Injuries to the hand and fingers are common in sports and must be taken seriously. Injuries in this area can be very debilitating and if treated incorrectly they can have long-term consequences.
On this page:
- Finger sprains & strains
- Fractures & dislocations
- Chronic hand & finger injuries
Sudden onset sprains, strains & fractures
A sprained finger occurs when the finger is bent in some way causing damage to the ligaments which connect bones together. It is a common injury in ball games such as American football, basketball, cricket, and handball. A sprain can be helped by rest, ice and compression and also a taping method, details of which can be seen below.
Read more on finger sprains
A thumb sprain occurs when the thumb is bent out of its normal range of movement, usually backward. It can happen in sports like skiing, rugby, and basketball and causes pain and swelling. The ligaments supporting the joint at the bottom of the thumb get damaged, and this can be helped by taping, icing, and compression.
Thumb sprain symptoms include pain at the time of injury, usually as the thumb is bent backward. There may be a pain in the web of the thumb when it is moved. Swelling over the metacarpophalangeal joint at the base of the thumb may be visible and the patient may have laxity and instability in the joint.
Read more on thumb sprains.
Hand & finger fractures
A broken finger is a break or fracture in any one of the 3 small phalange bones which make up each finger. A thumb fracture is more likely to occur at the base of the thumb at the MCP joint and be caused by bending backwards.
Finger fractures are usually caused by some kind of impact or collision. The athlete will feel immediate pain with swelling and bruising which will appear quite quickly. It will be painful to try and move the finger which may appear deformed if the bone is displaced or joint dislocated. If there is any nerve damage, the finger may be numb or feel tingly.
Read more on hand and finger fractures.
Jersey finger is a tear of one of the flexor tendons in a finger. There are four tendons of the Flexor Digitorum Profundus muscle which pass into each of the fingers. This finger injury is common in contact sports and can cause the tendon to bunch at the base of the finger. Read more on the steps you should take to treat this injury below.
Jersey finger symptoms include pain in the fingertip and inability to bend the finger normally although it can still be forced into a bent position. Tenderness on the pad of the finger will be present along with swelling and bruising which may develop later in the fingertip. It may be possible to feel the tendon as a bunched up soft mass on the palm side of the hand.
Jersey fingers most commonly occur in contact sports such as Rugby and American Football. It is called a Jersey Finger because of the way it often occurs. When gripping an opponents shirt, with the fingers bent, the opponent wrestles away, causing a forced extension (straightening) of the fingers. The injury occurs at the tip of the finger where the tendon meets the bone on the distal phalange. The ruptured tendon may retract to the base of the finger or the hand.
Treatment: Rest the finger and apply ice or cold therapy to reduce pain and inflammation. If it cannot be moved by the patient and is stuck in an extended position, seek medical attention. X-rays or ultrasound scans may be performed to confirm the injury and to check there is not an avulsion fracture.
Treatment for a jersey finger is via surgery. The tendon must be reattached to the distal phalange. The rehabilitation of the condition is important as flexor tendons often become very stiff if not treated properly. Early movement after surgery is important to avoid stiffness. Strengthening exercises using items such as putty and hand therapy balls may be recommended.
Volar plate injury
The volar plate is a very thick ligament which joins two bones in the finger. A volar plate injury occurs when the finger is bent too far back the wrong way, spraining or tearing the ligament. In some cases, this finger injury can also involve a fracture. Read more on volar plate injury and how to treat it here.
Symptoms occur immediately after the finger is bent backward and includes severe pain in the injured finger which is located specifically over the middle finger joint. Swelling will develop quickly and the finger may appear deformed. Trying to move the finger will be painful and bruising may appear especially on the palm side of the middle finger joint.
A bruised hand, also known as a hand contusion, occurs due to a direct trauma of the hand. Impacts and crush injuries are the most common causes. This hand injury usually results in bleeding and subsequent bruising and will be painful to touch. Rest and ice are two of the main ways to help this injury.
Symptoms include the obvious pain on impact with whatever has caused the contusion. The hand will be tender to touch with immediate swelling. The hand will be painful when trying to use it, especially gripping things, and there may be difficult using the fingers.
Treatment consists of rest and immediate application of cold therapy to help control the bleeding and swelling. Cold can be applied for 10 minutes every hour reducing the frequency as symptoms improve. A compression bandage can be applied to help control swelling and the hand should be raised to aid the flow of tissue fluids away from the injury.
Symptoms should improve within 2 or 3 days, however, if they persist then seek medical attention to ensure there are no further injuries. An X-ray may be required to check there are no fractures.
Gradual onset & chronic hand and finger injuries
Trigger finger & trigger thumb
Trigger Finger is a form of tenosynovitis which results in the finger becoming bent in towards the palm of the hand. This can also occur in the thumb known as trigger thumb. There is no specific cause but a variety of factors are detailed below which can make the condition more likely, including gaming and texting! The treatment depends on the severity of the condition and can range from resting to surgery.
Read more on trigger finger & trigger thumb.
A black fingernail is known as a subungual hematoma and is caused by a build-up of blood under a fingernail. This usually results from an impact or trauma to the finger which can cause considerable pain. In most cases, ice and ibuprofen are sufficient to treat it and medical attention is not needed, unless it is very severe, as detailed below.
Pain on the fingernail at the time of impact and afterwards. The pain is often described as a throbbing pain. Blood quickly bleeds and gathers underneath the fingernail increasing a feeling of pressure under the nail. Over time the nail will appear black.
Most subungual hematomas can be treated at home and do not require medical attention. If the total area of blood is no more than 25% of the nail then the following guidelines may apply.
Apply ice (wrapped in a cloth) or cold therapy for 10 minutes at a time, every hour to reduce bleeding and swelling. Elevate the hand to reduce bleeding and swelling. This aids the tissue fluids to flow away from the site of injury using gravity to assist. Anti-inflammatory medication such as Ibuprofen may be recommended to ease pain and inflammation. The pain and pressure will ease over a couple of days and the blood will drain on its own.
If the bleeding covers more than 25% of the nail then seek medical attention as the blood under the nail may need draining. A local anaesthetic may be injected into the finger so it is numb and a hole can then be made in the nail so the blood can drain through. This may be done using a cautery to burn a hole, a needle to drill a hole or a sterilized paper clip. No follow-up treatment is usually necessary. However, occasionally, the whole nail is removed.
Bowler’s Thumb is an overuse injury resulting from compression or repeated friction on the inside of the thumb which causes pressure on the Ulnar nerve. As the name indicates, bowling is the main cause of this injury and causes the area to feel numb and weak. Resting from the activity causing the pain will usually help treat it.
Bowler’s thumb symptoms include numbness and tingling at the end of the thumb. There may be a pain on the inner thumb and the web between the thumb and index finger. The athlete will likely experience weakness in pinching things and activities which involve the thumb. In some cases, a tender nodule may be felt in the thumb.
Bowler’s thumb gets its name from its frequency in the sport of ten-pin bowling. It is caused by compression of the ulnar nerve on the inside of the thumb. This is often due to a tight-fitting thumb hole in the bowling ball. It is also more common when the player is trying to put a lot of spin on the ball.
In long-term cases, the repeated compression or friction can result in adhesions or fibrous tissue around the nerve which can cause problems even when the individual is not bowling.
Rest from bowling. Correct any causative factors such as a thumb hole which is too small. Use a thumb guard or splint to protect the thumb. Alter the grip or round of the edge of the thumb hole on the ball. If conservative measures such as these do not work then surgery may be required. Surgery may involve adjusting the course of the nerve so that it doesn’t get compressed.
This finger injury makes you unable to extend or straighten the end joint of a finger without assistance. It can happen from sports and other daily activities and causes pain and tenderness to the area. The severity of the injury can vary from a stretching of the tendon to the tendon coming unattached from the bone.
Read more on Mallet finger.
A boutonniere deformity or buttonhole deformity is an injury to a tendon in one of the fingers, resulting in a deformed shape. This usually occurs after an impact to a bent finger. See below for more on the causes, symptoms, and treatments of Boutonniere deformity.
Symptoms include pain at the time of injury with tenderness on top of the middle finger bone which is likely to be swollen. The finger cannot be straightened at the middle joint and the end joint cannot be bent.
A Boutonniere deformity usually occurs after a direct impact to the middle finger bone. The middle finger joint may be forcefully flexed, causing a rupture of the extensor tendon. Less frequently, a cut to the upper surface of the fingertip may sever the attachment point of the tendon to the bone. They are also seen in approximately one-third of people with rheumatoid arthritis.
If caused by a traumatic injury rest the finger and apply cold therapy to ease bleeding and swelling. Visit a Doctor as soon as possible. After an examination, the doctor can provide a splint to keep the finger straight. This helps the tendon to heal in the correct position. They may also provide anti-inflammatory medication.
Expert interview: Consultant wrist and hand surgeon Mr. Elliot Sorene explains Boutonniere Deformity. Surgery is sometimes performed if the tendon is severed or if there is a fracture present. The tendon may be reattached or a fracture pinned and the finger straightened. It is then put in a splint to allow it to heal. Exercises may be given once the splint is removed to increase the strength of the finger extensor muscles.
Cellulitis is a bacterial infection of the superficial and deep layers of the skin. In the fingertip, this is known as a felon. It is often caused by a small injury to the end of the finger which can make it painful and swell up. Read more about this infection and how to treat it.
Symptoms of a Felon or fingertip infection include a throbbing pain at the end of the finger. Felons most commonly occur in the thumb or index finger. There may be swelling, inflammation and redness over the end of the finger.
Felons sometimes occur after a minor injury to the fingertip, such as a splinter or small puncture wound. Fingertip blood glucose testing has been implicated as a cause of fingertip infections. They may also happen with no clear cause.
If you suspect a felon or cellulitis of the finger then seek medical attention or visit a doctor as soon as possible. If an infection is diagnosed then the Doctor will prescribe antibiotic medication to clear the infection. In most cases, this is all the treatment which is required and the infection will clear by the end of the course.
In severe cases, where the blood flow may be compromised, decompression may be required. This involves a small incision in the fingertip so that fluid can be drained and so pressure released and is done under a local anesthetic injection.
Handlebar palsy is a name given to a common condition suffered by cyclists. The symptoms are caused by compression of the ulnar nerve at the wrist against the handlebar. Treating this injury is usually simple, but sometimes medical help may be needed. Read more about Handlebar palsy here.
Symptoms include numbness, tingling, and weakness over the outside of the hand, little finger and outer half of the ring finger. A feeling of clumsiness and a lack of co-ordination in the hand is often reported and pain may be present during activities requiring movement of the wrist.
Handlebar palsy is sometimes also known as ulnar neuritis (neuropathy) or ulnar nerve compression. It is caused by compression of the ulnar nerve where it passes through the wrist. From there the nerve runs into the little and ring fingers. It is common in cyclists due to the position of the wrist and compression on the handlebars.
The most important feature of treating this condition is to correct the cause of the problem. In cyclists, this may mean checking the bike set up such as the height of the saddle and handlebars and the wrist position when riding. Correcting these problems will usually stop the symptoms!
In cases where this does not work, seek advice from a professional sports injury therapist. They will be able to assess the injury. These symptoms could be due to compression of the nerve at any point along its course, not just at the wrist. The neck may be a problem and so posture should be checked, as well as other activities which may put a strain or pressure on the nerve higher up.
Dupuytren’s contracture is a condition which affects the hand and fingers, causing the fingers to bend in towards the palm of the hand. Tissue in the hand contracts and becomes shorter, although this does not normally cause pain. Many cases do not require treatment, although if the condition is severe, there are options you can take.
Read more on Dupuytren’s contracture.