. 

1. Dorsal Dislocation (Most Common):
   1. Procedure: A traction-countertraction technique is used. The doctor will apply gentle traction (pulling) along the length of the finger while simultaneously pushing the dislocated bone back into its normal position. This is typically done while stabilising the proximal bone (the one that remains in place).
   2. Post-Reduction: The joint is moved to confirm stability, and X-rays are taken to ensure proper alignment and to rule out fractures.
2. Volar Dislocation:
   1. Procedure: Volar dislocations are reduced by traction, followed by flexion to allow the dorsal structures to glide back into place. Care must be taken during the procedure to avoid damage to the extensor tendon.
   2. Post-Reduction: The same steps are followed to check for stability and joint function.
3. Lateral Dislocation:
   1. Procedure: Similar to dorsal dislocations, lateral dislocations require traction to lengthen the joint, followed by gentle realignment of the displaced bone.
   2. Post-Reduction: Stress testing may be done to assess the integrity of the collateral ligaments, followed by immobilisation.

Anesthesia: For all dislocations, a local anaesthetic (often a digital nerve block) is typically used to make the reduction process more comfortable.

Indications for Surgical Intervention in Complex Cases

Surgical intervention may be required in the following situations:

1. Failed Closed Reduction: If a dislocation cannot be reduced by closed methods or immediately redislocates after reduction, surgery may be necessary to correct the alignment or repair damaged structures.
2. Associated Fractures:
   1. Avulsion Fractures: This is described when a tendon or ligament pulls off a large bone fragment. Surgery may be needed to reattach the fragment or stabilise the joint.
   2. Intra-articular Fractures: Fractures that extend into the joint space often require surgical fixation to restore normal joint anatomy and prevent long-term arthritis.
3. Ligament or Tendon Damage:
   1. Significant ligament tears or tendon injuries (e.g., central slip or volar plate rupture) may need surgery to restore joint stability and function.
4. Chronic Instability: In cases of recurrent dislocations or long-term joint instability, surgical reconstruction of the ligaments may be necessary to stabilise the joint.

Immobilisation Methods: Splinting and Buddy Taping

1. Splinting:
   1. PIPJ Dislocations: After reduction, a dorsal blocking splint is often applied to keep the finger in a slightly flexed position to protect the volar plate and prevent hyperextension. Depending on the severity of the injury, the splint is usually worn for 2-3 weeks.
   2. DIPJ Dislocations: A finger splint is often used to immobilise the distal joint in slight flexion, particularly for DIPJ dorsal dislocations or fractures. Splinting helps to maintain alignment and promote healing.
2. Buddy Taping:

Technique: The injured finger is taped to an adjacent, uninjured finger for support. This method allows the injured joint to maintain some mobility while protecting it from further trauma.

Duration: Buddy taping is often used after splinting as part of the rehabilitation phase, typically for 2-4 weeks, depending on the joint’s stability.

3. Duration of Immobilisation:

Immobilisation should not be prolonged beyond necessary as this can lead to joint stiffness and delayed recovery. Typically, immobilisation lasts for 2-3 weeks, followed by a gradual return to normal activity. The orthopaedic surgeon will guide patients on this. 

Rehabilitation Protocols for PIPJ and DIPJ Dislocations

All rehabilitation must be done under the guidance of the orthopaedic team. Do not start any mobilisation or exercises without discussing them with your medical provider. 

1. Early Mobilisation:
   1. Controlled early movement is critical to avoid stiffness and promote healing. Once the initial swelling has subsided and the joint is stable, gentle range of motion exercises are initiated.
   2. For PIPJ dislocations, early mobilisation in a protective splint or with buddy taping can help regain flexion and extension.
2. Range of Motion (ROM) Exercises:
   1. Finger Flexion and Extension: Gentle exercises to restore full flexion and extension at the PIPJ and DIPJ are crucial. Patients are encouraged to perform these exercises several times a day to prevent stiffness.
   2. Active and Passive Stretching: Passive stretching can be introduced to maintain joint mobility, especially in cases where the joint is prone to stiffness.
3. Strengthening Exercises:
   1. Once ROM is restored, strengthening exercises are added to improve grip strength and finger function. Therapists may recommend exercises using therapy putty or rubber bands.
   2. Grip Training: Squeezing soft objects or gripping exercise tools strengthens the muscles of the hand and fingers.
4. Functional Training:
   1. In the later stages of rehabilitation, patients practice functional activities like gripping, typing, or handling small objects to restore coordination and fine motor control.
   2. Occupational Therapy: Patients with significant hand function impairments may benefit from occupational therapy to retrain hand movements for daily activities.
5. Return to Activity:
   1. Sport-specific Rehab: Athletes are gradually reintroduced to sport-specific movements, with finger taping or protective splints often used during early return to play.
   2. Timeframe: For simple dislocations, most patients can return to full activity within 4-6 weeks. However, more complex cases involving surgery may require a longer recovery period, typically 8-12 weeks.

Most patients can expect to regain normal hand function by following a structured rehabilitation protocol, though recovery may take longer in more severe cases. The orthopaedic team at Access Ortho will guide patients on their rehabilitation needs and arrange a referral to a hand therapist if necessary. 

Prevention

To prevent PIPJ and DIPJ dislocations, focus on the following strategies:

1. Warm-up and Stretching: Engage in proper warm-ups to prepare muscles and joints for physical activity.
2. Strengthening Exercises: Strengthen hand and forearm muscles, which support the joints, through exercises like squeezing stress balls or using resistance bands.
3. Joint Mobility Training: Perform regular flexibility and mobility exercises to maintain movement and reduce the risk of injury.
4. Proper Hand Protection: Use protective gear (e.g., padded gloves or buddy taping) in sports and manual activities. Follow proper techniques to avoid excessive strain on the joints.
5. Ergonomic Work Practices: To prevent joint strain, use ergonomically designed tools and maintain proper hand positioning in repetitive tasks.
6. Joint Stability Exercises: Strengthen collateral ligaments with targeted exercises, improve proprioception through coordination drills, and ensure forearm strength for enhanced joint stability.
7. Rest and Recovery: Allow adequate rest after physical activities to avoid overuse injuries that could weaken the joints.

Outlook / Prognosis

Expected Recovery Time for PIPJ and DIPJ Dislocations

1. Simple Dislocations: Recovery is generally quick for uncomplicated dislocations, where there is no associated fracture or significant ligament damage.

Recovery Time:

1. Immobilisation (splinting or buddy taping) is typically required for 2-3 weeks.
2. Patients usually regain full range of motion and hand function within 4-6 weeks, though minor stiffness may persist during the early phases of recovery.

Rehabilitation: Early motion exercises and physical therapy can help expedite recovery and prevent stiffness.

2. Complex Dislocations: The recovery time is longer if the dislocation involves fractures, ligament tears, or requires surgical intervention.

Recovery Time:

1. Immobilisation may extend to 3-6 weeks, depending on the injury severity.
2. Full recovery, including regaining range of motion and strength, can take 8-12 weeks or more.

Patients may require more intensive physiotherapy to address stiffness and weakness, especially after surgery.

Return to Activity:

• Low-impact Activities: Patients with simple dislocations may return to low-impact daily activities within a few weeks.
• Sports and High-impact Activities: Athletes or individuals with physically demanding jobs may take 4-8 weeks to return to full activity, with additional time needed for complex cases.

Long-term Prognosis for Interphalangeal Joint Injuries

1. Simple Dislocations:

The long-term prognosis for simple PIPJ and DIPJ dislocations is generally excellent.

Most patients recover full range of motion and hand strength. However, some may experience mild residual stiffness or occasional discomfort, especially in cold weather or after extended use of the finger.

2. Complex Dislocations:

In more severe cases, particularly those involving fractures, torn ligaments, or tendon injuries, there may be some long-term complications.

• Joint Stiffness: Persistent stiffness is a common long-term effect, especially if early mobilisation is not initiated.
• Loss of Movement: In some cases, patients may not fully regain the pre-injury range of motion, which can affect hand function in daily activities or sports.
• Chronic Instability: If the ligaments are severely damaged and not fully healed, recurrent dislocations or chronic instability of the joint may occur. This could necessitate surgical repair.

Post-Surgical Prognosis:

The long-term outlook following surgery depends on the success of the procedure and the rehabilitation process. Most surgical patients regain functional use of the finger but may have a longer recovery timeline.

Early and consistent post-operative physiotherapy is key to preventing stiffness and ensuring a good functional outcome.

Potential for Arthritis Development Following PIPJ and DIPJ Dislocations

Post-traumatic Arthritis:

One of the most significant long-term concerns following a PIPJ or DIPJ dislocation is the development of post-traumatic arthritis. This occurs due to damage to the cartilage and joint surfaces during the dislocation, leading to joint degeneration over time.

• Risk Factors:

1. Fracture-dislocations: Dislocations associated with intra-articular fractures (fractures that involve the joint surface) are associated with a higher risk of developing arthritis.
2. Chronic Instability: Recurrent dislocations or instability of the joint can contribute to abnormal wear and tear, increasing the risk of arthritis.
3. Delayed or Improper Treatment: Untreated or improperly reduced dislocations can lead to poor joint alignment, further contributing to arthritis development.

• Symptoms of Post-traumatic Arthritis:

Patients may experience joint pain, stiffness, and reduced range of motion over time. In more severe cases, there may be swelling, deformity, or difficulty using the affected finger during daily tasks.

• Prevention and Management:
  1. Prevention: Proper and timely reduction of the dislocation, early mobilisation, and adherence to rehabilitation protocols can help reduce the risk of developing arthritis.
  2. Management: If arthritis does develop, treatment options include:
     1. Physiotherapy: Exercises may be given to maintain joint mobility and strength.
     2. Anti-inflammatory Medications: To reduce pain and inflammation.
     3. Corticosteroid Injections: May be used to relieve inflammation and pain in the joint.
     4. Surgical Options: In advanced cases, joint fusion or arthroplasty (joint replacement) may be considered to restore function and alleviate pain.

In summary, the prognosis for PIPJ and DIPJ dislocations is generally favourable, especially with proper treatment and rehabilitation. However, complex injuries carry a higher risk of complications, including long-term joint stiffness, instability, and post-traumatic arthritis. It is, therefore, essential to seek specialist orthopaedic care for PIPJ and DIPJ dislocations. Access Ortho is a Fracture Clinic in Brisbane and Ipswich offering rapid appointments and is led by orthopaedic surgeons. 

When to Seek Medical Attention

Signs That Indicate the Need to Seek Immediate Medical Care

• Visible Deformity:

If the finger appears visibly out of alignment, crooked, or dislocated, it’s crucial to seek immediate medical care to avoid further damage to the joint, tendons, or ligaments.

• Inability to Move the Finger:

The inability to move the finger completely or feeling “locked” in a position suggests a severe dislocation or associated ligament/tendon injury that requires prompt attention.

• Severe Pain and Swelling:

Intense pain or swelling that doesn’t improve with rest, ice, or over-the-counter medications indicates that the injury may be more serious than a minor sprain or strain and may involve a dislocation, fracture, or ligament damage.

• Numbness or Tingling:

Any numbness, tingling, or change of sensation in the finger suggests nerve involvement, which may occur due to pressure from the dislocation. Immediate care is necessary to prevent long-term nerve damage.

• Cold or Pale Skin:

If the skin around the injured finger turns pale, cold, or bluish, this could indicate compromised blood flow. This is a medical emergency. You need to seek urgent care to restore circulation and prevent tissue damage.

• Inability to Reduce the Dislocation:

If a healthcare provider cannot reduce (realign) the dislocation or if it re-dislocates after an attempted reduction, further specialist medical attention is needed to prevent chronic instability or further complications.

Follow-up appointments and Monitoring for Interphalangeal Joint Injuries

It is important to attend follow-up appointments to avoid complications. At the follow-up appointments, the following will be assessed:

• Post-Reduction Monitoring:

After a dislocation is reduced, follow-up appointments are important to monitor healing and ensure the joint remains stable.

X-rays: Regular X-rays may be taken during follow-up visits to confirm proper alignment and healing of the joint, especially if a fracture or ligament injury is involved.

• Check for Complications:

Follow-up appointments help monitor potential complications, such as chronic joint instability, stiffness, or delayed healing. The medical provider may check for signs of post-traumatic arthritis, recurrent dislocations, or ligament damage.

• Rehabilitation Progress:

To ensure full recovery, the finger’s range of motion, strength, and flexibility must be evaluated on an ongoing basis. 

• Surgical Cases:

For cases involving surgery, close monitoring is required to assess the success of the procedure and prevent complications. Follow-up care includes wound checks, removal of stitches or pins (if used), and gradual transition to hand therapy.

• Long-term Follow-up:

Patients with complex dislocations may need long-term follow-up to assess for any chronic joint instability or degenerative changes that could lead to arthritis or reduced hand function.

Understanding Fracture Clinics

What is a Fracture Clinic?

A fracture clinic such as Access Ortho is a specialised medical clinic that focuses on the diagnosis, treatment, and follow-up care of bone fractures and musculoskeletal injuries. Access Ortho Fracture Clinic is staffed by orthopaedic surgeons, emergency physicians and orthopaedic nurse practitioners who are specialists in managing the recovery process for individuals with broken bones or joint injuries.

Access Ortho is an Urgent Care centre that only treats orthopaedic injuries. Our staff specialise in orthopaedic care, ensuring injuries are treated by practitioners trained in orthopaedics. 

At Access Ortho fracture clinic, patients receive ongoing care in specialist clinics after the initial emergency or urgent treatment of their injury. The clinic ensures proper healing, monitors for complications, and provides rehabilitation guidance.

When Should You Visit a Fracture Clinic for a PIPJ or DIPJ dislocation?

You should visit a fracture clinic such as Access Ortho in the following situations:

• After a finger injury:

You may attend Access Ortho Fracture as your first point of contact following a finger injury. The orthopaedic team will assess your injury and arrange radiology if required before outlining a treatment plan. Access Ortho will cast/splint your finger if required and arrange orthopaedic follow-up care. 

• After Initial Treatment of a Finger Fracture or Dislocation:

If you’ve been treated for a PIPJ or DIPJ dislocation in an emergency department or by your general practitioner, you may attend the fracture clinic for ongoing care and monitoring. You do not need a referral to come to Access Ortho.

• What to Expect During a Fracture Clinic Appointment for a PIPJ or DIPJ Dislocation?

During your visit to a fracture clinic, the appointment will generally include the following steps:

Medical History and Symptom Review:

The medical practitioner will ask about your injury, current symptoms (e.g., pain, swelling, stiffness), and how well you’ve recovered since your initial treatment.

Physical Examination:

Your finger will be examined for swelling, alignment, tenderness, range of motion, and any visible deformities or complications. If immobilisation devices like splints or casts are still in place, the doctor may assess their fit or remove them for a closer examination.

Imaging (X-rays or Other Scans):

Follow-up imaging is often used to check the progress of bone healing. This may include X-rays or, in some cases, CT scans or MRIs, especially if the injury involves joint damage or surgical repairs.

Discussion of Treatment Plan:

Based on the assessment findings and imaging results, the orthopaedic team will discuss whether any further treatment is needed, such as:

• Continuing immobilisation (splints, casts, etc.).
• Starting rehabilitation exercises to regain finger strength and flexibility.
• Surgery if complications arise (e.g., malunion or nonunion of the bone).

Rehabilitation Guidance:

• The clinic may refer you to a physiotherapist or provide instructions for rehabilitation exercises to improve your finger’s mobility and function.

Monitoring for Complications:

The specialist will check for signs of complications such as infection, poor healing, or nerve/tendon damage. If any issues are found, further treatment options will be discussed. Fracture clinics play a key role in ensuring a successful recovery from IPIJ and DIPJ dislocations. They provide medical care to help restore normal hand function. Access Ortho is one of Brisbane’s leading fracture clinics, providing specialist care for fractures, dislocations, sprains, and strains.

Commonly Asked Questions

How can I tell if my finger is dislocated or just sprained?

A dislocated finger will often look visibly deformed or out of alignment, and you may be unable to move it. Dislocations are usually accompanied by significant pain, swelling, and sometimes numbness.A sprain is described when the ligaments tear or stretch without dislocation. It may cause pain, swelling, and bruising. However, the finger usually remains in alignment and can still move to some extent.

Can I relocate a dislocated finger joint myself?

It is not recommended to try relocating a dislocated finger joint yourself. Doing so improperly could cause further damage to ligaments, tendons, or even nerves. It’s best to seek urgent medical attention to ensure the joint is safely reduced and to avoid complications.

How long does it take for a PIPJ or DIPJ dislocation to heal completely?

Recovery from a simple dislocation usually takes 4-6 weeks, with a full return to function in around 6-8 weeks. For more complex dislocations, especially if there are fractures or ligament injuries, recovery may take 8-12 weeks or longer.

Will I need surgery for my interphalangeal joint dislocation?

Most dislocations can be treated with a closed reduction (realignment without surgery), but surgery may be necessary for complex dislocations involving fractures, significant ligament damage, or unstable joints that don’t stay in place after reduction.

What’s the difference between a PIPJ and a DIPJ dislocation?

The PIPJ (Proximal Interphalangeal Joint) is the middle joint of the finger, while the DIPJ (Distal Interphalangeal Joint) is the joint closest to the fingertip. Dislocations of the PIPJ are more common than DIPJ dislocations and tend to have more severe ligament involvement.

How soon can I return to sports after an interphalangeal joint dislocation?

For minor dislocations, athletes may return to sports in 4-6 weeks once pain and swelling have subsided, and mobility is regained. For complex injuries, the timeline may extend to 8-12 weeks or longer. Wearing protective splints or buddy taping is often recommended when returning to sports. It is important to seek advice from your treating doctor regarding return to sport.

Can a dislocated finger joint lead to long-term problems?

Yes, untreated or poorly treated dislocations can lead to chronic instability, joint stiffness, or post-traumatic arthritis. Even with proper treatment, some individuals may experience mild long-term issues like stiffness, pain, or reduced range of motion. It is important to get orthopaedic specialist care for your injury.

Will my finger look different after it heals from a dislocation?

While most fingers return to a normal appearance after healing, in some cases, the finger may have a slight deformity or swelling, especially if there is a significant ligament or fracture injury. Mild changes in appearance can occur, but severe deformities are rare with proper treatment.

How can I manage pain and swelling after an interphalangeal joint dislocation?

Immediately after the injury, use RICE (Rest, Ice, Compression, Elevation) to manage pain and swelling. Over-the-counter pain relievers, for example ibuprofen or panadol, can help with discomfort. A splint or buddy taping may be used to protect the joint and reduce swelling.

 What exercises can I do to improve my recovery from a PIPJ or DIPJ dislocation?

Yes, hand therapy exercises focusing on range of motion and strengthening can aid recovery. Gentle finger flexion and extension exercises, as well as grip strengthening with a stress ball or therapy putty, can help restore joint function and prevent stiffness. Always follow the advice of a physiotherapist for personalised exercises. Your doctor will advise if hand therapy is required.