The joint has a wide range of motion (ROM) in flexion and extension but is relatively rigid in abduction and adduction thus, it is a hinge (ginglymus) joint functionally. The bony anatomy of the proximal interphalangeal (PIP) joint consists of medial and lateral condyles on the proximal phalanx, with matching concavities on the associated distal phalanx. After your splint or sling is removed, you’ll begin a gradual rehabilitation program designed to restore your joint’s range of motion and strength. Surgery may also be necessary if you have had recurring dislocations, especially of your shoulder. You might need surgery if your doctor can’t move your dislocated bones into their correct positions or if the nearby blood vessels, nerves or ligaments have been damaged. How long you wear the splint or sling depends on the joint involved and the extent of damage to nerves, blood vessels and supporting tissues. After your bones are back in position, your doctor might immobilize your joint with a splint or sling for several weeks. Depending on the amount of pain and swelling, you might need a local anesthetic or even a general anesthetic before manipulation of your bones. Your doctor might try gentle maneuvers to help your bones back into position. Treatment of hand dislocation depends on the site and severity of your injury. Most patients with chronic instability or stiffness in a finger (especially if it involves the proximal interphalangeal joint) should be referred for assessment by a hand surgeon. The need for such consultation would be indicated if the patient presents late after the injury, was inadequately assessed at initial presentation, or develops an unforeseen complication (eg, recurrent subluxation in a joint that appeared to be stable after reduction). A hand surgeon should be involved early in the treatment of any complicated proximal interphalangeal or distal interphalangeal injury. Any long-term complications (usually involving stiffness or instability) that develop must be addressed.Ī hand surgeon should see any patient with hand dislocations which require or may require surgery. Physical and occupational therapy are key components of treatment throughout. Grossly unstable joints and those for which closed reduction has failed typically require surgical intervention. Many hand dislocations can be effectively treated with closed reduction, traction, or both. The wrist and hand are painful and may look misshapen, and people cannot move them normally. Perilunate dislocations are more common than lunate dislocations. The lunate (which is located between the capitate and the end of the ulna)ĭislocation of the capitate is called a perilunate dislocation.The capitate (which is the largest bone in the hand, located in the middle of the lower palm).Two of the carpal bones are commonly dislocated: These dislocations usually occur when great force is applied to the wrist and it is bent backward, usually a fall on an outstretched hand or an injury in a car crash. The bones at the base the hand (carpal bones or wrist bones), between the forearm bones (radius and ulna) and the long metacarpal bones of the hand, usually the lunate or the capitate, move out of their normal position. The judgment of the initial treating physician can be critical in determining the long-term outcome of these injuries. Symptoms and the circumstances of the injury suggest the diagnosis, but doctors take x-rays to confirm it. However, hand dislocations have real potential for long-term disability in sports and other areas of life if adequate reduction is not performed, if associated injuries are not identified and appropriately treated or referred, and if potential complications of the injury and its treatment are not foreseen. Hand dislocation is a common injury in sports and in occupational settings, often appearing to be minor.
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