Finger Tendon Displacement: Causes, Symptoms, and Recovery

Dislocation of the proximal interphalangeal joint of the middle finger?

Dear Dr.
You,
Two weeks ago, while doing housework, I may have twisted or flicked my right hand in a very ordinary motion, and suddenly I felt a sharp pain in my middle finger.
I noticed that the tendon of my right middle finger had shifted towards the little finger at the metacarpophalangeal joint.
At that moment, I moved the joint a bit, and the tendon returned to its original position, but if there was any lateral force on my hand, the tendon would move again and return, causing pain once more.
The next day, I visited an orthopedic clinic, and the doctor took an X-ray, stating that the bones were fine, and then mentioned that it was a rupture of the fascia causing the displacement.
The doctor applied an aluminum splint to immobilize my middle finger and advised me not to move it, suggesting a recovery period of about five weeks.
After prescribing anti-inflammatory and swelling medications, I returned home.
Since the clinic doctor seemed busy with the next patient and was not very willing to answer my questions, I searched for related information online.
Based on what I found, I would like to ask Dr.
You the following questions and hope to receive some advice and answers.
Thank you for patiently reading this lengthy message.
Q1: The tendon that runs along the back of each finger, extending to the back of the hand at the metacarpophalangeal joint, should it be referred to as the extensor tendon?
Q2: The extensor tendon is secured at the metacarpophalangeal joint by annular ligaments (or collateral ligaments) to maintain joint stability.
When the clinic doctor mentioned a rupture of the fascia, should it actually be referred to as a ligament tear?
Q3: Is my condition a true ligament tear? Or is it a strain? If it is torn, will it really heal on its own?
Q4: If the splint is removed after five weeks and I start moving my finger, is there a possibility of incomplete recovery and displacement? Should I get an MRI to confirm the condition? However, the clinic doctor mentioned that it is difficult to apply for an MRI under health insurance?
Q5: In clinical cases, can this type of symptom heal on its own? Is there a chance that surgery might be necessary?
Q6: I am currently keeping my finger immobilized with the aluminum splint and am hesitant to move it.
Occasionally, when I remove the splint to clean my hand, I can slightly bend the joint without pain, but the area around the metacarpophalangeal joint is slightly swollen compared to my left hand.
It has been two weeks, and the swelling remains the same.
Will it eventually subside?
Thank you very much for your questions.

Xue Xiansheng, 50~59 year old female. Ask Date: 2019/05/05

Dr. You Dianqi reply Orthopedics

Hello, I appreciate your thorough research, and I am happy to read your text (however, the term "趾" should be corrected to "指").
Here are my responses:
1.
It is not called the extensor tendon; it is referred to as the extensor hood or sagittal band.
2.
If you are indeed referring to the collateral ligaments that stabilize the joints, they are not necessarily related to the sagittal band injury you sustained.
3.
The definitions of a rupture and a tear are similar; the physician currently hopes that you will stabilize the injury and allow the damaged sagittal band to heal on its own.
4.
There are no absolutes in medicine; it is certainly possible for recovery to be poor.
What the clinic doctor said is also correct.
Confirming with an MRI does have relevant regulations under health insurance; it is not very easy, but it is not impossible.
However, I believe we should return to the essence of medicine—history taking and physical examination are still the primary assessments.
If there are concerns, then consider using more advanced technology.
5.
In medicine, any possibility exists.
Indeed, some cases of sagittal band rupture may require surgery for relief.
6.
Regarding the swelling, give it some time; it should gradually decrease.
Thank you; it is my honor to serve you.

Reply Date: 2019/05/05

More Info

Understanding finger tendon displacement, particularly in the context of your recent injury, involves a comprehensive look at the anatomy, potential causes, symptoms, and recovery processes associated with such injuries.

Anatomy and Terminology
1. Tendons and Ligaments: The tendon that runs along the back of your fingers is indeed referred to as the extensor tendon, not the "伸趾肌腱" (which translates to "extensor muscle tendon"). These tendons are responsible for extending the fingers at the joints. The ligaments, including the collateral ligaments, stabilize the joints and allow for controlled movement.

2. Injury Mechanism: Your description suggests that you may have experienced a tendon displacement due to a sudden force or twist, which can lead to a condition known as tendon subluxation. This occurs when the tendon moves out of its normal position but can return to place, as you noted.

Symptoms and Diagnosis
3. Symptoms: The immediate pain and the sensation of the tendon moving out of place are common symptoms of tendon injuries. Swelling and tenderness around the joint are also typical. The fact that the pain subsided upon returning to the original position indicates that there may not be a complete tear, but rather a strain or partial tear.

4. Diagnosis: The X-ray results showing no bone injury are reassuring. However, the term "筋膜破裂" (fascia rupture) used by your doctor might be misleading. It’s more likely that you have a ligament injury rather than a complete rupture of the tendon or fascia.

Recovery Process
5. Healing Timeline: The recommended five-week immobilization period is standard for tendon injuries to allow for healing. During this time, the body works to repair the damaged tissues. Tendons can often heal on their own, but the extent of recovery can vary based on the severity of the injury.

6. Post-Immobilization Concerns: After the immobilization period, there is a risk of incomplete recovery or re-displacement if the joint is not properly rehabilitated. Engaging in physical therapy can be beneficial to restore strength and flexibility.
7. MRI Consideration: If you have ongoing concerns about the integrity of the tendon or ligaments after the immobilization period, an MRI can provide detailed images of soft tissues. However, if your doctor believes that the injury is minor and likely to heal well, they may not recommend it due to insurance constraints.

Clinical Outcomes
8. Self-Healing: Many tendon injuries, particularly those that are not complete tears, can heal effectively with conservative management. Surgical intervention is typically reserved for cases where there is significant instability or complete tears that do not respond to conservative treatment.

9. Swelling and Pain Management: The swelling you are experiencing is common after such injuries. It may take time to resolve, and gentle movement can help promote circulation and reduce swelling. However, it is crucial to avoid any movements that cause pain or discomfort.

Conclusion
In summary, your injury likely involves a strain or partial tear of the extensor tendon or associated ligaments. The recommended immobilization and subsequent rehabilitation are essential for recovery. If you experience persistent symptoms or concerns about your recovery, follow up with your healthcare provider for further evaluation. Engaging in a structured rehabilitation program post-immobilization will be key to regaining full function of your finger.

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