P.I.P. Joint Injuries
The Proximal Interphalangeal (P.I.P.) Joint is the most commonly sprained or dislocated joint in the hand. Many of these injuries are treated by a coach, a trainer or by the patient, who may consider them trivial.
Unfortunately, delays in diagnosis and treatment, under-treatment, and particularly over-treatment may lead to many problems and prolong disability and pain.
It is important to know if the finger was deformed at the time of injury and if someone had to pull it back into place.
An understanding of the complex anatomy of this joint is essential for diagnosis and treatment.
The major long-term problem is stiffness and prolonged irritability in the joint following these injuries. This may last for 6-9 months.
Sometimes there is permanent thickening of the joint following severe injuries. In the short term, however it is vital to prevent re-dislocation in unstable injuries and so various splints may be required.
There are multiple subtle variations in the severity and nature of PIP joint injuries. Some need no treatment at all and others need immediate surgery. Experience in treating these injuries is essential.
1. Collateral Ligament Tear (Partial, Complete)
2. Volar Plate Avulsion (Stable, Unstable)
This chip fracture on both the DIP and PIP joints is the most common pattern of injury (although a double avulsion fracture is very uncommon). This required splinting for a few days to control the pain and then an active exercise program because it is a stable injury.
3. Fracture/Dislocation (Stable, Unstable)
The severity of the above injury is not apparent on standard xrays. It is only on the oblique x-ray that one can appreciate the degree of joint surface depression. This required surgery as did the severe injury below.
1. Control Swelling with ice and COBAN bandage. This bandage can be obtained from the physiotherapists and is self-adhesive. It is thin enough to allow a full range of movement of the finger when applied properly. Only a single layer should be applied. Beware - it is easy to apply the bandage too tightly.
2. Prevent Re-Dislocation - this is not a common problem. Use buddy strapping to adjacent finger or extension block splints.
3. Prevent stiffness - if the injury is stable the finger can be exercised immediately in a bucket of ice and later in warm water. This is the commonest situation. In general these injuries are over treated with splints resulting in unnecessary stiffness.
4. Re-Xray - if the injury is unstable the joint may re-dislocate. Dislocation or partial dislocation (subluxation) may be present but the finger may appear deceptively straight due to the marked degree of swelling. Therefore regular X-rays are performed in these rare cases. In the case below there is persistent mild displacement of the joint.
5. Surgery - occasionally the injury is so severe that surgery is required to stabilise the joint. This is uncommon (see diagram below).