Welcome to the patient resource page about PIP Joint Injuries of the Finger created by Hicksville Physical Therapy.
Our hands are one of the most-used parts of our bodies, which means that there is a constant risk of injury. Finger joints commonly experience injuries, and typically, these injuries heal without intervention. However, there are more serious cases in which problems can arise if the issue is not properly treated. One such case is when the proximal interphalangeal joint, or PIP joint, is sprained. The PIP joint in the finger is one of the most difficult to heal. The injury may seem simply at first, but over time, it has the potential to develop into a stiff and painful finger, which can render normal gripping activities nearly impossible.
In this article, you will learn:
What portions of the finger are involved with the PIP joint?
Finger joints act as hinges to help our fingers straighten and bend. The main joint of the knuckle, where the fingers connect to the palm, is known as the metacarpophalangeal joint, or MCP joint. This joint is formed where the palm’s metacarpal bone joins together with the phalanges, or finger bones. In each finger are three phalanges, which are separated by two interphalangeal joints, or IP joints. The joint closest to the knuckle is the proximal IP joint, or PIP joint. The joint at the finger’s end is the distal IP joint, or DIP joint.
Ligaments connect bones together with strong bands of tissue. Multiple ligaments work to hold joints in place. When it comes to the PIP joint, the strongest ligament involved is known as the volar plate.
The volar plate joins the proximal phalanx and the middle phalanx located on the joint’s palm side. This ligament tightens each time the joint is straightened, preventing the joint from hyperextending. Additionally, each side of the PIP joint has a collateral ligament. These ligaments tighten each time the joint is bent sideways, helping to stabilize the joint.
What can cause injuries of the PIP joint?
A sprain is a general term describing an injured ligament.
When doctors use this term, they are typically saying that the ligament in question is partly torn and stretched. If the stretch is too severe, the ligament may rupture or tear altogether.
If the joint is hyperextended, the volar plate may be injured. In the case of a complete tear, the ligament tends to rupture or tear, separating it from the middle phalanx.
When this occurs, a tiny portion of bone may avulse, or pull away, from the middle phalanx.
Typically, this incident is no bother. However, if there is a notable about of the joint surface involved, surgery may be needed to repair the fragment and restore the surface of the joint.
The collateral ligaments may be injured if the joint is made to bend too far to the side to the point of rupturing the collateral ligaments. These ligaments may also be subject to injury if the PIP joint is dislocated, placing the middle phalanx behind the proximal phalanx.
What do PIP joint injuries look and feel like?
Typically at the onset of such an injury, the finger becomes painful and swollen near the PIP joint. The finger may appear deformed if the PIP joint has been totally dislocated.
During your time at Hicksville Physical Therapy, our Physical Therapist will begin by taking your history and performing a physical examination. Normally, the physical exam provides enough evidence to come to a PIP joint injury diagnosis.
In some cases, patients may be referred to a specialist. If an avulsion fracture is suspected, X-rays may be needed, and the recommended treatment may be adjusted. X-rays can also help doctors to determine whether the joint is properly aligned following an injury or a dislocation. Most of the time, no further tests are needed.
When your diagnostic exam is done, the team of Physical Therapists at Hicksville Physical Therapy will provide a range of treatment options to speed up your recovery, allowing you to return to your daily activities.
Non-Surgical Rehabilitation
If ligaments are sprained or only partly torn, your Physical Therapist may recommend some time in a splint followed by early exercise. The PIP joint is incredibly prone to injury and can become stiff when immobilized, even if only for a short period. The quicker the joint returns to movement, the less likely that stiffness will occur later. In many cases, sprains can be treated by buddy taping to the neighboring finger. This practice lets the healthy finger act as a brace to the injured finger while also letting the healthy finger bend the injured finger in daily activities.
If there is joint dislocation or a complete rupture of the volar plate, nonsurgical treatment is typically still used. The goal in this case is to stabilize the joint and begin motion as soon as possible. This injury typically results from hyperextension, so your physical therapist will provide a brace to stop the joint from totally straightening while still letting it bend. This brace is known as a dorsal blocking splint and is normally worn for three to four weeks, allowing the ligament to heal enough to keep the joint stable.
Sometimes, if the volar plate ruptures, it can become caught within the joint, preventing your physical therapist from realigning the joint (also known as reducing). Surgical evaluation may be recommended.
Recovery time differs for every patient, but successful nonsurgical treatment typically brings improvement within three to six weeks. The use of a dorsal blocking splint allows the joint to bend freely without completely straightening.
After three or four weeks, the joint should be healed enough that you can remove the splint and engage in strengthening exercises. Your Physical Therapist will create a custom exercise program to help you regain the strength and range of motion of your fingers.
PIP joint injuries can remain swollen for a long time. This joint is often permanently enlarged because of the scarring present during healing. Patients may have trouble wearing rings. We recommend waiting around one year before resizing any rings, as the scarring will continue changing a bit. The joint will shrink over time and may return to its normal size.
Post-Surgical Rehabilitation
You will likely need to wear a brace or splint for three weeks after surgery to provide the joint with a proper healing period. Recovery time will vary, but after surgery, patients usually need physical therapy for two to three months, and full recovery often takes up to four months.
During your first few Physical Therapy treatments, you’ll focus on controlling the swelling and pain associated with surgery. Then, you’ll be given gentle range of motion exercises and strengthening exercises to provide added stability around the joint. Your Physical Therapist will instruct you on how to grip and support objects to perform tasks safely and to reduce stress on the joint. It is important to avoid doing too much before the joint is ready.
Over time, you will begin doing exercises to help your fingers and hand get used to performing your daily tasks and activities. Your Physical Therapist will work with you to find ways to do daily tasks that reduce stress on the joint. Before the end of your Physical Therapy sessions, you will have learned multiple ways to avoid problems in the future.
Our main priority is to help you manage your pain, improve your range of motion and strength, and regain the fine motor abilities in your fingers and hand. When your recovery has progressed significantly, you will cease regular visits to Hicksville Physical Therapy. We will remain as a resource for you, but ultimately, you will be responsible for performing your exercises at home.
In rare, severe cases, surgery may be needed to repair significant damage to the volar plate or collateral ligaments. Surgery is also used to remove the volar plate if it is trapped within the joint, preventing your doctor from realigning the joint without surgical means.
