Injuries to the Digital Joints

Chapter 60


Injuries to the Digital Joints


Conservative and Postoperative Treatment


Metacarpophalangeal collateral ligament injury (digits II–V)


Collateral ligaments of the MP joint support the joint, especially during grip and pinch. Taut in flexion and lax in extension, these ligaments are most frequently injured as a result of hyperextension or extreme lateral force. The radial ligament is more vulnerable than the ulnar collateral ligaments. Partial tears are usually treated conservatively, whereas complete tears are corrected surgically. Conservative management and postoperative management are nearly similar and have been consolidated here.




















History


Physical presentation


Measurable tests


Goals


Date of injury


Mechanism of injury


Pain


Functional status


Ecchymosis at MP joint


Joint deformity


Lateral joint tenderness


ROM


Outcome measures


Edema measures


Visual Analog Scale


Sensation


Pain level


Stable MP joint


Pain reduction


Prevent adhesions of extensor mechanism with IP ROM


Stable, mobile MP joint


Avoid rotation or angulation


Return of function



Proximal interphalangeal collateral ligament injury


The PIP collateral ligament consists of the proper collateral ligament and the accessory collateral ligament. The primary stabilizer, the PCL, is taut in flexion and lax in extension, whereas the ACL is taut in extension and lax in flexion. Grade I sprains are stable through AROM and PROM. Stress testing may be painful, but stable. Grade II indicates a complete tear of at least one collateral ligament. It is stable through AROM and demonstrates less than 20 degrees of angulation. Grade III injuries include at least one collateral ligament and some aspect of the volar or dorsal structures. It is unstable in both AROM and PROM and usually requires surgical correction.




















History


Physical presentation


Measurable tests


Goals


Date of injury


Mechanism of injury


Pain


Functional status


Ecchymosis at MP joint


Joint deformity


Lateral joint tenderness


ROM


Outcome measures


Edema measures


Visual Analog Scale


Sensation


Pain level


Stable joint


Pain reduction


Prevent adhesions of extensor mechanism with IP ROM


Avoid rotation or angulation


Resume function


May 9, 2019 | Posted by in Reconstructive surgery | Comments Off on Injuries to the Digital Joints
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