Stiff and painful finger joints

Our fingers have been designed to have two joints between the knuckle and the fingernail. The one closest to your knuckle is the proximal interphalangeal joint (PIPJ), and the next further along is the distal interphalangeal joint (DIPJ). Another way of saying this is that the proximal interphalangeal (PIP) joint is the middle joint of a finger. It is an unforgiving joint when injured, and is notorious for becoming extremely stiff and chronically swollen. Injuries to this joint can either be missed or over-treated by prolonged immobilisation, invariably resulting in stiffness, pain and associated reduction in function which may be permanent.

 

Unfortunately many people have pain and stiffness in these two finger joints. One common reason for this is osteoarthritis. You can read more about osteoarthritis, and how it differs to rheumatoid arthritis, in this blog post on our IceFire Physiotherapy website. Osteoarthritis (OA) is more common in the DIPJ than the PIPJ.[1] In a large study of a Finish population, the prevalence of OA in the DIPJ of the fifth finger (little finger) in those aged between 55 and 64 years was about 25%, and even in those aged between 45 and 54 years it was about 9%.[2]

PIPJ injuries are especially common in athletes. In fact finger injuries in athletes are much more common than many people realise. Among American football players in the National league studied over a 10 year period, a study found that there were 1385 injuries to the hand, and over 48% of these involved the fingers.[3]

Basic Anatomy of the PIP joint:

The PIP joint is a hinge joint that is normally kept in alignment by a soft tissue envelope consisting of the joint capsule, the volar plate, collateral ligaments and the central slip. These structures tightly cosset the joint and allow for a very narrow joint space. Injuries to this soft tissue envelope can be either partial or complete.

diagram of pipj

diagram of fds fdp

 

Most PIP joint injuries are caused by high velocity impacts, such as in sports injuries or falls. Low-velocity injuries are equally common and are usually caused by twisting, which can result in disruption to the volar plate and collateral ligaments.

Classification of PIP joint injuries:

  • dislocations – volar, dorsal;
  • subluxations – volar, dorsal, ulnar, radial;

  • avulsion or ‘chip’ fractures associated with ligamentous injuries;

  • intra-articular fractures or fracture dislocations and

  • sprains/strains to the soft tissues of the joint
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Treating an injured PIP joint:

It is best to seek treatment early. A plain x-ray can be used to diagnose a complete dislocation or extent of the subluxation and to look for avulsion fractures. Unless the fragment is large, the fracture itself is not important, but it will indicate the site of the ligamentous injury.

A hand therapist will then be able to test joint stability gently to prevent further damage to the partially torn ligaments and look for areas of point tenderness. This assessment will allow for development of a treatment plan that may involve the following:

  • Splinting the affected digit
  • Application of compression to manage the swelling
  • Buddy taping in conjunction with safe tendon gliding exercise to maintain or restore movement
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Provided the fracture/dislocation is not severe and specific soft tissue structures have not been fully ruptured or avulsed, motion can begin early and near-normal joint motion and full function can be often be regained. Unfortunately joint thickening from scar may be permanent. Standard advice is to wait one year before resizing rings; after roughly one year the joint will have assumed its permanent appearance.

Injuries to the PIP joint are serious and must be treated with respect. Seeking early treatment will allow you to understand the nature of the injury and help you clarify your expectations regarding timeframes for restoration of movement, strength and function.

What If I hurt my PIP joint some time ago and it’s still really stiff?

Never fear! Hand therapists are creative types and there are a range of options to improve joint range of motion such as:

  • Serial plaster casting
  • Static progressive and dynamic splinting for mobilisation
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[1] FV Wilder et al., Joint-specific prevalence of osteoarthritis of the hand. Osteoarthritic Cartilage, 2006 14(():953-7.

[2] MM Haara et al., Osteoarthritis of finger joints in Finns aged 30 or over: prevalence, determinants, and association with mortality. Ann Rheum Dis 2003 62:151-8

[3] NA Mall et al., Upper extremity injuries in the National Football League: Part 1: Hand and digital injuries. The American journal of sports medicine 2008 36(10:1938-1944