Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Dislocation of PIP Joint

Dislocation of the PIP joint is a common injury which often affects team handball, basketball and volleyball players, and cricketers. In 80% of cases it is the little finger that is damaged. The most common mechanism of injury is axial loading and hyperextension of the joint causing dorsal dislocation (dislocation upwards and backwards). The dorsal dislocation always results in disruption of the anterior capsular ligaments and volar plate. Lateral dislocation (dislocation to the side) of the PIP joint occurs when a single collateral ligament ruptures with a portion of the volar (palm) plate. The rare volar (forwards into the palm) dislocation of the PIP joint is a more serious injury. This dislocation results in disruption of the extensor tendon and one of the collateral ligaments. Because of rupture of the extensor tendon this injury can result in a deformity. Many dislocations of the PIP joint go untreated by a physician because they are reduced by the athlete or coach on the sideline. Lack of treatment can cause permanent disability, particularly in the case of a missed fracture/dislocation.

Symptoms

– Pain is accompanied by tenderness and impaired function.
– Deformity of the joint outline can be seen.

Treatment

The doctor may:
– reduce the joint back into its normal position. The sooner this is done after injury, the easier the procedure. If manipulation is carried out within a few minutes, severe pain is not generally experienced;
– tape the digit to the adjacent finger (buddy tape) or, in severe injury, immobilize by applying a splint, which is worn for 1–2 weeks, to block extension. Buddy taping should be used during athletic competition for several months;
– splint only the PIP joint in continuous extension for 6–8 weeks for dislocations toward the palm;
– X-ray the joint, as a bone fragment may have been torn loose;
– allow protected early return to sport, which is usually possible.

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