Hand:
The small joints of the fingers (PIP and DIP joints) are naturally very stable and rarely need surgery unless there is also a fracture (see bone injuries). If very sore or unstable immobilisation in a splint or plaster initially full time for up to 2 weeks and then on and off for about 4 weeks is usually enough.
The larger finger joints (MP joints - at the junction of the fingers and palm) are naturally less stable so more dependent upon their ligament supports. There is controversy over their treatment but research we have undertaken has shown that most of these injuries do very well with strapping to the neighbouring finger for 3-6 weeks and free movement from there.
The end joint of the thumb (IP joint) is like the small joints of the fingers and can be treated the same way with initial full-time support and then part-time support up to about 4 weeks from injury.
The middle joint of the thumb (MP joint - at the junction of the thumb and palm) has important ligaments on both sides (the radial – outer side, and the ulnar – inner side). Because of local differences in the alignment of the soft tissues the radial (outer) ligament tears are treated differently to those on the inner side:
The outer ligament tears almost all heal well with 4 weeks of full time protection, typically in a lightweight cast. The inner ligaments often do not heal well without surgery unless there is a small local fracture of the bone where the ligament had attached. The injuries with fractures can usually be treated with 4 weeks of full time immobilisation in a lightweight cast. The injuries with no fracture usually need open surgery to confirm the diagnosis and perform a repair. This is usually supported in a plaster or splint for about 4 weeks.
The inner ligament tears would also heal as well but the tendon of another muscle can often get in the way of the ends of the healing ligament joining together. This leads to considerable weakness in the thumb. Because of this open (surgical) assessment of the ligament is recommended, usually with repair of the tear. The tear may be repaired in a variety of ways including s ching to the local soft tissues or bone (thumb proximal phalanx) or fixing it with s ches connected to anchors in the bone. Depending upon the severity of the repair the MP joint will be supported. This is almost always with a a lightweight cast or splint for 4 weeks and sometimes with a wire placed across the joint at the time of surgery. The wire is removed in the outpatient’s clinic after 4 weeks or so.
The ligaments holding bottom (near) joint of the thumb (CMC joint) are very important in stabilising the joint to ensure normal function and prevent risks of long-term arthritis. Injuries at this joint are usually associated with small fracture of the base of the thumb metacarpal bone known as a Bennett’s fracture (see fracture handbook).
Rarely there is a true ligament injury with no bone injury. The treatment of both injuries is the same. The joint needs to be held reduced for 5-6 weeks. This cannot be done successfully in plaster. Formal surgical reduction and stabilisation with a wire under a local (sometimes general) anaesthetic is needed. The one or two wires are supported in a lightweight cast for 5-6 weeks when the wire(s) are removed in the outpatient’s clinic.