Index finger sprain

An index finger sprain can be serious and disabling, but usually that need not be so.

It happens when the digit is forced into flexion, towards the palm, or in extension. It can occur sideways too, but that is less common.

The most commonly affected part is that between the finger and the hand, the so called metacarpal phalangal joint, or MCP.

It can occur between the phalanges too, but where two very movable parts meet, injury is less common. It's where the nearest or proximal phalanx meets the more rigid metacarpal in the hand that most of the problems occur.

A joint is stabilised by a series of strong ligaments to prevent the finger from flexing or extending too far. When a powerful force stretches these structures beyond their elastic limits, then a sprain occurs. The same happens in knees, ankles and in fact all joints. These injuries face the busy chiropractor on a daily basis, particularly if he or she is sports oriented. 

Index finger sprain

The names of these particularly ligaments doesn't concern us in this post. Notice also the tendon running to the terminal digit so that you can flex it. The muscle belly of this tendon is in the forearm.

If either tendons that connect a muscle to a bone, or ligaments linking bone to bone, are stretched too far then strain and sprain occur.

To test for ligament sprain, your chiropractor will stretch the joint passively; that means that your muscles do nothing, so the tendons aren't activated.

Swelling of the joint, sometimes discolouration, redness and pain, and changes in the range of motion are the signs of index finger sprain.

Testing the tendon and muscle complex on the other hand is done by keeping the joint quite still, but you contract the contractile tissues yourself against resistance. The ligaments are not affected by this contraction; pain is a sign of strain of these structures.

Ligaments are sprained.

Muscles and tendons are strained.

This lady fell awkwardly in a carpark falling onto the back of her hand, forcing it into flexion. Injuries of this nature happen so fast that one rarely remembers exactly what happened, particularly if there are other more painful injuries. In her case she had a nasty gash to her face that required stitching by her medical doctor.

Two months later her right hand, and in particularly the middle and index and fingers still showed signs of sprain and strain.

There was distinct oedema, or swelling, and local tenderness of the metacarpal phalangeal joints; the range of motion was distinctly limited, both in flexion and extension. Those are the signs of index finger sprain, in particular.

But isometric contraction of the muscles, without movement of the joints, was also painful; that the sign of a sprained tendon.

Those tendons pass through a sheath to the muscles in the forearm.

There are other muscles that move the fingers sideways, opening and closing them; known as abduction and adduction of the fingers. Isometric contraction of those muscles, known as the PADS and DABS, was also painful.

She didn't have a great deal of pain unless she tried to use her hand; opening the milk bottle for example was very painful. The concern of course is that two months after the injury she was still quite disabled. Gardening was difficult. 

Finger sprain is probably one the less common conditions treated by your chiropractor but, because the principles involved are the same whether you are dealing with a shoulder, knee or ankle, he or she is quite qualified. 

Those are to restore the range of motion by gently mobilising the index finger sprain, using ice to control pain and swelling and various muscle techniques to rehabilitate the contractile tissues.

This lady responded to these basic chiropractic techniques very quickly despite the duration of the injury. After only two treatments she declared she could again open a milk bottle and the pain was 60% less. Her hand was still swollen.

However, then the fifty percent less pain rule kicked in. She was mystified that the joint remained swollen and the pain increased a little; perhaps only 40% better than the last months. But she was again using scissors, able to garden with secateurs and of course the milk bottle was not a problem.

As healing occurs and the pain lessens we pick up all those activities that we've been denied for months; as the pain recedes faster than healing occurs sometimes we get back in the deep end again too quickly. A gardener of note, she had become very frustrated at being so inhibited; now that the pain was so much less, she returned to her garden with gusto.

It's right and proper to start doing more as healing occurs, but with a degree of wisdom and patience; otherwise setbacks occur.

Immobilisation arthritis

If the range of motion on an injured joint is not restored, the refreshment of the synovial fluid becomes limited, inhibiting the flow of fresh nutrients and oxygen to the cartilage lining the joint; and the build of waste products of cartilage metabolism.

These two potent forces lead quite quickly to what is known as immobilisation arthritis, and the joint becomes permanently stiff and painful.

Stretching and mobilising an injured joint is vital to prevent permanent disability.

Tingling in arms and hands

Occasionally the swelling associated with an index finger sprain may irritate the nerve causing tingling in the fingers; carpal tunnel syndrome needs to be excluded.

Useful links @ Index finger sprain

› Index finger sprain

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

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