Distal Interphalangeal Joint Dislocations

John D. Wyrick

History and Clinical Presentation

A 24-year-old right hand dominant man injured his right small finger while playing softball. The ball struck him on the tip of the finger and he thought he “only jammed” the finger. He describes pulling on the finger, which made it feel a little better, but always noted some deformity, which he attributed to swelling. He did not seek medical attention until 10 days after the injury. When seen, he described persistent pain and lack of motion as the main reasons for seeking help.

Physical Examination

Significant swelling diffusely throughout the right small finger is noted. It is more prominent distal to the proximal interphalangeal (PIP) joint. No wounds were present. Grossly, there was a prominence dorsally at the distal interphalangeal (DIP) joint and obvious deformity. Due to pain his passive motion was not tested, but his active motion was 10 to 25 degrees. Sensibility testing revealed static two-point discrimination of 5 mm.

Imaging Studies

Dislocation of the DIP Joint

Dislocations of the DIP joint are not commonly seen. More common is the dorsal PIP joint dislocation, which is the result of a hyperextension injury. Often these DIP joint injuries are reduced in the field and are never seen for medical attention.