Injuries to the fingers lead to an impairment of the manipulative function of the hand, which involves difficulties in writing or in grasping objects of different sizes. Finger deformities acquired as a result of various injuries are often also an aesthetic problem. Only properly planned treatment can restore the required mobility in the fingers and the appropriate grip strength needed to restore the function of the hand after the injury.
The most common injuries to the fingers of the handinclude:
- phalangeal fracture – broken toe,
- injuries affecting the metacarpophalangeal or interphalangeal joints – knocked out finger, skier’s thumb,
damage to the tendons of the muscles that flex or extend the fingers.
A finger fracture usually occurs as a result of direct trauma (slamming a door, being hit by a hard object or falling on the hand). A fractured toe is characterised by pain, swelling and inability to move. Long-term immobilization of the fractured finger is not advisable due to the tendency of hand tissues to a rapid scarring process, limiting the mobility of the finger. Rehabilitation, which will include manual stabilization, is recommended. And after the time of full bony adhesion, exercises increasing the grip strength of the hand can be introduced.
Most dislocationsoccur in the proximal interphalangeal joint. A knocked-out toe needs to be diagnosed and properly set by an orthopedic surgeon. Improper treatment of the injury may lead to permanent deformation of the finger and reduced mobility in the joint. After the finger is set, it is usually immobilized in a neutral position on a special splint. It takes up to 2 weeks to return to normal movements of this part of the body and it is possible to stop wearing the special orthosis, if properly managed.
The cause of ‘skier’s thumb‘ is damage to the ulnar collateral ligament at the metacarpophalangeal joint of the thumb. The injury in most cases is the result of external forces, and the mechanism of injury itself usually involves overloading the thumb by pulling it away from the rest of the hand. This ligament contributes to maintaining the correct alignment of the thumb during combined activities (e.g. grasping, pinching). The orthopedic rehabilitation itself is aimed at rebuilding lost strength and muscle mass, counteracting current joint stiffness and, above all, restoring the full functionality of the motor joint.
Tendonsare connective tissue structures that link muscle to bone. With their help, the force generated by the muscle belly is transferred to the bone, which in turn causes movement in the joints. Most injuries to the extensordigitorum muscle tendon are treated conservatively by wearing a plastic Stack finger splint to hold the distal interphalangeal joint in extension. The patient’s task is to move the other joints of the fingers to avoid stiffness. The treatment period is about 4 weeks. On the fingers, however, the flexortendons are located in connective tissue sheaths that ensure their position closer to the bone and better function. Deep wounds to the palmar surface of the hand can damage the flexor tendons as well as the surrounding nerves and vessels. Often a superficially small injury to the hand can cause significant damage to deeper structures. A return to normal activity involving the hand can occur after 4 to 6 weeks.
The treatment of both extensor and flexor tendon injuries is a complex process that requires, in addition to the experience of the operator and rehabilitator, the conscious cooperation of the patient. Treatments are carried out in a regional blockade after a personalized action plan. In the post-operative period the hand is immobilised in a splint (longevity) for 4-6 weeks and it is recommended to keep it elevated.
Eachpatient is under strict medical care and rehabilitation personalized to the needs conditioned by various factors. Thanks to modern surgical techniques we minimise the period of convalescence and pain associated with the surgery.
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