Proximal Interphalangeal (PIP) Joint Dislocation or Sprain

What is a PIP joint dislocation or sprain?

PIP joint dislocation occurs when trauma causes the bones in the middle joint of a finger to dislodge. This usually results in a very painful, swollen and bruised joint that does not move properly, if at all. A sprain occurs when ligaments in a joint are torn or pulled and may occur without joint dislocation.

Suspected sprains and dislocations must be evaluated and treated as soon as possible. It is important not to move the affected area to avoid further injury.

What are the symptoms of a PIP joint dislocation or sprain?

Symptoms (as follows) are very painful and usually occur after a twisting or hyperextension injury to the joint:

  • Pain in joint
  • Swelling
  • Bruising
  • Disfigured joint
  • Loss of joint function

Who is likely to get a PIP joint dislocation or sprain?

Anyone can get a hand sprain or dislocation. These people are particularly susceptible to the injury:

  • Athletes (contact sports especially)
  • People susceptible to falling
  • Those with naturally weak ligaments
  • People with highly active lifestyles

What causes a PIP joint dislocation or sprain?

Most common causes of a joint dislocation or sprain are from a direct trauma or injury to the hand. This may happen during a fall, twisting injury or while playing sports. If a dislocation or sprain is suspected, ice should be applied immediately and medical attention sought as soon as possible.

How are PIP joint dislocations and sprains diagnosed?

A hand specialist will carefully examine the affected area to diagnose a joint dislocation or sprain. The physician will check for pain, swelling, disfigurement, bruising and mobility. An X-ray will be recommended to check for bone fractures, which, if present, can drastically change management and treatment of the condition.

What are the treatment options for a PIP joint dislocation or sprain?

Non-surgical Treatment Options

  • Ice affected area
  • Splint or cast
  • Realignment of bones
  • Anti-inflammatory and pain reducing drugs, such as ibuprofen

Sprains can be treated with an immobilizing splint when performing at risk activities, but otherwise with simply buddy taping the injured finger to the adjacent finger and early hand therapy and range of motion to prevent stiffness. Joint dislocations should be re-set into position immediately, usually in an urgent care or emergency room setting, with immediate follow-up examination by a hand surgeon, such as the board certified physicians at the MOR Hand, Wrist & Elbow Institute. The joint will then be assessed for any fractures or residual instability that could necessitate surgical intervention.

Surgical Treatment Options

Sprains or dislocations to the PIP joint rarely require surgical intervention. As long as the joint is properly positioned and stabilized, injured ligaments should typically heal.

Clinically significant fractures that cause persistent instability of the PIP joint will need to be surgically addressed. The surgery required can vary from minimally invasive options, such as a manipulation with pins placed through the skin, to more invasive procedures like re-setting the fracture through an open incision with screws for fixation. In some cases, the damaged bone fragments can be reconstructed by transplanting a bone from the wrist. The decision as to which of these treatment options is most appropriate depends on the severity of the fracture. After surgery, the patient may have to be in a cast or splint for up to several weeks. Continued physical therapy will be necessary to ensure return of proper function, as these injuries can take a long time to heal.