Ligament Tears: Recovery and Rehabilitation Insights

Ligament tear

Hello Dr.
Shen,
Due to an accidental impact, I have sustained a rupture of the ligament in the first phalanx of my little finger.
There was no redness, swelling, or pain, but I am unable to fully extend the finger.
An X-ray examination showed no bone damage.
The doctor applied a splint for immobilization to allow the ligament to heal on its own, with follow-up appointments every four weeks.

After eight weeks of immobilization, the first and second phalanges (the area where the splint was applied) have developed redness, swelling, and slight itching with mild pain (there was no redness during the four-week follow-up, but there was some itching and mild pain).
The doctor mentioned that the scabbing of the ligament during the healing process is normal and that it will gradually improve.
Although I still cannot fully extend the finger, its function has returned, and I can begin rehabilitation exercises.
The redness and pain are expected to subside gradually.
It has been four weeks since the splint was removed, and I am able to move my finger normally.
I have been gently massaging the swollen area, but the redness and pain in the first joint still persist.
There is also a lump that I can feel in the second phalanx that has not diminished, and sometimes the swollen area itches slightly.
Is this a normal phenomenon? The degree of flexion in my finger is still greater than it was when the ligament first ruptured, and I still experience pain in the first phalanx.
However, I have no issues typing on the computer.
I am unsure if the ligament has fully healed or if I need to return for another follow-up and possibly reapply the splint.

Thank you for your response!

Li, 50~59 year old female. Ask Date: 2017/04/07

Dr. Shen Boquan reply Orthopedics

Hello, based on your description, it seems you are referring to a distal extensor tendon rupture, commonly known as Mallet finger.
It can be treated with either conservative therapy or surgical intervention.
Since you have immobilized it for a period, you may experience stiffness in the interphalangeal joint.
With some time for rehabilitation, you should regain range of motion and function.
You can follow up with your physician to discuss these recovery issues.
Wishing you good health.

Reply Date: 2017/04/07

More Info

Understanding ligament tears, particularly in the context of finger injuries, is crucial for effective recovery and rehabilitation. Ligament tears can occur due to various reasons, including trauma, overuse, or sudden impact, as in your case. The first step in managing such injuries is to ensure proper diagnosis and treatment, which seems to have been initiated correctly with the use of a splint and regular follow-ups.

When a ligament is torn, the body initiates a healing process that involves inflammation, which can lead to symptoms such as swelling, redness, and pain. The fact that you experienced some swelling and discomfort after the initial period of immobilization is not uncommon. In the healing phase, it is typical for the area to feel itchy or slightly painful as the body forms scar tissue and the ligament begins to repair itself. This process can take several weeks to months, depending on the severity of the tear and the individual's healing capacity.

Your doctor’s reassurance that the symptoms you are experiencing are part of the normal healing process is important. The presence of a lump in the second joint and ongoing discomfort in the first joint could be attributed to several factors, including residual swelling, scar tissue formation, or even minor complications such as synovitis (inflammation of the synovial membrane). It is essential to monitor these symptoms closely.

As for the range of motion, it is not unusual for the finger to still have limitations in extension even after the splint is removed. Ligament injuries can lead to stiffness, and rehabilitation exercises are crucial to regain full function. It is advisable to engage in gentle range-of-motion exercises as recommended by your healthcare provider. These exercises can help improve flexibility and strength over time.

If you find that the pain persists or worsens, or if the swelling does not subside, it would be prudent to return to your physician for a follow-up. They may consider additional imaging studies, such as an MRI, to assess the integrity of the ligament and surrounding structures. In some cases, further intervention may be necessary, such as physical therapy or, in rare instances, surgical repair if the ligament has not healed adequately.

In summary, while some discomfort and swelling can be expected during the healing process of a ligament tear, ongoing symptoms should not be ignored. Regular follow-ups with your healthcare provider are essential to ensure that the healing process is on track and to address any concerns you may have. Engaging in rehabilitation exercises as advised will also play a significant role in your recovery. Remember, patience is key in the healing process, and it is important to listen to your body as you progress through rehabilitation.

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