A review of tendon & ligament injuries of the finger & thumb
Sep
As chiropractors, our fingers and thumbs are critically important and ‘tools of the trade’, but when was the last time you reviewed these elegant anatomical structures that are vulnerable to many types of injury? In practice, it is a good idea to review anatomy and relevant injuries to those areas we don’t see as often in practice. This week, a review of common tendon and ligament injuries of the thumb and fingers. In my experience, whenever I would review a topic like this, these cases would magically show up in my office that week, so enjoy the influx of thumb and finger patients!
A previous study reported that about 4/10 upper extremity injury visits to the emergency room in the USA involved ligament and tendon injuries in the fingers. An understanding of the anatomy and mechanical functions of these tendons and ligaments is necessary to identify the type of injury involved and its appropriate treatment. It is also very important for clinicians to be able to determine a suitable timeline for the athlete to rest and to return to play. Therefore, this narrative review covers the anatomy, diagnoses and management of common tendinous and ligamentous injuries of the fingers and thumb seen in athletes.
Injuries discussed in this review:
- Mallet finger (aka, ‘baseball finger’ or ‘hammer finger’)
- Central slip extensor injury
- Flexor digitorum profundus (FDP) injury
- Ulnar collateral ligament (UCL) injury of the thumb
- Radial collateral ligament (RCL) injury of the thumb
- Collateral ligament injury of the fingers
- Volar plate injury
- Flexor pulley injuries
Excerpt from the Review:
Volar plate injury
The solar plate may be injured as a result of hyperextension or dorsal dislocation of a finger joint, most commonly the PIP joint and exclusively affecting the 4th and 5th digits. If left untreated, it may result in a pseudo-boutonnière deformity, where the PIP joint will not straighten and remains flexed, while the tip of the finger is hyperextended.
Symptoms of a volar plate injury include pain at the volar plate and possibly at the lateral sides of the joint due to a simultaneous injury to the collateral ligaments. Volar plate injuries may be identified via ultrasonography and MRI.
Surgery is often necessary in unstable joints, irreducible dislocations or associated avulsion; whereas conservative management comprises a dorsal aluminum splint with the PIP joint at 30° flexion which is increased in the extension angle by 8-10° weekly until full extension is achieved. Alternately, a figure-of-8 orthosis that limits extension by 15-20° has been shown to be as effective as aluminum splinting.
This week’s Research Review:
Tendon & Ligament Injuries of the Finger & Thumb in Athletes
This paper was published in BMJ Open Sport & Exercise Medicine (2025)
You can access this review for a few dollars here or subscribe for access to the whole catalogue of new and existing reviews here.
