For third and second degree sprains, the ligaments have not been completely ruptured. In these cases, the RICE method is the recommended option. RICE stands for Rest, Ice, Compression, and Elevation, and the method aims to reduce bleeding into the location of the injury to reduce swelling. The method is as follows; Rest The injured extremity should be rested and not put to use immediately following the injury. This reduces the likelihood of further retraction of muscle stumps, which can lead to ‘holes’ in the muscle. Additionally, the size of the haematoma decreases as well as the connective tissue scar. Ice Early use of cold therapy (cryotherapy) reduces the swelling around the injured area, as well as reducing haematoma size. It has also been associated with accelerated early regeneration compared to injuries that were not iced directly after occurring. Icing of the injury should be applied in stretches of 15-20 minutes every 30-60 minutes for around six hours. However, the pioneer of the RICE method Gabe Mirkin now suggests that cryotherapy should only be employed if the pain is unbearable, as some studies suggest that cryotherapy may delay healing Compression Compressing the injury reduces intramuscular blood flow due to the constriction of veins and arteries, reducing haematoma size. However, there is still debate as to whether it accelerates the healing process. Elevation Finally, elevation of the affected area above the heart reduces the blood flow to the injured region due to the difference in hydrostatic pressure between the finger and the heart. This has similar effects to the first three components of the method. Following the implementation of this method, splinting is recommended to keep the digit immobile. The skin under the splint should be carefully observed during the duration of its use due to the number of complications that can arise, including ulceration, maceration, and tape allergy. When removing the splint to assess the skin underneath, it is important that the digit remain in the splinted position. These complications can be reduced by including a layer of tubular gauze or a moleskin lining between the splint and the skin of the finger. If no splints are easily available, buddy taping can be employed. This is where the affected digit is taped to an adjacent finger to provide support. This limiting of motion helps to reduce ligament stress, which is important in the early stages of healing. If swelling persists, anti-inflammatory medications may be prescribed. DIP Dislocation PIP Dislocation A third degree sprain often results in a dislocation. Volar and dorsal dislocations are treated differently, and treatment should be withheld if a fracture is suspected. In the case of a dislocation, closed reduction can be attempted. This is where the joint is realigned without the need for surgery, and can be conducted immediately after the incident. For a dorsal dislocation, reduction should be conducted by undertaking distal traction of the fingertip, then applying volar pressure to the phalanx in the distal direction of the dislocated joint, and dorsal pressure to the other phalanx. Ensure that the joint can be moved with no pain. After this, a splint at a small bend is employed to maintain slight flexion and prevent hyper-extension of the joint for the next week. If hyper-extension of the joint is too painful or causes skin blanching, the joint may be placed in a neutral position. Limited movement of the affected digit is recommended to occur soon after the injury to limit loss of range of motion. This may only include small degrees of flexion, depending on the severity of the injury. For volar dislocations, reduction should be conducted by undertaking distal traction of the fingertip, then applying distal pressure to the phalanx in the distal direction of the dislocated joint, and volar pressure to the other phalanx. Unlike dorsal dislocations, after performing reduction on a volar dislocation, the joint must remain splinted at full extension. After reduction, tendons may be tested through active flexion and extension. Due to swelling and pain, a full range of motion is unlikely to occur, however if no active flexion or extension can be done, it indicates a high possibility of a tendon rupture. If no avulsion fracture is present, the splint should be in place for four to six weeks to allow the torn central slip to heal in the correct location, with an additional four to six weeks splinting during sporting activities. If there is an avulsion fracture involving more than thirty percent of joint space, an orthopedic surgeon should be consulted, as open reduction and internal fixation may be required. If the dislocation does not reduce easily, it may be necessary to administer local anaesthetic, or in extreme cases open reduction may be required. There are currently four causes of an irreducible DIP joint dislocation, brought about by an anatomic block, where there is difficulty accessing parts of the finger. These causes are: "a palmar plate avulsion off the middle phalanx with interposition in the joint, entrapment of the flexor digitorum profundus (FDP) tendon behind one condyle of the middle phalanx, button-hole tear through the palmar plate, and entrapment of the distal end of the middle phalanx in a longitudinal split in the FDP tendon". Any of these cases will require open reduction, conducted under anesthetic. Following open reduction, the joint should be immobilised for two to four weeks in a splint, after which exercises may be performed to achieve joint stability. Pooled literature suggests that the initial treatment of<unk> s should be conservative, without open reduction. Damron and colleagues suggest an approach that only requires open surgery for the cause listed above, and cases where after six months observation conservative treatment has failed. This approach is suggested due to the relative cost efficiency of conservative treatment, as there are fewer office visits, a single x-ray, and inexpensive splint materials compared to open surgery which requires multiple appointments, professional costs of surgery, as well as anaesthetic. Fractures involve the breaking of the bone. As such, it is recommended that medical attention is sought, so as to avoid the bone healing with a malunion, which may result in post-traumatic arthritis. Additional surgery may need to be conducted to properly treat a malunion. As with a dislocation, closed reduction is attempted before open reduction. The finger is then splinted to prevent further injury to the digit as it heals. A number of splints have been proposed for<unk> s, depending on the reduction conducted. These include taping, Stack splint, padded aluminum malleable splint, Piplex splint, elastic double finger bandage, perforated plastic splint, molded polythene splint, and Abouna splint. However, the type of splint is less important than patient compliance with the use and time spend with the splint. Splinting for less than the recommended duration may lead to less effective healing, a loss of function, and permanent extensor lag. In any of the above cases, depending on severity, stretching and strengthening programmes may be required in the rehabilitation stage. Range of motion exercises are required to prevent stiffness in addition to potentially long term loss of range of motion of the affected digit. Digital edema-control techniques will reduce the time taken to regain range of motion. Examples of such techniques include massage and compressive wraps. An increased amount of swelling during the rehabilitation period is indicative of an undiagnosed fracture or an overly aggressive rehabilitation programme.
Jammed finger
Trigger finger
Jersey finger
Broken finger
Hammer toe
Rocker bottom foot
Pigeon toe
Habit-tic deformity